Volume and diagnosis: an approach to cross-border care in eight European countries.

OBJECTIVES: Mobility of patients is a pertinent issue on the European Union's agenda. This study aimed to estimate the volume and main diagnoses of cross-border care in eight European countries, in order to provide policy makers with background information about the nature of patient mobility in Europe. METHODS: This article reports the combined findings from three independent studies that compiled self-reported information on admissions data and main diagnoses from more than 200 hospitals in eight European countries. RESULTS: The average volume of cross-border patients accounted for less than 1% of total admissions in the hospitals studied here. Diseases of the circulatory system (mainly acute myocardial infarction) and fractures were the most common reasons for hospitalisation of European patients abroad. Deliveries and other diagnoses related to pregnancy, pneumonia, appendicitis and other diseases of the digestive system, aftercare procedures, and disorders of the eye and adnexa were also common diagnoses for this population. CONCLUSIONS: Hospitals should reinforce their efforts to adapt the care provided to the needs of foreign patients in treatment areas that cover the most frequent pathologies identified in this population.

[The effect of methotrexate on activity of T-lymphocyte marker enzymes in patients with psoriasis vulgaris]. / Vplyv metotrexátu na aktivitu markerových enzýmov T-lymfocytov u pacientov so psoriasis vulgaris.

Radiochromatographic methods were used in order to ascertain the activity of adenosinedeaminase and purinnucleoside phosphorylase in lymphocytes isolated from the venous blood of 32 patients with psoriasis vulgaris in comparison with enzyme activities in 28 clinically healthy subjects. 11 selected patients with a severe form of psoriasis were subdued to therapy by means of methotrexate and its effect on the activity of these enzymes was investigated. Untreated patients yielded a statistically significant increase in the activities of adenosinedeaminase and purinnucleoside phosphorylase in comparison to the control group of healthy subjects. The increase rate of enzymatic activities abruptly reflexed the degree of affliction and spreading of the pathological process. Methotrexate significantly decreased the activity of both investigated enzymes in lymphocytes in patients with psoriasis. On the basis of the achieved results it is possible to justify the therapy of psoriasis by means of drugs which influence the metabolism of purines and at the same time they interfere the function of T-lymphocytes.

Reduced expression of HLA-DP antigens on PWM stimulated T lymphocytes in patients suffering from psoriasis vulgaris.

24 psoriasis vulgaris patients were investigated for the expression of class II HLA antigens on the surface of PWM-stimulated T lymphocytes. The percentage of the expression of HLA-DP antigens ranged from 50.1% to 82.6% compared to a 100% level in healthy controls (p less than 0.005). No significant differences in the expression of HLA-DR antigens were observed. A higher frequency of some HLA antigens was found in the group of patients studied: B13 - 23.1%/6.2%, B 17 - 15.4%/7.1%, and Dw7 - 59.4%/15.8%.

Activity of some lysosomal enzyme in rheumatoid and psoriatic arthritis.

In order to study the function of polymorphonuclear leukocytes in patients suffering from psoriatic and rheumatoid arthritis and psoriasis vulgaris the release of beta-glucuronidase, elastase and cytoplasmic lactate dehydrogenase was investigated. The life of polymorphonuclear leukocytes in rheumatoid and psoriatic arthritis is shorter. Polymorphonuclears from patients with psoriasis and psoriatic arthritis release, with as well as without phagocytic stimulation by zymosan, more lysosomal enzymes into extracellular space then cells of healthy controls. The total content of LDH and of lysosomal enzymes in leukocytes of patients suffering from all three forms of disease were not altered in comparison with the amount in PMNL of healthy subjects.

Rheumatoid type of psoriatic arthritis.

Psoriatic arthritis can sometimes have a rheumatoid character, manifested especially by symmetrical involvement of the small joints of the hands. This finding was present in 23 out of a total of 150 patients with diagnosed psoriatic arthritis. The association of the rheumatoid joint syndrome and positivity of tests for rheumatoid factors in 4 patients suggest a suspected coincidental association of rheumatoid arthritis and psoriasis. In 2 patients the originally positive tests for rheumatoid factors became negative, simultaneously with the occurrence of sacro-iliitis. The remaining 17 patients had rheumatoid-like joint involvement associated with negative tests for rheumatoid factors. All 17 patients had changes in the spine.