[Cyclosporin-A therapy in autoimmune diseases]. / A cyclosporin-A kezelés autoimmun kórképekben.

The author surveys the action of cyclosporin, its advantages over conventional immunosuppressive drugs and its side effects. This paper lists comparative research showing autoimmune diseases in which cyclosporin has been used as well as data confined to disease causality. It touches on almost all autoimmune diseases, and details rheumatoid arthritis, lupus erythematosus disseminatus, and the treatment of kidney disease, giving a review of the ideal usage of cyclosporin during laboratory and clinical testing and the reasons for dosage modifications. In organ transplants, it is necessary to determine the serum level of cyclosporin. In autoimmun diseases cyclosporin's effectiveness and side effects cannot be determined on the basis of blood serum level. Dose modifications should be based on serum creatinine levels and on diastolic blood pressure. On the basis of the literature and on his own experience, the author emphasizes the potential for new perspectives in drug usage. This is particularly true for Sandimmun-Neoral. His group for example has been the first to use Cyclosporin A to treat Polyglandular autoimmune syndrome and Henoch Schönlein disease and has achieved excellent results.

[Successful therapeutic use of intraglobin-F in idiopathic immuno-thrombopenia, refractory to corticosteroid and immunosuppressive therapy as well as to splenectomy]. / Corticosteroid, immunsuppressiv kezelésre és splenectomiára refrakter idiopathiás immunthrombopenia eredményes kezelése intraglobin-F-fel.

The authors present the case of a 21-year old woman patient who was admitted to hospital because of typical symptoms of chronic idiopathic thrombopenic purpura. Prednisolone therapy alone and subsequently combined with Immuran as well as later applied large dose of Methylprednisolone failed to be effective. Owing to the ineffective therapies and increasing hemorrhagic diathesis splenectomy was performed under perioperative Venagamma protection without success. Intraglobin-F therapy brought perfect recovery. The authors review the expectable results of immunoglobulin therapy, the strategy of ITP therapy changed as a consequence of the new therapeutic possibility as well as the indications of immunoglobulin treatment.

[Differential diagnostic problems in Lyme disease (Borrelia infection resulting in acute exogenous psychosis)]. / Differenciáldiagnosztikai problémák Lyme-kórban (Borrelia fertözés okozta akut exogen reakciós típusú psychosis).

Case of a 31 years old woman suffering from I and II type atrioventricular heart block, acute exogenic psychosis, intermittent type of fever and arthritis of right knee was described by the authors. The non typical clinical picture, the extremely elevated erythrocyte sedimentation rate and the exogenic type of psychosis caused differential diagnostic difficulties. Besides polysymptomatic autoimmune disorder, Lyme disease as emerged although there were no data of vector bite. In the consequence of steroid and combined antibiotic treatment the patient became immediately apyretic and the sedimentation rate returned to the normal limit. The psychotic symptoms have disappeared only two weeks following Ceftriaxon's and Doxycyclin's management. The high titer Borrelia seropositivity reserved to apply the diagnosis of Lyme disease.

[Smoldering myeloma]. / Smoldering myeloma.

The authors present the history of a 74 year old woman. The patient was observed from 1972. Initially the bone marrow and serum protein dischanges were identical to multiple myeloma, therefore she was treated with melphalan-prednisolone regimen for one year. She was symptom free for 12 years with none of any treatment. Her bone marrow picture and serum protein aberrations were stabil. In 1985, the clinical signs and laboratory parameters of multiple myeloma arised. Major clinical symptoms, myelomatous bone lesions were detectable and the monoclonal protein level increased. In activation period repeated local irradiation and VCMP and VACP polychemotherapy was performed. Her history was typical to smoldering myeloma. The presentation of that disease is not available in Hungarian literature. The authors present the criteria of diagnosis, the therapeutic possibilities and the differential diagnosis of benign and malignant gammopathies.

[Polyglandular autoimmune syndrome type II]. / A II. típusú polyglandularis autoimmun syndroma.

The authors deal with the case of young woman in whom in a 4-year period step by step different endocrine disorders developed after a virus infection. Finally a severe immunthrombocytopenia evolved. On the basis of these the rare polyglandular autoimmune syndrome type II. was diagnosed. Substituent therapy and stoss therapy with steroid was performed, but because of the insufficient therapeutic effect and the strong thrombopenic bleeding Cyclosporin therapy was necessary. The effect of the later therapy caused total remission of the illness. At present the patient is under their control. The case could arose interest because of the rarity of the illness and the very good effect of Cyclosporin therapy.

[Successful treatment of hyperthyroidism simulating acute abdomen and psychosis]. / Akut hasi katasztrófa képében jelentkezö és psychosist utánzó hyperthyreosis gyógyított esete.

A 49 years old female patient entered the surgical department because of epigastric and ileocoecal pains with the symptoms of acute abdomen. A surgical intervention was performed because of supposed appendicitis, but it was not verified. During the surgical observation the patient was confused and negativistic so she was transferred to the psychiatric department. Because of loss of 20 kg weight, high blood sedimentation and anaemia she was sent to our department with the suspicion of an organic disease. A moderate exophthalmos, glittering eyes and Graefe's sign was noted, therefore hyperthyroidism was diagnosed, which was proved by Kocher's blood picture, low serum cholesterol, extremely high T3 and T4 level, and iodine storage diagram. The antithyreotic treatment resulted a dramatic improvement in the extremely serious moreover hopeless case and after a long-term treatment the patient became symptom-free without complaints. Later because of regression of hyperthyreoidism and the growing nodular goitre the patient was treated on two occasions with radioactive iodine. At present the patient is in remission.

[Hyperparathyroidism simulating severe hypercalcemia syndrome]. / Súlyos hypercalcaemia syndroma képében jelentkezö hyperparathyreosis.

The case history of a 65 year old female patient has been reported here by the authors. The patient was admitted to the Intensive Therapy Unit owing to her repeated heart pain. Later she was transferred to the Department of Medicine to establish the exact diagnosis. Prepyloric ulcer and hypertension were occurred in her history. The symptoms of her preceding as well as her recent illness were: pain in epigastric field, nausea, adynamia, weakness, polyuria, significant loss of weight, somnolence and the shortened Q--T time in electrocardiogram related to hypercalcemia syndrome. The calcium value in blood proved to be at critically high level from time to time. The possibility of the secondary hypercalcemic state was excluded by sonographic examination and the elevated level of parathormone in blood established the diagnosis of the hyperparathyroidism. The surgical resection of parathyroidic adenoma yielded a complete recovery of the patient. The authors call the attention to the significance of the clinical signs in the diagnosis of the disease.