Lege Artis Medicinae

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BÁLINT Géza

SEPTEMBER 15, 2006

Lege Artis Medicinae - 2006;16(08-09)

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Lege Artis Medicinae

[TAKAYASU’S ARTERITIS DETECTED IN AN EARLY PHASE]

SZÁNTÓ Antónia, VEISZ Richárd, KRENÁCS László, CSIKI Zoltán, GRIGER Zoltán, ZEHER Margit

[INTRODUCTION - Takayasu’s arteritis is an idiopathic inflammatory disease of the great elastic arteries, mainly of the aorta and its primary branches. It primarily affects young women. CASE REPORT - A 20-year-old woman presented with general inflammatory symptoms that had begun 3 to 4 months before. Earlier she underwent a biopsy from a mass on the neck thought to be a lymph node, which on histopathological examination turned out to be a non-necrosing granulomatosis in the wall of a large artery. Based on this finding as well as on the presence of fever, weight loss, carotid murmur, anaemia, elevated platelet count, increased sedimentation rate, the lack of pulse and the findings of imaging examinations, Takayasu’s arteritis was diagnosed. Treatment was started with high-dose steroid monotherapy, which resulted in clinical and laboratory remission after a short time. The imaging findings (neck soft tissue sonogram and MRI) also showed improvement, however, a moderate but definite disease activity was still present, thus steroid treatment was supplemented with azathioprin. CONCLUSION - It is important to follow the disease both clinically and with imaging techniques for an early recognition of the need for changing or adjusting the treatment.]

Lege Artis Medicinae

[Treatment of Postmenopausal Women]

LAKATOS Péter, TAKÁCS István

Lege Artis Medicinae

[DIAGNOSIS, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF HYPERPROLACTINAEMIA]

IVÁN Gabriella, GÓTH Miklós

[Hyperprolactinaemia is one of the most common endocrine diseases. Besides hypothyroidism- associated hyperprolactinaemia and that arising as a side effect of certain drugs, the most common cause of hyperprolactinaemia is a pituitary microadenoma (<10 mm in diameter) or macroadenoma (≥10 mm) that produces prolactin (prolactinoma). In addition, several physiological conditions can elevate (mostly temporarily) the serum prolactin level, therefore, setting up the precise diagnosis requires careful evaluation of the patient’s history and the laboratory, clinical, and imaging findings. Moreover, macroprolactinaemia, which is usually not a pituitary tumour-related disease, should also be ruled out. Prolactinomas represent the most common form of functioning pituitary adenomas, accounting for 30-40% of such tumours. The typical clinical symptoms of hyperprolactinaemia may be modulated by the mass effect of macroadenomas. In women the disease typically manifests as menstrual disturbance of various degree, including primary or secondary amenorrhoea, oligomenorrhoea, short luteal phase, infertility and galactorrhoea. In men reduced libido, impotence, infertility, gynaecomastia and, rarely, galactorrhoea are the typical symptoms. Dopamine agonist therapy is the first choice of treatment. Dopamine agonist therapy (bromocriptine and the recently developed quinagolide and cabergoline) successfully lowers the serum prolactine level in nearly 90% of cases, and, importantly, it also reduces the size of the tumour in the majority of cases. This explains why today surgery and radiotherapy are only used in rare special cases of prolactinoma.]

Lege Artis Medicinae

[The Memorial of Géza Csáth]

KRAMER Imre

Lege Artis Medicinae

[THE ROLE OF INTRA-ABDOMINAL OBESITY IN THE DEVELOPMENT OF CARDIOVASCULAR DISEASE]

ZÁMOLYI Károly

[Obesity, particularly intra-abdominal (visceral) obesity, is a leading cause of cardiovascular disease, insulin resistance, type 2 diabetes, dyslipidaemia, and thrombosis. There is a growing consensus that abdominal obesity, measured by wait circumference, is a better predictor of coronary artery disease, diabetes and metabolic syndrome than body mass index. Although the primary function of adipocytes is storage and release of energy, several factors secreted by adipocytes have regulatory roles in metabolism and exert vascular effects. The pro-inflammatory adipokines, for example, play a causal role in the development of insulin resistance, type 2 diabetes and cardiovascular disease. Clinical studies provide growing evidence that adipous tissue is biologically highly active and possesses a range of metabolic and endocrine functions. The aim of this review is to explore the pathophysiological connections between abdominal obesity and the development of cardiovascular diseases.]

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[Effect of two month positive airway pressure therapy on the structure of sleep, cognitive function and anxiety]

CSÁBI Eszter, VÁRSZEGI Mária, SEFCSIK Tamás, NÉMETH Dezsõ

[Obstructive sleep apnea is a common disorder, characterized by repeated episodes of upper airway obstruction during sleep, resulting intermittent hypoxia and disruption of the normal sleep pattern, which caused cognitive dysfunction in these patients. Nasal continuous positive airway pressure is the treatment of choice for this disorder. The aim of the study is to evaluate the effect of short-term positive airway pressure on sleep pattern (polisomnographic measures), cognitive function and anxiety. Twenty four newly diagnosed and previously untreated patients with obstructive sleep apnea were evaluated a battery of neuropsychological tests before and after 2 and a half months of the treatment. We focused on working memory, short and long-term episodic memory, executive functions, anxiety and subjective sleepiness. Our results showed that the two and half month of treatment improved the respiration during sleep, sleep pattern and the subjective sleepiness. We found improvement in short- and long-term verbal memory, and complex working memory. Despite of treatment we did not find improvement in visuospatial learning. These results reveal that 2 and a half months of positive airway pressure treatment restored not only the normal respiration during sleep and normal sleep pattern, but also the cognitive functions. Our study suggests that cognitive dysfunction is at least partial reversible in obstructive sleep apnea patients after positive airway pressure treatment.]

