An approach to establishing a health information market.

The Tempus CME project "Regional Network for Healthcare Management" was aiming to perform a feasibility study for a communication network dedicated to the healthcare field. The needs assessment survey as well as the debates during the working sessions and during the conference on how communication can support a better healthcare delivery, substantiated the approach for achieving the Romanian health information market. The proposed communication network can be considered as a national information infrastructure offering good links between health, education, research and industry and a unique frame for information providers and users, for the estate and private companies. The network should also provide support and guidance for the development of new educational fields as applied informatics in healthcare.

Acetazolamide therapy evaluation in haemorrhagic stroke.

The influence of acetazolamide in patients with hemorrhagic stroke was assessed in 54 patients in comparison with the influence of other therapies in 68 patients included in a control group. Modified Rankin Scale and mortality rate were evaluated at three different moments: onset, 72 hours and control (3 weeks-one month from the onset). A better outcome was seen when acetazolamide was given. Mortality rate was significantly lower in the group of acetazolamide. This therapy may be safely used in haemorrhagic stroke, especially when hydrocephalus is associated.

Stroke and hypertension. Antihypertensive therapy withdrawal.

The effect of antihypertensive therapy withdrawal in acute ischaemic stroke patients was assessed in order to establish possible correlations between blood pressure values and the modified Rankin Scale (mRS) outcome. One hundred and twelve consecutive patients with acute ischaemic stroke and hypertension were treated with relatively similar regimen. Seventy-two hours following the onset of stroke, systolic blood pressure decreased to < or = 180 mmHg in 110 patients. Antihypertensive therapy was randomly discontinued in 59 patients. Clinical outcome and mortality were compared in patients with and without antihypertensive therapy withdrawal, no statistically significant differences (p > 0.05) between the two groups being found. Statistically significant positive correlations (p < 0.05) between mRS outcome and the decrease of systolic and diastolic blood pressure values were in patients treated with anticoagulant and antihypertensive therapy. Statistically significant negative correlations (p < 0.05) between mRS outcome and low levels of diastolic blood pressure were noted in patients who discontinued antihypertensive therapy. Our findings emphasize the need to associate antihypertensive and anticoagulant therapy in acute ischaemic stroke patients with hypertension. Spontaneous decrease of diastolic blood pressure values showed poor outcome. The management of hypertension associated with acute ischaemic stroke should be reconsidered.

Cognitive and motor retardation in depression.

The study analysed the profile of psychomotor retardation in depression by clinically and psychometrically assessing its motor, speech and cognitive components. Psychomotor performance level of a group of 100 moderately depressed patients was significantly lower than that of controls on most psychometric tests. The interrelations among the variables evaluating various aspects of the depressive psychomotor retardation were examined and factor analyses were performed. Clinical ratings of motor, speech and mental retardation were strongly intercorrelated and a general factor emerged. When psychometric evaluations of depressive psychomotor retardation were factor analysed only separate factors characterizing cognitive and motor slowing were identified. Few and weak correlations were recorded between clinical and psychometric evaluations of depressive psychomotor retardation. Factors responsible for psychomotor slowing in depression were discussed.

Postoperative outcome of intracranial meningiomas; long-term prognosis.

A retro- and prospective study was carried out in 150 patients who underwent surgery for benign (grade I) intracranial meningiomas (ICM). The mean duration of the follow-up was of 4 years. The subjects were divided into 4 groups according to the intervals of follow-up examination. The following variables were analysed: preoperative (clinical and paraclinical diagnosis), operative (macroscopic investigation) and postoperative (complications, sequelae, recurrences). The data were statistically processed. Conclusions are drawn concerning early results as well as predictors of long-term prognosis. Immediate improvement of the neurological and mental status was noted in 51% of patients. Late favourable outcome was found in only 35% of patients, demonstrating a tendency of late worsening. Postoperative morbidity includes complications (21%), sequelae (32%) and recurrence (22%). Predictor criteria in operated ICM patients are: onset type of illness, preoperative score, tumor location, edema and excessive vascularization of the brain as inspected at operation, early and late sequelae. Histological predictors for recurrence are: nuclear pleiomorphism, cellular mitoses, cell agglomerations. The frequency of recurrence, regardless of the operative technique, demonstrates the tendency toward malignancy of many of these tumors.

