[Advances in the prevention, diagnosis and therapy of vascular diseases]. / Újabb ismeretek a különbözo vascularis kórképek megelozésében, diagnosztikájában és terápiájában.

Atherosclerosis is a systemic disease affecting the coronary, carotid, intracerebral, renal and peripherial arteries. The early morphological and functional impairments could be detected in the second or third decades of life and their progression depend on the number and severity of risk factors and individual susceptility. Although the vascular risk factors (smoking, overweight, age, unhealthy diet, lack of physical exercise, hypertension, diabetes mellitus, chronic kidney disease and dyslipidemia) are the same and common in the different vascular diseases, the present clinical routine artificially classifies the diagnosis and therapy of different vascular diseases into different subfields of medicine with the negative impact of possible polypragmasia. Recently, worldwide health surveys (e.g. REACH registry) have proven the usefulness of a holistic approach in the diagnosis and therapy of multiorgan-affected vascular patients. This review summarizes the multidisciplinary advances and future perspective of vascular diseases.

[Successful treatment of infrarenal aortic aneurysm in the case of a patient after renal transplantation]. / Vesetranszplantált beteg infrarenalis aortaaneurysmájának sikeresen kezelt esete.

The management of the abdominal aortic aneurysm is associated with several risk factors, especially in patients after renal transplantation. Endovascular aneurysm repair (EVAR) can be the proper treatment in feasible cases. The authors present a patient's case who underwent renal transplantation and developed an infrarenal aortic aneurysm some years later. A 50-year-old male patient was operated with EVAR. During the starting period of the procedure bilateral iliac dissection developed, and the endovascular approach was converted into traditional open operation. At the time when the aorta was clamped, an extraanatomic shunt was applied to ensure the blood supply of the transplanted organ. In the early postoperative period, a transient renal function impairment was observed. Later on, the renal function returned to normal values. In this article, alternative methods used to prevent ischaemic damage of the transplanted organ during the procedure are presented as well. Finally, the authors report the international trends and experiences in the field of preserving the viability of a transplanted organ during abdominal aneurysm repairs. Orv Hetil. 2019; 160(37): 1471-1475.

[Multiple obliterative vascular disease. Challenge in diagnosis and in treatment]. / Multiplex obliteratív érbetegség. Kihívás a diagnosztikában és a kezelésben.

UNLABELLED: Currently, peripheral arterial disease is an underdiagnosed disorder. Several modifiable and non-modifiable risk factors have role in its development and progression. As system disorder it might be a part and an important predictor of fatal cardio- and cerebrovascular events. CASE REPORT: The authors describe the case of a 73-year-old male with multilocational vascular disorder, with simultaneously occurring carotid disease, critical limb ischaemia with aorto-bifemoral bypass, multiple infarction with mechanical complication, inoperable coronary disease and with implantable cardioverter defibrillator for ventricular arrhythmia. CONCLUSION: Peripheral arterial disease affects the whole vascular system and can progress into serious cardiac and cerebral manifestations causing the patient's death inspite of comprehensive treatment.

Hydrogen Sulfide Abrogates Hemoglobin-Lipid Interaction in Atherosclerotic Lesion.

The infiltration of red blood cells into atheromatous plaques is implicated in atherogenesis. Inside the lesion, hemoglobin (Hb) is oxidized to ferri- and ferrylHb which exhibit prooxidant and proinflammatory activities. Cystathione gamma-lyase- (CSE-) derived H2S has been suggested to possess various antiatherogenic actions. Expression of CSE was upregulated predominantly in macrophages, foam cells, and myofibroblasts of human atherosclerotic lesions derived from carotid artery specimens of patients. A similar pattern was observed in aortic lesions of apolipoprotein E-deficient mice on high-fat diet. We identified several triggers for inducing CSE expression in macrophages and vascular smooth muscle cells including heme, ferrylHb, plaque lipids, oxidized low-density lipoprotein, tumor necrosis factor-α, and interleukin-1ß. In the interplay between hemoglobin and atheroma lipids, H2S significantly mitigated oxidation of Hb preventing the formation of ferrylHb derivatives, therefore providing a novel function as a heme-redox-intermediate-scavenging antioxidant. By inhibiting Hb-lipid interactions, sulfide lowered oxidized Hb-mediated induction of adhesion molecules in endothelium and disruption of endothelial integrity. Exogenous H2S inhibited heme and Hb-mediated lipid oxidation of human atheroma-derived lipid and human complicated lesion. Our study suggests that the CSE/H2S system represents an atheroprotective pathway for removing or limiting the formation of oxidized Hb and lipid derivatives in the atherosclerotic plaque.

Rare, late complications in a patient with Hodgkin's disease.

We report a unique case of a cured Hodgkin's disease patient who developed several complications decades after mantle and neck radiation therapy. First on the right, then years later on the left side of the neck a pharyngocutaneous fistula developed complicated by rupture of the carotid arteries on both sides necessitating their ligation. The fistula on the right side was successfully closed by plastic surgery, but the one on the left side is still a problem as severe hypoperfusion of the brain limits therapeutic possibilities. We discuss the relationships between the treatment for Hodgkin's disease and subsequent complications as well as treatment of these complications.