Lege Artis Medicinae

[Eurpean Concerted Action on Thrombosis and Disabilities Angioma Pectoris Study]

MATOS Lajos1

OCTOBER 27, 1993

Lege Artis Medicinae - 1993;3(10)

[Patients with more than 50% stenosis in one or more coronary arteries had significantly higher fibrinogen levels (p<0.0001). Reduced fibrinolytic activity was also observed in patients with coronary artery stenosis, mainly due to higher levels of plasminogen activator inhibitor-1 (PAI). Decreased fibrinolytic activity was strongly associated with diabetes, elevated triglyceride levels, smoking and impaired left ventricular systolic pump function. Cholesterol levels correlated mainly with protein C and plasminogen levels.]

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Further articles in this publication

Lege Artis Medicinae

[The surgical treatment of shoulder instability]

BÁLVÁNYOSSY Péter

[The author briefly reviews the static and dynamic stabilizing system and the biomechanics of the shoulder and describes his principles and techniques of the surgical treatment of instability. A modified Bankart procedure is used for recurrent anterior dislocation. Bone blocks are implanted in cases of locked posterior dislocation. Different forms of cranial instability are described as well as partial and total superior glenoidal lesions. The author discusses surgical procedures used in the treatment of these instabilities. Cranial instability leads to impingement syndrome, which results in rotator cuff lesions. These lesions increase instability and the increased impingement leads to further rotator cuff damage. This vicious cycle can be interrupted by surgical intervention.]

Lege Artis Medicinae

[Clinical application of specific antibodies in immunotherapy of transplantation]

PETRÁNYI Győző, PÁLÓCZI Katalin

[In organ and tissue transplantation practice as well as in the therapy of autoimmune, haematological, immunological and oncological diseases, the possibility for applying immunotherapy is occuring more frequently. The paper deals with all those reagents which are primarily of polyclonal or monoclonal immunglobuline origin and play a significant role in the various cell-bound immune reactions on the surface of lymphocytes. In addition to the anti-lymphocyte or/rather anti-thymocyte globuline as well as the Orthoclone (anti-CD3 monoclonal antibody) reagents well known in clinical practice, it also refers to other lymphocyte surface anti-marker monoclonal anti-bodies (anti CD4, -CD8; anti TCR, anti-LFA reagents) under clinical trial. The article reviews the possible uses of the group of immunotherapeutical reagents in the clinical practice of Kidney and bone marrow transplantation. The pharmacological mechanism, side effects, and prospects for a wider use of these reagents in the future are discussed.]

Lege Artis Medicinae

[The origin of serum catalase in healthy subjects and in some diseases]

GÓTH László

[The activity of serum catalase is highly increased in acute pancreatitis, hemolytic disorders and in some liver diseases, but there is no data on its tissue origin. The serum catalase activity was determined by a spectrophotometric assay in healthy subjects (n = 4275) as well as in increased erythropoesis (n = 424), in hemolytic diseases (hemolytic anemia = 12, megaloblastic anemia = 28, Zieve syndrome = 8, hemorrhage = 38), in acute pancreatitis, (n = 111), in liver diseases (fatty liver = 21, alcoholic hepatitis = 42, acute yellow atrophy = 18, toxic hepatitis = 15), and in liver congestion due to cardiac circulatory failure (n = 28). These diseases yielded increased serum catalase activity. This enzyme has no tissue specific isoenzymes, therefore mathematical and statistical approaches were used. The correlation between serum hemoglobin and serum catalase was analysed. The catalase release was estimated from the time activity curves of serum catalase and compared to its tissue equivalent. In healthy subjects about 60 percent of serum catalase derived from the erythrocytes and the rest from other tissues. During enhanced erythropoesis and in hemolytic diseases, similarly to hemoglobin, its source was the erythrocyte pool. In acute pancreatitis also the erythrocytes might be responsible for the increased serum catalase level. in some liver diseases as well as in liver congestion due to cardiac circulatory failure the increase of serum catalase derived from the liver cells. The diagnostic analysis of serum catalase requires the consideration of its increase as well as its origin. ]

Lege Artis Medicinae

[Prenatal follow up of a complex cardiac malformation complicated with complete AV block]

SZABÓ István, CSABAY László, NÉMET János, HAJDÚ Júlia, PAPP Zoltán

[In a congenital disorder of heart development where the complex cardiac malformation is pared with complete atrioventricular block heart rate is stabile between 50–60 beats/min. Transfer of atrial impulses through the AV node is fully blocked and the slow rhythmic heart beat is maintained by a ventricular pacemaker. In a case of such a complete cardiac malformation recognized in week 32 of gestation and the AV block complication caused stabile 57–58 beat/min bradycardia. 2-di mensional, pulsed and color Doppler ultrasonography was used to identify the disorder and to follow up the intrauterine condition of the fetus. Cardiotocography (CTG) could not generate appreciable results at such a low heart rate. During observation no centralization of fetal circulation causing intrauterine hypoxia was recorded. Updated knowledge on the pathogenesis and obs tetrical management of the fetal third degree AV block is also presented. In this case ultrasonography allowed clear-cut identification of the disorder and also ensured correct evaluation of the intrauterine status of the fetus when other diagnostic methods for evaluation were not applicable. ]

Lege Artis Medicinae

[Ticlopidine Aspirin Stroke Study]

MATOS Lajos

[The 3-year incidence rate of all-cause mortality and non-fatal stroke was 17% in the ticlopidine group and 19% in the aspirin group. This means that compared with aspirin, ticlopidine reduced the risk of the events studied by 12% (p = 0.048). The incidence of fatal and non-fatal stroke was 10% with ticlopidine and 13% with aspirin, a 21% reduction in risk in favour of ticlopidine (p = 0.024). As side effects, ticlopidine caused diarrhoea (20%), skin rash (14%) and reversible neutropenia (1%), whereas aspirin caused diarrhoea (10%), skin rash (5.5%), gastritis (2%), gastrointestinal ulcer (3%) and haemorrhage (1%). Total cholesterol levels increased by 9% in the ticlopidine group and 2% in the aspirin group (p < 0.01).]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

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Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

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[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]