Lege Artis Medicinae

[Serum hepatitis C virus-ribonucleotide acid monitoring after liver transplantation - The Hungarian experience]

NEMES Balázs, SÁRVÁRY Enikő, KÓBORI László, GERLEI Zsuzsanna, PATONAI Attila, PERNER Ferenc, WESZELITS Viola, JÁRAY Jenő

MARCH 21, 2006

Lege Artis Medicinae - 2006;16(03)

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Lege Artis Medicinae

[VALVACE ]

MATOS Lajos

Lege Artis Medicinae

[Clinical Rheumatology Edited by: Béla Gömör MD]

KESZTHELYI Péter

Lege Artis Medicinae

[One step further - Prevention of cardiovascular diseases - About the recommendations of the 2nd Hungarian Therapeutic Consensus Conference]

NAGY Viktor

Lege Artis Medicinae

[THE EFFECT OF A BLACK RADISH PREPARATION ON THE REDOX HOMEOSTASIS IN INFLAMMATORY BOWEL DISEASE]

BLÁZOVICS Anna, KOVÁCS Ágota, SZÉKELY Edit, LUGASI Andrea

[INTRODUCTION - Natural antioxidants have been shown to indirectly act on signal transduction pathways and influence the induction of apoptotic genes in several ways. The black radish-based granules contain several bioactive components including isothiocyanates, flavonoids, vitamins and trace elements that can modify various molecular biological pathways. The aim of this study was to find out whether this preparation has an effect on the redox homeostasis of patients with inflammatory bowel disease. PATIENTS AND METHODS - Data from 32 middleaged patients (13 male, 19 female) with moderately active IBD were evaluated. Half of the patients (6 male, 10 female) received 0.2 g/day granules for 6 months in addition to regular treatment. Apart from other routine laboratory measurements, redox parameters including plasma reducing power, H-donor ability, free SH groups and IL-6, IL-1, TNFalpha, bile acids, cholesterol, triglycerides, red blood cell chemiluminescence and HbA1c level were determined. RESULTS - The black radish-based granules had no effect on the activity of inflammatory bowel disease. Beside a positive subjective judgement, bile acid levels had slightly increased and the values of redox parameters had decreased in the plasma by the end of the study period. The granules significantly diminished red blood cell chemiluminescence and moderately reduced the HbA1c-level. CONCLUSION - The results show that the granules rich in antioxidants and isothiocianate have a marked effect on the redox homeostasis of IBD patients even at low doses.]

Lege Artis Medicinae

[CARDIOVASCULAR EFFECTS OF MENOPAUSAL HORMONE REPLACEMENT THERAPY]

PARAGH György, HARANGI Mariann

[The incidence of coronary heart disease in women rises sharply in the years following menopause. Hormone replacement therapy involves the administration of oestrogen, which provides postmenopausal symptom relief and reverses the changes in calcium and lipid metabolism. Moreover, oestrogen is also postulated to engage multiple mechanisms that defend against hypertension. Early observations suggested that postmenopausal women treated with hormone replacement therapy have significantly reduced cardiovascular risk. However, the results of primary and secondary prevention randomized clinical trials confirmed an increased cardiovascular risk rather than a beneficial effect of hormone replacement therapy in highrisk women. Controversy between results of observational and randomized clinical trials may partly be due to the unexplored genetic background. The authors summarize the effects of oestrogen on lipids, inflammation, haemostatic parameters, blood pressure and vascular wall. Genetic factors that modulate the effect of oestrogen as well as current recommendations on hormone replacement therapy after menopause in high risk women are also presented.]

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Hypertension and nephrology

[About the care of patients with hyperuricaemia and gout]

[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.