Hypertension and nephrology

[Article Reports]

JUNE 25, 2015

Hypertension and nephrology - 2015;19(03)

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Hypertension and nephrology

[Hungarian data about the ramipril based free or fixed doses combination therapy in connection with patients adherence]

SIMONYI Gábor

[In the treatment of chronic diseases an appropriate therapeutic effect is only achieved with a long-term medication. Hypertension is no exception, because to achieve target blood pressure is of outstanding importance for the prevention of cardiovascular complications. The use of fixed drug combinations according to national and international data increases the patients adherence by 20 percent. In our article we present the one year patients adherence treated with ramipril and amlodipine free combination, ramipril/amlodipine fixed combination and ramipril/hydrochlorothiazide fixed combination in hypertension.]

Hypertension and nephrology

[A Practical Guidance to the Diagnostics and Treatment of Hyponatremia]

FORDÍTOTTÁK: Cseprekál Orsolya, KÓBOR Krisztina, KIS Éva, BRASNYÓ Pál, HARIS Ágnes, REUSZ György

Hypertension and nephrology

[Additions and Explanations to “A Practical Guideline to the Diagnostics and Treatment of Hyponatremia” ]

DEÁK György, HARIS Ágnes

Hypertension and nephrology

[The use of beta-blockers in Hungary 2007-2014 based on data from National Health Insurance]

BARNA István, GYURCSÁNYI András

[disease, various rhythm disturbances, migraine, essential tremor case, addition to the treatment of endocrine disorders caused tachycardia and also may be used in the treatment of systolic and diastolic heart failure. Using the National Health Insurance Fund (NHIF) database, we analyzed changes in the turnover of beta-blockers used domestically between 2007 and 2014. At the beginning of the period more than 50% was metoprolol as the used active ingredient, the end of the period, nebivolol became the most frequently assigned active agent betablocker (29%). Besides nebivolol the use of bisoprolol and carvedilol increased, among the “old” beta-blockers the use of pindolol, bopindolol continuously decreases, propranolol and sotalolol consumption stagnant after the initial small decrease. Metabolic syndrome, disorders of carbohydrate metabolism, in case of sleep apnea the advantage of nebivolol is accompanied by the status of enhanced sympathetic activity and consequent reduction of RAS activation. Vasodilation, inhibition of plaque formation, reduction of platelet aggregation and anti-proliferative effects of nebivolol are its unique characteristics in the beta-blocker group. Improves insulin sensitivity, thus it is not characterized by a long-term side effects that cause diabetes. Effective reduction in the central blood pressure with nebivolol is likely to reduce the risk of complications in stroke and other related central blood pressure. Therefore, if the recommendations of the international and domestic support for considering it is not surprising that the use of metoprolol reduced such a large extent and how nebivolol covered the significant majority of the entire domestic beta-blockers market. Carvedilol was before the second and currently has become the 3rd or 4th most frequently used beta blocker. The decrease in the use of metoprolol undoubtedly caused by change in the recommendations, getting out of the subsidized products, and the appearance of the above known, new effective drugs.]

Hypertension and nephrology

[I Have Brought a Case ]

KISS István

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[Comment to the article titled “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

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Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.

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[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

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[Organic and non-organic perspectives in feeding and eating disorders under three years of age]

SCHEURING Noémi, DANIS Ildikó, KAROLINY Anna, SZABÓ László

[Providing optimal nutrition to infants and toddlers is a critical issue for both parents and experts. Besides the quality and quantity of food, indications of feeding behaviour such as feeding method and acceptance by the child are also crucial when determining feeding issues. The development of self-feeding is a significant part of the healthy somatomental development of a toddler between the age of 0-3 years. Efficient treatment of infants and toddlers with feeding disorders is often challenging in clinical practice. These symptoms frequently appear together with additional behaviour disorders, therefore functional reasons have to be taken into consideration in such cases. Due to the complexity of manifestations, applying tools beyond me­dical competence and involvement of special related professions are necessary. The general diagnostic systems of BNO-10 (International Classification of Diseases) and DSM-V (Statistical Manual of Mental Disorders) which are also applied in our country cannot be used appropriately for clear classification of early childhood feeding disorders and for examination of their backgrounds. DC:0-3R (Diagnostic Classi­fication of Mental Health and Develop­men­tal Disorders of Infancy and Early Childhood- Zero to Three), generally used in Anglo-Saxon countries, can be considered as a complex diagnostic system. Using the DC:0-3R classification system (1), we will present six types of feeding disorders affecting children between the age of 0-36 months in which organic and functional origins have been examined as well. In our article we argue for the complex, psychosomatic interpretation and treatments of early childhood feeding disorders.]

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CANOMAD syndrome with respiratory failure

SALAMON András, DÉZSI Lívia, RADICS Bence, VARGA Tímea Edina, HORTOBÁGYI Tibor, TÖMÖSVÁRI Adrienn, VÉCSEI László, KLIVÉNYI Péter, RAJDA Cecília

CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.