Lege Artis Medicinae

[The Sides of the Coin]

dr. ZSUZSA Gábor

FEBRUARY 22, 2007

Lege Artis Medicinae - 2007;17(02)

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Lege Artis Medicinae

[DIURETICS IN CARDIOLOGY: PRESCRIBE OR USE?]

NAGY Viktor

[Diuretics are essential therapeutic tools. They effectively reduce blood pressure and have been shown in numerous hypertension clinical trials to reduce both cardiovascular and cerebrovascular morbidity and mortality. In addition, they are important components of the treatment of heart failure with apparent signs of congestion. While thiazides are recommended in mild forms, loop diuretics are used in the severe stages of congestive heart failure. Loop diuretics and thiazides often induce hypokalaemia, which has been demonstrated to be not as benign as thought before. Diuretic-induced hypokalaemia seems to be aldosterone dependent. Aldosterone levels increase during diuretic therapy. Aldosterone antagonists are unique among diuretics in that they improve survival of patients with heart failure independent of their effect on sodium metabolism. Because of this, diuretic treatment lives its renaissance in cardiology.]

Lege Artis Medicinae

[Altering cannabinoid signaling during development disrupts neuronal activity]

Lege Artis Medicinae

[For Geriatrists]

dr. IMRE Sándor

Lege Artis Medicinae

[DIFFUSE LARGE B-CELL NON-HODGKIN LYMPHOMA OF UNUSUAL LOCALISATION]

RESS Zsuzsa, ILLÉS Árpád, MATOLCSY András, TANYI Miklós, SZÖVÖRDI Éva, GERGELY Lajos

[INTRODUCTION - Diffuse large B-cell lymphoma frequently has bone involvement, but primary bone lymphoma is rare (around 4% of primary extranodal lymphomas). Long bones are most often affected, followed in frequency by the ribs, vertebrae, and pelvic bones. The main symptom is bone pain. CASE REPORT - The case of a young man is presented whose disease started with lumboischialgia. Since rheumatological treatment did not relieve the symptoms, MRI was performed, which showed a tumour with massive iliac bone destruction. Three months after the initial symptoms a surgical biopsy from the right ilium showed diffuse large B-cell lymphoma. Soon after acute renal insufficiency developed and the patient was put on haemodialysis. Based on the findings the disease was staged as Ann Arbor IV/B (bone and kidney), ECOG PS 3, International Prognostic Index 4. On the basis of the preliminary histological findings, reduced-dose CHOP chemotherapy was given, which resulted in a significant improvement of the renal function and haemodialysis could be abandoned. This was followed by 6 additional cycles of Rituximab-CHOP treatment and further 2 cycles of Rituximab-DHAP salvage chemotherapy with intrathecal prophylaxis, and, finally, since no response could be detected, R-IVAC treatment was given. After an initial response, the disease became progressive, and the patient died 9 months after the diagnosis was made from a disseminated chemoresistant disease. Autopsy confirmed extensive infiltration of the right iliac bone, kidneys, bone marrow, spleen, supraclavicular and abdominal lymph nodes, pancreas, scalp and brain. CONCLUSIONS - This case was chosen to be presented because of the unusual localisation of the diffuse large B-cell lymphoma, the initial diagnostic difficulty, and the very rapid progression despite the application of several aggressive chemotherapy schemes. A primary bone large B-cell lymphoma represents a diagnostic challenge with its rheumatological symptoms thus delaying diagnosis.]

Lege Artis Medicinae

[THE DIFFERENTIATION OF CHRONIC PANCREATITIS FROM PANCREATIC CANCER]

CZAKÓ László

[The poor prognosis of pancreatic cancer is mainly due to late diagnosis. The differentiation between pancreatic cancer and chronic pancreatitis is difficult, because the two diseases cause similar clinical symptoms and morphological alterations. Furthermore, chronic pancreatitis is associated with an increased risk of malignant transformation, thus the two diseases may be present simultaneously. The recent developments in molecular genetic tests and in imaging techniques, such as multidetector computed tomography, magnetic resonance cholangio- pancreatography, endoscopic ultrasoundguided fine needle aspiration and positron emission tomography/computed tomography, have fundamentally transformed the differentiation of the two disorders. This paper provides a systematic review of the recent evidence-based results concerning the differentiation of pancreatic cancer and chronic pancreatitis.]

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[Acoustic CR®-neuromodulation - first experiencies in Hungary with novel patented method in therapy of chronic subjectiv tinnitus]

BENCSIK Beáta, GÁBORJÁN Anita, HARNOS Andrea, LÁSZLÓ Klára, VÉGSŐ Péter, TAMÁS László

[Objective - Acoustic CR®-neuromodulation is a novel patented method for the therapy of chronic subjective tinnitus and has been tested in Hungary, as one of the first European countries introducing this procedure. It can be used for the treatment of monaural or binaural tonal tinnitus. Suitability of patients for this therapy was assessed by the help of an appropriate set of criteria. Aim of our study was to analyze 6-month therapy and related measurement data of patients first treated with this method in Hungary and evaluate the results. Method - 27 outpatients (20 males, seven females) with a minimum of 6-month long history of subjective tinnitus were assessed (four detected on the right side, six on the left side, 17 on both sides) who were treated for six months by Acoustic CR®-neuromodulation. On 44 treated ears (21 right, 23 left), changes of tinnitus frequency and loudness were measured and analysed, using Visual Analogue Scale (VAS) loudness/annoyance/pitch scores and Tinnitus Handicap Inventory tests, which were performed at defined intervals during the treatment period. Results - During this 6-month treatment period, significant decrease was detected in tinnitus frequency and loudness by tinnitometry (irrespective of the affected side), and an improvement in VAS annoyance/pitch scores and THI test results. VAS loudness did not show any significant changes. Conclusion - Acoustic CR®-neuromodulation therapy may be a useful treatment of subjective chronic tinnitus, but its efficacy should be proved in controlled clinical trials.]

