Lege Artis Medicinae

[Open letter to an oncologist in Szombathely]

GÁBOR Zsuzsa

AUGUST 31, 1993

Lege Artis Medicinae - 1993;3(08)

[It was out of compassion and sympathy that I took up the pen: you have suffered a serious injury, in front of the public of our million-strong daily newspaper. You were interviewed on the occasion of Cancer Awareness Days, which I was not able to hear. I was shocked to read the printed version. What may have happened was that the scissors of an editor who did not know the risks of medicine irresponsibly clipped your statement about curing your cancer patients. In doing so, he has robbed it of all its noble and truly honourable content, and has even given it a distinctly repugnant tone. In particular, it emphasises a particular point of view which is hardly comprehensible to a committed doctor.]

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Lege Artis Medicinae

[The relationship between genetic polymorphism of apolipoprotein E and atherosclerosis and its relevance with clinical practice]

CSÁSZÁR Albert

[The lipoprotein metabolism, having crucial role in atherogenesis is regulated by apolipo proteins, lipoprotein receptors and lipidtrans ferase enzymes. The genetic polymorphism of these proteins has been reported to be associated with lipid disorders. Beneath the rare forms (familial hypercholesterolemia, familial defective apo B syndrome) the most important monogenetic dyslipoproteinemia seems to be related to the apolipoprotein E polymorphism. The mean serum cholesterol concentration is influenced by the different apo E phenoytpes (E4 with high, E2 with low cholesterol level). In Hungary, the allele-frequencies (22 0,06, 22 0,80, 34 0,12) and the effect of apo E alleles on cholesterol concentration are very similar to the results found in other populations. Apo E polymorphism shows association with 1. hyperlipoproteinemia type III (E 2/2); 2. dyslipoproteinemia in familial hypercholeste rolemia (E2); 3. premature coronary heart disease (E4); 4. hypercholesterolemia in some populaton (E4); 5. insulin dependent diabetes mellitus in the Hungarian population (E2); 6. the rate of intestinal cholesterol absorption in some population (E4 with higher capacity). In such conditions the determination of apo E phenotype or genotype is very important to reveal the risks of the atherosclerosis and to asses the optimal hypolipidemic therapy.]

Lege Artis Medicinae

[Transvaginal color doppler in early pregnancy]

SZABÓ István, CSABAY László, NÉMET János, PAPP Zoltán

[The authors performed serial examinations using a transvaginal transducer with color Doppler facilities in normal and pathologic early pregnancies in order to examine the circulatory changes in the female genital tract and developing embryo. This is a preliminary study demonstrating the application of TVCD and summarizing the main circulatory characteristics in early pregnancy as a part of a detailed program investigating circulation in the first trimester of pregnancy. Parallel with the implantation as a result of trophoblast induction the branches of the uterine arteries can be visualized by TVCD, and characteristic ilus velocity waveform can be identified in each portion of this network. No diastolic flow can be detected in the embryonic arteries until 12–14 weeks of gestation. The fetal heart rate shows a characteristic change between the 5th and the 14th week of gestation. Examination of the circulatory changes in pathologic early pregnancies helps to establish an exact clinical diagnosis and to choose the proper treatment. The recent advent of the transvaginal probe with color Doppler imaging has permitted accurate studies of the circulatory changes in the female reproductive organs to be performed and provided more information about physiologic and pathologic processes in early pregnancy than all the non-invasive systems developed previously. ]

Lege Artis Medicinae

[Correspondence]

GÁBOR Zsuzsa

[In the May issue of your newspaper, we published the musings of doctor Lajos Matos, who complained about the "pains of screening". It is feared that a supplement could be filled with not so much refuting the arguments put forward to justify his concerns, but rather adding to them. It is worth reflecting, however, at least at the level of the list, because the train of thought, which has forgotten important aspects (and facts), has led to a very depressing conclusion. ]

