Dr. János Kádár

Internist - Immunologist
+36 30 908 42 04
drkadarj@t-online.hu

Examination

My name is Janos Kadar M.D. I am an internist, immunologist working at head doctor of Szent László Hospital Infectious Department, and my status is in inflammatory and autoimmune. I worked sixteen years at the Department of Internal Medicine of Semmelweis University and more than five years as the head of the department. In my private practice, I provide assistance in the treatment of autoimmune originated diseases.

The majority of the patients arrive with hard-to-resolve cases and they have gone through several previous examination. Within the confines of appointment, I examine the patients, review the medical records and talk to them. Most of the patients have their own ideas about the sources of their complaints and sometimes they come with exact questions. In some cases, it is necessary to decide whether there is organic reason e.g. an inflammatory process in the background and answer if it has immunological or infectious origins. Finally, we also have to discuss what could be the additional steps afterwards.

We can talk about the supplementary diagnostic procedures and the medication that may arise. We also review what could be the side effects and the expected duration of each treatment option. Both at Istenhegyi Klinika and Szentendre the private practice provide additional examination facilities for extra charge such as X-ray, wide range of laboratory tests, ultrasound and other imaging examinations.

Private practice is in several places like the Buda Allergy Center, a clinic in Medoc, Istenhegyi gene diagnostics, the Genium Family Planning Center and the MOM Park Medical Center. At these locations, additional test options available.

Most often I work with these problems and illness: autoimmune and immune diseases (SLE/lupus/Sjögren, rheumatoid arthritis, myositis, scleroderma, progressive systemic sclerosis), immune system disorders, organ-specific immune diseases (kidney disease, skin disease, joint inflammation (inflammatory low back complaints, complaints of the small joints), patchy hair loss, cartain blood count abnormalities, autoimmune thyroiditis), unexplained fever or hyperthermia, malaise, fatigue, prolonged diseases, inflammation, vasculitis.

Boundary Area of repeated miscarriage and infertility: on these issues the immunological considerations arise more and more frequently, and in many cases raised the question whether there is an immunological process in the background.

Sometimes the unusual frequency of upper respiratory catarrhal symptoms, prolonged cold- because of the repeated oral aphthae there is need for the immunological examination.

Frequently asked questions
  • Alopecia areata (hair loss)
  • Fever of Unknown Origin (FUO)
  • Thyroiditis
  • SLE
  • Backache
  • Sjögren syndrome
  • Habitual abortion (infertility)
  • Screening for hidden cause

It usually begins when the hair fall out in a limited area? It usually begins when clumps of hair fall out, resulting in totally smooth, round hairless patches on the scalp. In some cases the hair may become thinner without noticeable patches of baldness, or it may grow and break off, leaving short stubs (called "exclamation point" hair). In rare cases, complete loss of scalp hair and body hair occurs. The hair loss often comes and goes-hair will grow back over several months in one area but will fall out in another area.

When a patient comes to me because of hair loss,, the symptoms usually persist for a long time , the patient has often already gone through the urologist , gynecologist, otolaryngologist and dentist. Perhaps, despite his adulthood, his tonsils have been removed.

In most cases, the healing process is failed.

How will I help:

The patient interview is the primary way of obtaining comprehensive information about the patient in order to provide effective patient-centered-care. A comprehensive patient interview includes inquiring about the patient’s medical, medication, social, personal and family history, as well as a thorough review of the examinations. By reviewing the medical history, we determine whether there is a general inflamatory process, for example: we determine whether the clinical aspects of papolous trace back to allergy. If the above process, a prolonged antigen stimulation should arise , it is necessary to rethink about what other reasons might arise.

Often the cause is not detectable , and there is just only one method, the local, immunological inhibition : it is possible to choose the kind of medication which does not affect the whole organism, there is no systemic effect, but effective concentration can be reached on the treated area. Unfortunately, the patchy hair loss cannot be cured by immunologist, but in such cases you should always seek the opinion of an immunologist.

