Extended applications with smart cards for integration of health care and health insurance services.

In 1999 in Romania has initiated the reformation of the national health care system based on health insurance. In 1998 we analyzed this system from the point of view of its IT support and we studied methods of optimisation with relational, distributed databases and new technologies such as Our objectives were to make a model of the information and services flow in a modern health insurance system, to study the smart card technology and to demonstrate how smart card can improve health care services. The paper presents only the smart cards implementations.

Five steps from a simple data base to an expert system in nutrition.

The paper describes the experience from the Medical Informatics Department--ITC in the field of the human nutrition. The informatic systems were developed staring from a minimal data base and simple programs. The final versions are expert systems running within complex medical informatic products.

Computerized system for the networking of health services (Proposed solution for the informational support of the health insurance law in Romania).

The integration of health services in the health insurance system can only be performed by using an advanced informational system, due to the large volume of documents needed for the payment of medical services by the health insurance firms. To better facilitate the access to the medical databases throughout the country is it necessary that the different application and their respective supports are able to communicate with each other. Every component of the health system (doctors' offices, clinics, hospitals, pharmacies, county health insurance offices) consist of a local LAN/WAN network according to the individual computer capabilities. These networks are connecting through the Internet which can be describe as a network of networks that permits long range communication.

[Long-term results of mobilization by bone resection in patients with post-traumatic total stiffness and ankylosis of the elbow. Study and results of 39 operations]. / Résultats éloignés des résections osseuses mobilisatrices des raideurs totales et ankyloses post-traumatiques du coude. Etude et résultats de 39 opérations.

Thirty patients with post-traumatic stiffness and ankylosis of the elbow were treated operatively at the Colentina Clinical Hospital, from 1970-1986. They were treated by 39 surgical mobilisation using Ollier technique. In eleven patients with a persisting functional amplitude of the prono-supination, the resections have been effected on the distal end of the humerus and on the olecranon, and in nineteen with a limited prono-supination too, it was added a resection of the radial head. The mobilisations were realised without interposition. At follow-up the patients were evaluated after 1 to 8 years, using the pre- and post- operative Rocher's indices and the Kerboull's classification. The flexion-extension was improved by 55 per cent, the pronation by 55.3 per cent and the supination also with 55.3 per cent. The results plead for the maintaining of this type of surgical treatment for the treatment of post-traumatic stiffnesses and ankyloses of the elbow, though there are not complete satisfactory, especially for the joint stability.

[The late results after mobilizing bone resections in posttraumatic rigidity of the elbow]. / Rezultate la distanta dupa rezectiile osoase mobilizatoare în redorile posttraumatice ale cotului.

Two categories of posttraumatic rigidities are distinguished: partial and total. The severity of partial rigidities depends on the residual flexion-extension amplitude arch and they are divided accordingly into functional rigidities, with a residual amplitude arch of 60-100 degrees, and non-functional ones, with residual flexion amplitude arches of 0-80 degrees or over 100 degrees. The severity of total rigidities depends mainly on the preservation or loss of the pronation-supination movement. To the department where the authors are working were admitted during 16 years (1970-1986), 54 cases of posttraumatic rigidities of the elbow, on which 63 operations were performed. The surgical indications were established according to the anatomopathological type of lesions, to the time elapsed from the accident, to the age and occupation of the patient and to the residual amplitude arches. The late results were checked up after 1-10 years, on the average after 3-4 years, by comparison of pre- and postoperative Rocher indices. The flexion-extension movements benefitted postoperatively by 70% in total rigidities and by 45% in the partial ones and the pronation-supination movements, by 40%. The results regarding the change of the biomechanical functionality conditions following the mobilizing bone resections are shown in comparison with those obtained by arthrosis and total elbow prostheses.

Deeper insight into HBsAg--anti-albumin antibody correlations.

The presence and titers of anti-albumin antibodies (AAA)--ie, precipitins (AA-IP) and agglutinins (AA-Aggl)--and the serum concentrations of immunoglobulins and albumin were determined in 210 asymptomatic carriers of HBsAg grouped according to HBsAg titer and subtype. A different immunologic pattern was observed in the HBsAg/ad and HBsAg/ay carriers, the results suggesting an increased aggressivity for the HBsAg/ay subtype which was evident in subjects with lower HBs antigenemia and characterized by higher concentrations of IgG and IgM and rises in AA-P titers. A positive linear correlation was found between HBsAg and AA-Aggl titers; the carriage of HBsAg/ad was associated with significant higher values of AA-Aggl than of HBsAg/ay. These subtle correlations between HBsAg titer and subtype and AAA suggest that the human serum albumin (HSA) known to exist on the HBsAg particles may be similar in a modified form, to that representing AAA specificity.

Correlations between anti-albumin antibodies and HBsAG in hepatic patients.

A new category of autoantibodies--antipolymerized albumin antibodies (AAA)--was discovered in 1974. Studies performed from 1974 to 1976 showed their diagnosis and prognostic values in hepatic diseases; the AAA tests [immunodiffusion (ID) and hemagglutination (HS)] made possible a good estimation of the total liver cell function. Without being specific for a viral hepatitis B infection, highly significant linear correlations were found for AAA precipitin and agglutinin positivities with presence of HBsAg. High titre of AAA agglutinins unaccompanied by a positive ID test, characterise the "healthy carrier" of the HBsAg, while the isolated AAA positivity in ID is met in more severe, long-standing hepatic diseases.

Anti-albumin antibodies in chronic liver diseases: diagnostic significance of these antibodies in patients with conventional or immunosuppressive therapy.

The two categories of anti-albumin antibodies (AAA), namely precipitins (AA-P) and agglutinins (AA-Aggl), were investigated in 260 patients with morphologically diagnosed chronic liver diseases (CLD). A parallelism was observed between AA-P titre and the severity of chronic hepatitis as revealed by clinical diagnosis. Thus, significant differences in AA-P titre were noticed between chronic persistent hepatitis (CPH) and chronic aggressive hepatitis (CAH) and between CAH and liver cirrhosis (LC). No correlation was found between AA-P positivity and either HBsAg presence or disease activity, maximum AA-P values being registered in decompensated, inactive LC. AA-P positivity was found associated with a higher degree of liver cell dysfunction. In every category of CLD a striking association was also observed between AA-P positivity and raised serum aspartate transaminase and bilirubin levels, thus suggesting a common pathogenic substrate, namely liver cell membrane damage. These correlations were also observed after immunosuppressive therapy which would argue for the maintenance of AA-P diagnostic value. AA-Aggl showed raised incidences and titres in CAH patients, the values decreasing in LC. Therefore, the main diagnostic value is attributed to AA-P.

Beta2-microglobulin excretion and autoimmune phenomena in endemic Balkan nephropathy.

Quantitative determinations of beta2-microglobulins were carried out in 335 urinary samples collected from 335 subjects living in villages with a high rate of morbidity and mortality from endemic Balkan nephropathy. Three months after the first determination of beta2-microglobulin excretion, blood and urine samples were obtained from 19 patients with high values and from 19 with normal values of beta2-microglobulins. The results of the biochemical and immunological investigations performed on these samples suggest that the tubular alteration is the first lesion. The autoimmune phenomena elicited by the tubular alteration may contribute, by an antigen-antibody complex disease mechanism, to the appearance of glomerular secondary lesions.