Lege Artis Medicinae

[In the focus: cardiology]

PRÉDA István

SEPTEMBER 20, 2005

Lege Artis Medicinae - 2005;15(08-09)

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Lege Artis Medicinae

[RARE CAUSES OF GASTROINTESTINAL BLEEDING]

TAHIN Balázs, TÓTH Csaba, KOVÁCS Attila, DOBOS András, DÖBRÖNTE Zoltán, NAGY Lajos, TARABÓ Zoltán, MÁRKUS Béla, GARZULY Ferenc

[INTRODUCTION - The efforts to eliminate the source of gastrointestinal bleeding are not always successful, especially in rare diseases. CASE REPORT - In three patients causes and sites of haemorrhages were detected only at autopsy. The first patient underwent upper gastrointestinal endoscopy as well as surgical exploration. The post-mortem examination showed multiple gastric Dieulafoy’s vascular lesion. The second patient was examined by repeated upper gastrointestinal panendoscopy, but the site of haemorrhage remained unknown. Two polyps were removed during colonoscopy. Unexpected haemorrhage caused sudden death. The aortobifemoral graft, which had been implanted two years earlier had destroyed the duodenal wall, a fistula developed and caused haemorrhage. The third patient had had a right hemicolectomy abroad because of angiodysplasia, but the bleeding episodes repeated. The cause was revealed at autopsy as angiodysplasia of the small bowel. CONCLUSION - Dieulafoy’s disease can sometimes be discovered only by repeated endoscopy but sudden death may precede diagnosis. In the presence of an aortic graft we have to keep in mind that this could be the cause of catastrophic bleeding. Therefore, the examinations should be performed immediately - endoscopy has to involve the distal part of the duodenum - and operation is urgent. Angiodysplasia of the small bowel is a rare site of angiodysplasia which requires special diagnostic procedures like capsule endoscopy. The multiplicity of the disease and the age of the patients made the diagnostic difficult.]

Lege Artis Medicinae

[TRAVEL MEDICINE IN GP PRACTICE]

FELKAI Péter, KOVÁCS Erzsébet

[The authors describe the basic ideas of travel medicine, as a newly introduced interdiscipline of the medical science in Hungary. Recently, this segment is considered to be the part of Insurance Medicine, on the other hand the methods and the practice of the travel medicine is based on the other medical specialities’ knowledge. Due to the growing number of travellers in our country as well as the consequences of the joining Hungary to EU, travel medicine could play an important role in the improvement of the Hungarian travellers’ attitude to their health care status, the prevention against the emerged infectious diseases, and in the medical assistance for the international tourism. Travel medicine also a good guideline for the fit-for-travel considerations, made by the GPs. Hungary with its advantageous geographical position appears to be an excellent stopover for any medical evacuation from East European or other surrounding countries. That is why we would like to establish a first travel medicine facility in central Europe. It is expectable that the Hungarian travellers require more and more information regarding to their health care possibilities and prevention during their trip. The first authentic person is being asked by the patients’ are GPs. The GP’s tasks are: diagnosis and the treatment of travel related diseases, the pre-travel advices. All the mentioned factors are a new challenge for the GPs in Hungary.]

Lege Artis Medicinae

[Prostaglandin E1 treatment in patent ductus arteriosus dependent congenital heart defects]

TÁLOSI Gyula, KATONA Márta, RÁCZ Katalin, KERTÉSZ Erzsébet, ONOZÓ Beáta, TÚRI Sándor

Lege Artis Medicinae

[MAGNETIC RESONANCE IMAGING IN ABDOMINAL DIAGNOSTICS]

