Private providers are successfully competing with the public health centre system in rural areas but not because they provide cheaper or better services. The quality of private health care services is not controlled and is significantly poorer than public services. Current practice in both systems falls below the national standard, especially for the management of chronic health problems. The low quality of health care services at a community level may help explain the previously observed phenomena of high levels of self-medicating, low utilization of commune health centres and over-utilization of tertiary health care facilities.

The increased concentration of LTB4 in the CSF of MS patients may indicate a biological importance for this mediator in MS.

The concentration of the leukotrienes B4 (LTB4) and C4 (LTC4) was measured in the cerebrospinal fluid (CSF) of 38 multiple sclerosis (MS) patients and 51 with other neurological diseases. The LTB4 and LTC4 levels were significantly elevated in MS compared with the controls. The findings suggest that lipoxygenase products might play a pathogenetic role in the early, encephalitogenic phase of MS. The administration of lipoxygenase inhibitors or leukotriene antagonists might well open new perspectives for the treatment of MS.

Phospho- and galacto- lipids and lipidhydrolyzing enzymes have been determined in the white matter of a young patient with a subacute course of multiple sclerosis (MS). Significant changes were observed for the concentration of glycerophosphatides and the fatty acid pattern of the normal appearing with matter surrounding MS-plaques. Among the individual glycerophosphatides a significant decrease of phosphatidylserine and phosphatidylinositol was found, whereas the ethanolamine containing phosphatides showed lower figures (non significant). The fatty acid pattern of the ethanolamine-phosphatide-fraction of the diseased tissue a decrease of the 18:1 and the sum of 20:1 and 18:3 fatty acids as compared to the normal control, whereas the highly unsaturated, long-chained fatty acids 20:4 (arachidonic acid) and 22:6 (docosahexaenic acid) were elevated. The measurement of lipidhydrolyzing enzymes resulted in an increased phospholipase A1 activity in the diseased tissue. The experimental data point to a decreased activity of the fatty acid elongation system in the course of MS. The decrease of the acidic glycerophosphatides might be due to the increased phospholipase A1 activity.

Measurements of blood platelet aggregation were carried out in 30 patients suffering from multiple sclerosis (MS) and in 15 healthy individuals. Compared with the control group, the MS patients showed an increase in both spontaneous and induced (ADP and serotonin) platelet aggregation. The possible pathogenetic significance of these results is discussed.Key words: Increased platelet aggregationfrequency and possible pathogenetic value in multiple sclerosis.