Hypertension in acute ischaemic stroke: to treat or not to treat.

The reasons for not treating hypertension could be the risk of reducing cerebral blood flow (CBF) which may induce additional cerebral damage in the so-called ischaemic "penumbra". Hypertensive patients have altered autoregulation. A severe hypertension (over 230/120 mmHg) may lead to further damage by cerebral edema which asks for antihypertensive therapy. An antihypertensive therapy was applied in 81 patients within the 72 hours interval from acute ischaemic stroke (AIS) onset. In 42 patients, the antihypertensive treatment was discontinued after the 72-hour interval (the therapy with nifedipine in daily doses of 10-20 mg was not considered as hypotensive). We compared as end points: the survival, death, modified Rankin Scale (mRS). There were no statistically significant differences between end points of patients who discontinued (group C) and those who maintained (group T) the antihypertensive therapy. The mean value of blood pressure was higher in patients who maintained antihypertensive therapy (p < 0.001 for systolic blood pressure (BP); p = 0.001593 for diastolic blood pressure). The mean value of age in patients in whom antihypertensive therapy was discontinued was higher than that found in patients who maintained antihypertensive therapy (p < 0.05).

Predictors of outcome in depression.

Several socio-demographic, family and clinical history variables, stressful life events, index episode characteristics, symptom severity, clinically and psychometrically assessed personality type and traits, and treatment were evaluated as potential predictors of multiple outcome criteria in a sample of 157 outpatients and inpatients meeting commonly used criteria for depression episodes. Outcome criteria included: severity scores on the final evaluation, improvement rate, impairment level of functioning, clinically rated treatment response, episode duration and relapse frequency in one year follow-up. Gender, personality structure and type, stressful life event characteristics, prior episode number, clinical status after the last episode, symptom length at intake, initial symptom severity, psychotic and endogenous features emerged as significant predictors of depression outcome in univariate analyses. The combination of independent variables by multivariate regression analyses improved outcome prediction.

"Spontaneous" recovery in aphasics after single ischaemic stroke.

In a homogeneous group of 75 aphasics after single ischaemic stroke, randomly selected, performance tests were carried out two weeks and one, three and six months post-onset. None of them were systematically treated. Both for the global performance and for repetition, naming, auditory comprehension, reading comprehension, writing under dictation as well as for the communicative value of a standard interview, "spontaneous" recovery was more marked during the first three months and obviously reduced between three and six months post-onset. In 28 of these aphasics, the clinical form changed from a severe to a milder form, the fluent or nonfluent character remaining unchanged. Clinical form influenced recovery by the severity of aphasia or by certain symptoms. Initial severity is quite important in recovery, very severe cases being unfavored, severe and mild cases reacting better, while moderate cases recovered the best. Associated oral apraxia had a negative influence while age had a minor effect and sex a doubtful one.

Terminal complement complex in blood of patients with neurological diseases.

The local involvement of complement (C) in the pathophysiology of tissue lesions in several neurological diseases is known, but it has never been studied whether or not in neurological disorders the C activity in the circulation is altered as well. This was the aim of the present investigations. We measured in blood plasma, with an automatic device for analysis and quantitation of the haemolytic activity of the terminal complement complex, the variables T1, T2 and T3 which define the latter quantitatively. We did this, on the one hand, in 100 patients who had 46 neurological disorders systematized in 16 nosological groups, and, on the other hand, in a control group of 40 healthy blood-donors. The mean values of all variables found in the patients have not been statistically different from those found in the controls. This demonstrates that in neurological disorders possible activations of C remain restricted to the local tissue lesions and do not occur in blood, probably due to the opposition against C activation of the known inhibitor system.

Predictors of the response to tricyclic antidepressants in major depression.

