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Lege Artis Medicinae

DECEMBER 18, 2013

[New potential perspectives of statin therapy]

CSÁSZÁR Albert

[Statins have become crucial components of the therapy of cardiovascular diseases. Beyond their cholesterol-lowering effect, statins turned out to have further beneficial effects on various vascular mechanisms. One of the best known effects is antithrombotic capacity, which is related partly to platelet function and partly to the coagulation cascade. Besides experimental observations, interventional clinical trials have also demonstrated that statins have an antithrombotic effect both in arterial and venous thrombosis. Regarding the effects of statins on dementia, previous studies with relatively small sample sizes had controversial results. Recently, two observational studies of tens of thousands of elderly patients reported that statins reduce the incidence of nonvascular dementia. Evaluation of the data revealed that statins have pleiotropic effects in this case, too. The results discussed here shed light on new benefits of statin therapy used for reducing cardiovascular mortality, namely the prevention of thrombotic events and dementia. These benefits are related to the antithrombotic and anti-inflammatoric capacity of statins.]

LAM Extra for General Practicioners

DECEMBER 17, 2013

[NEW POTENTIAL PERSPECTIVES OF STATIN THERAPY]

CSÁSZÁR Albert

[Statins have become crucial components of the therapy of cardiovascular diseases. Beyond their cholesterol-lowering effect, statins turned out to have further beneficial effects on various vascular mechanisms. One of the best known effects is antithrombotic capacity, which is related partly to platelet function and partly to the coagulation cascade. Besides experimental observations, interventional clinical trials have also demonstrated that statins have an antithrombotic effect both in arterial and venous thrombosis. Regarding the effects of statins on dementia, previous studies with relatively small sample sizes had controversial results. Recently, two observational studies of tens of thousands of elderly patients reported that statins reduce the incidence of nonvascular dementia. Evaluation of the data revealed that statins have pleiotropic effects in this case, too. The results discussed here shed light on new benefits of statin therapy used for reducing cardiovascular mortality, namely the prevention of thrombotic events and dementia. These benefits are related to the antithrombotic and anti-inflammatoric capacity of statins.]

Hypertension and nephrology

SEPTEMBER 20, 2013

[The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)]

GIUSEPPE Mancia (elnök) (Olaszország)*, KRZYSZTOF Narkiewicz (szekciókoordinátor) (Lengyelország), JOSEP Redon (szekciókoordinátor) (Spanyolország), ALBERTO Zanchetti (szekciókoord

Journal of Nursing Theory and Practice

FEBRUARY 28, 2013

[Non-healing (chronic) wounds on lower limbs]

DARÓCZY Judit

[The incidence of chronic wounds is high (5-7% of the population); these include ulcers developing due to venal and arterial circulation failure, diabetes, tumours and pathological pressure. Chronic wounds represent serious economic and communal/individual social problems. Their treatment takes place at every level of healthcare: primary care, home nursing, specialist clinics, acute inpatient care and rehabilitation wards. Treating the wounds requires specialist expertise. Continuous training is essential, not only for doctors but also for nurses. Doctors and nurses have to work together in order to treat the wounds. The author sets out to describe the physiological basics of the healing of the wounds, the clinical properties of the wounds, and the principles of their professional treatment. ]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2013

[Complications of diabetes on the foot, the treatment of diabetic foot ulcers]

RÉDLING Marianna

[Diabetic foot syndrome is an array of symptoms with a complex pathomechanism, the complications of which (if treated late) can make it necessary to amputate the limb. Approximately 15% of diabetes patients can expect foot sores to develop in the course of their illness. The author presents the vascular complications of diabetic that underpin the development of diabetic foot syndrome, the tests serving to diagnose them, and the typical clinical manifestations and complications of diabetic foot ulcers. The most important factors in the successful treatment of diabetic foot sores are summarised: normalisation of the general medical condition; alleviation of chronic pressure points; ensuring arterial circulation; infection control; regular and appropriate mechanical debridement; wound treatment in keeping with the given phase of healing; patient education; prevention of relapse. The author places particular emphasis on the screening tests, treatment methods and patient education tasks that can be performed by specialist nurses. ]

Clinical Neuroscience

MAY 30, 2013

[The effect of hypertension and it’s therapy on cognitive performance of asymptomatic hypertensive patients]

CSIBA László, KOVÁCS Katalin Réka

[The essential hypertension increases the risk of cognitive impairment even in symptom-free patients. Sixty, non-treated hypertensives were investigated (44±10.5 év) with nine pszichological tests, measuring the reaction time, attention, short and long-term memory, psychomotor speed etc. The results of nine tests were summarized and compared with those of age-matched control persons (n=98). All hypertensives had normal CT findings. The carotid intima-media-thickness, the arterial stiffness and the velocities in the middle cerebral arteries were also analyzed (with tilting table test). The sum of the results of cognitive tests was significantly worse than that of controls 14.8±7.1 vs. 27.8±5.5 p<0.0001. The results of intima-media thickness and stiffness measurements were also significantly worse compared with controls while the middle cerebral velocities did not differ. After one year antihypertensive therapy not only the improvement of blood pressure, intima-media thickness and stiffness values could be detected but also the the score of summarized cognitive tests improved (from 17.4±6.0 to 31.6±6.0 p<0.0001).]

