Lege Artis Medicinae

[WHO Regional Office symposium]

SÁNDOR Judit

MARCH 31, 1992

Lege Artis Medicinae - 1992;2(03)

[In difficult times, it is good to know that we are not alone. Our health system in crisis and your reform efforts are not lonely, as the health system war is raging - albeit at different levels - across Europe, across the world.]

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Further articles in this publication

Lege Artis Medicinae

[A newly discovered vasoconstrictor peptide: endothelin]

SÜTŐ Tamás, DEVECSERI Zsuzsanna, ROSIVALL László

[The discovery of endothelium-derived relaxing (prostacyclin, EDRF) and contracting factors (EDCF) in the last decade opened up new vistas in investigating the regulation of the cardiovascular system. In this review, recent results of the research of a 21 amino acid residue EDCF, called Endothelin, including its discovery, isolation, biosynthesis, tissue specific expression, receptors and the characteristics of the Endothelin converting enzyme are summarized. Based on present knowledge of the wide variety of biological actions of Endothelins, we present their possible autocrine, paracrine and humoral actions, and their significance in the physiological regulation of the cardiovascular system as well as in pathological conditions. Despite the abundance of information however, the actual role of Endothelins in the short- and long-term modulation of the tissue function still remains to be determined.]

Lege Artis Medicinae

[ATP-sensitive potassium channels, and their modulators]

FINTA P. Ervin, PETER Illes

[Recently great interest has been concentrated on potassium channels inhibited by intracellular adenosine triphosphate (ATP-sensitive potassium channels), which connect the metabolic state of cells with their electrical activity. Channel closure initiates the secretion of insulin from pancreatic ß-cells; a number of hormones altering the level of blood-sugar act via these channels. The channels are present in neurones; they regulate both in the cell bodies and the nerve terminals (e. g. peripheral nerves) the excitability. The reby, in the central nervous system, they influence the neuronal activity both in the satiety center and some catecholaminergic brain nuclei. These channels mediate the effects of endogenous vasodilators in vascular smooth muscle. They have a pathophysiological role in protecting neurones and muscle cells from hypoxic damage. The ATP-sensitive potassium channels are targets of the sulphonylurea antidiabetic agents and of a new class of drugs, the potassium channel agonists. The latter compounds are investigated or used for the treatment of hypertension, angina pectoris, cardiac insufficiency, bronchial asthma, irritable bladder syndrome, chronic occlusive arterial disease and even in impotence. They are relatively well-tolerated drugs. Their adverse effects are related to their basic vasodilator profile and most commonly include headache, dizziness, palpitation or oedema. ]

Lege Artis Medicinae

[Native CT examination of the intraarticular ligaments of the knee joint]

ESZTERGÁLYOS János

[The high incidence of intra-articular ligament injuries of the knee justifies a more frequent use of noninvasive diagnostic procedures such as the native CT scan. In positive cases, a correct preoperative diagnosis may be produced; a negative result is especially important, since diagnostic arthroscopy may be avoided. Due to the anatomic arrangement of the knee joint ligaments and theis density, which differentiates them from adjacent structures, an accurate, reliable, and reproducible image can be obtained with the native CT scan. With the high resolution charactaristic of the native CT scan, the ligaments of Humphry and Wrisberg can be visualized, and the two bundles of the anterior cruciate ligament can be distinguished from one another. Exact localization of intra-articular ligament rupture is essential in the planning of an optimal treatment schedule. According to the literature and the authors experience, the native CT scan is equivalent to the MRI as a diagnostic procedure in knee intra-articular ligament lesions. It has the advantage of being far less expensive and it is presently available in Hungary. ]

Lege Artis Medicinae

[Dipyridamole test: comparative evaluation of simultaneous 2D echocardiography and 201TL scintigraphy in ischaemic heart disease]

GRUBER Noémi, FORSTER Tamás, VARGA Albert, ÉDES István, CSANÁDY Miklós, MESTER János, CERNAY László

[Simultaneous 2D echocardiography and 2017 scintigraphy were performed during dipyridamole testing (DT) in 57 patients with suspected IHD. The dipyridamole dose was 0.56 mg/kg/bm in 4 minutes. If no effect was observed, the test was continued from the eighth minute with a dose of 0.28 mg/kg/bm in 2 minutes. 2D echomonitoring of the left ventricular motion using apical views was initiated at the beginning of DT and continued for 7 or 13 minutes in case of the longer test. After 6.5 or 12.5 minutes, 74 MBq 201TI was injected intravenously. Standard planar scintigraphy was performed in 3 views starting within 15 minutes. On the basis of the clinical results, 25 patients were subsequently referred for coronary angiography. The sensitivity, specificity and positive and negative predictive values of 2D echocardiography were 79%,55%,69% and 67%, respectively. The corresponding values for 201TIscintigraphy were 93%, 27%, 62%, and 75%. Where the results of both methods were positive, the combined sensitivity and specificity values were 71% and 73%. The results indicate the suitability of both methods for detecting IHD. Furthermore, they suggest a higher specificity, but lower sensitivity of 2D echocardiogaphy as compared to 201TI scintigraphy. Our observations demonstrate that the com binaton of these 2 techniques is very useful in clinical practice for the evaluation of IHD.]

