Lege Artis Medicinae



FEBRUARY 21, 2004

Lege Artis Medicinae - 2004;14(02)

[Women with normal cycles on the average have lower blood pressure than age matched men. From the fifth decade of life increasing average blood pressure values of females reach or even exceed the levels of males. The frequency of hypertension among women in menopause and postmenopause is 3-4 times greater than in premenopause. This great difference can not be explained by the age dependent increase in blood pressure. There are several pathological components in the background of the elevation of blood pressure following the reduction and failure of female sex hormone production. Among these components are lifestyle changes, reduced physical activity, growing body weight, increased sympathetic activity, higher RAS (renin-angiotensin system) influence and increased salt dependence of blood pressure seem to be the dominant factors. Contrary to earlier suggestions recent clinical findings have proved that estrogen or combined hormone replacement therapy did not increase but rather slightly reduced the blood pressure in menopausal and postmenopausal hypertensive women. Therefore, hypertension itself should not be the contraindication against carefully managed hormone replacement therapy. The therapy is frequently used for preventing severe osteoporosis in spite of the disappointing cardiovascular results of the WHI and HERS trials. In the Joint National Committee 7 there are no special recommendations which would strictly prefer one or another antihypertensive agents in the pharmacological treatment of postmenopausal hypertension. However doctors are assisted in their individual therapeutical decisions by certain clinical and experimental findings which refer to higher sympathic activity, enhanced RAS influence and increased salt dependency in the pathomechanism of postmenopausal hypertension.]



Further articles in this publication

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TÁLLAI Béla, MORSHED Ali Salah, FLASKÓ Tibor, PONYI Andrea, DANKÓ Katalin, TÓTH Csaba

[INTRODUCTION - In some cases of polymyositis/ dermatomyositis (PM/DM) of autoimmune origin, different malignant tumours can initiate the difficult cascade mechanisms at cell level leading to the rapid weakness of the skeletal muscles. Till now, in the international literature only four cases of PM/DM associated with cancer of prostate has been reported. CASE REPORT - Authors present a case of a 57 yearold male patient, where weakness in patient's movements developed leading to total immobility in 3 months. Purple discoloration developed on his hand and face. Significantly elevated creatin kinase (CK) levels and blood sediment rate with mild anaemia were observed during laboratory examinations. Dysphagia and lack of appetite resulted in the loss 10 kgs in body weight. Both clinical evaluation, elevated serum CK level, skin symptomes, positive electromyography and muscle biopsy confirmed acute definitive dermatomyositis. Urological examination revealed a palpable hard area at the right lobe of the prostate. Prostate biopsy confirmed the presence of carcinoma in the right lobe of the prostate. There was no sign or symptome referring to either local propagation or distant manifestation. Therefore, radical prostatectomy was performed, the tumorous prostate and both seminal vesicles were removed. Histological examination proved malignant focus in the right lobe of the prostate. After the operation patient gradually became stronger, corticosteroid medication were decreased then stopped. Patient's original muscle power and movement recovered and his previous body weight was regained. During the regular control examinations all results of laboratory tests are in normal range. CONCLUSION - In the background of some autoimmune diseases malignant tumours can be revealed. It is rare when urological neoplasms initiative the process. In men with PM/DM commencing beyond 50 years of age it is necessary to think of the presence of prostate cancer, which can be cured by performing radical operation in appropriate time.]

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[Strictly controlled stamps]


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Lege Artis Medicinae


KOLOSSVÁRY Endre, PINTÉR Hajnalka, ERÉNYI Éva, KOLLÁR Attila, FARKAS Katalin, KISS István, HARCOS Péter, SIMON Károly

[The diagnosis of giant-cell arteritis is a real challenge for clinicians. There are several reasons for the difficulties in establishing the diagnosis. This disease is associated to rare conditions, therefore most physicians lack clinical experience. This condition shows very heterogeneous manifestation, the intensity of the symptoms vary in time. Early diagnosis is of great importance in order to prevent ischemic complications. Among these complications one should emphasise the role of anterior ischemic optic neuropathy that may result in abrupt blindness. In this case report, we show a rare socalled large vessel manifestation of giant-cell arteritis. This form of the disease needs different approach in diagnosis where color duplex ultrasonography may have distinguished importance. The final verification of the diagnosis is based on histology. However the lack of all histological criteria do not exclude the presence of giant-cell arteritis.]