The fever of Unknown Origin (FUO) is defined s defined as a temperature higher than normal that lasts for weeks with no obvious source despite appropriate investigation. When the patient present himself at the examination, he has already been tired of searching.

When a patient seeks advice, the brought sheaf of papers usually contains everything and the usual, routine tests have already been done . That means chest X-ray , abdominal ultrasound , laboratory testing have been made and the patient has already visited otolaryngologist many times. Some patients arrive with their tonsils removed, or they have already received one or more antibiotics treatment. Its typical symptoms are: weakness, tiredness, loss of appetite, decreased performance, or even the catarrhal symptoms of night sweats.

How will I help:

First of all, I look carefully at the reports and I interview the patient which is followed by the medical checking.

It is decided whether there are inflammation, autoimmune disease, infection or cancer in the background. It is common for accelerated sedimentation, anemia, asiderosis. The older of the complaint, the lower of the chance for infection.

Generally, there is non- exotic disease in the background, during the medical checking, we would prefer to search for often occurred diseases which require urgent reaction.

In some cases – the quarter of the cases – the source of the complaint has never been found, and usually it disappears by time. The medical check-up is being built by this fact, so if the examinations do not take us forward, I suggest to my patients (next to the treatment of the symptoms) that we should wait and see what time will bring. In order to see if there is any problem or if there is any clinical aspects blooming, I propose the periodic control, so we can easily find out and it is easier to detect.

In most cases, there is no medical emergency, but the complaints are unpleasants.

The thyroiditis, medically known as Hashimoto's thyroiditis, It is an autoimmune disease. The thyroid gland is an protracted inflammation, which usually do not associated with pain, today it is often that the process remain unnoticed. The final result is the destruction of the gland cells- the consequence is hypofunctionality (hypothyrosis). While the inflammation is carried, The autoimmune disease namely active, thyroid function can be temporarily enhanced, It views an periodic hypofunctio. Then, the thyroid gland slowly "burns out" It remains reduced function.

There are various ways of detecting the disease : blood tests, sample from thyroid tissue, taking picture with isotope. If the gland cells atrophy has occurred, it is no longer necessary to restrain the inflammation, immune system, in this case we have to replace the hormone loss.

With this method, we can create complete balance and in case of proper medical treatment, the life expectations and quality are not worst. In such cases it is advisable that the patient is treated by an endocrinogist.

In typically cases, patients have hormone production disorders and they arrive with blood tests which are indicative of inflammatory processes. Low-grade fever, tremors , increased sweating , palpitations occur.

How will I help:

During the medical checking, I have to decide whether there is an ongoing inflamatory process, there are any anti- thyroiditis anytbodies in the blood, at which stage the process stands: whether is it on the maximum of the inflamatory, when the hyperthyroidism is taking place, or the thyroid was beginning to die and hormone test is required.

It is common that the thyroid inflammation associated with other autoimmune diseases, a thorough questioning of the patient, the examination and the overview of the detailed findings is therefore very important.

SLE is a chronic autoimmune disease that can affect almost any organ system; thus, its presentation and course are highly variable, ranging from indolent to fulminant. Most of the cases of SLE occur in young women, frequently starting at childbearing age. Symptoms can vary and can change over time: characteristic of an arthritis, fever, abnormal laboratory findings are indicative of inflammation, abnormal urine findings, sun provoked skin symptoms.

The most common symptoms and signs include fatigue and fever, joint pain, stiffness and swelling, butterfly-shaped rash on the face that covers the cheeks and bridge of the nose, skin lesions that appear or worsen with sun exposure (photosensitivity), fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon), shortness of breath, chest pain, dry eyes, headaches, confusion and memory loss. Typical immunological findings: f.ex.: ANA positivity, ds- DNA positivity.

The disease is characterized by periods of spontaneous remission and relapse, but it could trigger life-threatening, serious condition. During the waves of activity, more and more new symptoms may appear. In cases of internal organ involvement form the worse prognosis group.

