Biomedical subjects
J Iványi
Publications and source records attributed to J Iványi.
The existence of lymphoid lineage restricted Philadelphia chromosome-positive acute lymphoblastic leukemia with heterogeneous bcr-abl rearrangement.
Analysis of lineage involvement was performed in 17 Philadelphia chromosome-positive acute lymphoblastic leukemia patients with no history of chronic myeloproliferative disorder. The percentage of blastic cells as defined by flow cytometry matched that of the Ph-positive cells in 14 out of 17 patients. The bcr-abl rearrangement was investigated by fluorescent in situ hybridization in morphologically identified blastic cells, myeloid elements, lymphocytes and erythroblasts using a combined light and fluorescent microscopical imaging. Lymphoid lineage restriction could be determined in all but three of the patients. These 14 patients exhibited heterogeneity in terms of m-bcr and M-bcr types of translocation as revealed by reverse transcription polymerase chain reaction. The three patients with multilineage involvement and M-bcr type of translocation reverted to chronic phase and the percentage of Ph-positive cells remained high. Thus, we could identify an uncommitted stem cell origin among Ph-positive ALLs only in those patients whose disease subsequently proved to be a lymphoid blastic crisis with clinically silent chronic phase.
[Clinical and pathologic description of stroke patients (1990-1994)].
UNLABELLED: Data relating to stroke patients at a department of internal medicine (50 beds) in a county teaching hospital were studied in period 1990-1994. In this five-year period, 1184 patients were admitted because of some forms of stroke. The mortality due to the stroke was 16.8% (199 patients, deceased group). Autopsy was performed on 159 of these 199 patients (autopsy rate: 79.8%). Age- and sex-matched controls were selected from the survivors (n = 159). The main risk factors of stroke were analyzed in both groups: hypertension, cardiac events (decompensation, atrial fibrillation, and old myocardial infarction), previously verified diabetes, and recurrent stroke in the history. The mean hospital nursing time for the survivors was 12.3 +/- 6.3 days, while that in the deceased 7.2 +/- 7.6 days. RESULTS: 1. Hypertension was present to similar extents in both groups (survivors: 82.1%, deceased group: 77.8%) 2. Decompensation occurred in 5% vs 18.2% fibrillation in 11.3% vs 13.8%, and old myocardial infarction in 5.6% vs 18.2% 3. Diabetes was observed in 21.3% vs 36.4% and 4. Recurrent stroke in 22.6% vs 39.6%. These risk factors strongly predicted the outcome of the stroke. Other recently observed factors (haemorrhagic form, conscious state, time of hospital admission, seasonal variation, higher erythrocyte sedimentation rate, hyperglycaemia, proteinuria, early deep vein trombosis) revealed also significant differences between survivors and deceased patients. Since pulmonary thromboembolism was twice as frequent in the deceased patients as in the survivors, early heparin prevention is necessary immediately after computer tomography which excluded the haemorrhagic type of cerebrovascular diseases.
[Preventive treatment in internal medicine by low-molecular-weight heparin (nadroparine calcium)].
On the basis of literature data the authors discuss the preventive treatment of the low-molecular-weight heparin in various non-surgical disorders. The method was compared with unfractionated heparin in the treatment of 20 high risk patients. The efficacy of the two different heparins was examined on the liver and renal function, blood lipids and the hematologic and hemostaseologic parameters. The thromboembolic and hemorrhagic complications were observed. Significant difference was not found with the comparison of the two preparations. The authors emphasize the simplicity, safety, home treatment possibility of the low-molecular-weight heparin and the regular control of thrombocyte-count only, too.
[Quo vadis pathologia? An elderly clinicians meditations about autopsies].
Relying on his own experience and the relevant literature of the past 15 years, the author analyzes the causes of the decrease in the number of autopsies. He disagrees with those who, referring to the application of state-of-the art examination methods, dismiss "the ultimate audit" as unnecessary and only suggest selection. Careful autopsies can still be rendered an authentic and reliable picture of treatment of the deceased on the one hand, and provide information about diagnostic difficulties as well as the possible mistakes and errors on the other. This is especially true of the elderly deceased usually with multimorbidity. As well as several aspects of the cooperation between the pathologist and the clinician there is the didactic importance of autopsies that should also be emphasized.
[Nothing is new under the sun].
Explore the source record for details and available documents.
[Evaluation of captopril-enalapril replacement therapy in hypertensive patients under ambulatory blood pressure monitoring].
