Lege Artis Medicinae

[In vivo confocal corneal microscopy for keratoplasty]

IMRE László, RESCH Miklós, NAGYMIHÁLY Attila

FEBRUARY 21, 2006

Lege Artis Medicinae - 2006;16(02)

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Lege Artis Medicinae

[A Bit of Astronomy]

GRÉTSY Zsombor

Lege Artis Medicinae

[PRINCIPLES AND NATIONAL REGULATIONS OF BLOOD DONOR QUALIFICATION]

TOMONKÓ Magdolna

[During the assessment of blood donor candidates the physician considers two factors; first, whether the loss of 450 ml blood would be of any risk for them (e.g., because of hypotension) and second, whether they have any illness, current (seasonal allergy, antibiotic use, etc.) or chronic conditions (oncological or autoimmune disease, drug use, etc.) that may confer risk to the recipient. For the safety of blood preparations it is essential that the donors are dependable individuals who lead a lifestyle of low risk of getting infected (by HIV, hepatitis, etc.). Hungarian practice concerning donor qualification are generally stricter (e.g., because of the differences in the health care system, in the health culture) than the directive of the European Union. This implies that a number of donor candidates are temporarily or permanently disqualified. Following medical interventions (e.g., surgery, transfusion), environmental effects (e.g., radiation exposure) and recovery from diseases, however, the donor may again give blood after a certain period of time. Certain chronic diseases, if properly managed and if the patient is in perfect general condition, do not constitute a cause for exclusion either. General practicioners can greatly contribute to safe national blood supply by identifying and advising potential blood donors.]

Lege Artis Medicinae

[LOWERING THE CHOLESTEROL LEVEL TO THE TARGET VALUE BY STATINS]

KARÁDI István

[The clinical application of statins has opened new perspectives in the therapy of atherosclerosis. Clinical studies have provided firm evidence that the achievement of the recommended lipid values in cardiovascular patients stops, or even reverses, the progression of atherosclerosis. Beside the cholesterol lowering effect this result is due to a complex vasoprotective, socalled pleiotropic mechanism. In the past two years a number of interventional trials confirmed that the lower the low density lipoprotein cholesterol level is reduced to, the lower the patient's cardiovascular risk. Based on international epidemiological trials the target value of the low density lipoprotein cholesterol of the most seriously ill, very high risk patients was defined as 1.8 mmol/l. The available statin preparations have only been able to achieve this low level of low density lipoprotein cholesterol in a portion of patients. Rosuvastatin, a recently developed statin derivative, however, can be successfully used even in monotherapy to achieve the target low density lipoprotein cholesterol value in the majority of patients with high cardiovascular risk. As part of the Galaxy program, a large study on the antiinflammatory and antiatherosclerotic properties of rosuvastatin will be conducted in the near future.]

Lege Artis Medicinae

[Medical Research, Human Rights]

ZSUZSA Gábor

Lege Artis Medicinae

[Restorative impact of rabeprasole on gastric mucus and mucin production impairment during naproxen administration: its potential clinical significance]

NEMESÁNSZKY Elemér

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[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Lege Artis Medicinae

[STATE-OF-THE-ART DIAGNOSIS AND TREATMENT OF PITUITARY ADENOMAS SECRETING GROWTH HORMONE]

CZIRJÁK Sándor

[The history of the treatment of pituitary adenomas that cause acromegaly is as long as that of neurosurgery. While in the first half of the past century the aim of surgery was to save the patient's life, later the radical removal of the tumour was coupled with an effort to decrease complications, morbidity and mortality to the minimum. Today, beside all these, the complete sparing of the remaining hypophyseal substance and restoration of normal pituitary function are also important goals. The achievement of these goals is efficiently served by recent advances in microscopy, the minimally invasive methods of craniotomy, the availability of endoscopy in neurosurgery, three-dimensional computerguided neuronavigation, intraoperative colour Doppler sonography, as well as intraoperative real-time MRI. Recent developments in pharmacological research have created new promising conservative treatment modalities that supplement surgery, including somatostatin analogues and growth hormone receptor agonists. Also as supplementary treatment to surgery, occasionally replacing it, new radiosurgical methods, such as stereotaxic radiation, gamma knife, and heavy particle irradiation have gained grounds in neurosurgical practice.]

