Lege Artis Medicinae

[Rossini’s Mood Disorder]

dr. KÖVES Péter

NOVEMBER 19, 2006

Lege Artis Medicinae - 2006;16(11)

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Lege Artis Medicinae

[A NEW WAY TO TREAT ALLERGIC ASTHMA: ANTI-IGE THERAPY]

MAGYAR Pál

[Immunoglobulin E (IgE) plays a central role in the pathogenesis of the inflammation of the bronchial mucosa and airway hyperreactivity, which in turn produces the symptoms of allergic bronchial asthma. Omalizumab, the recently developed anti-IgE monoclonal antibody binds to the Cε3 region of the IgE molecule and thus prevents binding of the IgE to the surface of FCεRI receptor bearing cells (mast cells, basophils and antigen presenting dendritic cells). In the absence of cell-bound IgE, these cells are not activated and thus do not release inflammatory mediators and proinflammatory cytokines upon allergen exposition. Treatment with omalizumab significantly decreases the number of bronchial mucosal eosinophils and FCεRI positive cells, and the FCεRI receptor expression of the latter. Double blind controlled clinical studies have demonstrated that omalizumab treatment reduces the number of exacerbations and emergency room visits, the β2-agonist requirement and the dose of inhaled steroids, improves exspiratory airflow limitation, asthmatic symptoms and asthma-related quality of life in patients with moderate to severe allergic asthma. Low baseline FEV1, the use of high dose inhaled corticosteroids and a history of emergency asthma treatment in the past year are significant predictors of a better response to omalizumab. Omalizumab is tolerated well by patients. With the exception of local skin reactions, no significant difference in adverse events between patients taking omalizumab and control groups have been reported. According to the GINA (Global Initiative for Asthma) stepwise therapy protocol of asthma, omalizumab is indicated for severe asthmatics whose symptoms can not be controlled by inhaled corticosteroids and long-acting β2 agonists.]

Lege Artis Medicinae

[I Still Have So Much to Do... A Discussion with Éva Csatár MD]

VARGA Brigitta

Lege Artis Medicinae

[In the focus: steatohepatitis - Readers questions answered by dr. István Tornai]

TORNAI István

Lege Artis Medicinae

[THE PATHOPHYSIOLOGICAL IMPORTANCE OF FAT TISSUE - INTRAABDOMINAL OBESITY]

PARAGH György, KÖBLING Tamás

[Obesity affects a significant proportion of the population in Western countries. Metabolic changes that are associated with obesity lead to metabolic syndrome, a significant risk factor of cardiovascular mortality. Body mass index, which is used to describe the extent of obesity, is not suitable on its own to predict cardiovascular risk or assess metabolic changes, because it doesn't provide information on the distribution of accumulated fat within the body. Several studies have shown that it is the central/abdominal/visceral type of obesity that significantly increases cardiovascular morbidity and mortality. Visceral and subcutaneous fat tissue differ both in their function and the biological effects of adipocytokines secreted by them. Apart from the known effects of free fatty acids on insulin resistance and consequently to other metabolic parameters, adipocyte-derived adipokines have been shown to have a beneficial, antiatherosclerotic effect. In order to precisely estimate the obesity-related cardiovascular risk in everyday practice, not only body mass index, but waist circumference, a marker of visceral obesity, should also be measured.]

Lege Artis Medicinae

[Checkmate]

dr. SZIGETI Zoltán

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Clinical Neuroscience

To handle the HaNDL syndrome through a case: The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis

ÇOBAN Eda, TEKER Ruken Serap, SERİNDAĞ Helin, SAKALLI Nazan, SOYSAL Aysun

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HaNDL) is a rare entity. This disease has been related to migrainous headaches. It is a benign, self-limited disorder, which is characterized by fluctuating neurological symptoms and cerebrospinal fluid lymphocytosis. We describe a case of a 47 years old man with acute onset of headache and aphasia. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis (25 cells/μl, 100% lymphocytes). Electroencephalogram showed moderate slow rhythm in the left hemisphere, with temporoparietal predominance, and without epileptiform activity. His blood tests as well as magnetic resonance imaging (MRI) results were normal. With the diagnosis of HaNDL syndrome the patient was accepted in the Department of Neurology and discharged with full recovery.

