Health services reform in Poland: issues in recent developments.

After ten years of debate and discussion, the political situation within Poland finally allows the possibility to implement basic reforms in the health care system. Parallel development of the political and technical aspects of the reform has now lead to a final proposal for fundamental reforms in health system responsibility, financing and management. This article describes the current conceptual developments and the political and social context for these final reform proposals at the time of their submission to the government. The primary changes suggested are aimed at increasing the awareness of local, regional and national administrations, health care professionals and the general public that health care has a cost, and that resources must be used carefully if they are to cover health needs. In addition, 'health care' as a term must be extended to include factors and activities besides direct medical services. Such factors as air and water quality, diet, smoking and alcohol consumptions are examples of matters which will also be included in the focus of health system planners. A key element of the organisational reforms is decentralisation of responsibility for health care planning and administration within the framework of nationally set standards and priorities. Based on local decisions, the current basic organisation unit of health care delivery, the ZOZ or integrated health care units, will be redefined and either decomposed into their component services or receive newly defined responsibilities more adapted to the local realities of available manpower and medical facilities. In addition, the development of a private health care sector complementing and even competing with the public services sector will be actively encouraged.

Prognostic factors in the hemolytic-uremic syndrome.

During 1972-1986, 142 children with the hemolytic-uremic syndrome were treated. Most of them were infants (73%). The total mortality rate reached 25.4%. Computer analysis revealed the following risk factors of a fatal outcome: severe gastrointestinal symptoms during the prodromal period, coma, convulsions, malignant hypertension, persistence of prodromal symptoms over 7 days, hyperkalemia over 7 mmol/l, acidosis with bicarbonate level less than 15 mmol/l, a delay of over 5 days in starting dialysis, and transport to dialysis unit of over 100 km. The greatest risk of death existed during the first 3 weeks from onset. Among 142 children, 106 survived the acute phase. They were followed up from 2 to 16 years. Nine were lost to follow-up. Twelve children developed chronic renal failure.

Chromosome changes associated with spontaneous phenotypic variation of transplantable melanoma.

The chromosome constitutions of black-melanotic (Ma), brown-melanotic (MI), and amelanotic (Ab) melanomas of the Syrian hamster were compared. The MI and Ab melanomas arose through a spontaneous phenotypic alteration of the Ma tumor. All three variants differ in their growth rates, with MI showing the slowest, Ab the fastest, and Ma intermediate growth rate. Cytogenetic examination revealed that each tumor line shows a distinct karyotype. The Ma tumor is near-diploid, whereas, Ab and MI tumors are hypertriploid and near-tetraploid, respectively. Each tumor line shows a unique set of marker chromosomes, though some markers are shared by two different tumor lines. No single marker chromosome was common for all three melanoma variants. We conclude that the spontaneous phenotypic variation of transplantable hamster melanomas is associated with profound changes in the chromosome constitution of the neoplastic cells. The general direction of these changes is toward increased ploidy and increased complexity of the structural abnormalities.

Cytogenic analysis of transplantable mouse B16 melanomas.

The cytogenetic analysis of transplantable in vivo melanotic and amelanotic lines of mouse B16 melanoma was performed. The second line arose by spontaneous alteration of the first one and these lines are the same in the rate of malignant growth during passages in vivo. The melanotic line shows stable near-diploid karyotype with modal chromosome number 41. The amelanotic line is mostly hypotetraploid karyotype with modal chromosome number 76. The balance of the diploids in the melanotic line is disturbed by the fact that chromosome 15 is partially trisomic, chromosome 6 trisomic, and chromosome 13 and X monosomic. Four marker chromosomes were common to both lines: M1-rob(12;12), M2-rob(5;15), M3-minute, M4-inv(1), M5-del-(14q-), but in the amelanotic line in most cases their number was doubled. Additionally, in the amelanotic line other specific aberrations rob(6;6) and rob(16;16) were observed. Both lines had comparable SCE frequencies. Constitutive heterochromatin in amelanotic line revealed the nonrandom deletion of the heterochromatic segments in chromosome 11 and, occasionally in chromosome 19.

Mesangial proliferative glomerulonephritis in children.

Over a ten year period 105 children with a histological diagnosis of a mesangial proliferative glomerulonephritis were diagnosed. Patients were divided into two groups according to their clinical presentation at the time of diagnosis. Ninety two children presented with nephrotic syndrome (NS) of whom 82 received steroid therapy. No response was observed in 26 children and in 56 remissions were short in duration and subsequent relapses were frequent. Eighty nine children with the nephrotic syndrome were treated with cyclophosphamide (CP) of whom 26 had a steroid resistant NS, 53 were steroid dependent and 10 were previously untreated. Eighty four entered remission with a mean duration of 46 months. Only 5 children did not respond to treatment with CP. No correlation could be found between the results of therapy and the degree of morphological changes on examination of renal biopsy. The second group consisted of 13 children presenting with a persistent nephritic syndrome and or proteinuria. These children were untreated and no progression of renal disease was observed after several years follow up.

Use of the macrophage migration inhibition test to evaluate antigenic differences in golden hamster transplantable melanomas.

Macrophage migration inhibition test in the presence of melanotic and amelanotic melanoma cells was analyzed by means of signal detection theory reasoning. The cellular immune response as measured by MMI test was stronger in hamsters grafted with amelanotic melanoma. A statistical analysis indicated that the amelanotic melanoma antigenic strength was greater than that of its melanotic counterpart.