Lege Artis Medicinae

[Hereditary angioneurotic oedema]

FARKAS Henriette

APRIL 22, 2008

Lege Artis Medicinae - 2008;18(04)

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[The features of the MEDAL Programme and critical evaluation of the results]

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[Pain and Pain Relief in Rheumatology]

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dr. BÁNFALVI Attila

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[RECENT ADVANCEMENTS IN THE DIAGNOSIS AND TREATMENT OF AGE-RELATED MACULAR DEGENERATION]

SERES András István

[Age-related macular degeneration is the leading cause of blindness in developed countries. In the last few years, new therapeutic approaches such as photodynamic therapy and intravitreal injections of vascular endothelial growth factor antagonists were introduced that do not only prevent disease progression but also give the hope of vision improvement. Of the new diagnostic methods, the use of optical coherence tomography improves diagnosis and also permits the qualitative measurement of therapeutic effects. Given the current high price of the new drugs and the need for frequent re-treatments, a significant increase in the economic burden of the disease is foreseeable.]

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[Legal and Ethical Dilemmas in Stem Cell Research]

dr. ROJKOVICH Bernadette

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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.

Lege Artis Medicinae

[ANGIONEUROTIC EDEMA CAUSED BY ANGIOTENSIN-CONVERTING ENZYME INHIBITORS]

BAKOS Noémi, BENCZÚR Béla

[Angiotensin-converting enzyme inhibitors are used in broad spectrum of cardiovascular pharmacotherapy as evidence based drugs. Cough, which is the most typical adverse effect of ACEinhibitors occurs in relatively high proportion of patients (20-63%) during therapy. Angioedema is a less frequent and often underdiagnosed but potentially life-threatening adverse effect of ACEI-treatment occurring typically on the face and extremities or rarely in a visceral form. Authors review the pathomechanisms of angioedema and the therapeutic options.]

Clinical Neuroscience

[F-DOPA PET/MR based target definiton in the 3D based radiotherapy treatment of glioblastoma multiforme patients. First Hungarian experiences ]

SIPOS Dávid, TÓTH Zoltán, LUKÁCS Gábor, BAJZIK Gábor, HADJIEV Janaki, CSELIK Zsolt, REPA Imre, KOVÁCS Árpád

[Introduction - Radiotherapy plays important role in the complex oncological treatment of glioblastoma multiforme (GBM). The modern 3D radiotherapy treatments are based on cross-sectional CT and MR information, however more attention is being paid to functional hybrid imaging describing the biological and functional morphology of tumor lesions. 18F-DOPA is an amino acid tracer with high specificity and sensitivity, which may play an important role in the precise definition of target volume in the irradiation process of GBM patients. Our study presents the first experiences with 18F-DOPA based PET/CT/MR 3D irradiation planning process. Methods - In Hungary the 18F-DOPA radiotracer has been available for clinical use since September 2017. Between September 2017 and January 2018, at the Somogy County Kaposi Mór Teaching Hospital Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center 3 histologically verified glioblastoma multiforme patients received 18F-DOPA based 3D irradiation treatment. In the contouring process the native planning CT scanes were fused with the PET/MR series (T1 contrast enhanced, T2 and 18F-DOPA sequences). We defined 18F-DOPA uptake volume (BTV-F-DOPA), the T1 contrast enhanced MRI volume (GTV-T1CE), and the volume of the area covered by oedema on the T2 weighted MRI scan (CTV-oedema) in all patients. We also registered the BTV-F-DOPA volumes not covered by the conventional MR based target volumes. Results - Examining the 3 cases, the average volume of 18F-DOPA tumor was 22.7 cm3 (range 15.3-30.9; SD = 7.82). The average GTV T1 CE was found to be 8.7 cm3 (range 3.8-13.2; SD = 4.70). The mean CTV oedema volume was 40.3 cm3 (range 27.7-57.7; SD = 15.36). A non-overlapping target volume difference (BTV-F-DOPA not covered by CTV oedema area) was 4.5 cm3 (range 1-10.3; SD = 5.05) for PTV definition. Conclusion - Based on our results the tumor area defined by the amino acid tracer is not fully identical with the MRI defined T2 oedema CTV. 18F-DOPA defined BTV can modify the definiton of the PTV, and the radiotherapy treatment. ]

Lege Artis Medicinae

[THE EFFECT OF SEXUAL HORMON ALTERATIONS ON THE FREQUENCY OF OEDEMATOUS ATTACKS IN PATIENTS WITH HEREDITARY ANGIONEUROTIC EDEMA]

FELVINCI Réka, VISY Beáta, NÉMETH Éva, VARGA Lilian, JAKAB László, FARKAS Henriette

[INTRODUCTION - Changes in the body's hormonal equilibrium may alter the frequency of angioedema attacks in patients with hereditary angioneurotic edema. We assessed the relations between the angioedema attacks and puberty, menstruation, anticoncipient pill taking, pregnancy, delivery and menopausa. We also studied the possible impact of an embryo with hereditary angioneurotic edema on the frequency of attacks during pregnancy. PATIENTS, METHODS AND RESULTS - 53 female patients were included in the study. Data was surveyed by a questionnaire and detailed gynecological examination. We pointed out that the frequency of the attacks increased in 34% of the patients during puberty, in 58% of the patients at the time of menstruation and in 63% of the contraceptive pill users. In 36% of the women the frequency decreased in the postmenopausal state. In case the pregnancy affected the disease, the embryo with hereditary angioneurotic edema increased the number of attacks during pregnancy. CONCLUSION - Our analysis shows that conditions with sexual hormon alterations have an effect on the number of edematous attacks, therefore patients with hereditary angioneurotic edema need more attention both in nursing and therapy when they are in a life-period of hormonal change. Our results offer the oppurtunity of a better prediction of edematous attacks thus the oppurtunity of better therapy and better quality of life.]

Hypertension and nephrology

[Lercanidipine in hypertension]

HERCZEG Béla

[Lercanidipine is a third generation DHP type calcium antagonist. It’s antihypertensive efficacy is proven using in monotherapy or combined treatment as well. The main advantage compared with the first and second generation DHP calcium antagonists is that fewer side effects, especially the much less common ankle oedema. Renal protective effect has proven by experimental and clinical studies, but in the future more prospective randomized studies should be supported this benefit. The drug is very useful for diabetes, obesity associated with hypertension due to the metabolic „neutrality”. The key of successful antihypertensive is the high level persistence. From this point of view the lercanidipine is a very useful factor during the treatment.]