[First experiences with the new financing system and health care plans]. / Az új finanszírozási renddel kapcsolatos eddigi tapasztalataink és terveink a szakellátás területén.

Our experience on the new health reimbursement system and further plans for secondary care. The author gives a short review about the steps of the health reform emphasizing the importance of initiation of performance based reimbursement which has supported to reach the aims of our reform. The results of the new reimbursement system, its practical difficulties, the actions taken to overcome them are also presented. It can be stated that no theoretical objection has been arised against the performance based reimbursement. A committee has been elected for the necessary continuous maintenance of the system. The equalization of the facilities, the reconstruction process of the hospitals, the investments financed by the World Bank loans are the conditions of the further reforms. The program "For the Healthier Nation" is the most important contribution to our health reform. Financially this program based on the "The Health Promotion Foundation".

[Unity of diagnostic pathology, continuing education and research at our institute]. / A diagnosztikus pathológiai, továbbképzö és kutató munka egységéröl intézetünkben.

Authors give a brief view on the activity in Institute of Pathology and Histopathology of Post-graduate University of Medicine. In its frame, close relation of diagnostic, post-graduate education and research activity is illustrated by examples of different fields (intestinal, cardiac, vascular system, respiratory tract, organ of locomotion, urological diseases, electronmicroscopic tumor diagnostics, endocrinology). Importance of modern morphological methods and their place both in practical and scientific activity are dealt with.

Immunohistochemical markers of tonsillar crypt epithelium.

The crypt epithelium of human palatinal tonsils is a specialized squamous epithelium characterized by the presence of intraepithelial passages which are filled by non-epithelial cells. The passages are covered by the so-called M cells. This reticulated epithelium (reticulum = network) is a highly differentiated one. In the present study immunohistochemical markers were searched for the discrimination between the superficial mucosal squamous epithelium (from which the crypts were developed) and the reticulated crypt epithelium. The reticulated epithelium is replaced by simple squamous epithelium in the course of recurrent tonsillitis. The immunohistochemical characteristics of this metaplastic epithelium were also studied. The superficial epithelium expressed blood group antigens extensively, but these antigens were almost absent from the crypt epithelium. Epithelial membrane antigen was present only in the superficial layers of the surface epithelium. Abundant positivity was characteristic for the reticulated epithelium. The metaplastic foci in the crypts were identical with the surface squamous epithelium using these markers.

Tonsils and lympho-epithelial structures in the pharynx as immuno-barriers.

The tonsils are mucosa-associated lymphoid organs. Several details regarding their normal function and pathological alteration are still unknown. In this review the relationship of the tonsils to similar lymphoid organs is discussed, the possibilities of antigen uptake (M cells and micropores of the crypt epithelium) are demonstrated, and alterations of the crypt epithelium due to recurrent tonsillitis are described. Further studies are required for the better understanding of tonsillar diseases.

The role of scanning electron microscopy in the diagnosis of human laryngeal cancer.

Malignant and non-malignant human laryngeal tissue samples (31 cases) were examined first by light microscopy (LM) and then the specimens were reprocessed for scanning electron microscopy (SEM). The presence of LM and SEM signs of malignancy were compared with each other. In all the 22 histologically unambiguous cases the LM and SEM results were in accordance with each other. From the 9 histologically doubtful cases, 2 were found malignant and 3 benign by retrospective SEM. The case histories of these 5 patients have confirmed the SEM results. This preliminary study suggests the application of SEM in histologically doubtful laryngeal biopsies.

Jejunoscopic lactose provocation.

A new method for testing lactose intolerance was developed. The examination is performed by jejunoscopy using lactose dilution for provocation and sucrose for control. Macroscopic and microscopic changes in the jejunal mucosa are examined after administration of solutions. The results of this study demonstrated that lactose administration causes prompt change in the jejunal mucosa in cases of lactose intolerance but had no effect in cases of lactose tolerance. Administration of sucrose did not result in any change. This method is effective in proving lactose intolerance and may be useful to elucidate the pathogenesis of this disorder.

Reduced lymphocyte activation in repeatedly inflamed human tonsils.

Tonsils of 20 patients with recurrent tonsillitis were investigated. Activated lymphocytes, that is lymphocytes with increased nuclear birefringence, were found in only 3 cases. The lack of lymphocyte activation is supposedly due to reduced antigen stimulation. Since antigens arrive at the tonsillar lymphoid tissue via the follicle-associated cells of the crypt epithelium, the ultrastructure of this epithelium was also studied in 5 cases. Tonsils of three dogs were used for comparison. In the repeatedly inflamed human tonsils the follicle-associated, so-called M cells contained fewer intracytoplasmic tubules and vesicles than those of the dogs. Moreover the frequency of these cells seemed to be reduced. Most of the crypts of inflamed tonsils were lined with a non-reticulated, stratified squamous epithelium. A hypothesis is presented on the pathomechanism of recurrent tonsillitis and suggestions are put forward about its pathohistology.

Renal actinomycosis associated with bilateral necrosing renal papillitis.

A rare case of renal actinomycosis with bilateral necrosing papillitis resulting in uraemia is reported. The part played in the process by the infection with Proteus vulgaris and the additional role of acute pancreatitis are discussed.

Immunoglobulin-producing cells in clinically normal, hyperplastic and inflamed human palatine tonsils.