Hungarian Radiology

[Melorheostosis Uncommon appearances]

KUTKOWSKA-KAZMIERCZAK Anna, EWA Obersztyn, KAZIMIERZ Kozlowski

[INTRODUCTION - Melorheostosis is a rare but well publicised disease. About 320 cases were reported up to 1994. The incidence is estimated 0.9 cases per million. CASE REPORT - We report a 40 year-old man diagnosed with severe melorheostosis and unusual radiographic appearances. No dripping candle wax cortical thickening was present. All the long bones of the upper extremities showed extensive periosteal and endosteal hyperostosis with extension of the changes into the hands and shoulder girdle. Osteosclerosis was present at both sides of the right sacro-iliac joint. There was also hypoplasia of the scapulae, distal ulnae, carpal bones and the left thumb. Distinctive features of the clinical history were that the disease was of prenatal origin. The lower extremities were normal and in spite of extensive bone and soft tissue changes in the upper extremities this patient never experienced pain - a prominent feature of adult melorheostosis. CONCLUSION - Melorheostosis is a rare disorder, diagnosis of which can be made from clinical presentation and radiographs. In case of atypical melorheostosis, the lower extremities may be found to be normal on radiographs. The presentation may be painless.]

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[POSSIBLE ROLE OF THE BASAL GANGLIA IN THE GENERATION OF THE N30 POTENTIAL OF THE MEDIAN NERVE SOMATOSENSORY EVOKED POTENTIALS]

BENICZKY Sándor, NAGY Helga, VARGA Edina, VÖRÖS Erika, KÉRI Szabolcs, VÉCSEI László

[Background and purpose - The origin and afferentation of the frontal N30 component of the median nerve somatosensory evoked potentials (SEPs) have not yet been fully elucidated. The aim of this study was to assess the possible selective impairment of the N30 component in patients with lacunar infarcts of the basal ganglia as compared to patients with lacunar infarctions sparing the basal ganglia and to a group of healthy subjects. Methods - Median nerve SEPs were measured in ten patients with lacunar infarctions of the brain (but no cortical atrophy or leukoaraiosis) and 13 healthy volunteers. Four patients had lacunar infarctions affecting the basal ganglia and 6 patients had lesions affecting other structures. Results - In two patients with lesions affecting the head of the caudate nucleus, there was no identifiable N30 component on the affected side. In one patient with bilateral lesions of the globus pallidus, the amplitude of the N30 component was significantly reduced. In one patient with lesion of the tail of the caudate nucleus, the N30 component was unaffected. The amplitude of the N30 component was also reduced in two patients with frontal subcortical white matter lesions. In all the other subjects, we recorded normal N30 components on both sides. Conclusion - Our results further support the importance of the basal ganglia, especially the head of the caudate nucleus in the generation of the N30 component of the median nerve SEPs.]

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The issue of social inclusion of the Roma minority in the Czech Republic from the viewpoint of the Model of the culturallyminded and adapted care

TOUMOVÁ Kristyna, TOTHOVA Valérie, OLISAROVÁ Vera

Objective: The aim of the research was to map out the area of social inclusion of the Roma minority according to the Model of culturally-minded and adapted care. Above all to find out the subjective opinion of the Roma on their lives in the Czech Republic, the distribution of family roles or the respect of Roma traditions and customs. Methods: Data collection was carried out using a quantitative survey, in the form of a non-standardised questionnaire. The research group consisted of 600 members of the Roma minority across the Czech Republic. Results: The results show that the Roma minority feels some intolerance, in some cases even discrimination from the majority of society. Although in a Roma family the traditional division of the roles of the mother - maternal role, the father - the family breadwinner persists, these roles change slightly depending on the style of family upbringing and cohabitation with the older generations. The life of a Roma according to Roma traditions and customs subsides slightly into the background. Younger and single Roma no longer follow traditions like their parents. Therefore, there is an obvious large influence from the majority of society towards the Roma minority. Conclusion: The Roma minority is a group of people with many specifics. To coexist with a majority society, therefore, there is a need for understanding and tolerance on both sides. For a better understanding of this minority, the conceptual model of the following authors J. N. Giger and R.E. Davidhizar can help us, as it complexly approaches the specific needs of an individual with a different culture or religion.

Hungarian Immunology

[On the role of aging in etiology of autoimmunity]

SEMSEI Imre, ZEHER Margit, BAKÓ Gyula

[Several types of diseases, among others autoimmune illnesses, could be coupled with the general processes of aging. The two-edged sword of the immune defense is directed once against environmental attacks and on the other side against the self. However, one has to make a difference between normal (physiological) clearance and autoimmune diseases, although both sides of autoimmunity are influenced by the general processes of senescence. Aging of the thymus seems to be one of the key elements of the etiology of autoimmunity, although other cell types and their aging also play a substantial role in this process. The spontaneous genetic instability, the acquired genetic mutations due to aging and the age-related alterations of the information level of the body together may be important elements of the patomechanism of both the physiological autoimmunity and the autoimmune diseases. Nevertheless, physiological autoimmunity seems to be directed mostly by natural factors (such as aging and apoptosis) but primary autoimmune diseases may be caused by genetic instability that is enhanced by aging as well.]