Lege Artis Medicinae

[The situation of health insurance at the end of 1992]

ANDRÁS László

FEBRUARY 24, 1993

Lege Artis Medicinae - 1993;3(02)

[The current practice in Hungary is to provide health insurance services under the social security system, which includes pension insurance. This is despite the fact that the separation of funds and services was already provided for by a parliamentary resolution and later by law. ]

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[Intraoperative ultrasonography during laparoscopic cholecystectiomia ]

ANTAL András, SCHMIDT Pál, TAKÁCS Judit, HADIJEV Janaki

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[The patho-histological characteristics of alcohol induced acute and chronic organ and tissue injuries were reviewed. Neuropathy and brain lesions, gastrointestinal tract in alcoholism, alcoholic liver disease, pancreatitis, cardiomyopathy, aseptic bone necrosis, rhabdomyolysis were discussed based on the literature. ]

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[Each year tumours, including oral cancers, result in more and more deaths in Hungary. The oral cavity has a special position, because the precancerous lesions and conditions which occur in it can be detected by simple procedures. The authors use the latest definitions and disease classifications approved by WHO, to systematize the essential knowledge for the early diagnosis of the most frequent precance roses in Hungary, taking into consideration aspects of clinical morphology, epidemiology, localizational frequency, the risk/level of the tumour and the main principles of treatment. In addition to a detailed description of leukoplakia, erythroplakia, smoker's palate, actinic cheilitis, lichen and sideropenic anaemia, cheilitis glandularis, cornu cutaneum, naevus pigmentosus, discoid lupus erythematosus, submucosus fibrosis, xeroderma pigmentosum and tertiery syphilis are also mentioned. The purpose of the review is to call attention to the fact, that, due to the significant increase in mortality caused by oral tumours, the early diagnostic activity of dentists should be supported by the awareness of general practitioners and a national stomatooncological screening network should be established. ]

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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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Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.

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[A short chronicle of three decades ]

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[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.]