Lege Artis Medicinae

[What Cannot be Learned from the Books]

BORCSICZKY Dóra

SEPTEMBER 19, 2008

Lege Artis Medicinae - 2008;18(08-09)

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Lege Artis Medicinae

[Hungary, 2008: Scurvy?]

ILIÁS Ákos, FALUDI Péter, TALLER András

Lege Artis Medicinae

[The History of Prosthetics from the Beginning until Today]

MAYER Ágnes

Lege Artis Medicinae

[The treatment of functional dyspepsia - Recommendation for a therapeutic scheme by the College]

LONOVICS János

Lege Artis Medicinae

[THE IMPORTANCE OF THE RECOGNITION AND TREATMENT OF LIPID METABOLISM DISORDERS IN THE SECONDARY PREVENTION OF CEREBROVASCULAR DISEASES]

FOLYOVICH András, HORVÁTH Eszter

[The high world prevalence of cerebrovascular diseases, and the particularly bad morbidity rates of Hungary are well known. The physiological properties of the brain make stroke prevention outstandingly important. Effective prevention will be reflected in the reduction of the late complications that are otherwise common and expensive to treat. Because of the common simultaneous development of stroke, cardiovascular and peripheral vascular diseases, overall vascular disease prevention is preferred, even if the various vascular diseases manifest in different degrees in a patient. Hungarian data also indicate the high risk of recurrence of cerebrovascular diseases, therefore, the importance of secondary prevention is obvious. Large international studies have proven the strokepreventing effect, and, by a pleiotropic drug action, additional benefits, of the efficient treatment of blood lipid disorders. Consensus conferences in recent years defined clear and even stricter lipid-lowering target values, mostly to be reached by “double inhibition”, bile acid binding resins, fibrates and nicotinic acid derivatives, beside the most common statin treatment. Neurological and stroke departments and clinics play a pivotal role in vascular prevention.]

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[Submucosal injection polypectomy]

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Clinical Neuroscience

Mid-term oral isotretinoin therapy causes a predominantly sensory demyelinating neuropathy

ALTUN Yasar, INAN Esra

Aim - The purpose of this prospective study was to investigate whether mid-term treatment with oral isotretinoin may impact peripheral nerve function. Methods - In this study, we included 28 patients with no apparent neurological or neurophysiological findings. The patients received treatment with oral isotretinoin for papulopustular or nodulocystic acne. The patients with normal findings in the first examination were given 1 mg/kg/day oral isotretinoin. Neurological examinations and electroneurographic studies were performed before and 6 months after the onset of isotretinoin treatment. Results - Clinical examinations and electroneurographic evaluations prior to treatment revealed no abnormalities in any of the patients. However, 20 patients (72%) displayed one or more abnormal values in the tested parameters after treatment. Although the mean amplitudes of compound muscle action potential of the ulnar and median nerves did not vary, significant decreases were observed in the mean sensory conduction velocities of median, ulnar, sural, medial plantar, medial dorsal cutaneous, and dorsal sural nerves 6 months after the onset of treatment. Conclusion - Systemic use of isotretinoin may cause electroneurographic changes. Probable electroneurographic alterations may be detected at a much earlier period via dorsal sural nerve tracing when electrophysiological methods used in routine clinical practice cannot detect these changes.

Hungarian Immunology

[Immunology of Felty’s syndrome]