Clinical Neuroscience

JANUARY 25, 2013

[The presentation of a transient hyperintense lesion with legionnaires disease in a patient, is it a coincidance or an incidental finding?]

KILIC Çoban Eda, AKSOY Selma, SAHIN Riza Ahmet, UZUN Nuray, GÖKYIGIT Münevver

[Up to date the presentation of transient splenial lesions in corpus callosum were reported in diffusion weighted magnetic resonance imaging (MRI) only in epileptic patients and patients under antiepileptic therapy. A 41 year old male with no previous medical history was admitted to our clinic with symptoms of pneumonia. The neurological exam revealed stupor, but when awake his speech and orientation were normal. There were no meningeal irritation signs, cranial nerves, piramidal and cerebellar functions were normal. He had moderate respiratory distress and had bilateral rales in lower lobes while oscultating. Laboratory tests revealed high liver function levels and high acute phase reactants. Arterial blood levels showed hypoxemia. A brain MRI showed a hypointensity in the splenium of corpus callosum on T1 weighted images. There was markedly increased signal in this region on diffusion weighted imaging and hypointense on ADC. The lesion was slightly hyperintense on T2 and FLAIR weighted images. A repeat brain MRI was done 30 days after the initial study and showed a complete resolution of the splenial lesion. Transient splenial lesions can be seen due to different mechanisms in different clinical settings. It should be noted that these lesions are mostly reversible. Unnecessary therapies and procedures should be avoided in these lesions.]

Lege Artis Medicinae

SEPTEMBER 20, 2012

[Systemic diseases in pseudoexfoliation syndrome]

HOLLÓ Gábor

[Pseudoexfoliation syndrome is a condition associated with the production and accumulation of a pathological protein (pseudoexfoliation material). Originally, the syndrome was recognised on the basis of its intraocular symptoms and had been considered to be an isolated eye disease for a long time. However, some 20 years ago it became clear that in pseudoexfoliation syndrome pseudoexfoliation material is present all over in the body. In the past decade, vascular dysfunction associated with this syndrome has been also recognised. Recent studies have shown that pseudoexfoliation syndrome is caused by genetic alterations affecting a lysil oxidaselike (LOXL) protein, LOXL1. LOXL1 has an important role in the synthesis of extracellular material. To our current knowledge, pseudoexfoliation syndrome is a systemic elastosis associated with oxidative stress. Its complications are in part ocular (development of nuclear cataract, zonular damage and development of pseudoexfoliative glaucoma) and in part systemic (dysfunction of capillaries, muscular and elastic arteries, impairment of baroreflex function, increase of arterial rigidity, development of aorta aneurism, recurrent venous occlusions and neurosensory hearing loss). Despite the recognition of the above complications, currently it is not possible to set guidelines of a potential cardiovascular screening for patients with pseudoexfoliation syndrome, since the frequency and significance of systemic complications vary across different populations.]

Hypertension and nephrology

MAY 20, 2012

[Sándor Gerő, the researcher clinician (1904-1992)]

GÁCS János

[Sándor Gerő presents two theories concerning the origin of atherosclerosis. The first one is called “primary lipid infiltration concept” which means the penetration of high concentration plasma lipids into the arterial wall without its damage. The other theory for the origin of atherosclerosis is primary damage of the vascular wall (namely of fibers, mucopolysaccharid etc.) which is followed by lipid infiltration. In the literature it is named “primary vascular concept” of atherosclerosis. The author investigates the two possibilities with experimental and clinical methods and concludes that primary vascular damage is more probable to be the origin of atherosclerosis.]

Lege Artis Medicinae

APRIL 20, 2012

[Treatment of hepatocellular carcinoma by liver transplantation: results in Hungary]

GÖRÖG Dénes, VÉGSŐ Gyula, DOROS Attila, GERLEI Zsuzsa, FEHÉRVÁRI Imre, NEMES Balázs, KÓBORI László

[INTRODUCTION - Hepatocellular carcinoma is an internationally accepted indication for liver transplantation in selected cases. The aim of this study was to present treatment results of patients diagnosed with hepatocellular carcinoma and put on the waiting list between 1995 and 2010. PATIENTS AND METHODS - Sixty patients were put on the waiting list, 23 of who died or became unfit for operation while waiting for transplantation. Liver transplantation was performed in 37 patients. Pathological examination revealed no tumour in 3 of the explanted livers, whereas incidentalomas were detected in 4 livers that were explanted because of cirrhosis. Thus, in total 38 patients were examined. RESULTS - Four patients died within 3 months of surgery because of arterial circulatory problems or graft dysfunction and 14 patients died thereafter, including seven whose tumour recurred. There was no recurrence of tumours in the early state among the 25 patients meeting the Milan criteria, and the overall 1-, 3-, and 5-year survival rates with an average follow-up period of 39 months were similar to those after transplantation because of viral cirrhosis: 72%, 72% and 67% vs. 78%, 71% and 67%, respectively. Survival rates after tumours beyond the Milan criteria were significantly lower (69%, 38%, 23%). CONCLUSION - Early-state (T1,T2) hepatocellular carcinoma that has developed following cirrhosis and is unsuitable for resection can be efficiently treated with liver transplantation, but our results do not support the use of transplantation for the treatment of tumours that do not fit the Milan criteria.]