Clinical Neuroscience

[Fingolimod therapy in multiple sclerosis - the issue of the pathomechanism]

TAR Lilla, VÉCSEI László

[Multiple sclerosis is an autoimmune inflammatory disease of the central nervous system with neurodegenerative chararacteristics. The newly discovered per os administrable drug fingolimod (FTY720) has a different mechanism of action than the current disease-modifying therapies. In vivo the drug binds to four out of the five sphingosine-1-phosphate receptors after phosphorylation. Fingolimod-phosphate (FTY720-P) causes internalization and degradation of the sphingosine-1-phosphate receptors in the membrane of lymphocytes thus in contrast to sphingosine-1-phosphate it acts like a functional antagonist. In experimental autoimmune encephalomyelitis - an animal model of multiple sclerosis - fingolimod blocks the sphingosine-1-phosphate gradient controlled lymphocyte egress from the lymph nodes and therefore reduces the peripheral lymphocyte count especially the encephalitogenic Th17 subset is reduced. Modulation of the sinus lining and blood-brainbarrier constructing endothelial cells also contributes to the complex mechanism of action. Additionally due to its liphohilic nature fingolimod is able to penetrate the blood brain barrier thus, beside its peripheral effects the drug can probably modulate the cells of the central nervous system directly. Presumably it can reduce neurodegeneration caused by astrogliosis through modification of astrocyte and oligodendrocyte activity. The results of current clinical studies are holding out with bright prospective in the aspect of either the favourable effects or the well tolerated side effects.]

Clinical Neuroscience

[Neurologic complications of aortic dissection]

MÉSZÁROS István, MÓROCZ József, SZLÁVI József, SCHMIDT János, NAGY László, KATÓ Csaba, TORNÓCI László

[Introduction - Beside the damages of the cardiovascular system the lesions of the the nervous system are the most common complications of aortic dissection. This is usually an early event, therefore the dissection of the aorta may manifest itself as an acute primary neurologic disease. The aim of this study is to describe the frequency and distribution of acute neurologic symptoms occurring in aortic dissection and the distribution of their clinico-pathologic features and to establish correlations between these and the acute inhospital mortality as well as to discuss available diagnostic and therapeutic possibilities. Patients and methods - The study was based of 95 cases of acute dissection of aorta (with additional three later events of redissection), observed in a longitudinal study over a period of 29.5 years, in a population of 106 000 (in Western Hungary). Results - Of the 95 patients 20 (21%) died before admission. Neurological complications were observed in 30 of the 75 patients admitted to hospital (40%). Symptoms involving the central nervous system were found in 24 patients, affecting the spinal cord in two and the peripheral nervous system in four cases. The dissection of the aorta was diagnosed in vivo only in 22 out of the 75 patients who died in hospital (29%). 53 patients (71%) without correct diagnosis received supportive therapy only. The average survival time of the 21 patients with proximal dissection of aorta was 48.5 hours. The survival time of 23 patients with the same type of dissection involving the vessels of the aortic arch was 22.2 hours. This difference in survival time was significant (p=0.0152). 20 of 23 patients (87%) in this group showed signs of neurologic damage confirming earlier experience that neurological complications can seriously worsen the otherwise already catastrophic prognosis of aortic dissection. Conclusions - The study brought compelling evidence for the need for early diagnosis and rapid transfer of patients to appropriate cardiac surgery centers for definitive diagnosis and therapy.]

Hungarian Immunology

[Examination of leukocyte-endothel interactions in inflammatory animal models]

GONDA Andrea, MIKECZ Katalin, HUNYADI János

[Leukocyte influx into tissues is one of the hallmarks of physiological reactions to inflammatory stimuli, which is followed by a multistep process, resulting in leukocyte extravasation from the postcapillary venules. The different kinds of adhesion molecules, that play role in the rolling and firm adhesion of the leukocytes, have been investigated very intensively. By the help of animal models of inflammation, numerous individuals, being in the same stage of the disease, can be examined. The requirement for the adhesion molecules for inflammatory responses could be investigated with antibodies or, nowadays more often, gene knock out (KO) or transgenic mice. Beside evaluating the morphological and cytokine profile differences, using intravital microscopy is of great importance in the inflammatory experiments, while it allows observing interactions of virtually any blood cell types with the endothelial wall in vivo. The results are sometimes conflicting, indicating that the process of leukocyte-endothel interactions depends on different kind of other factors than the adhesion molecules, and still not fully understood.]