Lege Artis Medicinae

[New options in antiviral therapy]

SZLÁVIK János

MARCH 20, 2001

Lege Artis Medicinae - 2001;11(03)

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Lege Artis Medicinae

[6th Debrecen Cardiology Days]

CZURIGA István

Lege Artis Medicinae

[Art analogies - Medical language]

BOGA Bálint

Lege Artis Medicinae

[Antiatherosclerotic effect of ACE inhibitor drugs]

CZURIGA István

[Based on animal and human research data, it is likely that renin-angiotensin-aldosteron system has an important role in the pathogenesis and progression of atherosclerosis. It has been demonstrated in several large clinical trials that ACE inhibitors reduce the risk of ischemic events in patients with left ventricular dysfunction. Whereas some benefits of ACE inhibitors may be related to the lowering of blood pressure, other specific effects on vasculature have also been proposed. ACE inhibitors appear to possess unique cardioprotective and vasculoprotective properties even for patients without hypertension or left ventricular dysfunction. Recent data suggest that most patient with atherosclerotic cardiovascular disease should be considered for ACE inhibitor therapy, unless they are intolerant or have contraindication for the drug. The goal of this article is to review the data from clinical trials that support the anti-atherosclerotic and antiischemic effects of ACE inhibitors.]

Lege Artis Medicinae

[Treatment of pneumothorax in cystic fibrosis]

CSISZÉR Eszter, CSEKEŐ Attila

[INTRODUCTION - More and more children affected by cystic fibrosis reach adulthood. The frequency of complications, such as pneumothorax, increases parallel with the long disease course. PATIENTS AND METHODS - The treatment of 17 manifestations of pneumothorax in 10 young adult cystic fibrosis patients in our institute was analysed retrospectively. RESULTS - Depending on the extension of pneumothorax and the clinical state of the patients the first choice of the treatment was observation alone in 6 cases, insertion of pleuracan in 3 cases and tube thoracostomy in 8 cases. Due to ineffective suction, thoracotomy was necessary in 6 patients, bilaterally in 3 cases. CONCLUSION - The outcome of conservative treatment even in "small, circumscribed pneumothorax" cases of symptom-free patients is uncertain and risky. Insertion of a pleuracan is recommended only in urgent, life-threatening cases, but definitive result should not be expected. If possible, chest drainage should be chosen as the first procedure. After 5-7 days of ineffective chest suction, thoracotomy is mandatory. Recurrence of the pneumothorax is direct indication for surgery. Antibiotic treatment is suggested for the duration of drainage, as well as for the surgical procedure.]

Lege Artis Medicinae

[Stendhal and the „aria cattiva”]

GROÁK Lajos

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Lege Artis Medicinae

[History of vaccine production in Hungary ]

ÓCSAI Lajos

[This study presents the complete history of the Hungarian vaccine production, partly in association with the process of fighting vaccine-preventable infectious diseases, and underlines the fact that every government actively contributed to the age-adjusted mandatory vaccination schedule of the past 140 years. It demonstrates the various achievements from the smallpox lymph production through the launch of diphtheria serum production at Phylaxia and the establishment of the National Public Health Institute (OKI) with its vaccine production and the later institutional transformation of OKI into Humán as economic corporation to its closure. Among all OKI’s vaccine production activities, this study focuses on the production of influenza vaccines, due to its international importance in the 1960s and 1970s. The vaccine production against diphtheria tetanus and pertussis stands out from Humán’s activities, and the tetanus component of this vaccine is still used in the products of a multinational vaccine manufacturer. ]

Clinical Neuroscience

[Early onset dementias: Case studies]

MERKLI Hajnalka, PÁL Endre, GÁTI István, KOSZTOLÁNYI Péter, KÖVÉR Ferenc

[Introduction - Dementia is a decline of intellectual abilities. The etiology of dementia syndrome is diverse. The authors describe three patients with early-onset dementia. Case reports - The first patient was a 44 years old male with mild gait, body ataxia, memory loss, slowness and apathy. Investigations proved AIDS dementia syndrome. In the second case of a 37 years old female patient, herpes simplex encephalitis was suspected due to sudden onset of speech arrest and to brain MRI and CSF findings. Her symptoms improved during antiviral treatment but later progressive dementia developed. CSF serological tests proved the presence of neurolues-dementia paralytica. The third patient was a 38-years-old female. Neurological examination was performed because of progressive memory loss, changed behaviour and impaired attention. Neuropsychological test showed severe dementia. Metachromatic leukodystrophy was proven by decreased arylsulfatase activity. Conclusions - It is not easy to recognize the early symptoms of dementia. In these cases, besides detailed history, neurological examination and neuropsychological tests, brain MRI and cerebral spinal fluid serological tests were indispensable for a correct diagnosis, especially in the young patients.]

