Lege Artis Medicinae

[How to treat thrombophilia in pregnancy?]

PAJOR Attila

MAY 26, 2008

Lege Artis Medicinae - 2008;18(05)



Related contents

Lege Artis Medicinae


FÜLÖP Vilmos

[Recurrent miscarriage and failure of in vitro fertilization and embryo transfer affect millions of women annually. It is one of the great problems of the medical community that in as many as 75% of these failures their cause is never established. Considering that recurrent abortions may have several causes including anatomical, morphological, genetic, medical, bacteriological as well as immunological abnormalities it is inevitable to pursue these kinds of examinations and tests. One part of the immunological background can be explained by autoimmune diseases while the other part of it is associated with immunopathological factors. Currently available practical testing batteries that can directly assess immunological background, as well as their importance are covered. Recently developed and mainly immunology based treatments are also described. The results generally show that immunoglobulin products can be used safely in pregnancy. In the author's institute the efficacy of this therapy has been 93.5% in cases of immune-mediated abortion. As an alternative to intravenous immunoglobulin (IVIG) therapies, partner specific platelet suspension can be used only in selected cases with proven immunological background. Therapy monitoring, that is, assessment of the functional efficacy of IVIG is possible by determining FcR blocking antibodies in the maternal serum. Based upon the functional percentage of serum blocking activity the dosage and number of treatments can be changed.]

Hypertension and nephrology

[Role of IL-10 family of cytokines in kidney fibrosis]

PAP Domonkos, VERES-SZÉKELY Apor, SZEBENI Beáta, SZIKSZ Erna, KISS József Zoltán, TAKÁCS István Márton, REUSZ György, SZABÓ J. Attila, VANNAY Ádám

[Chronic renal failure is a major health problem, affecting 8 to 16% of the population. Regardless of the etiology the common hallmark of chronic renal failure is inflammation, leading to the activation of renal myofibroblasts. Chronic activation of myofibroblasts lead to abnormal accumulation of extracellular matrix, disruption of the architecture of the kidney and finally to reduced renal function. Although our knowledge is rapidly expanding about the pathomechanism of chronic renal failure, we still have no drug to treat or hinder the progression of the disease. In our present review article, we summarize the role of the cytokines of the IL-10 family in renal scarring.]

Clinical Neuroscience

[Strategies of using the new antiepileptic drugs for epilepsy in adults]

NIKL János

[The new antiepileptic drugs have not changed the basic pharmacological treatment principles of epilepsy, but they have given greater choice in focal and in generalized epilepsies as well. The new drugs are not necessarily more effective than traditional drugs, but they have favourable pharmacokinetic characteristics, fewer interactions and better adverse effect profile in the acute and chronic phase of the treatment. They generally show a lower teratogenicity risk than the standard antiepileptics, although carbamazepine, one of the standard drugs can be used and zonisamide, a new one must be avoid in pregnancy. Due to characteristics mentioned above they are not only effective as add-on therapy, but in monotherapy as well. On the basis of the international and national recommendation lamotrigine and levetiracetam belong to the first line antiepileptics. The favourable tolerability of the new antiepileptics may improve the patient’s compliance and adherence to the given treatment. The low teratogenicity makes them especially suitable for the treatment of women of childbearing age. The new antiepileptic drugs can succesfully used for the treatment of special patients’ groups as for the post stroke, poszttraumatic epilepsies, for the epilepsies accompanied with brain tumours as well as for epilepsies in the elderly. The new drugs are advantageous for the treatment of such patients who have psychiatric symptoms or signs of cognitive decline and high risk of these symptoms respectively.]

Hypertension and nephrology

[Antihypertensive therapy in patients with COPD - the significance of nebivolol]


[The occurrence of hypertension associated with chronic obstructive pulmonary disease (COPD) is increasing. Recognising COPD is important in order to choose the appropriate antihypertensive drugs. Anti-hypertensive drugs that can be used to treat patients with hypertension and COPD include diuretics, ACE-inhibitors, angioten-sine receptor blockers (AT1 receptor antagonists) and calcium antagonists, as well as cardioselective beta blockers, as these drugs decrease total and cardiovascular mortality. Of these agents, the importance of the most cardioselective one, nebivolol should be stressed, as this drug has no clinically significant effect on parameters of respiratory function, and, through its additional effects (namely by increasing the synthesis of NO), it has a beneficial effect on COPD-related deterioration of respiratory functions, haemodynamic alterations (cor pulmonale) and local factors that participate in the respiratory inflammation and endothelial dysfunction.]

Lege Artis Medicinae

[County level mortality data of urogenital system in Hungary between 2010-2014]

KISS István, PAKSY András

[According to The International Statistical Classification of Diseases and Related Health Problems (10th Revision, ICD 10; XIV), urogenital diseases resulted in an average 910 yearly deaths in Hungary from 2010 through 2014, less than 1% of the cumulative mortality rate. Out of all urogenital conditions, kidney and bladder diseases were the leading cause of death, accounting for nearly 85 percent of all deaths in the examined period. It should be noted that mortality due to urogenital cancers, renovascular hypertonia, diabetic nephropathy, congenital malformations and pathologies related to childbirth and pregnancy are excluded from consideration in the present review. As the Hungarian Central Statistical Office does not disclose the causes of death by age and gender at its county-level data, this paper reports gender-specific mortality rates. Due to the fact that the county-level mortality rate of urogenital diseases is low and the yearly standard deviation is high, the five-year overall mortality rate of 2010-2014 is presented. Hungarian counties differ greatly in terms of mortality from urogenital diseases. The number of deaths per 100 000 population ranges between 6.74 in Békés county and 16.38 in Fejér county. Counties within the same region may exhibit substantially different mortality rates. An overall 7.01 deaths per 100 000 population was reported in Győr-Moson-Sopron county, whereas among residents of the neighbouring Vas county the rate was reported as 14.73 per 100 000 population. The observed variations prevail even when standardised mortality rates are compared and thus the differences in the counties’ age distributions are accounted for. Regional differences become more apparent when only the deaths caused by kidney diseases are analysed out of all urogenital pathologies. In this case, two- or threefold differences are observed between the respective Hungarian counties. Major disparities are still present between counties within the same region. For example, the number of deaths per 100.000 population is 3.74 in Hajdú-Bihar county, and 8.04 in Jász-Nagykun-Szolnok county, respectively. The diagnosis frequency of kidney diseases has a strong positive correlation with case fatality, but it may not fully account for all regional variations in mortality rates. Regional characteristics of dialytic care and the accessibility of dialytic facilities is not related to patient mortality. ]