Lege Artis Medicinae

[The proper use of nasal decongestants]

GERLINGER Imre

FEBRUARY 20, 2011

Lege Artis Medicinae - 2011;21(02)

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Lege Artis Medicinae

[Fulvestrant therapy of breast cancer’s pulmonary metastases]

BITTNER Nóra

Lege Artis Medicinae

[Influenza vaccination of pregnant women and the experiences related to the pandemic influenza A-virus H1N1 infection in Hungary 2009]

CZEIZEL Endre

[During the influenza A-H1N1 pandemic, only about 16% of pregnant women were vaccinated against the virus, despite their higher expected mortality risk. According to the official data, five pregnant women died. In addition, the high fever that occurs in influenza increases the risk of some congenital abnormalities. The vaccine used in Hungary is not associated with severe complications in pregnant women and their fetuses, therefore, it can be administered during any stage of pregnancy. The author discusses the causes that deterred pregnant women from being vaccinated. The main problem seems to be that some physicians were under-informed and were reluctant to take responsibility.]

Lege Artis Medicinae

[Myocardial infarction in systemic lupus erythematosus]

BOLF Zsuzsanna, KOVÁCS Mónika, LUPKOVICS Géza

[Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease with relatively common cardiovascular morbidity and mortality. We present a case of a 56-year-old woman treated for SLE, who had an infection of the upper respiratory tract and fever followed by multiple cardiac symptoms: pericarditis, endocarditis and finally acute myocardial infarction (AMI), which was attributed to coronaritis. Acute PCI resulted in revascularisation and combined drug therapy also reduced the patient’s inflammatory symptoms. Our case draws attention to the fact that SLE, as well as diabetes, is a condition equivalent with ischaemic heart disease.]

Lege Artis Medicinae

[Anti-atherosclerotic effect of pioglitazone - The first evidence of the role of triglyceride/HDL ratio]

CSÁSZÁR Albert

[The presence of multiple risk factors can multiply exponentially the risk of cardiovascular events, thus cardiovascular diseases are more severe in diabetes mellitus. One of the challenges we face today is the application of drugs that, besides improving glucose homeostasis, also have antiatherosclerotic effect. Such candidates are glitazones, which have pleiotropic efficiency beyond their main effect: they improve distribution of adipose tissue, blood pressure and endothelial function and also have anti-inflammatory and anti-coagulation capacity. Regarding the effects on lipid metabolism, there are differences between various glitazones: improvements are mainly achieved by pioglitazone, which markedly reduces triglyceride levels, and also elevates HDL levels and decreases the ratio of small, dense LDL-particles. Studies on clinical outcomes also show the superiority of pioglitazone. Imaging of blood vessels (carotis-IMT, intracoronary ultrasound technique) also suggest a greater efficiency of pioglitazone. According to the latest analysis of the PERISCOPE study, the stability of the coronary plaque was associated only with the triglyceride/ HDL ratio in case of pioglitazone. The newest data also revealed that pioglitazone uniquely increases the cholesterol-efflux attributed to HDL-related macrophages. On the basis of the latest results, pioglitazone not only improves glucose homeostasis, but also has a remarkable anti-atherosclerotic effect, which is primarily due to its favourable lipid metabolism profile.]

Lege Artis Medicinae

[Leaving Paradise – Or the Hidden Curative Effects of Pomegranate]

BECHER Péter, PATAI Árpád, MÁJER Katalin

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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

Cyanocobalamin and cholecalciferol synergistically improve functional and histopathological nerve healing in experimental rat model

ALBAY Cem, ADANIR Oktay, AKKALP Kahraman Asli, DOGAN Burcu Vasfiye, GULAEC Akif Mehmet, BEYTEMUR Ozan