Involvement of the joints is quite common (90%), inflammation of joints ( arthritis ), the joints are aching, limited movement is described, in particular the characteristics of the morning stiffness. Affected joint’s permanent deformity is rare. The different mucous membranes, palate, nasal septum rarely get sick.

The kidneys’ life expectancy is essential. In the care of the kidney is one of those organs that we should absolutely check. The heart can be damaged in many ways, the disease can affect the pericardium, the heart muscle, cardiac valves.

How will I help:

When I first meet the patient, who suspects SLE, it is essential to examine the reports and I have to interview the patient.

It is very important that, the patient brings the completed, previous findings. I must first determine whether there is indeed lupus. In this case, an international point system has been applied. If internal organs affected, the best place for the patient is between hands of an internal medicine – immunologist.

The treatment aims to reduce the inflammation processes, prevent the development of organ damage. The treatment includes adrenocortical hormones (steroids) and other immunomodulatory medications. The regular medical check-ups are highly important for SLE patients. Some laboratory studies suggest that it may have been premature ignition. Particular care is needed for family planning, especially the immunological point of view regarding the selection of the appropriate periods, and the necessary medication.

The rheumatologist is responsible of analyzing the low back pain, searching for the diagnosis and caring of patients. However, there are cases where the process has immunological origin, as a result of inflammation. The complaints occur for example, in the morning, but it is also possible that the patient is suffering all night because of the pain, and cannot sleep.

In the morning the joints are stiff and this can sometimes take several hours. Typicalsymptoms are low-grade fever or other large joints pain, fatigue. Sometimes painful joints along the sternum as well. Most of the time, around the sacrum- so-called" Sacroiliac " joints affected. This recognition is important because it determines many things. The inflammation of the joints can be a very early indication.

The above mentioned clinical aspects, since there has been no accompanied immunological findings deviation, it is called "seronegative" arthritis. A wide variety of diseases belongs to this, and it sometimes causes concerns, because there is no an undeniable laboratory or clinical symptom , so the diagnosis should be based on the doctor's experience. In addition, the treatment’s effect does not occur immediately, so it is very difficult to check the effectiveness of the medication.

The physician must meet two contradictory tasks: secured diagnosis and early treatment. Indeed, when the disease is already certain, in fact, there are differences showed in X-ray, the treatment will no longer be early - the diagnosis was too late. Once the disease onset is slow and often we are too cautious, therefore, the chosen medication cannot be given.

Certain skills, experience and courage must need for diagnosis and early detection of such diseases. Surprisingly, there are many of these patients, most of them have misplaced in the first period.

How will I help:

If the origin of low backache is the inflammation of the joints, or perhaps this is the first sign of disease of immune system, the most important task is inflammation.

This is not only important because the patient gets rid of the pain - although this aspect is not negligible.

Due to inflammatory metabolites formed in the joints, which sooner or later, but surely few months later very often chew the articular surface, where burns are come into being. This point must be prevented, because at this stage, there is limited possibilities to treat it.

If the first sign of the immune system disease is the law-backache, there are immense advanages of timely recognition.

Nowadays, to reduce the inflammation, doctors suggest an active treatment first, thus they often use adrenal hormones, steroids. The patient can slowly withdrawn these by adding another immune system retarding medicine.

All I can do is to encourage patients to prepare for inflammatory condition assessment tests - this consists of mostly a simple phlebotomy - in order to quickly detect the immunological cases.

Sjögren syndrome is a systemic chronic inflammatory disorder characterized by lymphocytic infiltrates in exocrine organs. Most individuals with Sjögren syndrome present with sicca symptoms, such as xerophthalmia (dry eyes), xerostomia (dry mouth), and parotid gland enlargement. Sometimes it affects organs. Sjogren's syndrome often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. In Sjogren's syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased production of tears and saliva.