BÁLINT Géza, BÁLINT Péter

[Felty’s syndrome can be regarded as “super-rheumatoid” disease. Immungenetically the syndrome is much more homogenous, than rheumatoid arthritis. HLA-DRB1*0401 antigen is present in 83% of the patients. Felty’s syndrome develops usually after a longer course of rheumatoid arthritis, in 1% of rheumatoid patients. Rheumatoid arthritis patients with long lasting unexplained neutropenia can be diagnosed having Felty’s syndrome, even without detectable splenomegaly. On the contrary, rheumatoid arthritis with splenomegaly, but without present or previous neutropenia with unexplained origin cannot be regarded as having Felty’s syndrome. Inspite of the fact, that the arthritis of Felty’s syndrome can be inactive, because of the neutropenia and increased risk of recurrent infections, the patients should be kept under tight supervision, and should be properly treated, if required. Immunologically Felty’s syndrome is characterized by rheumatoid factor positivity in 95-100%, ANA positivity in 50-100%, antihistone positivity in 63-83%. Antibodies against dsDNA rarely, but against ssDNA frequently occur. No anti Sm and interestingly no anti Ro and anti La antibodies can be detected inspite of the high incidence of associated Sjögren’s syndrome. Immunoglobulin levels are higher and complement levels are lower, than in rheumatoid arthritis. Circulating immuncomplex level is usually high. Non-specific antineutrophil anticitoplasmatic antibodies can be found in high percentage. The neutropenia of Felty’s syndrome can be either caused by increased IgG neutrophilic binding activity or by inhibition of the granulocytes colony growing in the bone marrow, by peripheral blood mononuclear cells. Expansion of large granular lymphocytes can be seen in 30-40% of patients with Felty’s syndrome. Large granular lymphocyte syndrome is not rarely associated with rheumatoid arthritis. The neutrophil account is normal or elevated in this syndrome, but splenomegaly occurs. These cases are called as pseudo Felty’s syndrome. The patients with Felty's syndrome suffering from recurrent infections required treatment even if the arthritis is inactive. Methotrexate treatment should be started first, if this treatment fails, other disease modifying drugs or colony stimulating factor can be given. There is no experience with other biological treatments. In treatment of resistant cases splenectomy is indicated. Non-steroid anti-inflammatory drugs should be better avoided.]

Hungarian Radiology

[Diagnostic Errors in Radiology: What We Cannot Change and What We Must Do ]

LACZAY András

Lege Artis Medicinae

[Recommendations of the European Atherosclerosis Society (EAS) and the European Society of Cardiology (ESC) for dyslipidaemia. Focused on: primary prevention]

BAJNOK László

[In 2019 the European Atherosclerosis So­ciety (EAS) and European Society of Car­dio­logy (ESC) renewed their dyslipidae­mia guidelines. The new version is more progressive than the previous ones. Thus, in the low-risk, not severely hy­per­choles­te­ro­lae­mic population cholesterol-lowering medication is also suggested. Except this low-risk group, atherogenic target values, e.g. for LDL-cholesterol, were reduced by an entire category, in some cases to the lowest one. If these goals cannot be achieved with statin-monotherapy, combined treatment is recommended generally by the cholesterol inhibitor ezetimib, and in some very high-risk cases also by innovative cholesterol lowering so-called PCSK9 inhibitor. ]

Hypertension and nephrology

[Elderly patients with end-stage renal disease, its epidemiology and questions regarding it in Hungary]

SZEGEDI János, KISS István

[The number of elderly people and the kidney disease’s importance connected to it has increased worldwide, therefore the chronic kidney disease became an endemic. Parallel to the dwindling of population the people in it age. Because of the men’s higher mortality rate the proportion of women in the elderly is greater. Prognosis indicates that by 2060 every third citizen will be aged 65 or more. Between 1990 and 2015 the life expectancy at birth increased by 6.95 years in the case of men (in 1990 it was 61.13, and in 2015 it was 72.08) and by 4.9 years in the case of women (in 1990 it was 73.7, and in 2015 it was 78.6) in Hungary. Chronic kidney disease concerns 10 to 14 % of the population and 1% of all of them suffers from end stage kidney failure. In the end of 2015 3.52 million patients received kidney replacement therapy around the globe (2.42 million received hemodialysis, 329000 received peritoneal dialysis and 704 000 lived with transplanted kidneys). Of all the risk factors of chronic kidney disease age, hypertension, diabetes mellitus and obesity stand out as the most important ones. The kidneys’ anatomy and function change in elderly age, making it possible for the kidney disease to manifest in greater numbers. The elderly dialysis patients’ number increases worldwide which is connected to their higher life expectancy and better life prospects which on the other hand ultimately means that more and more patient lives to suffer from kidney disease. It cannot be disregarded either that the increasing number of elderly patients suffering from hypertension or diabetes means that because these are causes of kidney disease, the latter’s numbers are also increasing. International data indicates that in the case of incident ESRD patients their number was between 68-2784 and the older than 75 years was 142-1660 per million population. In Hungary there was 778/pmp and 677/pmp, respectively. In 2015 the ratio of incident dialysis patients the ones aged above 65 was 58,9% in the case of incident patients and 50,3% in the case of prevalent patients. The ratio of the ones aged above 75 was 28,2% in the case of incident patients and 22,6% in the case of prevalent patients. The number of elderly dialysis patients differs by region too. Dialysis treatment started in elderly age requires special knowledge and teamwork, similarly to the question of refusing the treatment. The latter team work, adequate experts (doctors and nurses) and the related professions’ representatives build the foundations of a proper clinical practice.]