Hypertension and nephrology

[Beetroot May Provide Sustained Blood Pressure Lowering]

VÁLYI Péter

DECEMBER 10, 2015

Hypertension and nephrology - 2015;19(06)

COMMENTS

0 comments

Further articles in this publication

Hypertension and nephrology

[Role of nephroclinicopathology in the nephrological diagnosis]

NAGY Judit, KEMÉNY Éva, IVÁNYI Béla

[In cases where a definitive diagnosis of a renal disease cannot be established on the basis of the clinical and laboratory data as well as imaging techniques the histological examination of the renal biopsy can be useful for establishing a pathological diagnosis, assessing the prognosis and can give etiopathogenetic information to guide the further management. The description and the degree of the active and chronic changes may influence the rationale treatment and the likelihood of the response. However, discussion between the nephrologist and the nephropathologist is indispensable at the decision to take the biopsy and at the evaluation of the result of the histological examination.]

Hypertension and nephrology

[The Classics of Hypertonology 4. – Professor John H. Laragh, 1924-2015]

KÉKES Ede

Hypertension and nephrology

[Application of central sympatholytic agents and vasodilators between 2007-2014 based on OEP’s database]

BARNA István, GYURCSÁNYI András

[Due to the a large number of antihypertensive drugs on the Hungarian market, in the light of the constantly updated recommendations for therapy, seemed to be worth to consider the traffic data provided by the National Health Insurance. We analysed the turnover of the centrally-acting and direct vasodilator antihypertensive, using the data of The National Health Insurance Fund (NHIF) between 2007 and 2014. Every year the December data were comparesed, the turnover of the month did not substantially different from other month, an average of 5-6 million boxes of cardiovascular products are prescribed. Over the past seven years it was fluctuating, but overall there was almost 19% increase in the turnover of centrally acting medicinal products. The prescription number of guanfacine decreased almost one-third, moxonidine orders fell 37%, while the turnover of rilmenidine doubled during that same period. A significant expansion of the centrally acting rilmenidine became clear in the domestic market. The minimal side effects, the favourable profile of applications, the number of international and domestic studies make it an excellent second-third additional agent. The use of vasodilators overall increased of a small degree (15%), mainly due to a 53% increase of doxazosin. Considering the domestic prescribing habits they follow very well the international and domestic recommendations. The observed differences in each group are the effects of the positive results of recent studies.]

Hypertension and nephrology

[Measurement Options of Overweight and Obesity and their Levels of Usefulness]

KISS István, KÉKES Ede

Hypertension and nephrology

[The Double-Faced Thiazides]

KEMPLER Péter, HORVÁTH Viktor József

All articles in the issue

Related contents

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

[The author’s response to the comment on “Exploratory study of outcomes of blood sample mass examinations by rank correlations”]

Lege Artis Medicinae

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

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.