Lege Artis Medicinae

[Napoleon’s Death]

SZENDI Gábor

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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Clinical Neuroscience

[Vinpocetin in neurological diseases]

SZAPÁRY László, KÉSMÁRKY Gábor, TÓTH Kálmán, MISNYOVSZKY Melinda, TÓTH Tímea, BALOGH Ágnes, NAGY Krisztián, NÉMETH György, FEHÉR Gergely

[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.]

Clinical Neuroscience

[OXYGEN-GLUCOSE DEPRIVATION-INDUCED CHANGES IN ORGANOTYPIC CULTURES OF THE RAT HIPPOCAMPUS]

BALI Balázs, NAGY Zoltán, KOVÁCS J. Krisztina

[Introduction - (-)Deprenyl is an irreversible inhibitor of type B monoamine oxidase (MAO-B), which is now used for treatment of Parkinson’s or Alzheimer’s diseases. Evidence suggests that the neuroprotective effect of deprenyl may not be related exclusively to the inhibition of the enzyme MAO-B. Methods - To test the impact of deprenyl on ischemiainduced changes in vitro, we followed the time course of propidium iodide (PI) uptake as an indicator of neuronal cell death as well as the expression of apoptotic factors in organotypic hippocampal slice cultures exposed to oxygen- glucose deprivation (OGD) for 45 min. Results - The first signs of neuronal death were detected 2 hours after OGD and were extended to all subfields of the hippocampus by 24 hours post-injury. Presence of deprenyl (10-9 M) significantly delayed the cell death induced by the insult. Exposure of control cultures to deprenyl significantly increased the abundance of Bcl-2 and Bcl-xl mRNAs as revealed by RT-PCR. OGD resulted in an elevation of anti-apoptotic factors, while the expression of pro-apoptotic bax remained unchanged. Conclusion - These data suggest that deprenyl is neuroprotective in an in vitro model of ischemia. Although deprenyl upregulates the expression of Bcl-2 under basal conditions, its effect on anti-apoptotic factors is not significantly manifested during OGD.]

Lege Artis Medicinae

[Death and the Maiden The Response to the Other One]

FERENCZI Andrea

Clinical Neuroscience

[Pompe’s disease - Part II - Treatment strategies and enzyme replacement]

ILLÉS Zsolt, VÁRADI VISY Katalin

[Pompe’s disease is an ultra-orphan disease caused by the deficiency of lysosomal alpha-glucosidase. At present, it is the only inherited muscle disorder, which can be treated by replacement of the enzyme. Three international randomized trials examined the clinical efficacy of enzyme replacement therapy (ERT) in infantile and late-onset diseases. ERT reduced the risk of death, respiratory support, invasive ventilation and improved cardiomyopathy. Respiration, muscle function and quality of life were improved in both infantile and late-onset diseases. These randomized and pilot trials also proved the safety of the treatment. At present it is not clear if antibodies induced by ERT result in decreased efficacy. In this review, we also discuss our experiences obtained by the treatment of three patients, and review the spectrum of supportive and experimental treatment strategies.]

Hypertension and nephrology

[The beginnings and difficulties of peritoneal dialysis at the end of the last century. Part II. Hungarian experiences]

KARÁTSON András

[In Part I, I summarised the beginnings, the theoretical background and the international experiences of peritoneal dialysis. Hungarian publications related to peritoneal dialysis in the 1950s were focusing on the role of the method in the treatment of chronic renal disorders. The first dialysis centres were established in the medical universities of Hungary (Szeged in 1955, Budapest in 1960, Pécs in 1964, Debrecen in 1970) and in Miskolc in 1968. Despite the restricted hemodialysis capacities the intermittent technique of peritoneal dialysis did not spread in accordance with the demand. A survey conducted at the beginning of the 1970’s in the territory of the five counties with 1.5 million inhabitants revealed that considering the numbers of patients with renal diseases requiring dialysis, developing of a network of care and increasing the dialysis capacities is necessary and so is the development of a system of szatellite peritoneal dialysis, which was implemented with our support in 10 units of the county hospitals. A devoted and enthusiastic organiser of the nation-wide system of peritoneal dialysis was professor Taraba, who, due to his untimely death, was deprived of seeing the nation-wide spread of CAPD. At the beginning of the 1980’s the first reports on the favourable effects of CAPD appeared in Hungary. Solutions prepared in pharmacies and the lack of up-to-date equipment resulted in the frequent occurrence of peritonitis. In addition, the unfavourable memories of dialysis performed with bottled solutions (long treatment times, frequently peritonitis) were still vivid among patients and colleagues supervising the treatment. As a consequence, our survey conducted in 1991 revealed that the spread of CAPD all over the world in Hungary resulted in a significant increase of those treated with the intermittent method (more than 10% of the dialysis patients), while those treated with CAPD remained under 2%. Several reports on CAPD and the consequences that followed from them as well as the further training organised in the Szent Margit Hospital, Budapest and in Gánt, and also the guidelines issued by the Society of Hungarian Nephrologists the number of those treated with dialysis has exceeded 6000 in the past decade. 10% of them received CAPD/APD treatment.]