Hypertension and nephrology

[The 20th Jubilee Debrecen Nephrology Days]

DEÁK György

SEPTEMBER 10, 2016

Hypertension and nephrology - 2016;20(04)

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Further articles in this publication

Hypertension and nephrology

[The comparative analysis of quality of life in the european countries]

REKETTYE Gábor, KÉKES Ede

[The well-being of the citizens is a determining factor of the social development in every country. The well-being is expressed in the notion of quality of life. Quality of life consists of lots of components and it is more than just being healthy, so its terrain extends far beyond the medicine. Based on a comprehensive research carried out by Eurostat the statistical office of the European Union the study intends to report about the components of the quality of life and about the findings of the survey made with the aim to map the opinions and views of the citizens about it in the different European countries. The paper deals with the relations among these components and with the comparison of the views of the countries.]

Hypertension and nephrology

[The CARDI-COG Study]

POÓR Ferenc

Hypertension and nephrology

[Celebrating the 90th Birthday of Professor Edit Gláz]

KÉKES Ede, KISS István

Hypertension and nephrology

[Hypertension and cognitive feature]

KÉKES Ede, KISS István

[Around authors of the literature data and our own experience of the relationship between hypertension and cognitive function. The age progresses, more and more of the dysfunction and vascular dementia. This plays a significant role in hypertension. Simple methods, tests you should regard the practice and also check this function, considering that the aging population is an unstoppable process. The effective antihypertensive treatment, blood pressure variability reduction positively affected by the deterioration of the cognitive function, especially if treatment is started as soon as possible.]

Hypertension and nephrology

[A new, effective tool in the treatment of hypertension in light of the available evidence]

MASSZI Gabrilella

[Hypertension is important even in the group of common diseases. Cardiovascular mortality could be significantly reduced if high blood pressure could not only be treated, but controlled as well. The newly introduced fixed combination perindopril-amlodipin-indapamide medication could be a good tool for genereal practitioners, specialists in internal medicine and cardiologists. Combined treatment with the ACE inhibitor perindopril, the new vasorelaxant type diuretic indapamide and the third generation type Ca-chanel blocker amlodipin is effective in reducing blood pressure. Besides effectivity the organ protective pleiotrop qualities (cardioprotective, plakk stabilising, antiatherosclerotic, antithrombotic, stroke preventive, endothel dysfunction reducing, renal protetcion granting) provide a long lasting beneficial impact on life expectancy and a better quality of life to the patients. If we choose the right dosage, we could raise the compliance level of patients resulting in excellent degrees of compliance. In our article we wanted to draw attention to the major evidencies which are the best acknowledgements of this triple combination although we didn’t explore all avenues.]

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Related contents

Clinical Neuroscience

[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.]

Clinical Oncology

[Complications of infusion treatment with emphasis on extravasation of cytostatics]

HARISI Revekka

[The extravasation of cytostatics is the most signifi cant complication of infusion therapy in cancer treatment. Extravasation refers to the inadvertent infi ltration of cytostatic drugs into subcutaneous or subdermal tissues surrounding the intravenous or intraarterial administration site. According to literature data incidence estimates between 0,01-7%. Extravasated drugs are classifi ed according to their potential for causing damage as vesicant, irritant and nonvesicant. Knowledge of risk factors, the patientrelated and treatment-related ones is important to minimize the occurrence of extravasation. In order to reduce the risk of extravasation, the staff involved in the tumor infusion therapy must be specially trained to implement several preventive and therapeutical protocols. In 2012, ESMO-EONS has put together a new comprehensive treatment protocol on the topic of cytostatics extravasation. Protocol recommended that every oncological department, who administers chemotherapy have to have extravasation trained team and a standby extravasation kit. According to the new ESMO-EONS guideline subcutaneous corticoids are not recommended, anymore. In case of mechloretamine extravasation the recommendation is immediate subcutaneous injection of sodium thiosulfate. After extravasation of anthracyclines, mitomycin C and platin salts the best treatment opportunity is subcutan dimethyl sulfoxide administration. In case of anthracyclines’ extravasation intravenous dexrazoxane treatment is also effective. Hyaluronidase, injected into or under the skin, facilitates absorption of extravasated drugs because of increases connective tissue permeability, promotes the spreading and reduces the local concentration of the extravasated citostatic agents. Hyaluronidase might be effi cacious in preventing skin necrosis by extravasation due to vinca alkaloids. The treatment of unresolved tissue necrosis or pain lasting more than 10 days is surgical debridement. Because of the medical and juristic importance of the extravasation event, it is necessary to establish uniform guidelines for treatment of extravasation, in all Hungarian Oncological Centers.]

Clinical Neuroscience

A case with reversible neurotoxicity induced by metronidazole

EREN Fulya, ALDAN Ali Mehmet, DOGAN Burcu Vasfiye, GUL Gunay, SELCUK Hatem Hakan, SOYSAL Aysun

Background - Metronidazole is a synthetic antibiotic, which has been commonly used for protozoal and anaerobic infections. It rarely causes dose - and duration - unrelated reversible neurotoxicity. It can induce hyperintense T2/FLAIR MRI lesions in several areas of the brain. Although the clinical status is catastrophic, it is completely reversible after discontinuation of the medicine. Case report - 36-year-old female patient who had recent brain abscess history was under treatment of metronidazole for 40 days. She admitted to Emergency Department with newly onset myalgia, nausea, vomiting, blurred vision and cerebellar signs. She had nystagmus in all directions of gaze, ataxia and incompetence in tandem walk. Bilateral hyperintense lesions in splenium of corpus callosum, mesencephalon and dentate nuclei were detected in T2/FLAIR MRI. Although lumbar puncture analysis was normal, her lesions were thought to be related to activation of the brain abscess and metronidazole was started to be given by intravenous way instead of oral. As lesions got bigger and clinical status got worse, metronidazole was stopped. After discontinuation of metronidazole, we detected a dramatic improvement in patient’s clinical status and MRI lesions reduced. Conclusion - Although metronidazole induced neurotoxicity is a very rare complication of the treatment, clinicians should be aware of this entity because its adverse effects are completely reversible after discontinuation of the treatment.

Hypertension and nephrology

[Report on the 5th Szeged Hypertension Days]

Lege Artis Medicinae

[CHRONIC LYMPHOEDEMA - PREVENTION AND TREATMENT]

STIRCZER Gabriella

[The congenital or acquired damage of the lymphatic system can lead to the increase of the interstitial fluid in the affected extremity which can lead to chronic lymphoedema. Congenital lymphoedema is relatively rare. The interest in chronic lymphoedema is relatively high as the frequency of tumours is increasing (with surgical and irradiation therapy in the background) and of the growing numbers of the secondary lymphoedema cases due to chronic venous insufficiency in the extremities. The diagnosis and early treatment of the disease is important because the illness without therapy can be progressive and lead in severe complications, such as permanent disability of the patient. In the last 10-15 years the conservative therapy protocol of chronic lymphoedema has been introduced in Hungary and the necessary appliances are financed by the National Health Service (OEP). However, it is unfortunate that there are not enough lymphoedemic centres and patients often visit the outpatient departments only after the advice of a fellow-patient. These days, a great proportion of the patients are without treatment and in many cases the therapy can only concentrate for the prevention of the complications.]