BÉLY Miklós, KRUTSAY Miklós
JUNE 20, 2013
Lege Artis Medicinae - 2013;23(05-06)
[In our previous study we refuted the thesis that sodium urate crystals are not, or only rarely detectable in formalin-fixed histological samples because they dissolve in the aqueous formalin solution. Our observations indicate that dissolution of urate crystals is primarily caused by haematoxylineosin staining. Undeniably, however, urate crystals are partially dissolved in the aqueous solution of formaldehyde, and thus a small amount of urate deposits may totally dissolve from tissue samples. The aim of the present study was to identify those steps of the staining procedure that are responsible for the dissolution of urate crystals. We found that the dissolution of urate crystals during the course of staining was caused by the combined effects of haematoxylin staining, treatment with 1% aqueous lithium carbonate solution and dehydration with acetone. As the simplest histological method for the detection of urate crystals, we recommend examining unstained sections (mounted with Canada balsam) of formalin-fixed, paraffin-embedded tissue samples in polarised light. According to our previous study, about two thirds of urate crystals remain detectable on unstaied sections, whereas haematoxylin-eosin stained sections of the same tissue samples (derived from patients with gout) did not contain urate crystals. In the samples where urate crystals could be detected in haematoxylin- eosin stained sections using polarised light, the unstained sections contained much more crystals, which shows that dissolution is greatly decreased on unstained sections.]
Lege Artis Medicinae
Lege Artis Medicinae
[The outcome of chronic hepatitis C (CHC) therapy has been improved significantly. If sustained virologic response (SVR) is achieved, then it may prevent the occurrence of liver failure and hepatocellular carcinoma. With the currently used double combination therapy (peginterferon and ribavirin) SVR can be achieved in 40-50% of patients with genotype 1. In treatment naive patients, triple combination with protease inhibitors can result in 70-75% SVR. In treatment experienced patients, however, the result of the previous therapy, which mostly depends on the reaction to interferon (IFN), has a significant influence on the outcome of triple combination. INF sensitivity is the highest in relapsers, triple combination can achieve about 85% SVR, while in null responders this is only 30%. Viral resistance is a new phenomenon during triple combination therapy of CHC. In poorly IFN responsive patients the virus is effectively exposed to protease inhibitor functional monotherapy, leading to the rapid emergence of resistant virus. IFN sensitivity is well represented by the on-treatment viral response, therefore the knowledge of the previous viral response, relapse, a partial response or a null response is absolutely important. Optimization of triple therapy is crucial, since for a lot of patients with advanced liver disease it might be the last chance to achieve an SVR. The selection of the patients seems very important. Relapsers are the best candidates, there is no doubt with the indication. However, there are many debates for cirrhotic nullresponders, since the most virological failures are expected in this group. Prevention of viral resistance is crucial. PegIFN and ribavirin suppress both wild-type and resistant virus. PegIFN α-2a based treatment proved to be the most effective backbone for triple combination. This combination should be preferred especially for treatment experienced patients. Adherence to therapy is also critically important to prevent resistance. If resistant mutants appear, treatment should be stopped promptly.]
Lege Artis Medicinae
[Alzheimer’s disease is a new endemic of the 21st century, which is going to become the biggest health and social problem of the ageing societies in the next few decades. Significant discoveries have been made by structural and functional imaging and biochemical (especially CSF) and genetic tests regarding the diagnosis of Alzheimer’s disease. The modern diagnostic results were recently incorporated into the diagnostic criteria. This review summarises these diagnostic results.]
Hypertension and nephrology
[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.]
LAM KID
[In medical practice there are a number of “truths etched in stone” that are passed on from textbook to textbook and learned by generations before they become obsolete. This short study aims to eliminate a misbelief from the diagnosis of gout that is related to the histological detectability of urate deposits. According to the generally accepted thesis, urate crystals obtained from patients with gout are dissolved in formalin solution, therefore, tissue samples should be fixated in alcohol. The authors have found that urate crystals can be detected on conventionally mounted, native (unstained) sections, despite formalin fixation, whereas the great majority of urate crystals are dissolved during haematoxylin-eosin staining. Therefore, for the detection of urate crystals the tissue samples should be examined on native, unstained sections.]
Hypertension and nephrology
[The prevalence of hyperuricemia is is increasing as it is related by several different mechanisms to obesity and metabolic syndrome spreading epidemically worldwide. Several beneficial cardiovascular and renorotective effects of the xanthin-oxydase inhibitor allopurinol, administered in the treatment of hyperuricemia and gout, have been found out recently. The newest European EULAR guidelines for the treatment of gout recommended the treat-to target principle. A target value of ≤360 umol/l in patients with mild-to moderate gout and ≤300 umol/l in more serious cases has been suggested. The guidelines took an unequivocal commitment, that allopurinol is the first-line treatment. The hypouricemic therapy should be started as soon as possible after the diagnosis and should be continued lifelong in patients with gout.]
Hypertension and nephrology
Lege Artis Medicinae
[In medical practice there are a number of “truths etched in stone” that are passed on from textbook to textbook and learned by generations before they become obsolete. This short study aims to eliminate a misbelief from the diagnosis of gout that is related to the histological detectability of urate deposits. According to the generally accepted thesis, urate crystals obtained from patients with gout are dissolved in formalin solution, therefore, tissue samples should be fixated in alcohol. The authors have found that urate crystals can be detected on conventionally mounted, native (unstained) sections, despite formalin fixation, whereas the great majority of urate crystals are dissolved during haematoxylin-eosin staining. Therefore, for the detection of urate crystals the tissue samples should be examined on native, unstained sections.]
1.
Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease2.
3.
4.
5.
1.
2.
3.
Hypertension and nephrology
[Treatment and care of hypertensive patients during and after the Covid-19 pandemic. Possibilities and effectiveness of telemedicine]4.
Hypertension and nephrology
[Post-career development of cardiometabolic changes and hypertension in competitive athletes]5.
COMMENTS
0 comments