A typical middle-aged woman patient. The disease is not so uncommon, every 100 people are affected. The majority of the cases are very slowly, it may take several years, but there are other autoimmune diseases, are characterized by same symptoms, it accompanied with inflammation, muscle inflammation, lung that involve a flaring up forms. involving, flaring up forms. In many cases a palpable enlarged lymph nodes, in rare cases cancer may also develop.

How will I help:

When a patient visits me, with the suspicion of Sjögren's syndrome, I should be thoroughly study the existing findings and I need to question the patient. It is very important to bring the completed, previous findings. I must first determine whether the disease is active or not. Because if it is not, which means the disease is dormant or extinct, there is no need to treat it, as we are facing only the result of the destruction, the decrease mucus production of the atrophied glands. The treatment aims to reduce inflammation and to prevent the development of organ damage. This can be treated by taking adrenocortical hormones (steroids) and other immunomodulatory medicines.

It cannot be stressed enough the importance of a regular medical check-up. Some laboratory tests can already indicate a flare at an early stage. If the patients takes immunological medication, this has to be under regular control and the effects and side effects have to be followed. It is also necessary to control the status of the lymph system. I usually recommend two to four medical checks per year. In this case, blood test is done as well and the result is evaluated after two weeks.

The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease.

With pregnancy and complaints related to early abortion, the most appropriate way is to turn to gynecologist first. The recognizable or discoverable immunological causes compose a small margin of cases. Even in such cases, the first step is recourse to adequate gynecological care – regarding the rules of the profession, the diagnose can only be clear after the immunological background tests have been made.

Currently, with few exceptions, practitioners of assisted reproduction tend to attribute “unexplained” and/or repeated IVF failure(s), almost exclusively to poor embryo quality, advocating adjusted protocols for ovarian stimulation and/or gamete and embryo preparation as a potential remedy. The idea that, having failed IVF, all it takes to ultimately succeed is to keep trying over and over using the same recipe is overly simplistic. There are numerous non-embryologic factors that can be responsible for failed IVF. There are two types of immunologic reactions or immune factors involved in conception and infertility:

Autoimmune disorders are more common, implicated in >90% of immune-related infertility. Specifically, it means that woman’s immune cells are forming antibodies – small proteins that target and attach to cells and identify them for destruction – to tissue that is normal and part of their own body. This is an abnormal reaction that is associated with several non-pregnancy related diseases.

Alloimmune disorders, in contrast, involve the formation of antibodies against tissue associated with the male partner (e.g. paternal sperm proteins).

Implantation begins six or seven days after fertilization of the egg. At this time, specialized cells from the embryo (i.e. trophoblast), that later become the placenta, begin to create connections with the endometrial lining; encouraging growth up and around the developing embryo. The process is as much overgrowth of the embryo as it is invasion of the endometrium. At the site where the fetal and maternal tissue meet, the maternal immune cells in the lining, become involved in a “cross talk” with one another through mutual exchange of hormone-like substances called cytokines.

Because of this complex immunologic interplay, the uterus is able to foster the embryo’s successful growth without allowing bacteria and other abnormal cells to have a free pass. In other words, the immune cells aren’t shut down, they agree to host the embryo when all goes right. Thus the trophoblast establishes the very foundation for the nutritional, hormonal, and respiratory interchange between mother and baby. In this manner, the interactive process of implantation is not only central to survival in early pregnancy but also to the health of the baby after birth.

Problems occur when the maternal immune cells don’t cooperate. Typically when this occurs, it will lead to implantation failure or pregnancy loss thereafter.

How will I help

The consultant has the following tasks:

First of all, I try to detect whether the woman has any immunological disorders, which can be treated separately. If there is no other immunological disease, we discuss the other, not examined diagnostic possibilities the patient has and what can be expected. My strategy is to learn as much as we can about the infertility in question before reaching any definitive diagnosis, and to help to that end we offer the best diagnostic test and treatment options available

There are many cases, after all, when there is no difference found, but pregnancy is still failed. Even in this case, small dose of heparin and aspirin could be taken, multivitamins or small doses of steroids could be a possibility: the latter therapy should be initiated after one or two days of the rejection of the egg, but at the latest after the menses outage.