Clinical Neuroscience

Association of anterior thoracic meningocele and azygos lobe of the lung

DENIZ Ersay Fatih, SENAYLI Atilla, BICAKCI Ünal

Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

Clinical Neuroscience

Hyperhomocysteinemia in female migraineurs of childbearing ages

ALEMDAR Murat, SELEKLER Macit Hamit

Background and purpose - Migraine is a risk factor for ischemic stroke in women of childbearing ages. Previous researches revealed a higher prevalence of hyperhomocysteinemia in migraineurs. Possible differences on the frequencies of hyperhomocysteinemia between migraine with aura and migraine without aura could contribute the established variances in stroke risk between these migraine types. Therefore, we aimed to search if the frequency of hyperhomocysteinemia was different between these subtypes of migraine or not. Methods - We analyzed the findings of serum homocysteine levels in female migraineurs of 16-49 years old who admitted to our outpatient clinic. Results - Homocysteine level was elevated in 13.3% of study population. There were not any significant differences on median serum homocysteine levels between migraine with aura (8.0 mikromol/L) and without aura (8.5 mikromol/L). (p=0.426) The frequencies of hyperhomocysteinemia were also similar (9.1% versus 16.7%, respectively; p=0.373). Correlation analyses did not reveal any linear correlation between ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura (p=0.417 and p=0.647, respectively). Similarly, any linear correlation between disease ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura was not detected (p=0.359 and p=0.849, respectively). Conclusion - The median serum homocysteine levels and the frequencies of hyperhomocysteinemia are similar between migraine with aura and without aura in women of childbearing ages. Therefore, the variances on stroke risk ratios between these types of migraine are probably not originated from the differences of serum homocysteine status.

Clinical Neuroscience

[Clinical experiences with Creutzfeldt-Jakob disease: three case studies]

SZŰCS Anna, VÁRALLYAY Péter, OSZTIE Éva, PAPP Erzsébet, SÓLYOM András, FINTA Lehel, VARGA Dániel, BARCS Gábor, HOLLÓ András, KAMONDI Anita

[The clinical picture, electroencephalographic, imaging and cerebrospinal fluid parameters as well as the molecular background of Creutzfeldt-Jakob disease have been well explored. The diagnostic criteria, offering clinicians a fair chance to identify these patients in vivo, have recently been updated. However, the diagnosis is still a challenge in everyday neurological routine. We report on three of our Creutzfeldt-Jakob patients for calling attention to the classical and the recently defined features of the disease. We conclude that based on the rapidly progressing neuropsychiatric syndrome Creutzfeldt-Jakob disease may be suspected; follow-up EEG may reveal the typical (pseudo)-periodic pattern with progressive deterioration of the background activity. In addition, diffusion-weighted brain MRI imaging (DWI) has high diagnostic value. Detection of 14-3-3 protein in the cerebrospinal fluid supports the in vivo diagnosis.]

Hungarian Radiology

[The role of static MR-urography in diagnostics of urinary obstruction]

KIS Zsuzsanna, FAZEKAS Péter, KULCSÁR Dániel, KÖTELES Márta, KOVÁCS Annamária, MAGYAR Klára

[INTRODUCTION - The idea and methodology of MRurography has just crystallized recently due to the development of technology. The traditional MRU technology means the strongly T2 weighted sequence, suitable for depicting stationary liquid spaces. Its use is independent of the functional status of the kidneys thus it is suitable for depicting dilatated ureters in case of nonfunctioning kidneys, too. Authors's aim was to define the role of sMRU in the diagnostics of obstructive urinary diseases. PATIENTS AND METHODS - 60 sMRU examinations were performed on 59 patients using a 1.5 T Siemens Symphony MR scanner in the CT-MR Laboratory of the Markhot Ferenc County Hospital between May 1, 2003 and October 31, 2005. The sMRU was performed with 2D T2 TSE sequence with angiographic character. In each case, the examinations were completed with conventional sequences in multiple planes. The role of gadolinium enhanced T1-weighted MR urography in the same diseases was not studied. In 7 cases, low-dose thin slice CT examination was performed to reveal the precise cause of obstruction. The examinations were preceded by abdominal ultrasound or intravenous urography (IVU). RESULTS - Out of the 60 sMRU examinations uretery dilatation were observed in 50 cases. In the background of obstruction, stone could be detected in 13 patients, dilatation was observed in 4 patients and MR did not indicate stone. In 7 cases with known neoplastic disease, associated urinary obstruction could be detected. In the background of obstruction primary neoplasm was found in 10 patients unknown prior the MR examination. Other benign obstruction occurred in 13 cases. Obstruction was not proved in 10 patients. In these cases the examination was justified by uncertain ultrasound findings together with abnormal renal function parameters. Follow up sMRU was performed in one patient. False diagnosis was established in two patients, the cause of dilatation was not found in one patient. CONCLUSIONS - The sMRU examination can provide more precise detection of the causes of severe urinary obstructions. It helps to define the level of obstruction in case of known malignant tumors. The grade of urinary dilatation could be also evaluated. The sMRU examination in conjunction with conventional sequences in multiple planes made possible to set up a correct therapy plan.]