Lege Artis Medicinae

[Relative antithrombotic effects of aspirin and of F(ab')2 fragments of an antibody blocking glycoprotein IIB/IIIA receptor]

KISS Róbert Gábor, JEAN-MARIE Stassen, TANIA Roskams, DÉSIRÉ Collen

[The antithrombotic effect of heparin (control group, 100 U/kg bolus and 50 U/kg/hr infusion), of heparin and aspirin (ASA group, 10 mg/kg bolus) and of heparin and F(ab')2 fragments of the murine monoclonal antibody against the platelet glycoprotein lib/Illa (GPIb/Illa) receptor (7E3-F/ab'/2 group, 0.8 mg/kg bolus) were studied in 3 groups of dogs with a 3 cm long everted (inside-out) segment of the carotid artery inserted into the femoral artery and a superimposed constriction which reduced blood flow to 35% of baseline.ASA and 7E3-F(ab')2 caused inhibition of ex vivo platelet aggregation with a decrease from 63 + 8 to 16 + 10% (mean + SEM, p < 0.001) in the ASA group and from 57 £ 5 to 0% in the 7Ė3-F(ab”)2 group. The template bleeding time increased in the ASA group (from 1.4 + 0.2 to 2.9 + 0.4 min, p < 0.05) and in the 7E3-f(ab')2 group (from 1.4 + 0.2 to 51 + 12.6 min, p < 0.001). In the control group the everted segments occluded and remained closed in 6 dogs and showed cyclic flow reduction phenomena in the 5 other dogs. In the ASA group inserted arteries occluded and remained closed in 5 dogs and showed cyclic flow reduction in 4 dogs; one segment remained open (p = 0.69 compared to control). In the 7E3-F(ab')2 group all segments remained patent (p < 0.001 compared to the control and to the ASA group). Thus, the GPllb/Illa blocking monoclonal antibody is significantly more effective than aspirin in the prevention of platelet mediated arterial occlusion. ]

Lege Artis Medicinae

[Significance of intracranial lipomas in connection with a rare case ]

CSERNI Gábor

[Intracranial lipomas are rare lesions which are diagnosed in about 0,08% of autopsy cases. An intracranial lipoma in the left Sylvian area of a 93 year old woman was incidentally observed during autopsy. Histological findings supported the diagnosis based on the macroscopic characteristic features. Intracranial lipomas, which are predominantly localized in the median areas are presently considered as develop mental anomalies of the subarachnoid space and not as real tumors. The theory of their pathogenesis explains the other developmental brain anomalies that are often associated with the lesion, as well as the finding of intralipomal vessels and cranial nerves. Though such lipomas are usually asymptomatic, several cases were demonstrated to be associated with seizures. Other symptoms may include hydrocephalus, headaches, behavio ral disorders, focal neurological signs. Diagnosis is based on CT or MRI findings. Intracranial lipomas are usually treated symptomatically and surgical treatment is seldom indicated In most cases shunt operations are performed, since resection is difficult and complete relief of symptoms cannot be expected as a result. ]

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[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

Clinical Neuroscience

A new method to determine the optimal orientation of Slim Modiolar cochlear implant electrode array insertion

HORVÁTH Bence, PERÉNYI Ádám, MOLNÁR Fiona Anna, CSANÁDY Miklós, KISS József Géza, ROVÓ László