Clinical Neuroscience

[AIDS-RELATED TOXOPLASMA-ENCEPHALITIS PRESENTING WITH ACUTE PSYCHOTIC EPISODE]

ILNICZKY Sándor, DEBRECZENI Róbert, KOVÁCS Tibor, VÁRKONYI Viktória, BARSI Péter, SZIRMAI Imre

[The most frequent neurological manifestations of the Acquired Immunodeficiency Syndrome- (AIDS) are Cerebral Toxoplasmosis, Primary Central Nervous System Lymphoma (PCNSL), Progressive Multifocal Leukoencephalopathy (PML) and AIDS-encephalitis (AIDS-dementia complex, multinucleated giant cell encephalitis, HIV-encephalopathy). Neurological complications usually occur in the advanced stages of the disease, and they are uncommon in the beginning as presenting illness, but may result in lifethreatening condition or in death. Rarely the disease presents as a neuropsychiatric illness in an undiagnosed AIDS patient, delaying a proper diagnosis. We present the case of a 34 years old patient treated for AIDS-related Toxoplasma-encephalitis in our department. His illness started as an acute psychosis followed by rapid mental and somatic decline, leading to death in three months. His HIV-seropositivity was not known at his admission, and the extraneural manifestations were slight. The diagnosis was established by serology, imaging methods and histopathological investigation. After presenting the medical history and results of autopsy studies of the patient we discuss the problems of the differential diagnosis, especially regarding the findings of the imaging methods.]

Lege Artis Medicinae

[Introduction of hepatitis G and TT virus diagnostics in Hungary]

TAKÁCS Mária, RUSVAI Erzsébet, BROJNÁS Judit, TÓTH Gábor, N. SZOMOR Katalin, TÓTH Etelka, SZENDRŐI Andrea, MEZEY Ilona, BERENCSI György

[INTRODUCTION - The majority of the viral hepatitis is caused by five hepatitis viruses (A, B, C, D, E). In 1995, three new flaviviruses were discovered, the GBV-A, GBV-B and GBV-C (also known as HGV) viruses. The TT virus was discovered in 1997. Based on literature data, it is now supposed that a part of the unknown hepatitis cases is caused by the recently discovered hepatitis G or TT virus. The aim of this study was to determine the occurrence of hepatitis G and TT viruses in Hungary. PATIENTS AND METHODS - To reveal the RNA of the HGV viruses in the sera of patients suffering from hepatitis of unknown origin, RT-PCR was applied using the primers published in the literature. Seminested PCR was used to detect the DNA of TTV. The nucleotide sequences of nested PCR products were determined. Anti-HGV antibodies were detected by ELISA. RESULTS - The sera of 408 healthy persons older than 60 years were tested for the presence of hepatitis G virus antibodies: 113 tested positive. HGV virus antibodies were found in the sera of patients suffering from hepatitis of unknown origin or aplastic anaemia. 51 sera were tested and 20 were found to be positive for GBV-C antibodies, 4 for HGV RNA. Altogether, 213 sera of patients suffering from hepatitis of unknown origin or from aplastic anaemia were tested for HGV RNA and 26 were found to be positive. Eight PCR products were sequenced, and these sequences were found to be different from each other. 154 sera of patients with hepatitis of unknown origin were tested for the presence of TTV-DNA and 72 of them were positive. Seven PCR products were directly sequenced. Genotype 2 was found to be the most frequent one in Hungary.CONCLUSION - Our results show that both HGV and TTV are present in Hungary and none of them can be considered rare. Further studies are needed to reveal the association between the genotypes of these viruses and hepatitis of unknown origin.]

Lege Artis Medicinae

[THE INFLUENCE OF IMMUNOGENOMIC FACTORS ON HIV-INFECTION]

FÜST György

[Authors discuss data published in the last 2-3 years indicating that besides the characteristics of the virus itself, the natural course of HIV disease is also regulated by genetic factors from the very onset till the end. Susceptibility for HIV infection of the carriers of a non-expressing mutant allele (CCR5Δ32) of one of the main coreceptors of HIV is markedly lower than that of the non-carriers. HLA-concordancy, that is few differences in the HLA alleles between the infected and noninfected partners, increases the chance of the HIVtransmittal. On the other hand, carriage of some HLA genotype e.g. that of the HLA A2/6802 supertype may significantly decrease the risk of the sexually transmitted HIV infection or that of the HIV infection from the mother to child. The rate of progression of the HIV disease which may vary in broad range from the median value of 10 years is also dependent on genetic factors. Progression is lower than the average in the carriers of the CCR5Δ32, HLA-B*27 and HLAB* 57 alleles while it is significantly more rapid in carriers of the HLA-B*35.1 allele. Recent data on the regulation by genetic factors of some sideeffects and the efficacy of combined antiretroviral treatment indicate that in the near future individual treatment may be used on the basis of the genetic background of the patients.]