Lege Artis Medicinae

[Management of Transplantation Waiting Lists]

MATKÓ Ida

JULY 14, 2008

Lege Artis Medicinae - 2008;18(06-07)

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Lege Artis Medicinae

[UNSOLVED THERAPY - COMPLEX TREATMENT OF BUERGER’S DISEASE]

SZOMJÁK Edit, DÉR Henrietta, KEREKES György, VERES Katalin, DEZSŐ Balázs, TAKÁCS István, TÓTH Judit, MÓZES Péter, SOLTÉSZ Pál

[INTRODUCTION - Buerger’s disease is a nonatherosclerotic, segmental, inflammatory, progressive obliterative disease of the blood vessels that most commonly affects the small and medium-sized arteries and also the veins of the lower limb. It is strongly associated with tobacco use. CASE REPORT - A 37-year-old heavy smoker forest worker presented with severe gangrenous changes on the fingers as the upper limb manifestations of Buerger’s disease, which required acral amputation. After complex medical treatment, pharmacological sympathectomy on the left side and surgical sympathectomy on the right side, bilateral conserving necrectomy, cessation of smoking and 2 cycles of cyclophosphamid, the patient's status significantly improved, his pain diminished and, although to a limited extent, he could use both hands. CONCLUSIONS - Buerger’s disease is a disorder with unclear aethiology and is difficult to diagnose. Despite of a good prognosis, a causal treatment is not yet possible, so any antithrombotic, haemorheological, vasodilator or immunosuppressive therapy that have been reported to have beneficial effect should be considered for treatment.]

Lege Artis Medicinae

[“I Want Magic!” A Discussion with Dóra Elek, Director of the Baltazár Theatrical Group]

GYIMESI Ágnes

Lege Artis Medicinae

[Multifocal nodular hepatic steatosis]

BAJOR Judit

Lege Artis Medicinae

[Tiotropium treatment of patients with simultaneous chronic obstructive pulmonary disease and asthma]

BALIKÓ Zoltán

Lege Artis Medicinae

[Stem cell therapy: A new approach to treat vascular stenosis]

BODA Zoltán

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[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

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[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

LAM KID

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[Introduction - Stroke is the third leading cause of death worldwide (following cardiovascular and cancer mortality) and associated with serious disability for the vast majority of patients. There is no salvage therapy for irreversibly damaged brain areas, improving the circulation of the surrounding hypoperfused territories may be associated with benefitial clinical states. Cerebral hypoperfusion may play a role in the pathogenesis of other kind of neurological diseases, improvement of global circulation may have a preventive effect on these conditions. Aims - The aim of our study was to review the experimental and clinical articles focusing on the role of vinpocetin in different neurological conditions. Results - Vinpocetin appears to have several different mechanisms of action that allow for its antiinflammatory, antioxidant, vasodilating, antiepileptic and neuroprotective activities in experimental conditions. On the other hand, several meta-analysis of the existing studies in acute stroke examining short and long term fatality rates with vinpocetin was unable to assess efficacy. In chronic cerebrovascular patients, vinpocetin improves impaired hemorheological variables, has significant vasodilating properties, improves endothelial dysfunction, neuroimaging studies showed selective increase in cerebral blood flow and cerebral metabolic rate, all of which are potentially beneficial in cerebrovascular disease and may improve cognitive functions. Summary - Based on the above mentioned results vinpocetin plays an important role both in basic research and in clinical management of different neurological diseases.]

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[Notes on the management of hypertension in chronic kidney disease ]

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[The prevalence of hypertension among pa­tients with chronic kidney disease is high, reaching more than 80%. Hypertension is both one of the main causes and also the most common consequence of chronic kidney disease. It is also a main factor responsible for the high cardiovascular morbidity and mortality in this patient population. Blood pressure control can improve patient outcomes, lower cardiovascular risk and slow down the progression of kidney dis­ease, irrespective of the underlying cause. The optimal therapy should therefore focus not only on blood pressure reduction but also on renoprotection. Basic understanding of the renal pathophysiology in hypertension and renal effects of various medications is of paramount importance. In this review, we summarized cornerstones of the antihypertensive therapy in patients with chronic kidney disease. The management of patients receiving kidney replacement therapies, such as hemodialysis, peritoneal dialysis or transplanta­tion requires special knowledge and expe­rience, therefore it is not discussed here. The aim of this review was to allow non-nephrologist physicians to take care of their kidney patients with more confidence and effectiveness.]