Lege Artis Medicinae

[Current diagnostics and treatment of adolescent hypertension]

PÁLL Dénes, KATONA Éva, FÜLESDI Béla, JENEI Zoltán, POLGÁR Péter, PARAGH György, KAKUK György

JULY 10, 2001

Lege Artis Medicinae - 2001;11(06-07)

[As the prevalence of hypertension in young people aged 14-18 is reported to be 1-1.5%, regular blood pressure measurement is proposed by the international committees in the adolescence, at least once a year. To establish the diagnosis of hypertension, repeated blood pressure measurements and sex-, age-, heightand weigt-based nomograms are needed. If casual blood pressures are consequently elevated, an ABPM measurement may provide additional informations, e.g. about white coat hypertension, daytime and nighttime blood pressure patterns and target organ damage. Thus, in such cases ABPM measurement is proposed to become the part of the routine examination. Following the diagnosis of hypertension in the adolescent, a further important step is to clarify the causes of the disease. In the majority of adolescent cases, essential hypertension is the diagnosis, but secondary (especially renal causes) are more frequent than in adulthood. First line treatment of adolescent hypertension is definitely non-pharmacologic. Pharmacologic treatment may be indicated if blood pressure is significantly increased (diastolic blood pressure, especially), if secondary hypertension is diagnosed or target-organ damage is present, or there are consistent complains related to the increased blood pressure. Treatment can be initiated with any of the antihypertensive drugs used in adults, but most frequently the use of beta-blockers and ACEinhibitors is recommended.]

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[Current therapy of Hodgkin’s disease]

ROSTA András, MOLNÁR Zsuzsanna, SCHNEIDER Tamás, VÁRADY Erika, DEÁK Beáta, ÉSIK Olga

[Hodgkin’s disease is a clonal B-cell disease. The exact etiology of the disease has not yet been identified, research data showing the crucial role of the Epstein-Barr virus. The Hodgkin’s disease is curable in 70-80 % of the cases. In the early stage of the disease, the treatment of choice should be the combined modality therapy. The required number of cycles of combined chemotherapy, the dose and the field extension of radiotherapy are all subjects of recent clinical trials. In the advanced stage of Hodgkin’s disease more (6- 8) cycles of combined chemotherapy and, if necessary, radiotherapy of the affected field is the treatment of choice. In advanced Hodgkin’s disease with unfavourable prognosis, the role of higher dose-intensity and the combination of more potent chemotherapeutic agents are evaluated in clinical trials, with special consideration to the danger of late toxicity (BEACOPP, Stanford V protocol). In the treatment of early (within 1 year) chemosensitive relapses of Hodgkin’s disease, high-dose chemotherapy with autologous peripheral stem cell transplantation has improved therapeutic results. Current results of advanced cases with unfavourable prognosis, of primary progressive and resistant disease, relapsing Hodgkin’s disease and the treatment of elderly patients are yet unsatisfactory. The main trends of recent research are: development of new potent chemotherapeutic agents, application of allogeneous "mini" transplantation (graft versus Hodgkin’s disease effect) and the therapeutic use of mono or bispecific monoclonal antibodies. It is desirable, that primary, secondary and further treatments of Hodgkin’s disease are performed in specific hematological or oncological centers where necessary experience of complex treatment is available, as well as the application of aggressive treatment methods, modern radiotherapy and also the facilities for handling unwanted complications.]

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[Simple statistic methods II.]

HAJTMAN Béla

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SORONCZ-SZABÓ Tamás

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