Lege Artis Medicinae

[Intraabdominal sarcoma of follicular dendritic cells]

OROSZ Zsolt, HOLLÓSI Melinda, FORRAI Gábor, RAHÓTY Pál

NOVEMBER 20, 2007

Lege Artis Medicinae - 2007;17(11)

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Lege Artis Medicinae

[INFLAMMATION AND ATHEROSCLEROSIS]

JAKAB Lajos

[The role of vascular wall inflammation in the pathogenesis of atherosclerosis is becoming increasingly clear. However, the causal relationship between the inflammation and the course of atherosclerosis, which begins in childhood and continues for life, is debated in the literature. The interpretation of the basic pathophysiologial essence of inflammation is also controversial. This paper summarizes the basics and various features of inflammation, the body's defensive and aversive reaction. The “acute phase reaction syndrome” is a general, immediate, non-specific defense reaction of the organism, which is strongly associated with the specific, adaptive immune response. There are inflammatory processes that are chronic from the start. When looking at the main types and functions of the arterial wall proteoglycans, it is clear that they, along with the lipoprotein receptors and HDL cholesterol, are closely connected to the process, course and characteristics of the inflammation. The arterial wall proteoglycans are definitely capable of directly and indirectly influencing the inflammatory process. The issue of a possible target of statin derivatives other than the inhibition of cholesterol biosynthesis has not been resolved. Atherosclerosis may be considered a primarily chronic individual vasculitis syndrome that involves all layers of the blood vessels, and is determined by the risk factors and by the special structure of the arterial wall. The presence of inflammation is a prerequisite to the development and throughout the entire course of atherosclerosis.]

Lege Artis Medicinae

[The 17th Congress of the European Respiratory Society]

BALIKÓ Zoltán

Lege Artis Medicinae

[Internal Medicine Aspects of Bowel Diseases Inflammatory Bowel Diseases – Novelties in Attitude Edited by: János Fehér and Ágota Kovács]

dr. SZÉKELY György

Lege Artis Medicinae

[Treatment of hypertension and heart failure with a modern beta-blocker - Cost-effectiveness considerations]

NAGY Viktor

Lege Artis Medicinae

[What’s behind a pathological liver finding]

GASZTONYI Beáta

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To handle the HaNDL syndrome through a case: The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis

ÇOBAN Eda, TEKER Ruken Serap, SERİNDAĞ Helin, SAKALLI Nazan, SOYSAL Aysun

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related to migrainous headaches. It is a benign, self-limited disorder, which is characterized by fluctuating neurological symptoms and cerebrospinal fluid lymphocytosis. We describe a case of a 47 years old man with acute onset of headache and aphasia. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis (25 cells/μl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with temporoparietal predominance, and without epileptiform activity. His blood tests as well as magnetic resonance imaging (MRI) results were normal. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged with full recovery.

Lege Artis Medicinae

[PATHOLOGICAL FEATURES OF SYSTEMIC SCLEROSIS]

VARJÚ Cecília, KUMÁNOVICS Gábor, CZIRJÁK László

[Systemic sclerosis is characterized by fibrosis and subsequent atrophy of the skin and several internal organs as well as by generalized obliterative vasculopathy. The ethiology of systemic sclerosis is not quite clear yet, but the role of certain environmental factors, genetic properties and microchimaerism has been proven. Vasculopathy is a key feature that includes both functional changes (Raynaud's phenomenon) and morphological alterations (lesion of the endothel). The triggering event is the activation of endothelial cells. This is followed by an autoimmune inflammatory process causing vascular lesion, which will eventually lead to progressive pathologic fibrosis with increased deposition of collagen and intercellular matrix proteins. Normal tissues of vital internal organs will gradually loose structure, become atrophic and irreversibly damaged. In the treatment of systemic sclerosis the most significant achievements of the past decade have been made in the therapy and prevention of scleroderma renal crisis, pulmonary arterial hypertension and other vascular complications, resulting in higher survival rates and better quality of life. In pulmonary fibrosis the beneficial effect of cyclophosphamide therapy has been proven. Today, research focuses on new therapeutic approaches based on the recently clarified molecular pathological processes, as well as on laboratory and clinical markers that predict the activity of the disease or the efficiency of therapy. The aim of the present paper is to review current knowledge on the pathology of systemic sclerosis and provide help in the diagnosis, therapy and follow-up of the disease.]