Our goal was to determine the optimal orientation of insertion of the Slim Modiolar electrode and develop an easy-to-use method to aid implantation surgery. In some instances, the electrode arrays cannot be inserted in their full length. This can lead to buckling, interscalar dislocation or tip fold-over. In our opinion, one of the possible reasons of tip fold-over is unfavourable orientation of the electrode array. Our goal was to determine the optimal orientation of the Slim Modiolar electrode array relative to clear surgical landmarks and present our method in one specified case. For the measurement, we used the preoperative CT scan of one of our cochlear implant patients. These images were processed by an open source and free image visualization software: 3D Slicer. In the first step we marked the tip of the incus short process and then created the cochlear view. On this view we drew two straight lines: the first line represented the insertion guide of the cochlear implant and the second line was the orientation marker (winglet). We determined the angle enclosed by winglet and the line between the tip of the incus short process and the cross-section of previously created two lines. For the calculation we used a self-made python code. The result of our algorithm for the angle was 46.6055°. To validate this result, we segmented, from the CT scan, the auditory ossicles and the membranaceous labyrinth. From this segmentation we generated a 3D reconstruction. On the 3D view, we can see the position of the previous lines relative to the anatomical structures. After this we rotated the 3D model together with the lines so that the insertion guide forms a dot. In this view, the angle was measured with ImageJ and the result was 46.599°. We found that our method is easy, fast, and time-efficient. The surgery can be planned individually for each patient, based on their routine preoperative CT scan of the temporal bone, and the implantation procedure can be made safer. In the future we plan to use this method for all cochlear implantation surgeries, where the Slim Modiolar electrode is used.

Hypertension and nephrology

[Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix combination – a non-interventional trial (RAMONA study)]

TOMCSÁNYI János

[Purpose: Monitoring the effectiveness and safety of the fix combination formulation Egiramlon® therapy containing ramipril and amlodipin in patients, suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved 9169 patients (age >18) with mild or moderate hypertension [TUKEB No: 16927- 1/2012/EKU (294/PI/12.)]. Ramipril/Amlodipin 5/5, 5/10, 10/5, 10/10 mg combinations were administered/ titrated in three visits, during the four months period according to the physician’s decision Blood pressure was measured by validated blood pressure sphygmomanometry and ABPM (Meditech, Hungary). The dosis of the fix combination formulation was determined individually during the visits by the 923 doctors involved in the study. The target blood pressure value was 140/90 mmHg, but in case of high risk patients population (diagnosed cardiovascular disease, diabetes), 130/90 mmHg target value was determined. Results: In 70.1% of the patients had no protocoll deviation. Patients data and examination results were processed according to this 6423 patient population. The average age of the patients were 60.2 year, in 50-50% sex distribution. The average duration of the treated hypertension was 9.8 years and the average blood pressure value was 157/91 mmHg. Till the end of the study, systolic blood pressure has decreased with 26.4 mmHg and diastolic pressure with 11.8 mmHg. An average 5.5 bpm heart rate frequency decreasing was observed at the end of the study. As a result of the treatment 52.4% of the patient population has reached the target blood pressure value.]

Hypertension and nephrology

[Monitoring of effectiveness of ramipril-amlodipine fixed combination, a non-interventional trial (Ramona study). Subgroup analysis of patients with chronic kidney disease]

SIMONYI Gábor

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Clinical Neuroscience

[Changes of cognitive functions in healthy aging]

JUHÁSZ Dóra, NÉMETH Dezsõ

[Introduction - Mental health has crucial role in our life. Cognitive changes or decline can lead to many difficulties in daily routine of older people (e.g. organization of daily activities), which can, consequently, influence their well-being. Therefore it is an important question, which cognitive abilities are affected by age-related decline. Methods - In our study we aimed to investigate the changes of cognitive abilities in healthy older adults between 61 and 85 years of age compared to the performance of younger adults. Digit span, counting span, listening span, letter fluency, semantic fluency and action fluency tests were used to assess cognitive abilities, namely working memory and executive functions. Results - The results showed that younger adults performed significantly better in all tests than older adults. Importantly, the performance of older adults was better on tests requiring less complex mental computations (e.g. digit span test) than on more complex tests where both storing and mani-pulating information was required (e.g., counting span test). We also showed that within the older age group, cognitive functions’ decline was linearly associated with increasing age. Conclusion - The present study used several, well-established neuropsychological tests to map the changes of working memory and executive functions in healthy older adults between 61 and 85 years of age compared to younger adults. Our findings can contribute to the development of prevention programs aimed at improving the quality of life of older adults and preventing age-related cognitive decline.]