Cardiology

Hypertension and nephrology

APRIL 30, 2024

[Effect of rilmenidine therapy on heart rate- and blood pressure variability as well as baroreceptor sensitivity]

FINTA Ervin

[The sympathetic nervous system plays an important and widely investigated role in the pathogenesis of the hypertension and its concomitant diseases.]

HUN 2024;28(2)

Hypertension and nephrology

APRIL 30, 2024

[Analysis of the antihypertensive effect of the antihypertensive rilmenidine]

FARSANG Csaba, LENGYEL Mária, BORBÁS Sarolta, ZORÁNDI Ágnes, DIENES Szórádi Bernadett

[The most recent national (MHT 2018) and the latest European guidelines (ESH 2023) (1, 2), diuretics, the calcium antagonists, ACE inhibitors, ARBs, α1-adren- noceptor blockers and ß-blockers, the so-called "centrally acting" imidazoline (I)-1 receptor agonists were also mentioned.]

HUN 2024;28(2)

Hypertension and nephrology

APRIL 30, 2024

[More ramblings in the plethora called primary aldosteronism]

BAJNOK László

[The issue of primary (hyper)aldosteronism (PA) is fraught with many contradictions, attempts to identify it are important but undeservedly rare. The recently introduced histological method with practical benefits indicates a new aspect of the spectrum disease character and a revolutionary study has also been published regarding the functional (radionuclide) imaging of PA.]

HUN 2024;28(2)

Lege Artis Medicinae

APRIL 30, 2024

[The misuse of insulin ]

BUZÁS György Miklós

[Discovered in 1922, insulin has saved millions of lives, and improved the quality of life of diabetic patients: it was and is the mainstay of antidiabetic treatment. Like many discoveries, however, it can also be used incorrectly, causing harm and even death. Attempted or terminated suicide as an important example of insulin misuse must be distinguished from accidental, deliberate or factitious insulin overdoses. With increasing prevalence of diabetes and spreading use of pharmaceutical insulin products, such cases are expected to rise. Regular, human and analogue insulins are used for this purpose. Famous killings by insulin were reported in both scientific and lay literature as reality cases, and achieved high rates of publicity. Insulin shock therapy used in psychiatry and post-vagotomy insulin tests can also have side effects or end up lethally. Insulin and insulin-like growth factor are also applied as drugs for doping. Investigations to prove insulin misuse benefit from the most advanced methods of clinical chemistry. ]

HUN 2024;34(4)

Lege Artis Medicinae

APRIL 30, 2024

[Club of broken-hearted women: myth or reality? MINOCA Takotsubo syndrome – case study ]

BODOR Alexandra, BENCZÚR Béla

[MINOCA (Myocardial Infarction with Non Obstructive Coronary Arteries) is a collec­tive term used for several disease with different ethiology and pathophysology. Takotsubo syndrome or “broken heart disease” is a quite new entity, discovered by Dr. Hikaru Sato professor. The first case was documented in 1983, published in 1991 and since then, we have better understanding on patients with ACS with­out occlusions in coronary arteries. The name “takotsubo” comes from Japan, which describes the shape of the pot traditionnaly used for octopus fishing. The shape of the vessel is similar to the left ventricular “apical ballooning” sign, what we can observe during ventriculography in TTS.The pathophysiology is still not clearly understood, but as far as we know, it is a quite complicated neurohormonal cas­cade, triggered by emotional and physical stress or iatrogenic factors. In the following case we introduce a young, female patient with ACS, where coronarography was performed but no coronary occlusion was  identified, but the ventriculography show­ed the previously introduced phenomenon and with  a twist at the end of diagnostic examinations. ]

HUN 2024;34(4)

Clinical Neuroscience

MARCH 30, 2024

[Thrombolysis treatment and multi- disciplinary management of central retinal artery occlusion in comparison with traditional ophthalmological treatment options ]

VAJDA Szilvia, GUNDA Bence, KNÉZY Krisztina, BARSI Péter, VARGA Csaba, MAUROVICH-HORVAT Pál, BERECZKI Dániel, NAGY Zoltán Zsolt

[The management of central retinal artery occlusion (CRAO) has long been conservative therapy with limited efficacy carried out in ophthalmology departments together with etiolo­gi­cal investigations lacking a standardised protocol. However, CRAO is analogous to ischemic central nervous system stroke and is associated with increased stroke risk, thus, systemic thrombolysis treatment and multidisciplinary management can be beneficial. Since May 2022, at Semmelweis University CRAO patients diagnosed within 4.5 hours are given intravenous thrombolysis therapy and undergo etiologic workup based on current stroke protocols. Here we report our experience with the multidisciplinary, protocol-based management of CRAO in comparison with former non-protocol based ophthalmological conservative treatment.

We reviewed CRAO patients’ data treated conservatively and with paracentesis within 6 hours at the Department of Ophthalmology between 2013 and 2022 including changes in visual acuity, neurolo­gical and cardiovascular findings compared to those in the thrombolysis project. 

Of the 78 patients receiving non-protocol care, visual improvement was seen in 37% with natural course, 47% with conservative treatment and 47% with paracentesis. Four patients had significant carotid stenosis (2 underwent endarterectomy), 1 carotid dissection, 6 cardioembolism and 1 giant cell arteritis. Of the 4 patients within 4,5 hours, 3 gave their consent to the clinical trial and were treated with thrombolysis and underwent a full etiological assessment. 
2 pa­tients had improved visual acuity, 2 pa­tients had significant carotid stenosis and underwent endarterectomy, 1 patient was started on anticoagulation for newly diagnosed atrial fibrillation.

CRAO patients presenting within 4,5 hours are rare and more patients are needed in our study to establish the efficacy of thrombolysis. However uniform protocollized evaluation helps identifying embolic sources thus, avoiding further and potentially more serious thromboembolic events.]

HUN 2024;77(3-4)