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[Chirurgic treatment of pyogenic liver abscess]

PETRI András, HÖHN József, HÓDI Zoltán, WOLFÁRD Antal, BALOGH Ádám

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Clinical Neuroscience

[Apoptosis in focal brain ischaemia]


[Ischaemic stroke is one of the major causes of death and disability in the developed world. It is caused by focal impairment of cerebral blood flow. The subsequent ischaemic cell death is predominantly necrotic in nature. However, a therapeutically important characteristic is the delayed apoptotic cell demise in the border zone of the primary lesion core. Apoptosis is one of the most intensively studied field of current medical and biological research. The better understanding of its mechanism may provide novel and more effective ways of therapy in a wide range of diseases including ischemic stroke. The salient neurological features of focal brain ischaemia and the morphological signs of apoptotic and necrotic cell death are summarized. The mechanism of apoptosis is discussed. It is divided into an early genetic phase of decisionmaking followed by a cellular execution phase. The characteristics of the early shift in the finely tuned balance of proand antiapoptotic genes and their protein products, which is preceded by an inbalance in intracellular ionized calcium homeostasis, energy depletion and mitochondrial dysfunction is discussed. The crucial role of caspases in apoptosis is emphasized. The three possible pathways during the execution phase is described: the intrinsic- and extrinsic caspase activation cascade and the caspase-independent intracellular signal transduction route. The molecular mechanism of neural cell membrane damage in the execution phase is discussed and some examples of altered protein synthesis also known as message-selection are given. The important role of late reperfusion in the execution phase is emphasized. The possible targets of antiapoptotic therapeutic approaches and the results of experimental studies are presented as well as the perspectives of their use in human clinical care.]

Lege Artis Medicinae

[Is postmenopausal hormone therapy suitable for cardiovascular prevention?]


[After menopause, coronary disease and infarction become increasingly common in women owing to estrogen deficiency. Therefore, hormon replacement therapy (HRT) had been widely used to prevent these problems and manage postmenopausal symptoms. In 2002, a large, randomised, placebo-controlled study reported that HRT was accompanied by serious side effects and was not suitable for cardiovascular prevention. However, subsequent re-alanyses of the data of this study and new studies in the past 10 years suggest that in women younger than 60 years and if started within 10 years after the menopause, HRT has a number of advantages and very few disadvantages. It substantially improves quality of life, while the absolute risk of side effects is small, and HRT is suitable for the primary prevention of coronary diseases. I summarise the cardiovascular aspects of menopausal hormone therapy, in order to help the necessary paradigm shift in this matter.]

Hypertension and nephrology

[Blood presssure paradoxon in very elderly patients]


[The paper is warning for the necessity of very complex consideration before taking antihypertensive therapeutic decisions (indication, point or points of actiou, blood pressure target levels, dynamics of BP reduction, etc) for elderly hypertensive patients. Blood pressure reduction can mean efficient protection against cardiovascular events also among the elderly hypertensives. However in those old and very old hypertensive patients who have not only severe stiffness of their large vessels but suffer in advanced co-morbidities and integrated pathologic geriatric syndromes, the blood pressure reduction can result in sometimes even life threatening general deterioration. Antihypertensive therapeutic dilemmas of elderly caregivers appear mainly in relation to old hypertensive patients of age over 80 years. For this „very old” age period the HYVET study gave us evidence based conclusions about the cardiovascular protective usefulness of combined antihypertensive treatment resulting in BP reduction to 150 Hgmm systolic BP target levels. However a non-negligable rate of selection of the included patients in HYVET study can weaken the generalizability of the HYVET findings in this age period and the extensibility of its antihypertensive therapeutic conclusions for the entire „very old” population because this population has also a high proportion of patients with chronic progressive illnesses and general decline. Thus the elderly hypertensives’ caregiver must always carefully and critically balance between the messages of the HYVET and the nonselective observational follow up studies among elderlies showing frequently the so-called epidemiologic blood pressure/ mortality paradoxon. The paper is also trying to find potencial pathomechanical interpretations and point of actions for the epidemiologic blood pressure/mortality paradoxon found in the very old population.]

