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Lege Artis Medicinae

FEBRUARY 20, 2010

[The importance of differences between diuretics in the treatment of hypertension - Metabolic neutrality in focus]

ALFÖLDI Sándor

[Indapamide is a “second-generation” vasodilatatory thiazide diuretic. Its antihypertensive efficacy when used at a low dose is equivalent to those of the other first-line antihypertensive drugs. Unlike other thiazide diuretics, low-dose indapamide was not found to have any adverse glucose or lipid effects in previous studies, moreover, it decreased insulin resistance in patients with hypertension. The risks of hypokalemia and hyperuricemia were also substantially lower. In the large, randomized, placebo-controlled HYVET-study, low-dose, indapamide-based antihypertensive therapy significantly decreased the risks of cardiovascular diseases and mortality in elderly (age >80 years) patients with hypertension. According to new guidelines, indapamide is preferred to other thiazide diuretics for patients with hypertension associated with metabolic syndrome or diabetes mellitus.]

Clinical Neuroscience

NOVEMBER 30, 2009

[Myelination disturbance in a patient with hyperuricemia and hyperserotoninemia combined with 18q deletion syndrome]

LÁSZLÓ Aranka, VÖRÖS Erika, BUGA Klára, HORVÁTH Katalin, MAYER Péter, OSZTOVICS Magda†, PÁVICS László, SVEKUS András, PATTERSON C. Marc

[We previously reported a male patient with an 18q21.3 deletion, hyperuricemia and typical symptoms of the Lesch- Nyhan syndrome who lacked hypoxanthine-guanine-phosphoribosyl- transferase (HGPRT) deficiency. The patient developed progressive peripheral neuropathy in additon to his profound mental retardation and self-injurious behavior. At the age of 23 years MR imaging revealed globally delayed myelination with relative sparing of the corpus callosum and frontal lobes. They were focal hyperintensities suggestive of gliosis. Multimodality evoked potentials found evidence of impaired central and peripheral conduction. Single photon emission computed tomographic (SPECT) imaging demonstrated left frontal hyperperfusion and under it a temporoparietal hypoperfusion.]