Hypertension and nephrology

[Report on the 18th Gyula Hypertension Day]

DUDÁS Mihály

OCTOBER 20, 2018

Hypertension and nephrology - 2018;22(05)

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Hypertension and nephrology

[Hypertension and atrial fibrillation. Part 1. - Epidemiological data. The pathomechanism of PF in hypertension]

KÉKES Ede

[Atrial fibrillation (PF) is the most common arrhythmia on the basis of analyzes conducted in different regions of the world. The main reason for this is the aging of the population. High blood pressure is one of the major factors of mortality in both developed and poor economical countries. The combined presence of the two diseases presents many hazards to our body. The most significant of these is the development of thromboembolic stroke, which is constantly increasing with age. The author analyzes in detail the aetiology called atrial cardiomyopathy, behind which there are complex structural, architectural, contractile and electro-physiological changes and leads to clinical manifestation of PF.]

Hypertension and nephrology

[The importance of recognition and proper treatment of hypertension and the maintenance of adherence in hypertension care]

NEMCSIK János, PÁLL Dénes, JÁRAI Zoltán

[Hypertension is the leading cause of death and disability-adjusted life years. In the United States hypertension accounts for more cardiovascular (CV) deaths than any other modifiable CV disease risk factor and was second only to cigarette smoking as a preventable cause of death for any reason. In our country the situation is similar. In Hungary the number of subjects with hypertension is approximately 3.5 million and this high prevalence contributes markedly to the poor Hungarian CV morbidity and mortality figures. The recognition of hypertension, the initiation of drug therapy and the long-term follow- up of the patients is mainly the task of primary care. Besides that it inheres high responsibility, this is also a grateful commitment, as hypertension in most of the cases can be treated properly with lifestyle-changes and medications leading to a marked decrease of CV complications, especially stroke. In our review article we would like to focus on the high prevalence of hypertension worldwide as well as in our country, the exact implementation of screening, the risk reduction potential of the proper treatment and the importance of the long-term maintenance of treatment adherence.]

Hypertension and nephrology

[How Hemodialysis Started in Hungary in the Latter Half of the Past Century]

KARÁTSON András, KAKUK György, MAKÓ János, KISS Éva, ZAKAR Gábor

Hypertension and nephrology

[Significance of the Extracellular Matrix, Collagens and their Biomarkers in the Development and Prediction of Hypertension According to the Latest Literature Data]

LELBACH Ádám, KÁNTOR Márk, DÖRNYEI Gabriella, KOLLER Ákos

Hypertension and nephrology

[Accredited Postgraduate Training]

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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.

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[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

JANSZKY József, HORVÁTH Réka, KOMOLY Sámuel

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]

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Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.

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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.

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[Pharmacotherapeutic strategies on treatment of patients with high cardiovascular risk based on the 2018 European Hypertension Guidelines]

FARSANG Csaba

[The new joint hypertension guidelines of the European Society of Hypertension and European Society of Cardiology will simultaneously be published in August, 2018 in the J. Hypertension and Eur. Heart J. on the diagnostics, evaluation, treatment and follow up of hypertensive patients. This guidelines put emphasis on definition, and therapeutic strategies in patients with high cardiovascular risk. In this paper I summarise the cardiovascular risk factors and put emphasis on possibilities of reduction of cardiovascular risk. ]