Lege Artis Medicinae

[NEW DISORDERS OF EATING AND OF BODY IMAGE]

TÚRY Ferenc, LUKÁCS Liza, RÁCZ Olimpia, HORVÁTH Krisztina

[Eating disorders show an important change in the last few decades concerning their frequency and clinical picture, as well. Besides bulimia nervosa, which was described two decades ago, muscle dysmorphia appeared ten years ago as a special body image disorder of males, regarded as a reverse form of anorexia nervosa in females. Eating disorder, body builder type was described only in 2000, meaning an overconcern about the body composition and muscle mass, accompanied by strict dieting rules. Another type of these disorders was described also in 2000, the nontraditional gender role in women, which is a strong preference for male characteristics and activities, the person being comfortable with her sex, while there is no intersex condition. This overview discusses the proposed diagnostic criteria and the role of some sociocultural factors in these recent disorders.]

Clinical Neuroscience

[SLEEP DISORDERS IN PARKINSON SYNDROMES]

SZŰCS Anna, KOVÁCS Gábor Géza, NARULA Lalit, HALÁSZ Péter

[About 90% of neurodegenerative diseases with parkinsonism are associated with sleep disorders including daytime sleepiness, sleep-related breathing disorders and parasomnias. It is hard to define what ratio of insomnia and daytime hypersomnia is caused by the antiparkinsonian tratment, by the somatic and mentalemotional symptoms of the neurodegenerativ disease and by the neurodegenerative brain process itself. Recent research suggests that the latter group is more important than expected. In Parkinson syndromes the structures included in sleep regulation - mainly within the brainstem - are also affected resulting in specific sleep disorders being the primary biological symptoms of these diseases. The recently described parasomnia - REM sleep behavior disorder - has a specific significance in this respect: it may prevent by several years a high ratio of the parkinsonian disorders - especially synucleinopathies - offering the possibility of prevention by identifying the affected individuals. There seems to exist a similar although less clarified association between daytime sleepiness and Parkinson disease. Analysing the behavior of the orexin system in neurodegenerative diseases may help to learn more about this, recently described neurohumoral system and may clear the association of narcolepsy with neurodegeneration. By understanding the associations of parkinsonian disorders and sleep disorders new therapeutical strategies may be invented and may offer new aspects to understand the mechanism of them.]

Lege Artis Medicinae

[Recognition of mental disorders in primary care]

FÜREDI János, RÓZSA Sándor, SZÁDÓCZKY Erika, ZÁMBORI János

[BACKGROUND - Several studies have shown that a substantial part of patients with mood and anxiety disorders seeks help at their primary care physician. It is well known that recognition of these disorders cause difficulties for general practitioners. In our study starting in 1998, we attempted to map the psychiatric disorders present in primary care patients. This paper investigates the factors that may contribute to the difficulties in recognition and diagnosis of mental disorders. METHOD - 1815 primary care patients in 12 general practice offices has been evaluated for mood and/or anxiety disorders with DIS interview. The DIS diagnosis was compared with complaints and symptoms of patients and diagnosis given by their GPs. RESULTS - Diagnosis given by GPs and DIS evaluation showed low concordance. The main factor in this proved to be the presence of somatic disorders, whereas socio-demographic factors played little role. The highest concordance of diagnosis was found when acute or chronic somatic disorders were not present.]

Clinical Neuroscience

[Clinicopathological variability in neurodegeneration with brain iron accumulation]

VINCZE András, KAPÁS István, MOLNÁR J. Mária, KOVÁCS G. Gábor

[Neurodegeneration with brain iron accumulation (NBIA) is a rare, progressive neurodegenerative disorder with extrapyramidal and cognitive clinical symptoms characterized by iron accumulation predominantly in the globus pallidus, as well as extensive axonal spheroids in various regions of the brain. Recent studies indicate multiple genetic causes, however the illness can occur without obvious genetic background. The most frequent genetic form is the pantothene kinase associated neurodegeneration (PKAN) with mutation in the pantothenate kinase 2 (PANK2) gene. Further forms include phosphoslipase A2 (PLA2G6) gene mutation, neuroferritinopathy, and aceruloplasminaemia. To demonstrate the phenotypic variability associated with NBIA we present two patients. In the first patient iron deposition in the globus pallidus and axonal spheroids throughout the whole brain confirmed the neuropathological diagnosis of NBIA. Based on the long duration (27 years), the relatively late onset (at age of 13) of the disease, and the symmetrical hypointensity in the globus pallidus, without the eye-of-thetiger sign in cranial MRI, this case most likely represented an idiopathic form of NBIA but atypical PKAN may be also considered. In our second patient, who is still alive after duration of 9 years, MRI revealed the typical eye-of-the-tiger phenomenon that supported the clinical diagnosis of NBIA and was highly suggestive of PKAN. Since NBIA shows similarities with other neurodegenerative disorders, genetic examination may be essential in the diagnosis of this disease, however, cranial MRI together with the clinical picture may be highly indicative of NBIA.]