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Orvosi Hetilap
Authors:
György Szabó
,
Éva Keller
,
Gergely Szabó
,
Gabriella Lengyel
, and
János Fehér

A szénhidrátszegény transzferrin (CDT: carbohydrate-deficient transferrin) meghatározása a napi 60 g-nál több alkoholt fogyasztók körében volt használatos, elsősorban biztosítás-orvostani szempontok miatt, mivel a szintje 2-3 héttel a fogyasztás befejezése után is informatív értékű. Célkitűzés: A vegyszerek, gyógyszerek vagy táplálékkiegészítők és úgynevezett proteinek nem rendeltetésszerű használata esetén a CDT% szintjére vonatkozóan nincs sok információ a szakirodalomban, ezért eseteinket bemutatásra érdemesnek tartjuk. Esetismertetés: A bodybuilderek CDT%-értéke mindhárom esetben, nem orvosi utasításra, hanem önként, laikus módon használt szerek, gyógyszerek, élelmiszerek fogyasztása után – alkoholt nem fogyasztván –, lényeges emelkedést mutatott. Következtetés: Mivel mindhárom bodybuilder egyébként egészséges, alkoholt nem fogyaszt, munkahelyén vegyszerrel nem kerül kapcsolatba, feltételezésünk szerint csak az általuk szedett, forgalomban lévő testépítő anyagok hatására mutathatnak emelkedett CDT%-szintet.

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Orvosi Hetilap
Authors:
György Szabó
,
Éva Keller
,
László Környei
,
Gabriella Lengyel
, and
János Fehér

A szénhidrátszegény transzferrin (CDT: carbohydrate deficient transferrin) meghatározása a napi 60 gr-nál több alkoholt fogyasztók körében volt eddig használatos, elsősorban biztosítás-orvostani szempontok miatt, mivel annak szintje 2–3 héttel a fogyasztás befejezése után is informatív értékű. Célkitűzés: A vegyszerek használata esetén a CDT-szintre vonatkozóan sok információ nincs a szakirodalomban, ezért eseteinket bemutatásra érdemesnek tartjuk. Esetismertetés: Az első esetben nitrobázisú lakk használata után egy hónappal történt a CDT-vizsgálat: a CDT értéke megemelkedett. A másik esetben mezőgazdasági (vegyszerező/permetező) növényvédelmi munkakörben dolgozónál történt a meghatározás 6 hónappal a munka befejezése után. A CDT értéke szintén nagyon emelkedett volt. Következtetés: Mivel mindkét dolgozó dokumentáltan alkoholos italfogyasztásra absztinens volt, így valószínűsíthető a CDT kórjelző/problémajelző értéke a vegyszerfogyasztás hatására. A szerzők úgy látják, hogy a CDT magas értéke vegyszeres expozíciók esetén utalhat a vegyszer okozta károsodás következményére.

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Hungarian Medical Journal
Authors:
György Szabó
,
Éva Keller
,
László Környei
,
Gabriella Lengyel
, and
János Fehér

Up to now, the measurement of carbohydrate-deficient transferrin (CDT) has been used in persons with a regular alcohol consumption of > 60 g/day, primarily due to aspects of insurance medicine, as its levels have an informative value even at 2 to 3 weeks after the discontinuation of consumption. Objective: There is scarce information in the literature concerning CDT levels in individuals who used chemicals, and therefore we think our cases deserve interest. Case Report: In the first case the measurement was performed at 1 month after the use of a nitro-based varnish, and the CDT value was elevated. In the other case the examination was performed in an agricultural worker who had used chemical weed-killers regularly but discontinued it 6 months before. He also had a very high CDT value. Conclusion: As both workers were documented abstainers, the CDT elevation might be due to the exposition to chemicals. The authors consider these high CDT values as markers of an injury caused by exposition to chemicals.

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Hungarian Medical Journal
Authors:
Emil Fraenkel
,
Rita Takács
,
József Hamvas
,
Gabriella Lengyel
, and
János Fehér

