Hungarian Immunology

[History of immunology in Hungary Part VI]

KARASSZON Dénes, CSABA Béla

FEBRUARY 20, 2005

Hungarian Immunology - 2005;4(01)

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Hungarian Immunology

[Immunology delectat]

SZEGEDI Gyula

Hungarian Immunology

[Experimental arthritis model]

SZÁNTÓ Sándor, GONDA Andrea, MIKECZ Katalin, GLANT Tibor, SZEKANECZ Zoltán

[Animal models of experimental arthritis can be used to understand pathophysiology of the arthritic processes in patients and provide opportunity to develop new therapeutic approaches. The animal models can be divided into different categories based on the pathomechanism of the model and on the features that resemble human inflammatory joint diseases. This review provides an overview of the most widely used types of experimental arthritis models emphasizing their advantages and limitations in the basic arthritis research.]

Hungarian Immunology

[Functional measurements of the hand’s circulation in Raynaud’s patients]

CSIKI Zoltán, GALUSKA László, GARAI Ildikó, SZABÓ Nóra, GALAJDA Zoltán, VARGA József, ZEHER Margit

[INTRODUCTION - In patients presenting with isolated tissue perfusion disturbance without large vessel involvement the examination of hand microcirculation is of major importance. In our study we present the results of three examination methods used for hand perfusion monitoring which measure the tissue microcirculation in different depths. PATIENTS AND METHODS - We examined 58 primary Raynaud's patients using capillary microscopy, laser doppler perfusion imaging and hand perfusion scintigraphy with Tc-99m-DTPA. From our patients 38 were smokers, 42 patients frequently suffered from headache. For the validation of our laser Doppler results we involved into the study also 16 non-smoker healthy volunteers. For the standardisation of the results the studies were performed in a climatised room. During the laser examination we performed and analysed also the post-occlusion hyperaemia test. RESULTS - In the majority of our patients no morphological alterations were found with capillary microscopy. In primary Raynaud’s patients the perfusion values measured with laser-Doppler scanner in basic condition were significantly lower both in fingers’ and palm’s regions compared to healthy controls. In the primary Raynaud’s group the smokers had significantly lower hyperaemic response than the non-smokers and we measured also significantly lower FPR (finger-to-palm ratio) values with hand perfusion scintigraphy. Both with laser doppler imaging and hand perfusion scintigraphy there was no difference between the values measured in patients with or without headache. CONCLUSIONS - We consider of benefit the functional examination of hand circulation in all diseases involving the hand microcirculation.]

Hungarian Immunology

[Pathomechanism of Crohn’s disease and ulcerative colitis]

GÁL István, CSIKI Zoltán, SZEGEDI László, G. KISS Gyula

[The two archetypes of inflammatory bowel diseases, Crohn’s disease (CD) and ulcerative colitis (UC) have a considerably high prevalence and chronic morbidity, and thereby a striking public health relevance amongst the maladies involving the gastrointestinal tract. Unveiling their pathogenesis can be the key for the development of successful therapeutic approaches. Our view of these diseases has undergone radical changes in the past few years, and the latest discoveries have shed new light upon their pathomechanism. A multifactorial view is appropriate when explaining their pathogenesis, although certain factors are seemingly of particular importance.]

Hungarian Immunology

[Immune-dysfunctions in patients with Hodgkin’s lymphoma being in a long lasting complete remission]

ALEKSZA Magdolna, KERESZTES Katalin, BARÁTH Sándor, SIPKA Sándor, ILLÉS Árpád

[OBJECTIVES - Immunosuppression has long been known to be associated with Hodgkin’s lymphoma. The authors report on immunologic abnormalities with special focus on cellular immunity in patients with Hodgkin’s disease in complete remission. METHODS - We determined the proportion of the lymphocytes subpopulations, activated T cells, CD4+/CD25+ suppressor T cell population and intracytoplasmic cytokines by flow cytometry. The soluble cytokines were measured by classical ELISA technique. RESULTS - Based on lymphocyte cell surface antigen expression the subpopulations were as described in the literature, however a unique elevation of CD4+/CD25+ cell fraction was detected. The decreased amount of IFN-γ in the serum suggest Th2 dominance, but reduced intracellular IL-4 production in both CD4+ and CD8+ cells results from Th1 dominance. These results somewhat contrary but can not be completely compared as in vivo and in vitro techniques used for the analysis are not identical. However a constant elevation concentration and expression of IL-10 and TGF-β is observed. CONCLUSION - These alterations may reflect the existence of an immunosuppressive state also in the peripheral blood of Hodgkin’s lymphoma patients not only in the lymph nodes.]

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[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Clinical Neuroscience

Simultaneous subdural, subarachnoideal and intracerebral haemorrhage after rupture of a peripheral middle cerebral artery aneurysm

BÉRES-MOLNÁR Anna Katalin, FOLYOVICH András, SZLOBODA Péter, SZENDREY-KISS Zsolt, BERECZKI Dániel, BAKOS Mária, VÁRALLYAY György, SZABÓ Huba, NYÁRI István

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]