Hungarian Immunology

[2nd C1-esterase inhibitor deficiency workshop, April 2001, Budapest]

FARKAS Henriette, VARGA Lilian, HARMAT György, FÜST György

MARCH 20, 2002

Hungarian Immunology - 2002;1(01)

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Hungarian Immunology

[Neonatal activation of interferon-γ in macrophages]

ERDŐS Melinda, MARÓDI László

[Each individual passes through developmental or transient immunodeficiency due to the immaturity of the immune system in early childhood, expecially in the neonatal period. Therefore, neonates contract infections by intracellular and extracellular microorganisms more easily than older children and adults, and develop more severe disease with a high mortality rate. A number of abnormalities in the neonate’s host defense systems have been described suggesting that the immune system at birth functionally differs from that in adults. Neonatal T and B cells show decreased reactivity to antigens and mitogens and have deficienct IgM-IgG isotype switching. Newborns have decreased functional capacities of the hemolytic complement system. Under the same in vitro and in vivo conditions neonatal granulocytes show functional deficiency earlier than adult cells. Effector mechanisms of the cell-mediated immunity involve activation of macrophages by T helper1 cytokines, particularly interferon- γ (IFN-γ). IFN-γ is the most important macrophage-activating cytokine in vivo. Neonatal T cells express lower levels of IFN-γ and macrophages are hyporesponsive to activation by this cytokine. This deficiency may be explained by decreased phosphorilation of STAT1 despite comparable expression of STAT1 protein in neonatal and adult macrophages.]

Hungarian Immunology

[Patomechanism of hereditary angioneurotic oedema and provoking factors of oedematous attacks]

FARKAS Henriette

[The author describes the genetic background of hereditary angioneurotic edema, an autosomal dominant disorder. The pathomechanism of edemaformation and the significance of major mediator substances are explained along with clinical manifestations and their management. A special emphasis is placed on prophylaxis, the mainstay of which is the elimination of precipitating factors. The latter include mechanical trauma, diagnostic and therapeutic interventions performed in the cephalic-cervical region, mental stress, and sex hormones. The effect of endocrine therapies, ACE inhibitors, and infections - Helicobacter pylori in particular - on the natural course of the disease is also discussed.]

Hungarian Immunology

[Long-term follow-up of a large Hungarian lupus patient population]

KISS Emese, SONKOLY Ildikó, SZEGEDI Gyula

[INTRODUCTION - The authors give a report about their experiences obtained by long-term follow-up of a large Hungarian lupus patient population. They also compare their results with literature data. PATIENTS AND METHODS - Clinical and laboratory characteristics of 800 SLE patients followed at this institution were analysed. Issues of diagnosis, therapy and outcome measures were also discussed. RESULTS AND DISCUSSION - Results indicate that the incidence and prevalence of SLE are increasing. Recently, milder cases are also recognised. Early diagnosis makes possible an early adequate therapy. Partly due to these the survival improved, and the mortality reduced. The compliance of patients also improved. The authors suggest the importance of regular medical follow-up. Despite of that, the clinical presentations of SLE have not been changed the disease became milder. Considering the longer survival in lupus, chronic complications, such as vascular diseases, osteoporosis and cancer are suspected to appear more frequently. On the other hand, there is a small group of patients still being in risk, as they fail to respond conventional immunosuppressive therapy. These patients die within a short period due to progression of SLE. This indicates the importance of research work on the pathogenesis of SLE. Based on the results of basic research novell immune modulator modalities should be developed.]

Hungarian Immunology

[PAPER REVIEW]

SZABÓ Zoltán

Hungarian Immunology

[In memoriam professor Gyula Petrányi]

SZEGEDI Gyula

All articles in the issue

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Lege Artis Medicinae

[NSAID-ASSOCIATED GASTROPATHY: RECENT ASPECTS OF PREVENTION]

HERSZÉNYI László

[Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs worldwide. Gastroduodenal ulcers are found at endoscopy in 15 to 30% of patients who use NSAIDs regularly. The annual incidence of severe upper gastrointestinal complications such as bleeding or perforation is 1.0 to 1.5%. From a cost-benefit perspective, prevention strategies should consider both gastrointestinal, and recently, cardiovascular risk factors. No prophylaxis is necessary with low gastrointestinal risk. There are currently four possible strategies to reduce the risk of adverse gastrointestinal effects: 1. the use of selective COX-2 inhibitors or coxibs rather than traditional NSAIDs; 2. cotherapy, primarily with proton pump inhibitors, to ensure protection to gastric mucous membrane; 3. co-therapy with a coxib and a proton pump inhibitor in patients with very high risk (eg., history of bleeding); 4. eradication of Helicobacter pylori infection in patients with a history of ulcer. The use of coxibs decrease the risk of gastrointestinal damage by roughly 50%. In the presence of gastrointestinal risk factors or for patients on aspirin also treated with an NSAID or a coxib, protection with a proton pump inhibitor is recommended. Proton pump inhibitor therapy is also useful for the prevention and treatment of NSAID-induced dyspepsia. The beneficial effects of proton pump inhibitors cannot solely be explained by their profound antisecretory action. Therefore, several acid secretion- independent mechanisms of action have been proposed.]

Lege Artis Medicinae

[The 41st Congress of The European Society of Hepatic Research - 26-30 April, 2006. Wien]

LOMBAY Béla

Hungarian Radiology

[Portal embolisation prior to liver resection]

MÓZES Péter, MÉSZÁROS György, TÓTH Judit, SÁPY Péter

[INTRODUCTION - By partial embolisation of the vena portae the number of the patients suitable for radical liverresection can be enhanced, the safety of the operation can be increased, the subsequent results improved. The method is based on the experience that when blocking the circulation of the portal system in special segments of the liver, the other part of the organ tries to substitute the functional deficiency by hypertrophy. Vena portae embolisation is justified in cases when the liver substance remaining after the planned operation is critically small. PATIENTS AND METHODS - The authors carried out vena portae embolisation at Debrecen University Medical and Health Science Centre since October 2003 on six patients. Assessments were made studying the volume of the whole liver, the lobe affected by embolisation and that of the unaffected lobe, by CT-volumetry. The average age of the patients (four men and two women) was 63 years (51-67 years). The hepatic tumour was an extended metastasis localised to one lobe in five cases, and HCC in one of the patients. In each case we carried out closing the right lobe’s portal system. RESULTS - In five cases the left lobe showed increase following the portal embolisation of the right lobe intended to be removed. On the average four-six weeks passed between the two CT-examinations. The growth of the left lobe was an average of 42% (min. 11.8%, max. 75.6%). CONCLUSION - In selected patients the embolisation of the vena portae system of the tumorous liver-segments is a suitable method for enlargening the size of the liver substance remaining after an extensive resection.]

LAM KID

[Comparison of different schemes of vitamin D3 therapy]

SZILI Balázs, BAKOS Bence, KATÓ Karina, KIRSCHNER Gyöngyi, TOBIÁS Bálint, BALLA Bernadett, HORVÁTH Péter

[Vitamin D plays an important role in several pathways in humans. Its relation with several diseases has been previously de­scribed. Vitamin D deficiency affects al­most the full population on temperate zone at the end of the winter. Recommendations on vitamin D supplementation are inconsistent and there are only a few data about the efficacy of cholecalcipherol given not in daily manner. In the present paper, we examine the different administration mo­dalities, and their efficacy in increasing serum vitamin D levels. High doses administered rarely appear to be equally efficient and safe compared to low doses provided frequently.]