Lege Artis Medicinae

[Measurement of coronary artery calcification in adults with type 1 diabetes mellitus using dual-source, multi-slice computed tomography]


SEPTEMBER 21, 2009

Lege Artis Medicinae - 2009;19(08-09)

[INTRODUCTION - Coronary artery calcification can be characterized non-invasively and numerically using computed tomography (CT). In adult patients with type 1 diabetes mellitus, coronary atherosclerosis may be present without clinical symptoms. PATIENTS AND METHODS - Asymptomatic adults with type 1 diabetes mellitus (n=46) were investigated. Coronary artery calcification was expressed in Agatston-scores using a dual source CT scanner. RESULTS - Twenty-one patients had a coronary artery calcification score of ≥1 (range 1-2353), while in 25 patients no detectable calcium (score 0) was observed. Patients with vs. without coronary artery calcification had a higher age (51.0±9.9 vs. 42.8±7.8 years; p=0.0045), a longer duration of diabetes (30.6±9.2 vs. 24.2± 8.6 years; p=0.0238), a higher waist circumference (87.9±11.5 vs. 79.7±9.4 cm; p=0.0146), and a higher BMI (26.2±2.9 vs. 23.8±3.1 kg/m2;p=0.0109). Moreover, patients with vs. without detectable coronary artery calcification had higher serum lipid levels (LDL-cholesterol, 3.35±0.32 vs. 3.01±0.68 mmol/l; p=0.0069) and higher serum uric acid levels (228.4±48.7 vs. 195.1±39.4 µmol/l; p=0.0437). Hypertension was more common (p=0.0144) in patients with coronary artery calcification than in patients without it. There was no significant difference between the groups in HbA1c (7.97±0.85 vs. 8.26±1.28%; p=0.7491), however, estimated insulin sensitivity was lower in patients with vs. without detectable coronary artery calcification (7.15±2.09 vs. 9.20±2.03 mg/kg/min; p=0.0017). CONCLUSION - Our results suggest that coronary artery disease in type 1 diabetic patients is associated with higher age, longer duration of diabetes, and cardiovascular risk factors rather than with long-term glucose control.]



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Lege Artis Medicinae

[Do you have to die here?]

VITRAI József, FÜZESI Zsuzsanna, KAPOSVÁRI Csilla, KAPÓCS Gábor, RÁCZ József, SINKÓ Eszter

Lege Artis Medicinae

[The importance of vitamin D deficiency in practice]


[The effects of vitamin D in bone health have been known since the 1920s. Recently, it has been proven that its role in the body is much more complex. Activated vitamin D is a steroid hormone that regulates transcription of more than 200 human genes through its receptor that is detectable in almost all types of cells. In contrast to the former conceptions, it can be activated not only in the kidneys; moreover, local 1-α-hydroxylation plays a greater role in its extraskeletal effects. Vitamin D deficiency, currently defined as serum levels of <30 ng/ml, is caused by the lack of ‘effective’ sunlight exposition. Thus, vitamin D deficiency is one of the most frequent deficiencies in the developed world that plays a role not only in the development of skeletal conditions but many other diseases, as well. A low vitamin D level causes a reduced calcium absorption, a higher bone remodelling rate and increased bone loss. It also reduces muscle strength and increases the risk of falling. Normal vitamin D status is required for the effectiveness of drugs for osteoporosis treatment; however vitamin D treatment in itself is not effective in osteoporosis. An increasing number of studies show the benefits of vitamin D supplementation and treatment in extraskeletal conditions. Vitamin D plays an important role in the prevention of several auto-immune diseases, infections, cardiovascular diseases, and cancers. Therefore, all UV-B radiation-deprived adults require an intake of vitamin D to maintain a level of >30 ng/ml. Vitamin D3 treatment is safe. The necessary dose can be reliably approximated by the calculation that an incremental consumption of 100 IU/day raises serum vitamin levels by 1,0 ng/ml. Clinical trials suggest that for the vast majority of individuals, a prolonged intake of 10,000 IU/day does not pose any risk.]

Lege Artis Medicinae

[Up-to-date management of systemic sclerosis]

SZŰCS Gabriella

[Systemic sclerosis is a chronic autoimmune disease characterized by three major features: widespread fibrosis in the skin and internal organs, a non-inflammatory small vessel obliterative vasculopathy and immunological activation with disease-specific autoantibodies. It is necessary to take a systematic approach to the diagnosis and evaluation of each case in order to provide appropriate treatment. Disease-modifying approaches can be classified according to the underlying pathogenic process. Thus vascular therapies include agents used for Raynaud’s phenomenon, critical digital ischaemia and organ-based vascular complications such as scleroderma renal crisis and pulmonary hypertension. Immunosuppressive drugs are used in lung involvement or rapid skin progression. The results of different anti-fibrotic therapies are controversial. Finally in managing organ-based manifestations and complications a multidisciplinary approach to the therapy is useful with patient education as an integral component of successful management.]

Lege Artis Medicinae

[The role of neurohormonal regulation in the development of insulin resistance in chronic stress]


[The effects of the chronic stress could not be avoided recently. The pathognomic regulation of the neurohormonal events is responsible for the manifestation of diseases such as obesity, cardiovascular diseases, diabetes mellitus type 2, depression, tumors, inflammations, allergy. Two major regulatory systems are involved in the neuroendocrine alterations caused by stress: the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous systems. The chronic activation of the adrenocortical system leads to insulin resistance and obesity associating with vascular, arteriosclerotic and inflammatory symptoms. The revealing of the pathognomic events on time and the enhanced physical activity may provide the effective prevention of these frequent diseases.]

