SciCombinator

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Journal: Orvosi hetilap

168

Behcet’s disease is a multisystem autoimmune disease with variable clinial manifestations. The diagnosis may pose a difficult challenge for the clinician, who has to be familiar with the wide spectrum and combination of the symptoms of Behcet’s disease. It is considered a rare disease in Hungary, and there are only few reports on Behcet’s disease in the Hungarian literature. However, the past history of Hungary, the worldwide growing incidence of the disease, and the authors' experience raise the possibility that the occurrence of the disease is higher than previously thought. In this review the authors present and discuss literature data on the pathogenesis and pathomechanism, as well as their own experience concerning the symptomatology of Behcet’s disease in order to promote diagnosis and offer adequate therapy for the patients. The authors presume that the importance of the disease is underestimated in Hungary due to a considerable number of unrecognized cases and they propose to establish a national registry for Behcets disease. Orv. Hetil., 2013, 154, 93-101.

Concepts: Epidemiology, Medical terms, Autoimmune diseases, Prevalence, Hungary, Beh├žet's disease, Hungarian language, Kingdom of Hungary

167

Hairy cell leukemia is a mature B-cell non-Hogkin lymphoma characterized by unique clinical, morphological and immunhistochemical features. Patients with hairy cell leukemia usually present with splenomegaly, progressive pancytopenia and a relative indolent clinical course. The diagnosis does not always indicate immediate treatment, as treatment depends on the clinical stage of the leukemia. Asymptomatic disease without progression requires a watchful waiting policy, while other categories usually need treatment. The treatment of choice is purin nucleosid analogues (pentostatin, cladribine) which can achieve complete remission even for decades. Interferon and monoclonal CD20 antibodies can also significantly prolong tevent free survival. Unfortunately, only the latter two therapies are easily available in Hungary. Splenectomy, which was suggested as first line treatment before the era of purin nucleosid analogues, is only recommended as ultimum refugium. Although hairy cell leukemia is a well-defined lymphoproliferative disease, sometimes it is difficult to differentiate it from other similar entities such as hairy cell leukema variant, splenic marginal zone lymphoma, small lymphocytic lymphoma etc. Making the correct diagnosis is of utmost importance because of the great difference in treatment modalities. Recently, a somatic mutation was found in all analysed hairy cell leukemia samples, but not in other splenic B-cell lymphomas. This article reviews the significance of this observation and presents the different types of methods for the detection of this mutation. Orv. Hetil., 2013, 154, 123-127.

Concepts: Lymphocyte, Cancer, Types of cancer, Hematology, Leukemia, Lymphoma, Blood disorders, Hairy cell leukemia

27

The “gold standard” of the prevention of atrial fibrillation related thromboembolic events is anticoagulation therapy with oral vitamin K antagonists. A certain proportion of high-risk patients with atrial fibrillation are not receiving effective antithrombotic therapy because of problems associated with its use. Resolution of subsequent left atrial appendage thrombi is quite a great challenge in patients who are not tolerating “standard” antithrombotic drugs. According to the knowledge of the authors, this is the first report of a patient with non-valvular persistent atrial fibrillation and high stroke risk, who was intolerant to “standard” anticoagulant therapy and had persistent left atrial appendage thrombi following the use of a wide variety of “standard” anticoagulants. Successful resolution of left atrial appendage thrombi with dabigatran and successful percutaneous left atrial appendage closure were performed in this case. Orv. Hetil., 2013, 154, 262-265.

Concepts: Stroke, Atrial fibrillation, Thrombosis, Pulmonary embolism, Warfarin, Anticoagulant, Dabigatran, Left atrial appendage

27

The aim of the authors is to present two cases which raise the possibility of an association between polycystic ovarian syndrome/hyperandrogenism and ovarian cyst torsion in peripubertal girls. Androgen excess may cause more frequently ovarian cyst formation in premenarcheal or young adolescents with undiagnosed polycystic ovarian syndrome than in adults. The authors recommend that polycystic ovarian syndrome as wel as late onset congenital adrenal hyperplasia should be considered in peripubertal adolescents with ovarian cyst torsion. In case polycystic ovarian syndrome is confirmed, adequate management according to age and pubertal development of the patients should be commenced. Orv. Hetil., 2013, 154, 113-117.