Non-alcoholic fatty liver disease (NAFLD) is an acquired metabolic disease of the liver caused by accumulation of triglycerides in the hepatocytes followed by necrobiotic inflammatory reaction, fibrosis, and even cirrhosis. The accumulation of fatty acids in consequence of insulin resistance lies in the background of the process; the next step of pathogenesis is activation of microsomal polysubstrate systems and the oxidative stress caused by the released free radicals. Obesity, insulin resistance, diabetes mellitus and hyperlipidaemia are important pathogenetic factors. Patients with cholelithiasis and with a history of diabetes mellitus are known to have complications of cholelithiasis more frequently in comparison to those without diabetes. Objective: The aim of the study was the observation of the incidence of cholelithiasis and its complications in patients with NAFLD, as well as the comparison of the incidence of cholelithiasis between healthy persons and patients with NAFLD. Method: Abdominal ultrasonographical findings of patients hospitalised at the authors’ department and of outpatients have been analysed. Patients with severe co-morbidity were excluded of the analysis. The patient population studied can be considered as a selected sample, since patients undergoing abdominal ultrasound examination attended the clinics because of various clinical complaints, and the majority of them were hospitalised at the department. Alcohol abuse was excluded with the help of history taking by several investigators. Gender distribution within each group was also analysed. The independence of the two examined variables was measured by the χ 2 test. Results: Steatosis was described in 38% of the examined patients; cholelithiasis was described in 16% of patients. Of patients diagnosed with steatosis, 16% had cholelithiasis or some of its complications. Non-alcoholic fatty liver disease has been diagnosed by ultrasonography in 33% of patients with cholelithiasis. The incidence of NAFLD among patients examined because of cholelithiasis and its complications is two times higher than the incidence of cholelithiasis among patients examined for NAFLD. Complications of cholelithiasis occurred more frequently among patients with NAFLD than in those without it. The χ 2 test has brought no significant result for the independence of cholelithiasis and NAFLD. Conclusion: The pathogenetic factors of non-alcoholic fatty liver disease may play a role in the development of cholelithiasis, and presumably the non-alcoholic fatty liver disease develops more quickly than cholelithiasis, upon the effect of the shared pathogenetic factors.

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Increased prevalence of insulin resistance in patients with nonalcoholic fatty liver disease (NAFLD) has been demonstrated in various studies. However, there are only few references regarding the relationship between plasma insulin values or insulin sensitivity index and the biochemical severity of liver infiltration. The aim of this study was to examine a relationship between symptoms of the metabolic syndrome, i.e. insulin resistance, body weight and plasma lipoproteins and the laboratory parameters of liver fatty infiltration in patients with nonalcoholic fatty liver disease. There was found a significant positive correlation between plasma insulin and alaninaminotransferase ( r = 0.359, p < 0.01) and a significant positive correlation between plasma insulin and aspartateaminotransferase ( r = 0.42, p < 0.01). Additionally, a significant positive correlation was found between the index of insulin resistance (HOMA index) and alaninaminotransferase ( r = 0.637, p < 0.01) and a significant positive correlation between the index of insulin resistance (HOMA index) and aspartateaminotransferase ( r = 0.49, p < 0.01).

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Hungarian Medical Journal
Authors:
Janos Feher
,
Balint Kovacs
,
Illes Kovacs
,
Monika Schvöller
, and
Corrado Balacco Gabrieli

Currently, age-related macular degeneration is one of the most common eye diseases causing severe and permanent loss of vision. This disease is estimated to affect approximately 300–500 thousand Hungarians. While no treatment was available earlier, in the recent decade an antioxidant therapy became very popular using combinations of high dosage antioxidant vitamins C, E, beta carotene and zinc. Based on theoretical concepts and mostly in vitro experiences, this combination was thought to be effective through neutralizing reactive oxygen species. According to a large clinical trial (AREDS), it reduced progression of intermediate stage disease to advanced stage, but did not influence early stage disease. This original combination, due to potential severe side effects, is not on the market anymore. However, the efficacy of modified formulas has not yet been proven. Recently, a combination of omega 3 fatty acids, acetyl-L-carnitine and Coenzyme Q10 has been introduced for treating early stage age-related macular degeneration through improving mitochondrial lipid metabolism and ATP production in the retinal pigment epithelium, improving photoreceptor turnover and reducing generation of reactive oxygen species. According to a pilot study and a randomized, placebo controlled, double blind clinical trial, both central visual field and visual acuity slightly improved after 3–6 months of treatment and they remained unchanged by the end of the study. The difference was statistically significant as compared to the base line or to controls. These functional changes were accompanied with an improvement in fundus alterations: drusen covered area decreased significantly as compared to the base line or to control. Characteristically, all these changes were more marked in less affected eyes. A prospective case study on long-term treatment confirmed these observations, with an exception that after slight improvement, visual functions remained stable, while drusen regression continued for years. Sometimes significant regression of drusen was found even in intermediate and advanced cases. All these findings strongly suggested that the metabolic approach may be the first choice for treating age-related macular degeneration. Currently, this is the only combination of ingredients which corresponds to the recommended daily allowances and shows clinically proven efficacy.