In a relatively young sample of 108 nonbipolar patients with major depressive disorder and at least moderately severe depression, the contribution of a comprehensive set of socio-demographic, psychosocial, clinical and personality trait variables toward the prediction of short-term, multidimensionally evaluated response to tricyclic antidepressants was investigated by univariate and multivariate analyses. There is a naturalistic study without a standard treatment protocol, but treatment type, duration and dosage were controlled. Only patients who received at least moderate dosages of tricyclic antidepressants for minimum four weeks were included in this study. A relatively low number of predictors emerged. Initial severity of both symptoms and impairment of functioning were the most powerful predictors for all outcome criteria. Illness history was also relevant. Personality traits reflecting vulnerable personality style at the emotional and interpersonal level proved their predictive value. The combination of independent variables by multivariate regression analyses improve the prediction of treatment response.

Carbohydrate metabolism, as reflected by glycosylated hemoglobin, in clinically active definite multiple sclerosis.

In 30 patients with the diagnosis of definite multiple sclerosis (MS) established on clinical criteria (CDMS-A1 patients), who were in a severe clinical state of MS, i.e., in whom one or more MS clinical signs or symptoms had become obvious during the last 10 days, the integrated concentration of plasma glucose over long-term (the last 6-8 weeks) was established by measurement of the percent of the glycosylated fraction of hemoglobin (Hb A1). This was also investigated in two control groups: CG-1, which consisted in 33 registered healthy blood donors matched for sex and age with the MS patients, and CG-2, consisting in 7 patients with diabetic neuropathy. The mean-value of Hb A1 of 5.1% (SD = 0.82) in the MS patients and that of 5.12% (SD = 0.96) in CG-1 controls are not statistically different (t = 0.09). The Hb A1 mean-value of 10.53% (SD = 3.5) found in the CG-2 controls is different (p < 0.001) from both the mean-values in MS patients and CG-1 controls, which validates the reliability of the HB A1 investigation. The findings indicate that clinical activation in definite MS is not associated with disturbances of glucose metabolism.

Calcium blockers in ischemic stroke.

The study investigated the evolution of 72-nifedipine treated cases with ischemic stroke. Dipyridamole was administered to 72 controls. Subjects showed clinical improvement, thus calcium blockers can constitute a therapy alternative. A good influence of nifedipine was remarked in blood pressure.

Statistical study of lethal stroke.

Deceased cases with cerebral infarction and hemorrhage constituted the subjects of the present study. They were divided into two groups: 127 cases in group 1 (1954-1959) and 427 cases in group 2 (1977-1982). The purpose of the study was to compare clinical data to evidence any statistical difference between groups. No statistically significant difference was noticed, except the increase of age mean in both diagnoses due to the overall increase of age mean of the population (2.5-10 yrs).

Pseudotumor cerebri: risk factors, clinical course, prognostic criteria.

UNLABELLED: Eighty-five patients with the diagnosis of pseudotumor cerebri were retro- and prospectively studied. For clinical evaluation, the following criteria were used: neurological--headache, ophthalmological--visual acuity, visual field, ophthalmoscopy and psychic--memory. Each patient was assigned 2 categories of results expressed by: neuropsychic and ophthalmological scores which were statistically processed. The following conclusions related to the aim of our paper can be drawn: I. RISK FACTORS: pregnancy (8% of cases), obesity (15%), generalized infections or located in the pelvic region+operated on (6%), hormonal treatment (cortisol (12%), estrogens (6%)); II. The clinical course was significantly favourable for: headache (51% of cases), defects of visual acuity (54%) and papilledema (63%). The long-lasting effects of the treatment applied showed: recovery (for the 2 parameters) in 27% of patients and improvement with sequelae for one and/or the other parameter in 73% of the cases; III. Among the more significant prognostic criteria were the ophthalmological symptoms and signs at onset of the disease. The ophthalmological sequelae (visual acuity, visual field defects, chronic papilledema and optic atrophy) are important factors in the prognosis of the disease and represent predictors for the surgical management.

Mapping of VEPs and ERG responses to punctual stimulations in the visual field.