PALKÓ András

[Magnetic resonance imaging (MRI) plays more and more important role in the abdominal imaging diagnostics since fast measurement sequences have become available making it possible to avoid movement artifacts and resulting in better quality and more informative images of the abdominal parenchymal organs and most segments of the gastrointestinal tract. The greatest advantage of MRI is that it is able to create images of adequate geometric resolution and excellent tissue characterization capacity without the use of ionizing radiation and iodinated contrast media. Today MRI is applied mostly in those cases when previous data suggest that computed tomography will not be informative or the results of recent imaging examinations (x-ray, ultrasound, computed tomography) do not provide sufficient diagnosis. Presumably MRI will be used with increasing frequency as the first or single best method of choice in the near future. Beased on these facts in abdominal diagnostics, MRI may be considered as a problem-solving modality which plays an outstanding role in the detection, differential diagnosis, staging and follow-up of many neoplastic and inflammatory lesions.]

Lege Artis Medicinae

[Research as “Flow” – a Discussion with Péter Csermely]

GYIMESI Andrea

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Lege Artis Medicinae

[COVID-19-cardiology at spring, 2020]

VÁLYI Péter

Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Clinical Neuroscience

The methylation status of NKCC1 and KCC2 in the patients with refractory temporal lobe epilepsy

UNAL Yasemin, KARA Murat, GENC Fatma, OZTURK Aslan Dilek, GÖMCELI Bicer Yasemin, KAYNAR Taner, TOSUN Kursad, KUTLU Gülnihal

Purpose - Methylation is a key epigenetic modification of DNA and regarding its impact on epilepsy, it is argued that “DNA methylation may play an important role in seizure susceptibility and maintenance of the disorder”. DNA methylation status of KCC2 (SCL12A5) and NKCC1 (SCL12A2) associated with refractory temporal lobe epilepsy was investigated in our study. Materials and methods - Thirty-eight patients with temporal lobe epilepsy (TLE) who were diagnosed by video EEG monitoring and 32 healthy control subjects were included in the study. Twenty-three patients in TLE group were men and the remaining 15 were women. Among them, 27 had unilateral temporal focus (9 with right; 18 with left) and 11 patients had bilateral TLE. We analyzed promoter region methylation status of the KCC2 (SCL12A5) and NKCC1 (SCL12A2) genes in the case and control groups. Gene regions of interest were amplified through PCR and sequencing was accomplished with pyro-sequencing. Results - We found a significant relationship between TLE and methylation on the NKCC1. However, there was no association between TLE and methylation on the KCC2 gene. Also, we found no association between right or left and unilateral or bilateral foci of TLE. There was no relationship between TLE and methylation on the NKCC1and KCC2 genes in terms of mesial temporal sclerosis in cranial MRI, head trauma or febrile convulsions. Conclusion - The methylation of NKCC1 can be a mecha­nism of refractory temporal lobe epilepsy. There are limited findings about DNA methylation in TLE. Therefore, further studies with large sample sizes are necessary.

Hypertension and nephrology

[Effects of peripheral resistance lowering and elevating beta-blockers on central blood pressure - nebivolol in focus]

BENCZÚR Béla

[Central blood pressure, that is, blood pressure (BP) in the ascending aorta, is considered an important physiologic parameter as it reflects the hemodynamic relationship between the heart and the aorta, both in systole and in diastole. In the systolic phase, central BP represents the pressure against which the left ventricle has to eject blood during systolic contraction. Thus, central arterial pressure reflects both left ventricular stroke volume and afterload, defines cardiac work, and contributes to the development of left ventricular hypertrophy in hypertensive individuals. In the diastolic phase, central BP is a key determinant of the blood flow delivery to the myocardium. Despite the increasing knowledge regarding the importance of central blood pressure and the availability of non-invasive measurement technics it couldn’t spread in everyday clinical practice and rarely or not mentioned in the therapeutic guidelines. The different antihypertensiv drugs significantly differs based on their effects on central blood pressure particularly β-blockers. The so-called ’classical’ β-blockers have un - favourable effect on central blood pressure due to increasing peripherial vascular resistance. In the opposit the vasodilating β-blockers including nebivolol markedly decrease central blood pressure which could explain their beneficial effects.]