Introduction - Peripheral nerve injury (PNI) is a frequent problem among young adults. Hopefully, regeneration can occur in PNI unlike central nervous system. If nerve cut is complete, gold standard treatment is surgery, but incomplete cuts have been tried to be treated by medicines. The aim of the study was to evaluate and compare clinical and histopathological outcomes of independent treatment of each of Vitamin B12 (B12) and Vitamin D3 (D3) and their combination on sciatic nerve injury in an experimental rat model. Materials and methods - Experimental animal study was performed after the approval of BEH Ethics Committee No. 2015/10. 32 rats were grouped into four (n=8) according to treatment procedures, such as Group 1 (controls with no treatment), Group 2 (intraperitoneal 1 mg/kg/day B12), Group 3 (oral 3500 IU/kg/week D3), Group 4 (intraperitoneal 1 mg/kg/day B12+ oral 3500 IU/kg/week D3). Sciatic Functional Index (SFI) and histopathological analysis were performed. Results - SFIs of Group 2, 3, 4 were statistically significantly higher than controls. Group 2 and 3 were statistically not different, however Group 4 was statistically significantly higher than others according to SFI. Axonal degeneration (AD) in all treatment groups were statistically significantly lower than in Group 1. AD in Group 4 was significantly lower than in Group 2 and 3; there was no significant difference between Group 2 and 3. There was no significant difference between Group 1,2 and 3 in Axonolysis (A). But A of Group 4 was significantly very much lower than all others. Oedema- inflammation (OE-I) in all treatment groups were significantly lower than in Group 1; there was no significant difference between Group 2 and group 4. OE-I in Group 2 and 4 were significantly lower than in Group 3. There were no significant differences between Group 1, 2 and 3 in damage level scores; score of Group 4 was significantly lower than of Group 1. Conclusions - B12 and D3 were found effective with no statistically significant difference. But combined use of B12 and D3 improve nerve healing synergistically. We recommend combined use of B12 and D3 after PNI as soon as possible.

Clinical Neuroscience

Delirium due to the use of topical cyclopentolate hydrochloride

MAHMUT Atum, ERKAN Çelik, GÜRSOY Alagöz

Introduction - Our aim is to present a rare case where a child had delirium manifestation after instillation of cyclopentolate. Case presentation - A 7-year old patient was seen in our outpatient clinic, and cyclopentolate was dropped three times at 10 minutes intervals in both eyes. The patient suddenly developed behavioral disorders along with gait disturbance, and complained of visual hallucinations 20-25 minutes after the last drop. The patient was transferred to intensive care unit and 0.02 mg/kg IV. physostigmine was administered. The patient improved after minutes of onset of physostigmine, and was discharged with total recovery after 30 minutes. Conclusion - Delirium is a rare systemic side effect of cyclopentolate. The specific antidote is physostigmine, which can be used in severely agitated patients who are not responding to other therapies.

Clinical Neuroscience

CANOMAD syndrome with respiratory failure

SALAMON András, DÉZSI Lívia, RADICS Bence, VARGA Tímea Edina, HORTOBÁGYI Tibor, TÖMÖSVÁRI Adrienn, VÉCSEI László, KLIVÉNYI Péter, RAJDA Cecília

CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.

Clinical Neuroscience

Valproic acid associated pleuropericardial effusion: case report

DEMIR Figen Ulku

Introduction - Valproic acid is an effective antiepileptic and mood stabilizer used in the treatment of many neurological and psychiatric disorders. Although there are frequently seen side effects, effusions between layers of pleural and pericardial membranes are rare to be seen. Case - Pleuropericardial effusion was detected in a 23 years old woman who was under valproic acid treatment because of epileptic seizure. After 1 year of valproic acid treatment, patient complained of dyspnea. As all the researches intended on etiology were usual, valproic acid has been thought to be responsible for the matter. Control examination after 1.5 months regarding the end of treatment revealed complete recovery of pleuropericardial effusion. Discussion - Pleural and pericardial effusions are rarely seen complications related to the use of valproic acid. It must also be kept in mind that valproic acid causes a potential for such side effects which can be blamed etiologically when the other possibilities for patients are excluded.