Concepts: Ovarian cyst, Testosterone, Polycystic ovary syndrome, Mineralocorticoid, Congenital adrenal hyperplasia, Congenital adrenal hyperplasia due to 17 alpha-hydroxylase deficiency, Adrenal insufficiency, Virilization

25

The authors review the history and risk factors of thrombophlebitis of the lower limb, and describe the main points of surgical and conservative treatment of varicophlebitis. They present the case of a 71-year-old woman who had ascending varicophlebitis and bilateral pulmonary embolism. The authors draw attention to important points: patients must be followed after phlebitis of the lower limb, and their thrombotic factors must be examined to prevent the new thromboembolic events. Orv. Hetil., 2015, 156(16), 644-649.

Concepts: Pulmonary embolism

4

Introduction: In gastrointestinal diseases folk medicine usually recommends herbs and teas with antiinflammatory activities, especially mucilage and bitter agent containing plants. The use of stomatics as adjuvant therapy in medical practice is frequent. Aim: The authors explored the mineral element content of some herbs, because mineral elements may have significant role in the development and treatment of gastrointestinal diseases, and a close connection between the presence or absence of mineral elements and inflammatoric mediators was noted. Methods: The mineral content in Trigonellae foenugraeci semen, Farfarae folium et flos, Taraxaci radix and Cichorii radix and teas prepared from these herbs was determined using inductively coupled plasma optical emission spectrometry. The results were evaluated from nutritional and biomedical points of view. Results:Farfarae folium et flos tea was found to be a rich source of calcium, chromium, manganese and molybdenum. Trigonellae foenugraeci semen, Taraxaci radix and Cichorii radix displayed favourable calcium to magnesium ratio (1-1.5) and they contained other elements (manganese, iron, copper, zinc) which may have significant role in the immune defence system. Conclusion: The beneficial therapeutic effect of the studied herbs may be related to their mineral element content. Orv. Hetil., 2013, 154, 538-543.

Concepts: Medicine, Iron, Magnesium, Dietary mineral, Aluminium, Metal, Copper, Chemical elements

0

Preparative and clinical transfusiology and transfusion, a majestic part of clinical medicine saved the life of hundred millions. However, bloodborne or transmitted infections became a serious issue in France in the 1980s, when many haemophiliacs were infected by HIV or hepatitis C virus by receiving plazma FactorVIII concentrates. This resulted in a quick and powerful development of screening as well as pathogen-inactivating methods, which reduced pathogen contamination and transmission to minimal levels. Times and pathogens are continously and rather quickly changing, so during the last decade many - not only egzotic - new pathogens and diseases were recognised, and some of them (e.g., Zyka virus, Ebola, hepatitis E virus, etc.) can also be transmitted by blood or blood-component transfusions, and in some instances they escape from standard screening and inactivation procedures. Hereby we try to focus and draw attention to some of these potentially pathogenic new bloodborne microbiological agents, and along with this we try to emphasize the significance of application of updated next generation screening and inactivation procedures. Interestingly a recent British trial, based on large population data, showed some evidence of a slight increase of non-Hodgkin lymphoma incidence in patients with multiple previous transfusions. Probably these facts are even more important in haemophiliacs, who receive prophylactic treatment 3 times weekly either by plasma factor concentrates derived from multiple donors or by gene synthetic factor sources. It is important that haemophiliac patient and family should receive the necessary information, and go for a fully informed consent based on the potential advantages and hazards of a particular treatment modality, the same way as in the chronic treatment of other diseases. Orv Hetil. 2018; 159(37): 1495-1500.

0

The occlusion of the internal carotid artery (ICA) frequently leads to stroke and develops most commonly as a consequence of embolism or atherosclerotic thrombosis. Following acute care, if the patient’s general condition makes it possible, the patient is usually emitted from the hospital or, if necessary, his treatment continues in the rehabilitation department. The occlusion is generally considered irreversible, but a regular duplex ultrasonographic (sometimes CT angiographic) check of the patient is required. According to recent literature, spontaneous recanalization of the ICA may occur occasionally. The authors demonstrated by evaluating a local case that ICA occlusion is not necessarily permanent: through a case of a 67-year-old man, who suffered a right ICA occlusion, subsequent ichaemic stroke, then spontaneous recanalization of the occlusion allowing a successful endarterectomy later on, they overview the literature and propose appropriate prospective examinations to track patents with similar conditions. Orv Hetil. 2018; 159(37): 1525-1528.

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There are several statements about the connection between cardiovascular diseases and climate change. On behalf of our observation-based knowledge we hypothesized a relationship between the occurence of aortic aneurysm (AA) rupture and weather changes.

0

In a clinicopathological retrospective epidemiological study we investigated benign tumors and tumor-like lesions located in the orofacial region, diagnosed at the Universiy of Szeged, Department of Oral Medicine.