Lege Artis Medicinae

[Multiple Risk Factor Intervention Trial]

[The aim of the study: to investigate whether a multi-risk factor programme can reduce coronary heart disease mortality.]

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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.

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Evidence suggests that pathogen-associated pattern recognition receptors (Toll-like receptors, TLRs) are implicated in the pathophysiology of schizophrenia. TLRs are important in both peripheral immune responses and neuronal plasticity. However, the relationship between peripheral TLR expression and regional brain volumes is unknown in schizophrenia. We therefore assessed 30 drug-naïve, first-episode patients with schizophrenia. TLR4+/TLR1+ monocytes were measured using flow-cytometry. High resolution magnetic resonance images (T1 MRI) were obtained and analyzed with FreeSurfer. Results revealed significant negative correlations between the percentage of TLR4+ monocytes, mean fluorescent intensities, and brain volumes in frontal and anterior cingulate regions. The measures of TLR1+ monocytes did not show significant relationships with regional brain volumes. These results raise the possibility that abnormal TLR-activation is associated with decreased brain volumes in schizophrenia.

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[Case report of supine hypertension and extreme reverse dipping phenomenon decades after kidney transplantation]

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[Supine hypertension, a consequence of autonomic neuropathy, is a rarely recognized pathological condition. Reported diseases in the background are pure autonomic failure, multiple system atrophy, Parkinson’s disease, diabetes and different autoimmune disorders. In our case report we present a case of supine hypertension which developed in a patient decades after kidney transplantation. The patient was followed for 25 months and we demonstrate the effect of the modification of antihypertensive medications. At the time of the diagnosis supine hypertension appeared immediately after laying down (office sitting blood pressure (BP): 143/101 mmHg; office supine BP: 171/113 mmHg) and on ambulatory blood pressure monitoring (ABPM) extreme reverse dipping was registered (daytime BP: 130/86 mmHg, nighttime BP: 175/114 mmHg). After the modification of the antihypertensive medications in multiple times, both office supine BP (office sitting BP: 127/92 mmHg; office supine BP: 138/100 mmHg) and on ABPM nighttime BP improved markedly (daytime BP: 135/92 mmHg, nighttime BP: 134/90 mmHg). In conclusions, our case report points out that autonomic neuropathy-caused supine hypertension and extreme reverse dipping can develop in chronic kidney disease, after kidney transplantation. The modification of the antihypertensive medications can slowly restore this pathological condition.]

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Insights into the structure and function of the hippocampal formation: Relevance to Parkinson’s disease

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The link between the hippocampus and declarative memory dysfunctions following the removal of the medial temporal lobe opened unexplored fields in neuroscience. In the first part of our review, we summarized current theoretical frameworks discussing the role of hippocampus in learning and memory. Several theories are highlighted suggesting that the hippocampus is responsible for assembling stimulus elements into a unitary representation that later can be utilized to simulate future events. The hippocampal formation has been implicated in a growing number of disorders, from neurodegenerative diseases to atypical cognitive ageing and depression. Recent neuroimaging studies provided new opportunities to study in detail the hippocampal formation’s role in higher levels of the nervous system. We will present data regarding the regional specialization of the hippocampus in experimental models developed for healthy and neurological conditions with a special focus on Parkinson’s disease. Combined evidence from neuroimaging studies suggested that hippocampal volume is reduced in non-demented, newly diagnosed patients with Parkinson’s disease, which is associated with impaired memory performance. These findings proposed that, beyond the well-known striatal dopamine loss, impaired hippocampal synaptic plasticity may contribute to cognitive and affective impairments in early Parkinson’s disease.

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[Introduction - Complex regional pain syndrome is a di­stressing neuropathic pain condition without known etiology and evidence based treatment. Case presentation - Here a posttraumatic severe case of complex regional pain syndrome is presented, successfully treated by amitriptyline monotherapy. Amitriptyline is one of the most effective evidence based treatments of peri­pheral diabetic neuropathic pain and other neuropathic pain syndromes. Discussion - Amitriptyline seems to be effective to decrease pain, autonomic and motor symptoms in chronic regional pain syndrome. Conclusion - Controlled trials may be warranted to test the effectiveness of amitriptyline in complex regional pain syndrome.]