Lege Artis Medicinae

[Perinatal faulty hormonal imprinting: early impact, late consequences]

CSABA György

[The description and basic study of hormonal imprinting were the first in the series of research, which led to the recognition of the role of perinatal chemical effects in the late (adult age) manifestation of some diseases and inclination to diseases. Today it is clear, that certain pathological states, as obesity or diabetes, hypo- or hyperactivity (autoimmunity and allergy) of immune system can be deduced to perinatal (hormonal or metabolic) imprinting. The perinatal hormonal (chemical) imprinting takes place at the first encounter between the developing hormone receptor and the target hormone which sets the binding capacity of the receptor for life. In the critical periods of ontogeny (in addition to the perinatal imprinting) it can be developed at weaning, in adolescence and in continuously dividing and differentiating cells during the whole life. It is provoked by considerable quantitative differences of the physiological hormone or the presence of strange target-hormone-like molecules. The faulty hormonal imprinting leads to the adult-age diseases at any time of life and is inherited epigenetically to the progeny generations. Faulty hormonal imprinting always could be present in earlier times however, at present, because of the erroneous multiplication of endocrine disruptors in the environment, nutrition and medicine, its importance is continuously growing. The effects of faulty hormonal imprinting seem to be dangerous however, it can be imagined in the far future also a positive effect by the transformation of the human endocrine system at an evolutionary route. In the metabolic or immunological imprinting as well, as in the DOHaD (Developmental Origins of Health and Disease) the foremost recognized hormonal (chemical) imprinting is materialized.]

Lege Artis Medicinae

[The importance of endothelial dysfunction and possibilities of its treatment in chronic heart failure]

MOHÁCSI Attila, LIZANECZ Erzsébet

[Endothelial cells - under autocrine and paracrine control - may have a central role in the regulation of vascular tone. Endothelial dysfunction is a very early sign of heart failure but the clinical consequence is not well understood. Recent evidence suggests that upregulation of the neuro-endocrine-, and the renin-angiotensin-aldosterone system would lead to increased tissue- and circulating angiotensin-II levels. Elevated concentration of angiotensin-II provides a mechanism by which vasomotor responses to nitric oxide, prostaglandins are blunted, while the effects of vasoconstrictors such as thromboxans, endothelin and chatecholamins are enhanced. The higher basal vascular tone leads to the degeneration and atrophy of skeletal muscle, moreover to the the ischaemic damage of myocardial cells. Because renin-angiotensinaldosterone system is under genetic control, the deleterious effects of angiotensin-II depends on the angiotensin-converting enzyme gene. Pharmacological attempts to counteract endothelial dysfunction in heart failure may include the angiotensin-converting enzyme inhibitor, which can potentially improve the endothel dependent vasodilatation response. The importance of measuring endothelial function by non-invasive techniques is yet unknown, thus, before we introduce the widespread testing of patients for endothelial function, more research has to be done.]

Lege Artis Medicinae

[The effect of chronic stress on defense mechanisms chronic inflammation and carcinogenesis]

MOLNÁR Ildikó

[During stress, the activation of the hypothalamus- pituitary-adrenal axis and the sympathetic, sensory nervous system leads to an increased production of glucocorticoids, catecholamines and other active peptides. The specific receptors on immunocompetent and tissue cells for glucocorticoid, corticotropin-releasing hormone and histamine, substance-P, norepinephrine, calcitonin gene-related peptide can modify the cytokine production of macrophages, lymphocytes and tissue cells. Local hormonal effects have a role in the degranulation of mast cells and thus in histamine release and neurogenic inflammation. Long-term, chronic inflammations promote carcinogenesis, in which the tumourassociated macrophages have an important role. Carcinogenesis is associated with disturbed cooperation between the neuronal immune and endocrine systems.]