Lege Artis Medicinae

[The "performance funding" experience of the first six months]

DEMES Istvánné1

APRIL 27, 1994

Lege Artis Medicinae - 1994;4(04)

[Act LXXXIV of 1992 and Government Decree No 52 of 1993 regulated the new funding arrangements. Financing is generally geared to the achievement of health policy objectives and is implemented along the parameters that determine it. When the new financing system was launched, it could not, of course, assume the fulfilment of these objectives in a complex manner, but only contained all these expectations in its elements and inspiration. ]

AFFILIATIONS

  1. Főosztályvezető Országos Egészségbiztosítási Pénztár, Egészségügyi Finanszírozási Főosztálya

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Lege Artis Medicinae

[Laboratory control of the oral anticoagulant therapy]

VAJDA Zoltán, PÁL András, SIKOS Zita, SAS Géza

[There are two basic requirements in the treatment and prophylaxis of thromboembo lic diseases by chronic anticoagulation with coumarin (Syncumar). The first is the preven tion of a new thrombosis while the second is the avoidance of concomitant bleeding complications. For this reason it is necessary to achieve an appropriate anticoagulation level which can be characterised by labora tory measurement of the prothrombin level. In this paper, the theoretical and practical as pects of the laboratory control of Syncumar treatment are reviewed. The most serious problem is that the prothrombin level (Quick time) determinations utilising thromboplastin preparations from different sources give diffe rent values in the same patient plasma, which makes comparison of data from different laboratories impossible. The paper gives a brief overview of the definition and practical use of the International Sensitivity Index (ISI), characterising the different thromboplastin preparations, and the International Normali sed Ratio (INR) which can be calculated on the basis of the ISI. In spite of unquestionable improvements, the uncertainty about instrument-thromboplastin-ISI relationships reduces confidence in the INR system, especially when differences in INR values have clinical significance. Efforts need to be directed toward providing local, laboratory/instrument specific ISI values. ]

Lege Artis Medicinae

[The clinical significance of amaurosis fugax]

HORVÁTH Sándor, SOMLAI Judit

[The symptoms of amaurosis fugax (transient monocular loss of vision) indicate not only atherosclerotic disease of the ocular or extra cranial cerebral vessels, but also that of the systemic circulation. The prognostic significance of amaurosis fugax developing after the age of 50-55 years is similar to that of transient ischaemic attack of the brain: it could be a harbinger of atherosclerotic disease of the extra- and intracranial brain vessels as well as the coronary arteries. According to the mortality data, patients presenting with symptoms suggestive of amaurosis fugax will die due to heart disease, primarily myocardial infarct. Diagnostic evaluation should include not only ophthalmological, but also neurological and cardiovascular in vestigation to verify carotid and coronary atherosclerosis. Therapy of the whole disease and not just the symptoms will influence life expectancy in patients with amaurosis fugax. ]

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[Methylprednisolone pulse therapy in systemic lupus erythematosus]

GERGELY Péter

[The aim of this retrospective study was to assess the efficacy and safety of methylprednisolone pulse therapy. Thirty five patients with severe systemic lupus erythematosus (lupus nephritis, severe hemolysis and antiphospholipid syndrome with central nervous system involvement, arterial occlusion and thombocytopenia) were treated by pulse methylprednisolone, followed by long-term corticosteroid (and cyclophosphamide) therapy. Thirty four patients achieved remission, after a mean of 4.7 weeks, which lasted on average for > 2.7 years. Six patients presented with an exacerbation after 1-2.5 years. Twenty eight patients are still in remission. No side effects were observed during pulse therapy. Methylprednisolone bolus therapy is safe and effective in severe systemic lupus erythematosus, including cases of lupus nephritis and severe central nervous system manifestations, but an appropriate choice of long-term therapy is essential.]

Lege Artis Medicinae

[The value of immunoscintigraphy in patients with metastatic malignant melanoma]

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[Immunoscintigraphy with 99MTc-labeled F(ab'),fragments of monoclonal antibody (reactive with a high molecular associated antigen) was performed in patients with malignant melanoma. 24 investigations on 23 patients were carried out. A total of 40 lesions in 23 patients were detected by chest radiography, ultrasound, CT, bone scintigraphy or histology. 24 of the 40 lesions (60%) were visualized by immunoscintigraphy. Following correction of the physiological liver background by digital subtraction, 3 liver metastases were localized. These results indicate that immunoscintigraphy with radiolabeled F(ab')2 fragments can provide clinically useful information. ]

Lege Artis Medicinae

[Methodological letter from the Public Health and Epidemiology Technical College on vegetarian and similar diets in crèches and educational establishments]

[The nutritional status of vegetarians is strongly influenced by the type of diet they eat. While semi-vegetarian and lacto-ovo-vegetarian diets can meet the nutrient needs of young children, provided they are carefully and professionally planned, strict vegetarian or macrobiotic diets may not meet the needs for some nutrients and may be deficient in both children and adults. ]

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[The connection between the socioeconomic status and stroke in Budapest]

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[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

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[The Comprehensive Aphasia Test in Hungarian]

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[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]