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Clinical and Experimental Medical Journal
Authors:
Emil Fraenkel
,
György Szabó
,
Gabriella Lengyel
,
Peter Jarčuška
,
Ivica Lazúrová
,
Elek Dinya
, and
János Fehér

Abstract

The non-alcoholic fatty liver (NAFLD) is an aquired metabolic liver disease as a consequence of triglyceride accummulation within the liver cells. It is accompanied by necrobiotic inflammatory reaction, fibrosis and also by liver cirrhosis. Its differentiation from alcoholic fatty liver (AFLD) looks sometimes to be difficult. It is simple knowing the clear anamnesis, but if the individual does not want to inform us about the alcohol consumption, the differentiation is not very easy.

Aim of the study: The aim was to determine the value of carbohydrate deficient transferrin (CDT) in patients with non-alcoholic fatty liver, as well as to analyse the high values according to the anamnesis.

Patients and methods: The group of patients consisted of 39 individuals, whose ultrasound examination showed the signs characteristic of fatty liver. The sex rate was: 21 female and 18 male patients. The values of CDT, body mass index (BMI) and HOMA index were determined. The mean value of CDT was: 239±0,52% (in male 2.51±0.61, in female 2.28±0.4). No significant difference was found between the two sexes. The diversity of CDT values was normal. The value of BMI belonged to the overweight area without any significant difference between the two sexes.

Conclusion: On the basis of the results the NAFLD and the AFLD can be diffenrentiated according to the CDT value, and this value could be a higher specific value than the activity of gammaglutamyl transpeptidase, though also in this relation the valuations of anamnesis and other factors are very important for achieving the correct diagnosis.

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Orvosi Hetilap
Authors:
Tamás Bálint
,
Gabriella Lengyel
,
Romána Zelkó
,
Sándor Halász
,
Zoltán Vincze
, and
János Fehér
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Orvosi Hetilap
Authors:
Tamás Bálint
,
Gabriella Lengyel
,
Romána Zelkó
,
Sándor Halász
,
Zoltán Vincze
, and
János Fehér
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Orvosi Hetilap
Authors:
Márta Kovács
,
Péter Pák
,
Artúr Németh
,
Gábor Pák
,
János Fehér
, and
István Rácz

Bevezetés és célkitűzések: A portalis hypertensio következtében kialakult vékonybéleltérésekről kevés irodalmi adat ismert. Retrospektív, összehasonlító vizsgálatukban a szerzők a kapszulás endoszkópia diagnosztikus eredményeit, valamint az észlelt elváltozásokat elemezték cirrhosis hepatisban szenvedő betegekben tisztázatlan eredetű gastrointestinalis vérzés esetén. Betegek és módszer: 11 cirrhosis hepatisban és portalis hypertensióban szenvedő beteg és 22 májbetegségben nem szenvedő kapszulás endoszkópiás vizsgálat eredményeit hasonlították össze felső panendoszkópiával és kolonoszkópiával nem tisztázott eredetű gastrointestinalis vérzés esetén. A filmeket két egymástól független vizsgáló értékelte. A kapszulás endoszkópiával vizsgált betegeket átlagosan 19 (1–42) hónapig követték. Eredmények: Két centrumban 48 hónap alatt 7 férfit és 5 nőt vizsgáltak, a betegek átlagéletkora 66,2 (±7,6) év volt. Az első klinikai tünet észlelésétől a vizsgálatig eltelt idő átlagban 15,7 (±14,9) hónap. A betegek ez idő alatt 2,8 (±1,3) alkalommal kerültek kórházi felvételre; egy beteg esetében átlagosan 7,9 vizsgálat történt a kapszulás endoszkópiát megelőzően. Mind a 11 betegnél vérzésforrást diagnosztizáltak kapszulás endoszkópia során a vékonybélben. 7 betegben (63%) két definitív vérzésforrást észleltek. Az összes beteg esetében portalis hypertensióval összefüggő elváltozásokat találtak (8 esetben angiodysplasia, 2 esetben portalis hypertensiv enteropathia és 1 esetben bélvaricositas igazolódott). A követés során az újravérzések aránya 27,3%-os volt; a kontrollcsoportban 18,2%-os. Következtetések: Portalis hypertensióban obskúrus gastrointestinalis vérzés esetén a kapszulás endoszkópia eredményes vizsgáló eljárás negatív panendoszkópiát és kolonoszkópiát követően. A vékonybélvérzések hátterében leggyakrabban multiplex angiodysplasiák állnak, és gyakoriak a többszörös vérzésforrások ebben a betegcsoportban.

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