Authors performed a comparative study of replacement of captopril (2-3x daily) therapy with once daily enalapril. Blood pressure was measured by 24-hour ambulatory monitoring. The study enrolled 62 patients with mild to moderate hypertension. Captopril was previously administered 2-4 times per day, in mean dose of 74.4 mg, for 3.2 years as an average. After a 4 x 4 weeks study period the final enalapril dose was 15 mg, once in the morning. Enalapril was administered as monotherapy in 36 cases. During the trial mean blood pressure decreased from 140 +/- 14/85 +/- 9 mmHg to 125 +/- 12/76 +/- 7 mmHg (p < 0.01), diurnal index increased from 12/10% to 15/11%. Enalapril treatment lowered daytime percent time elevation index (PTI) from 56 +/- 30% to 27 +/- 23% (p < 0.05), nighttime PTI from 64 +/- 34% to 37 +/- 35% (p < 0.05), and hyperbaric impact values from 183 +/- 152 mmHg x hour to 97 +/- 128 mmHg x hour (p < 0.01). Adverse effects of both drugs were rare and mild, enalapril caused no changes in overall quality of life. Improvement of antihypertensive efficacy after a switch to enalapril treatment could be related to better compliance achieved by once-daily dose, and tight out-patient blood pressure control. The authors concluded that after a 16 weeks of therapy, once-daily enalapril administration was more effective and compliant in reducing blood pressure, than 2-4 times per day captopril treatment, when measured by 24-hour ambulatory blood pressure monitoring.
[Acarbose, an unduly neglected antidiabetic drug].
UNLABELLED: The long-term benefit of acarbose treatment was studied prospectively 20 NIDDM patients on diet, and 20 IDDM patients were treated with acarbose and followed for six years. 5 NIDDM patients and 7 IDDM patients were dropped-out due to side-effects or planned pregnancy or price of the drug. In the NIDDM group, acarbose treatment had to be supplemented with sulfonylureas in six patients, and a conversion to insulin had to be carried out in two patients. At the end of the study, all of NIDDM patients had a significantly lowered fasting blood-glucose level as compared to the baseline value. In the IDDM group, the postprandial blood-glucose level (at 90 minutes after meal) was significantly decreased, whereas the fasting glucose level remained unchanged versus the baseline level. In both groups, the values of HbA1c and serum lipids were significantly better than before acarbose treatment. The frequency of hypoglycaemic episodes was decreased, the body weight was without significant change. In addition, five NIDDM patients with late sulfonylurea-resistance were also treated with acarbose and followed for two years. After six months of treatment, however, four out of the five patients had to be converted to insulin. CONCLUSIONS: 1. in both types of diabetes, acarbose is an effective drug and decreases the frequency of hypoglycaemic episodes, 2. NIDDM patients having diet in effectivity require sulfonylureas or insulin late if acarbose administered and 3. in IDDM patients acarbose subsides the postprandial hyperglycaemia and smoothes the daily blood-sugar profile.
[Six-year follow up on recently diagnosed NIDDM patients].
The six-year prospective data on 100 newly detected NIDDM patients aged 40-69 years were analysed. After careful and controlled dietetic training, the carbohydrate metabolism parameters (glycohaemoglobin, mean blood sugar level and glycosuria), the physical status, fundus picture and laboratory data (lipids and renal function) were examined yearly and the alterations of the treatment were registered. 24 patients dropped out during six years. 10 patients died. The carbohydrate status was also favourable and a moderate weight reduction was reached. After two years 59% of the patients proved well controlled. At the end of six years 41% of the patients were still well controlled merely by dietary means. The data were compared with those on 100 similarly detected new NIDDM patients whose education and control were provided by family physicians. There were non essential differences between the two groups in specific complications, BMI and lipids. The level of carbohydrate metabolism control was significantly better in the diabetic clinic-controlled patients; the proportion of sulfanylurea-treated patients was only 40.5% after six years compared with 73% among family physicians-controlled patients. The importance of a correct and controlled diet, good education and continuous control is emphasized.
[Again (?): the quality of life of hypertensive patients].
Explore the source record for details and available documents.
Co-expression of c-abl and c-myb oncogenes in Philadelphia chromosome-negative, bcr-negative chronic myeloid leukaemia.
Three cases of Philadelphia (Ph) chromosome-negative, bcr-negative chronic myeloid leukaemia (CML) have been investigated for oncogene expression by Northern blot and cytoplasmic RNA dot blot hybridization. Considerably high levels of expression of c-abl and c-myb were observed in all cases. In the Ph-negative cells the normal 6.0 and 7.0 kb c-abl and 3.8 kb c-myb transcripts were found. No amplification of c-abl or c-myb oncogenes was detected in the DNAs of Ph-negative CML cells. Data suggest that co-operation between the overexpressed c-abl and c-myb oncogenes is causally related to Ph-negative bcr-negative CML.
[Reducing the incidence of fatal pulmonary embolism by preventive administration of heparin].
