50 years of Hepatology: The Royal Free Hospital School of Hepatology.

Writing about the history of Hepatology would necessarily imply writing about the history of the Liver Unit and the School of Hepatology created by Dr. Sheila Scherlock at the Royal Free Hospital (London). On the 70th anniversary of the creation of the first liver unit (Hammersmith Hospital) this article presents a brief account of the history, organization, structure, educational program and contributions of perhaps the first and the most influential medical research models created for the study of liver diseases: the Royal Free Hospital Liver Unit.

[A peculiar man - about Hans Selye, as reflected in his Hungarian connections]. / Egy "furcsa ember" - Selye Jánosról magyar kapcsolatainak tükrében.

Hans Selye made a great impact on the Hungarian medical, scientific and public life. His first Hungarian publication about the alarm-reaction appeared 1938 in the Orvosi Hetilap. His Hungarian relationship was quite extensive after the war as he published, gave lectures, and accepted Hungarian students for specialized training in his Canadian institute saw. The rich documents in archives about Selye are currently being processed and those will surely shed light on Selye's life in further details.

[Applicability of the problem of peptic ulcer in modern gastroenterology, military-and-medical and medical-and-social assessment].

The round-up article is devoted to the history of gastroenterology. The authors deal with a subject of aetiology, pathogenesis and treatment of diseases associated with destruction of mucous coat of GI tract. The main criteria of military-and-medical and medical-and-social assessment used in evaluation of patients with different forms of peptic ulcer are performed.

Origins of the Canadian Association for the Study of the Liver: A personal memoir.

The Canadian Association for the Study of the Liver (CASL) (Association Canadienne Pour L'Étude Du Foie) is a thriving organization. Although it was established more than a quarter of a century ago and has been successful since the beginning, most members are unaware of how CASL came into being or of its humble origins as a precursor club in the 1970s. The present article reviews those early days. It is written as a memoir because of the author's personal involvement and is based on detailed records, correspondence and handwritten notes from that era.

Managed care. Evolution and distinguishing features.

Managed care as a system of health care delivery has grown tremendously in popularity in the United States during the past decade in response to demands by employers and government for cost containment, enhanced access, and improved quality. Managed care took root in the 1800s as prepaid health services provided by employers for immigrants coming to the United States to work. The forerunner of modern managed care, prepaid group practice, later was dwarfed by the unbridled development of FFS medicine under indemnity insurance in the post-World War II period and stunted by early reactions of organized medicine. The early health care reform years of the 1960s spawned HMO legislation in the 1970s, which prompted ever-escalating growth in HMO enrollment. Market-driven health reform has prompted the evolution of health care delivery to the modern-day version of managed care. In this system, health care is provided by a limited number of contracted providers at reduced rates of reimbursement. Patients are channeled to these contracted providers, and clinical decision making of these providers is influenced by the MCO through utilization management and quality assurance. Financial risk is shifted from payers and insurance companies to providers to influence further clinical decision making. All of these characteristics of managed care pressure providers toward higher levels of integration and foster greater reliance on management information systems. Gaining a perspective from the history of managed care, understanding managed care's distinguishing features, and dealing effectively with the pressures of these unique characteristics are important in successfully caring for patients, managing the risk structure, and succeeding professionally in this current environment for health care delivery.

The scientific growth of gastroenterology during the 20th century. The 1994 G. Brohee Lecture.

Energized by the growth of the basic sciences during the latter half of the 20th century, gastroenterology advanced from a modest clinical activity to an increasingly scientific discipline. The decisive change followed World War II, when the Office of Scientific Research and Development transferred university and industry wartime research contracts to the National Institutes of Health (NIH), followed by establishment of the National Science Foundation and the General Medicine Study Section (NIH). Other factors contributing to the progress of gastroenterology included: (1) the increasing body of scientific knowledge; (2) innovative technological advances; (3) philanthropic, pharmaceutical, and governmental (NIH) support of research; (4) emphasis on controlled clinical and laboratory studies; and (5) the enlarging global scientific communication network. Selected highlights on the evolving knowledge of gastrointestinal hormones and the discovery of cholecystography illustrate some of the pathways of gastroenterology's 20th century advance.