Lege Artis Medicinae

[Hereditary angioneurotic oedema]

FARKAS Henriette

APRIL 22, 2008

Lege Artis Medicinae - 2008;18(04)

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FRENKL Róbert

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[Praeoperative management of patients with increased cardiovascular risk before major vessels’ surgery]

MERKELY Béla, JAMBRIK Zoltán

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[Polydactylic Human Figures on North American Stone Paintings]

NAGY Gyula

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[Homosexuality from a Medical Perspective]

KÓRÁSZ Krisztián, KORAS Réka, SIMON Lajos

Lege Artis Medicinae

[STEM CELL THERAPY AFTER ACUTE MYOCARDIAL INFARCTION]

NYOLCZAS Noémi, GYÖNGYÖSI Mariann

[Left ventricular remodelling and chronic heart failure as a consequence of myocardial infarction is a major problem despite of the everimproving therapeutic options. The available treatment methods have fairly limited success in preventing the development of these changes. Myocardial regeneration with stem cell treatment is a promising therapeutic alternative. Although the results should still be confirmed in large, randomised, multicentric controlled trials, data from animal studies and small clinical trials suggest that therapy with stem cells after acute myocardial infarction is safe and feasible, is able to reduce the extent of necrosis, and may improve myocardial perfusion and left ventricular function. This review presents the types of cells that can be used, the ways of application, and the available results of clinical trials of stem cell therapy after acute myocardial infarction.]

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Clinical Neuroscience

Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.

Clinical Neuroscience

[Recent changes in the paradigm of limbic encephalitis]

ILLÉS Zsolt

[In the recent years, novel antibodies associated with limbic encephalitis have been described, which target such extracellular receptors or proteins that have been already indicated in the pathogenesis of hereditary or degenerative diseases. In a number of cases, where pathogenic role of antibodies generated against the voltage-gated potassium channel (VGKC) had been presumed, antibodies against a trans-synaptic scaffolding protein, LGI1 were indicated. Antibody response against NMDA-receptors has been suggested as a major cause of limbic encephalitis especially in young females, resulting in a typical clinical syndrome sometimes triggered by an ovarian teratoma. Antibodies against other receptors essential in synaptic transmission and plasticity (AMPA and GABAB receptors) have been also indicated, partially elicited by paraneoplastic processes. Such antibodies against surface proteins result in severe but potentially treatable diseases due to reversible internalization of the antigens crosslinked by the bivalent antibodies. In contrast, the rare classical onconeural antibodies reacting with intracellular targets (anti-Hu, anti-Ta/Ma2, anti- CV2/CRMP5) may elicit additional symptoms beside limbic encephalitis and the prognosis of such syndromes is poor.]

Hypertension and nephrology

[The history of diuretic treatment in Hungary. Part I. Imre Fodor]

RADÓ János

[The diuretic effect of mercurial compounds was discovered in 1920. However, the term of “mercurial diuresis” was created 36 years earlier by Ernő Jendrassik. Imre Fodor published his experiences with the mercurial diuretic, which has been cited by several authors worldwide. The Hungarian pharmaceutical industry also took its part from the production of the mercurial diuretic with Novurit that proved to be an excellent and worldwide well known preparation in the next 40 years. Even Imre Fodor required the repeated administration of mercurial diuresis because of his severe cardiac oedema in the last period of his life. When the drug became ineffective, i.e. developed refractory oedema, he made a “self-experiment” with the administration of ACTH to restore the sensitiveness to the mercurial diuretic on the basis of most recent American literature at that time. His experience has been published by his colleagues just before his death. Imre Fodor was an eminent clinician, a school creating internist who entered his name into the science dealing with the use of diuretics.]

Clinical Neuroscience

[Screening of hereditary neuromuscular disorders in the roma population living in Hungary]

HERCZEGFALVI Ágnes, PIKÓ Henriett, KARCAGI Veronika

[Recent medical genetic research has identified a number of novel, or previously known, but rare conditions, caused by private founder mutations. The Finnish and Ashkenazi Jew populations provide the best examples for identifying genes in unique genetic disorders. In these populations, research efforts and high-level medical services resulted in intense improvements of medical care and in organization of population- based screening programs. Hereditary disorders of the Roma populations are known for a long time. The genetic background of these diseases has been established by extensive molecular genetic studies. The Romas represent 6% of the Hungarian population and live under extremely bad health conditions. Therefore, our aim was to map the incidence of the hereditary neuromuscular disorders among the Hungarian Roma population. Moreover, we intended to provide proper information, genetic counseling and possible prevention strategies for the families at risk, which should represent a primer task in public health. Because of our experience in neuromuscular disorders, we choose six, frequent, autosomal recessive disorders for these clinical and genetic studies: hereditary motor and sensory neuropathy type Lom (HMSNL), hereditary motor and sensory neuropathy type Russe (HMSNR), congenital cataracts facial dysmorphism syndrome (CCFDN), Limb- Girdle muscular dystrophy 2C (LGMD2C), congenital myasthenic syndrome (CMS) and spinal muscular atrophy (SMA). Following identification of the founder mutations, the possibility of prenatal diagnosis and carrier screening for family members will contribute to the decrease of the recurrence risk for these severe, mostly untreatable disorders.]

LAM KID

[Infective sacroiliitis]

BARTHA Attila

[INTRODUCTION - Pyogen infection of the sacroiliac joint occurs rarely in rheumatological practice. Its clinical symptoms are diverse, so the diagnosis is often made late. CASE REPORT - The author presents a case of a 67-year-old woman. The patient did not have any major diseases nor any predisposing factors for infection. Five days after doing hard physical work she felt strong pain irradiating from her lower back to the right lower limb. She was referred to the Department of Neurology with the diagnosis of right lumbar radiculopathy. She was primarily examined for tumours because of her high red blood cell sedimentation rate and CRP level and her inability to walk. The correct diagnosis was set up on the basis of MRI examination: infective sacroiliitis on the right side, which has spreaded to the adjacent tissues. USguided biopsy was unsuccesful, so empiric antibioitic treatment was started. The patient was discharged from hopsital after 35 days and continued clindamycin therapy at home. At control examination 6 month later she did not have any symptoms or complaints and laboratory examinations did not indicate inflammatory activity. MRI examination still showed an extensive oedema. CONCLUSION - Pyogen arthritis should be considered even in the absence of fever, leukocytosis and predisposing factors. By making the correct diagnosis and starting long-term antibiotic therapy in time, joint destruction is preventable and the patient is curable.]