Visual field projection maps were obtained using retinal and cortical EP amplitude values. Single meridian investigations were also performed. Stimulation was done with punctual photic stimuli delivered by the LED perimeter built for the purpose. Schedule with 28 stimulation loci was adopted. The B wave of the average ERG and P100 component of the cortical VEP were measured. The maps were obtained by interpolation of amplitude values on a grid of 21 x 21 characters. By comparing the retinal and cortical visual field maps, conclusions regarding the normality of visual structures (peripheral or central) can be drawn. Our procedure adds to the previous data on visual field investigation (cynetic or static) important elements concerning vision electrophysiology.

Early prognosis of survival or death after a recent stroke by blood levels of acute-phase proteins.

From 129 patients with a recent stroke 105 survived and 24 died within 3 weeks from stroke-onset. At around 40 hours after the latter, the blood-levels of the acute-phase proteins ceruloplasmin and albumin did not forecast the death of the respective patients, but, in contradistinction, the level of fibrinogen was significantly higher in those who eventually died, than in those who survived. Therefore, a higher level of fibrinogen could be a risk-factor for death after stroke.

Adolescent offspring of endogenous unipolar depressive parents and of normal parents.

Ninety-six children aged 10-17 of unipolar endogenous depressive proband parents and 96 matched control children of well parents were investigated using DSM-IIIR diagnostic criteria. Both sets of parents were also studied. Although the rate of psychopathology was significantly higher in proband than in control children, adaptive functioning as a measure of the severity of the psychopathology did not differentiate the two groups of children. Among factors related to the mental status of the children were: severity and onset under 30 years of age of the parental depression and lifelong association of parental anxiety with depression. Personality measurements performed in children showed different personality structures in proband offspring. Data on adolescent psychopathology and personality showed little evidence of a homotypic relationship with the adult affective disorders.

Psychomotor functioning in unipolar and bipolar affective disorders.

The performances of unipolar and bipolar depressive patients and also of a control group on motor, verbal and mental components of psychomotor functioning were clinically and psychometrically evaluated and compared at a univariate and multivariate level. The groups were similar with respect to age, sex, educational level, illness onset age and depression severity. In univariate comparisons of test-based assessments of psychomotor functions the overall tendency was towards a more pronounced retardation in unipolar depressive patients compared to bipolar ones and controls, the differences being marked on some measures and relatively small on others. Multivariate analyses using scores on 20 psychomotor variables revealed a rather good discrimination of the depressive groups, 78.57% of cases being correctly classified, with 0.80 sensitivity for unipolar patients and 0.75 specificity. Clinical evaluation of spontaneous psychomotor activity did not reveal notable differences between the two depressive groups.

Acute-phase proteins in stroke: influences of its cause (cerebral hemorrhage or infarction), of the cerebral site of infarction, and of the sex of patients.

In most of the 129 patients with a recent stroke by cerebral hemorrhage or infarction a note-worthy acute-phase response was found, as demonstrated by important quantitative alterations of blood levels of several acute-phase proteins (APP). These alterations were different in patients with cerebral hemorrhage as compared to those with cerebral infarction. The alterations due to cerebral infarction were not different according to the site of the infarction in brain, i.e. in the brain territories irrigated by the carotid artery system or by the basilar artery system. The APP alterations do not depend on the sex of patients or on the time elapsed from stroke-onset to blood collection.

Depressive disorders and depressive personality traits in offspring aged 10-17 of bipolar and of normal parents.

Sixty proband children (P) of bipolar I parents and 60 control children of normal parents (C), in the age range 10-17, were investigated clinically by K-SADS-E interview and psychologically by personality inventories. In the global psychopathology rate of 63% in P children and 25% in C children, depressive disorders reached 8% in P children and 0% in C children, while depressive personality traits reached 22% in P children and 15% in C children. Cluster analysis evidenced a variety of personality structures, but 3 clusters were striking: a cluster characterized by high anxiety and depressive reactivity (17% P and 5% C children), a cluster characterized by high depressive reactivity and emotional instability (5% P children), and a hyperthymic cluster (5 % P children). Sixty-seven percent of P children and 36% of C children showed deviant personality traits (p<.01).