Hypertension and nephrology

[Report on the 49th ERA-EDTA Congress]

MAY 20, 2012

Hypertension and nephrology - 2012;16(02)

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Hypertension and nephrology

[May patients with chronic kidney disease do sports?]

APOR Péter, RÁDI Attila, BABAI László

[Physical activity and sports in healthy people do not result in renal impairment. In end-stage renal disease - together with dialysis - moderate physical activity supports the maintenance of the controlled status. In chronic kidney disease moderate exercise improves filtration, the lipid profile, diminishes proteinuria and oxidative damage, maintains the muscular performance and metabolically active muscle mass. Metabolism of diabetics are significantly improved with exercise, it provides renal protection. Excess consumption of proteins, non-steroidal antiinflammatory drugs or creatine can be a problem in competitive sports. The high muscle mass implies higher creatinine level.]

Hypertension and nephrology

[Róbert Langer (Editor): History of the Baross Street Surgery Clinic]

ALFÖLDY Ferenc

Hypertension and nephrology

[Gender differencies in coronary reactivity in angiotensin II hypertension rat model]

MÁTRAI Máté, NÁDASY György L, HETHÉSSY Judit, SZEKERES Mária, Monos Emil, SZÉKÁCS Béla, VÁRBÍRÓ Szabolcs

[It is known that hypertension shows several gender specific elements both in pathogenesis and in therapy. Understanding this phenomenon may bring us closer to individualized therapy. That was the reason why we examined process of hypertensive adaptation on the level of small intramural coronary arteries. 10-10 male and female Sprague-Dawley rats were used in this study. Animals received osmotic pumps in anaesthesia, which emitted 100 ng/bwkg/min angiotensin II acetate for four weeks. After four weeks treatment, animals were sacrified and heart weights were measured. We isolated intramural, small branches of the left anterior descendant coronary artery, placed them into vessel chamber and tested biomechanical properties and pharmacological reactivity. Heart weight and wall thickness were higher in females comparing to males. However, basal vascular tone and thromboxane-mediated vasoconstriction were elevated in males. Bradykinin relaxation was bigger in females. In female animals inward eutrophic remodeling was found, while in males increased wall stress and elastic moduli dominated the adaptation process. In conclusion, initial steps of angiotensin II mediated hypertension induced markedly gender dependent alterations.]

Hypertension and nephrology

[Position Paper Concerning the Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers (Inhibition of the Renin-Angiotensin System) in Chronic Renal Disease]

MÁTYUS János, KISS István

Hypertension and nephrology

[Too early publication? (priority of the Hungarian authors was saved by a South- American radiologist)]

RADÓ János

[It is supposed that the invention of diuretic (furosemide) renography was a premature discovery. This is suggested by the fact that it was rediscovered by more than one people. Author supported this contention by a statistical analysis of „citation intervals” performed on the basis of Garfield’s suggestions. The length of the time from the description of the procedure to the appearance of citations („citation interval”) proved to be an average of 21.3±9.6 (SD) years, significantly longer than in the case of the author’s five important other recognitions combined, where the average citation interval was 8.7±7.4 (SD) years (p<0.01). Camargo a South-American radiologist who first confirmed the original study, was later just in time the editor of a North American journal to save the priority of the original inventor Hungarian authors. In medical science the investigators take the risks in the interest of the patients including „publishing too early”.]

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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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Long-term follow-up results of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastoma multiforme patients. The importance of MRI information in survival: Single-center experience

LUKÁCS Gábor, TÓTH Zoltán, SIPOS Dávid, CSIMA Melinda, HADJIEV Janaki, BAJZIK Gábor, CSELIK Zsolt, SEMJÉN Dávid, REPA Imre, KOVÁCS Árpád

Introduction - Glioblastoma multiforme (GBM) is the most common malignant primary anomaly of central nervous system. The GBM infiltrates the nearly sturctures from the initial tumor and its metastatic attribution is well known. The aim of our single-centered retrospective study was to introduce the importance of postoperative medical imaging confirmation of total tumor resection for patient with GBM combined concomitant and adjuvant chemoradiotherapy on a 10 year long patient follow up. Methods - From January 2006 to April 2015 we registered 59 patients with newly diagnosed GBM at the University of Kaposvár Health Center Institute of Diagnostic Imaging and Radiation Oncology. The histological diagnosis was confirmed by a proficient neuropathologist (World Health Organisation WHO; grade IV astrocytoma). According to histological status if the ECOG performance status of patients allowed it the mutidisciplinary oncoteam recommended adjuvant chemoradiotherapy all features strictly by Stupp protocol. (60 Gy dose on the gross tumor volume and 2-3 cm margin for the clinical target volume with parallel 75 mg/m2 TMZ. Four weeks after monotherapial phase patients had to recieve 6 cycles of TMZ first cycle with 150 mg/m2 up to 200 mg/m2). The irradiation was carried out by a conformal three dimensional planning system. Results - 59 patients with the median age of 63 (range 17-84) year. Our sample counted 34 male patients and 25 woman patients. 14 patients underwent gross total tumor resection while, 39 patients underwent partial resection and the rest from our sample 6 patients passed through biopsy. Statistical analysis showed a lengthier survival among males than females, with a median survival of 13 months for males and females, the OS of 26.209 for males, meanwhile 15.625 for females. However, the difference is not considerable (log-rank p=0.203). Our study found that the estimated survival of patients at least 50 years old is significantly shorter at a median survival of 12 months (log rank p=0.027) than that of patients below 50 years of age at a median survival of 23 months. The longest estimated median survival was calculated with patients of ECOG '0' condition (16 months). However, no significant difference was found in the estimated survival of patients of different ECOG conditions (log-rank p=0.146). Based on the extent of surgery, complete resection resulted in the longest average survival of 36.4 months, followed by 21.5 months among patients with biopsy, and 15.8 months among patients with partial resection. Different surgical procedures, however, did not result in significant differences in survival (log-rank p=0.059). The overal survival of patients who had complete resection confirmed by MRI compared with the overal survival of patients with residual tumor confirmed by MRI as well we can estimate that there is significant difference between these two groups (p=0,004). Conclusion - Despite complex and intense treatment, recurrence is inevitable and causes relatively rapid death. In our analysis complete resection, as defined from the neurosurgeon’s report and postoperative MRI, resulted in an independently significant improvement in OS. Our results are the evidences that the treatment of patients with glioblastoma multiforme in Hungary is at least on the same level as any other developed European countries.

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