Lege Artis Medicinae

[United Nations program to reduce premature cardiovascular mortality by 2025 and the estimation of the success of the program]


[Worldwide surveys show that cardiovascular (CV) mortality is the decisive element of total mortality. Between 1990 and 2013, the absolute number of CV deaths increased by 40.8%. Within this, ischemic heart disease (IHD) and stroke, such as the two main elements of mortality, have also increased to such an extent. Compared to the increase in absolute deaths, the age-standardized mortality rate per 100,000 population declined by 21.9%. The cause of the paradox is the development of therapy and the increase in the average age of the population. What is decisive for the lost life years (YLL) in CV cause of deaths IHD is moved from 4th to 1st place, stroke from 5th to third. This change is typical in the most regions of the world, including Central Europe and, above all, Hungary. The following factors contribute to increasing IHD and stroke mortality: smoking, hypertension, obesity, physical inactivity, diabetes. In 2011, the United Nations Conference on Communicable Diseases a uniform resolution was made, that it is a key objective for all nations to reduce their premature mortality by 25% in 2025. The CV diseases have been highlighted in a separate program and their name was “Heart of 25 by 25”. The main objective is to reduce the of premature CV mortality (probability of dying between 30 and 70 years). The target consists of main points: 30% reduction in smoking, 25% reduction in the prevalence of high blood pressure, halt the rise in obesity and diabetes type 2. Worldwide estimations were made on what would be expected in 2025 when the program was successful or unsuccessful. If the current trend remains then 30% in women and 34% in men would increase premature mortality. If all factors are influenced, then the increase will be only 1% for women and a reduction by 6% for men for developed countries, a reduction in both sexes would exceed 20%.]

Clinical Neuroscience

[Hypertension and it’s therapy in acut phase of stroke]

KÁPOSZTA Zoltán és munkatársa

[The elevation of blood pressure above normal and premorbid values within the first 24 hours of symptom onset in patients with stroke is relatively common. This acute hypertensive response is usually managed by different group of physicians, including general practitioners, emergency physicians, neurologists, internists, intensivisists. Management strategies of this phenomenon vary considerably. The first consideration in blood pressure management in this clinical setting is to determine whether the patient might be a candidate for thrombolytic therapy. For those patients are not entitled to that therapy premorbide blood pressure values and the type of stroke are the key data for sufficient control of hypertension. In patients with chronic hypertension, the lower end of the autoregulation curve is shifted toward high pressure and an impaired autoregulation due to acute stroke may increase the risk for further brain tissue damage if the blood pressure is inadequately controlled. The current guidelines recommend lowering blood pressure in patients with an intracranial haemorrhage below 160- 180/100-105 mmHg, if the patient is normotensive, while the target level is 180/105 mmHg in hipertensive patients. However, in ischaemic stroke no treatment is recommended if systolic blood pressure <220 mmHg and/or diastolic blood pressure <120 mmHg in the acute stage. Clinical studies are rare which assess the effectiveness of different antihipertensive drugs in acute stroke. The first strong evidence came from the ACCESS (The Acute Candesartan Cilexetil Therapy in Stroke Survivors) trial which suggested that a 7-day course of candesartan after an acute ischaemic stroke significantly improves cardiovascular morbidity and mortality.]