Patients suffering from recurrent tonsillitis (RT), hyperplastic tonsillitis (HT), or idopathic tonsillar hyperplasia (ITH) were compared in immunological studies with subjects showing clinically normal tonsils. Serum concentration of immunoglobulins, particularly IgG, were found to be increased in association with tonsillitis. Conversely, the number of IgG-, IgA- and IgM-producing immunocytes per tissue unit was reduced in the germinal centres of lymphoid follicles, in the extrafollicular areas, and in the reticular parts of the crypt epithelium. The overall percentage distribution of these cells was normally 65:30:3.5:1.2 for the IgG, IgA, IgM and IgD classes, respectively. In RT these figures were 53:39:4.7:4.4; in HT, 67:25:4.0:4.5; and in IHT, 50 : 33 : 7.2 : 10. Thus, there were only small alterations in the immunocyte class proportions, except for a significant relative increase in IgD-producing cells. The results indicate that there is a functional defect of the tonsils in association with disease. The relative accumulation of IgD cells is probably explained by an inadequate local maturational process in B-cell system, altough some influence of low age cannot be excluded in the HT and ITH groups.

Lymphocyte activation and the increase of nuclear birefringence.

Nuclear birefringence of neutral red or rivanol stained cell suspensions from rat spleen has been investigated. Polyclonal or monoclonal mitogens produced an increased birefringence of the nucleus following 30 min in vitro stimulation at 37 degrees C. The nuclear birefringence increased by 62.2% [p less than 0.001], when the cells were incubated in the supernatants of a previously phytohemaglutinin stimulated culture. Amantadine, a potent phytohemagglutinin inhibitor, was unable to prevent the effect of the supernatant, but heating for 1 h at 56 degrees C destroyed its activity. The results suggest that increase in nuclear birefringence is mediated by a soluble factor which is released in the course of lymphocyte activation. The nuclear birefringence of surviving cells from human spleens obtained within 6 to 24 h post mortem increases after in vitro stimulation.

[Functional morphology of Peyer's patches. Lymphocyte activation in Peyer's patches]. / A Peyer-plakkok funkcionális morfológiája. Lymphocyta aktiválódás patkányok Peyer-plakkjaiban.

Peyer plaques of rats were studied by morphological methods in order to compare the structure of these organs with the present theories on their function. It was established that near to the follicules of plaques folds perpendicular to the intestinal passage are formed, which are able to direct a part of the bowel-contents into the direction of the follicules. Between the surface of the follicules and large intestinal villi recesses are formed, in which stagnation of the intestinal content takes place. As a result of this antigens and mitogens containing in the intestinal lumen can contact lymphoid cells of through the special epithelial cells the Peyer-plaques. The latter were recently studied by polarized light too, since earlier studies of the authors have shown that birefringence of these cells depends on their functional state. Authors disclosed that birefringence of the cells of the Peyer-plaques is significantly stronger, than that of the cells of spleen, lymph nodes, and thymus. Cells with increased birefringence are situated on the epithelial side of the capsule of follicules. Reported studies evidence, that Peyer-plaques are structures specialized for incorporation of antigens. Lymphoid cells of Peyer-plaques are activated by effects coming from the intestinal lumen.

Immunoglobulin systems of human tonsils. II. Patients with chronic tonsillitis or tonsillar hyperplasia: quantification of Ig-producing cells, tonsillar morphometry and serum Ig concentrations.

Patients suffering from recurrent tonsillitis (RT), hyperplastic tonsillitis (HT) or idiopathic tonsillar hyperplasia (ITH) were compared in immunological studies with subjects showing clinically normal palatine tonsils. Serum concentrations of immunoglobulins, particularly IgG, were increased in association with tonsillitis. Conversely, the number of IgG-, IgA- and IgM-producing immunocytes was reduced per tonsillar tissue unit. The density of such cells was decreased in the germinal centres of the lymphoid follicles, in the extrafollicular areas and in the reticular parts of the crypt epithelium. However, only small changes in immunocyte class ratios were observed, excepting a significantly raised proportion of IgD-producing cells. The immunohistochemical results indicated a defect in the tonsillar immunological function associated with disease, perhaps as a result of inadequate stimulatory signals for local maturation of B-cell clones. An influence of low age on this result in the HT and ITH groups could not be excluded. In the RT group there was a significant negative correlation between the tonsillar density of IgA-producing cells and the rate of synthesis of serum IgA. This may indicate that compensatory mechanisms are reflected in inversely related levels of local and systemic IgA synthesis.

A new rapid method for the in vitro demonstration of tonsillar lymphocyte activation.

A simple method is presented suitable for the demonstration of the initial stage of lymphocyte activation. The method is based on the evaluation of the intranuclear birefringence of lymphocytes. With this technique, the activation of the cells is detectable after 30 minutes' in vitro activation. Tonsillar lymphocyte activation was demonstrated after phytohemagglutinin, antigen, or anti-mu antibody stimulation. This activation causes an increase in the intranuclear birefringence. A small group of rabbit tonsillar lymphocytes showed an increased birefringence without in vitro stimulation, thus indicating a continuous in vivo activation of the tonsils.

Regulatory hyperparathyroidism: the role of C-cell hyperplasia.

Four cases with clinical and biochemical evidence of hyperparathyroidism are reported. The syndrome was due to DHT-intoxication of iatrogenic origin in the first case to histologically confirmed C-cell hyperplasia of the thyroid in the three others. The collective term "regulatory hyperparathyroidism" is porposed for the syndromes which, in distinction to secondary parathyroidisms, have a pathogenesis other than a negative calcium balance. Management of the syndrome is discussed with particular emphasis on the removal of the TCT-producing hyperplasia or adenoma, and the restoration of the electrolyte balance.