Lege Artis Medicinae

[Side effects of long-term treatment with proton pump inhibitors]

PAP Ákos

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Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]


[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Lege Artis Medicinae

[Possibilities of applying basis/bolus method in treatment of adolescent with type 1 diabetes mellitus]


[INTRODUCTION - Since the end of the pastcentury, the basis/bolus method has been adeterminate factor of adjusting insulin thera-py. Experiences with insulin pump treatmentprove that well-quantified and adequatelytimed basal insulin treatment can fully com-pensate for the diurnal glucose-producingactivities of the liver and the diurnal changesin the activity of insulin receptors. Suitablyselected basal insulin treatment can, there-fore, keep the changes in blood sugar levelthat are dependent of the diet’s carbohydratecontent well under control. CASE REPORT - By presenting the approxi-mately five-year treatment of an adolescentboy, the author presents the current options(and failures) of insulin therapy that might beused with more or less success. Each treat-ment approach had its place in the variousstages of the patient’s diabetes. Nevertheless,insulin pump therapy, admittedly the moststate-of-the-art method today was unsuccess-ful due to patient’s lack of compliance, thusthis treatment had to be stopped. Still, on thebasis of the experiences with insulin pumptherapy, the restored intensive-conservativetreatment was set up on glargine basalinsulin, defining doses of bolus in correlationwith 10 grams of carbohydrate, which madethe diet less strict. This approach resulted ina considerable improvement of the patient’smetabolic profile. CONCLUSION - The right choice of thedoses and efficacy curve of basal insulin isessential for achieving a good metabolic bal-ance during intensive-conservative therapy.In case of deteriorating metabolic balance,suspending the inefficient insulin pump ther-apy is justified and means no disadvantagefor the patient, as long as the subsequentadjustment is prudent. By defining doses of ashort-acting bolus insulin analogue in corre-lation with carbohydrate intake along withglargine therapy permits adaptation to themetabolism of patients with poor compli-ance and unsatisfactory lifestyle - in expec-tation of better results. ]

Hungarian Radiology

[Isolated gallbladder rupture following blunt abdominal trauma]


[INTRODUCTION - Gallbladder injuries following blunt abdominal trauma occur rarely and are usually associated with damage to other abdominal organs. Isolated rupture of the gallbladder is extremely rare. CASE REPORT - A 42-year old intoxicated male patient suffered a blunt abdominal trauma 4 days before the admission. The physical examination was of normal and no specific laboratory values were found. Ultrasound examination demonstrated the gallbladder with hyperechoic thickened wall and inhomogenous content. Beside of the gallbladder fluid collection was detected with irregular margins. To prove the diagnosis of gallbladder injury computed tomography was carried out. Break of the gallbladder wall and hight density lumen content, corresponding to blood was detected. Around the gallbladder an irregular fluid collection was seen, which reached the level of the transverse section of the mesocolon. Computed tomography excluded traumatic lesion of other parenchimal abdominal organs. Surgery confirmed the radiological diagnosis. CONCLUSION - The patient with isolated gallbladder injury had a multiphasic clinical course. Sometimes the diagnosis has to be established at a relatively asymptomatic stage. The basic methods of the diagnostics are the ultrasound examination and computed tomography.]

Lege Artis Medicinae



[In several randomised, controlled clinical studies conducted to decrease cardiovascular morbidity and mortality, there was long-term observational follow-up after the termination of the double-blind phase. There is evidence that the beneficial effect of the therapeutic intervention in the active study phase was maintained in the follow-up period. This phenomenon was observed both for life-style modification and for pharmacological intervention, including the use of ACE-inhibitors, statins, fibrates and intensive insulin treatment. This fact suggests the possibility that even after several years, the body “remembers” the beneficial effects of the cardiovascular risk reduction achieved years earlier. The phenomenon may be called “cardiometabolic therapeutic memory”.]

Hungarian Radiology

[Xanthogranulomatous cholecystitis]


[INTRODUCTION - The xanthogranulomatous cholecystitis is a rare and benign form of lesions associated with diffuse thickening of the gall bladder wall. It is important to recognize it radiologically because it can be mistaken easily for gall bladder carcinoma. The characteristic US, CT and MR findings, however, may be helpful in the differential diagnosis. CASE REPORT - We present the cases of two middleaged female patients suffering from right upper quadrant, radiating abdominal pain for several weeks without occurrence of fever. In both patients, the ultrasound examination revealed marked thickening of the gall bladder wall containing hypoechoic nodules. Further, non-specific sign such as cholecystolithiasis and fine infiltration of the adipose tissue surrounding the gall bladder and dilatation of extrahepatic or intrahepatic bile ducts were visible. On the post contrast CT images, rim enhancement was detectable. MR/MRCP examination showed a sharp delineation of the gall bladder from the liver parenchyma. Both patients underwent cholecystectomy. The pathological examination excluded malignancy and confirmed the diagnosis of xanthogranulomatous cholecystitis. CONCLUSION - The characteristic features of xanthogranulomatous cholecystitis (hypoechoic xanthogranulomas in the markedly thickened gall bladder wall and the presence of calculi) can be detected by ultrasound examination. CT or MRI may play an important role in confirmation of the diagnosis of an inflammatory process and provide useful information in exclusion of gall bladder carcinoma.]