The authors had introduced the heparin prevention routinely from 01 January 1985 on the patients with predisposing factors in consideration of the contraindications. The death of pulmonary embolism was compared retrospectively with the pre- and post-prevention five years period in an autopsy material. During 10 years 340 patients died in pulmonary embolism. During the first period the total mortality was 24.6% because of pulmonary embolism, but in the second period it was only 19.4%. This percentage would be improved with more widely used heparin prevention (early and sufficient dose).
[Diabetic ketoacidosis (169 episodes in 131 patients in the course of 10 years)].
Diabetic patient material--presenting hyperglycaemic ketoacidotic episode--observed in Gyula and Szekszárd County Hospitals in period 1980-89, was reviewed by authors. 131 patients were admitted with 169 ketoacidotic episodes (among them 23 patients had 62 recurrences). The mean age of patients were 49.4 years (14-84 years), duration of diabetes 9.5 years (from one month to 45 years). The common cause of diabetic ketoacidosis was respiratory (26 per cent) and enteral (35.5 per cent) infection. The consciousness of patients had shown close correlation with the increase of blood sugar and urea nitrogen level as well as with the decreasing of the pH value of capillary blood. The first step of the therapy was the parenteral fluid intake with isotonic solution (in the first hour the average 1351 ml). In 18 patients fast-acting insulin (Novo Actrapid MC) was given by constant infusion, in the remaining cases intravenous or intramuscular low doses of the same insulin were administered. The importance of early potassium replacement, and the dangers of forced and rapid correction of acidosis is emphasized. Lethality related to episodes was 10 per cent, related to the patients 12.9 per cent. The number of ketoacidotic cases did not decrease parallel with the improvement of therapeutic possibilities, as it was experienced by their earlier evaluations. The importance of the prevention of acute metabolic disorders is outlined might be resulted from increasing the efficacy of patients education and better knowledge of GP's, as well.
[Angiologic aspects of surgery of the extremities in diabetics].
Explore the source record for details and available documents.
[The anti-lipidemic effect of Minipress].
Prazosin (Minipress) monotherapy was given to 152 patients with essential hypertension for one year in a multi-center study involving 13 hospitals and university clinics. In three centers serum levels of total cholesterol, HDL-cholesterol and triglycerides were also determined in 32 patients with hypertension and hyper/dys-lipoproteinemia. As a consequence of Minipress monotherapy significant decreases were found in serum level of cholesterol (after three months and also after one year), triglycerides (after one year), while the serum concentration of HDL-cholesterol increased. Atherogenic index (a ratio of total cholesterol over HDL-cholesterol) was significantly decreased by Minipress. As new data showing a causative correlation between hypertension and hyperlipoproteinemia were published in the literature authors, on the basis of their results, suggest to determine lipid profile in every patient with hypertension. They regard Minipress as the first line drug in young patients with "familial dyslipidemic hypertension". When choosing an antihypertensive drug metabolic side effects should be taken into consideration.
[Insulin-induced lipoatrophy--caused by monocomponent insulin?].
Authors give case history of two patients for type II diabetes treated with insulin by whom with monocomponent insulin lipoatrophy developed on the region of insulin administration. In the case of one of them the problem was solved by elimination of technical fault, the local reaction of other patient ceased only by converting to human insulin into the lipoatrophic region. In the latter case dynamics of contemporaneous psoriatic change raises immunological connections.
Observations with captopril (Tensiomin) treatment in hypertensive patients (one-year period).
In the treatment of patients suffering from therapy-resistant hypertension the angiotensin converting enzyme inhibitor captopril seems to be one of the most promising drugs of the past decade. The authors examined and followed the effect of captopril (Tensiomin) for one year in 13 severe therapy-resistant hypertensive patients. The average arterial blood pressure of 12 patients suffering from essential hypertension and 1 patient with renal hypertension was, before the introduction of captopril therapy, 215/120 mmHg (SD +/- 23/18). At the end of the one-year examination period the average blood pressure was 186/111 mmHg (SD +/- 25/19). The acute effect of captopril was found to be very favourable, and the required blood pressure fall could be obtained during its long-term use even in cases of renal failure. Except for one case multiple combination therapy had to be applied in all patients for the moderation of blood pressure (in 5 cases 4, in 2 cases 5, in 1 case 6 drugs). The long-term use of the drug did not influence notably the serum potassium-carbamide-creatinine and SGOT values or the white blood cell count. On the basis of their results the authors emphasize that the therapeutic effectivity of captopril monotherapy is not sufficient in severe therapy-resistant hypertension cases, its adjuvant action may be expected in drug combinations. With daily doses lower than 200 mg demonstrable side-effects did not occur.
[Positive and negative sides in the management of diabetics].
Explore the source record for details and available documents.