The aspect of immunological infertility certainly is an area of medicine where there is still a lot of progress, a lot of research is being conducted, and even decisive progress can be expected in the future.

In most cases, the hidden cause is without symptoms, not painful, not sensitive and is located in a part of the body other than that of the symptoms. This makes finding the hidden cause quite difficult. Since the inflammation can be drawn out, we often do not think of an abnormality in a given site. For example: joints inflammation, fever, hair-loss, fatigue, allergy symptoms or inflammation of various layers of the eyes could occur.

The immune system is able to react strangely to prolonged irritation, stimulation, and at distant places, harmful reactions can occur. Such stimulus can be f.ex: virus-carrier ( hepatitis B or C), autoimmune disease, after organ transplant or implant, due to cancer or bacteria.

How will I help:

When a patient comes to me for or after screening for hidden cause, the disease or symptoms usually persist for a long time and the patient has been already gone through the urologist, gynecologist, otolaryngologist and dentist. Perhaps, despite his adulthood, the tonsils have been already removed.

In most cases, the healing process is failed.

The patient interview is the primary way of obtaining comprehensive information about the patient in order to provide effective patient-centered-care. A comprehensive patient interview includes inquiring about the patient’s medical, medication, social, personal and family history, as well as a thorough review of the examinations. By reviewing the medical history, we determine whether there is a general inflammatory process, for example: we determine whether the clinical aspects trace back to allergy or is there any other diseases or tumor.

In most cases, the cause cannot be determined, so there are only two possibilities left:

  1. Waiting and instead of examining the disease in cross-section, we examine it in longitudinal section, meaning that we are waiting for the clinical aspect to begin to blossom, hence the symptoms aid to detect. In most cases, this has never happened and unfortunately the causes stay hidden.
  2. the immunological inflammation process to be confined by taking medication.
About me

I am a 60 years old doctor and a father of two children, graduated in 1980.

At the medical University I worked for 16 years as a patient care doctor, i have taught there and I was involved in the researching work. I continued to teach a candidates medical students and medical specialist. At 1988 i worked for one year in the National Institute of the Rheumatology and Physiotherapy. I worked for a year in the United States. I got my academic qualification In 1990, since then i practice care in the Saint Ladislaus Hospital. Now I'm a head doctor of the contagious department of the hospital's. Here we are dealing with Internal Medicine diseases which primarily have an infectious or immune (an autoimmune) causes. As an exception on Friday i order for two hours a day in the morning at the ambulatorium of the hospital.

Private clinics is on weekdays afternoon, also on the Friday morning.

Studies:
---- Semmelweis University of  Medicine (1974-1980)
qualifications:
---- Internal Medicine (1985)
---- Immunology and Allergology (1990)
---- Infectious Diseases (2000)

Scientific degree:
--- Candidate of  medical science (1990)
Membership:
---- Hungarian partnership of Allergology and Immunology
---- Hungarian partnership of  Reproductive Immunology
---- Hungarian partnership of  Immunology
---- Hungarian partnership of  Internal Medicine
---- Hungarian partnership of  Nephrology
---- Hungarian partnership of  Infectious Diseases

Contact

Personal consultation, private clinics phone number is given in order to log in:
Phone: +36 30 908 42 04
e-mail: drkadarj@t-online.hu

Buda Allergy Center, Immunobiology Center:
Monday at 16: 00-18: 30
Address 1015 Budapest, Ostrom street.16
Phone +36 30 631 93 09
www.immunkozpont.hu

The MeDOC Health Centre for the private clinic:
Tuesday at 15: 30-18: 30
Address 1133 Budapest, Visegrad Street. 74
Phone + 361-783-6004
www.medocklinika.hu

Istenhegyi gene diagnostics centers order on:
Wednesday at 16: 00-18: 30
Address 1125 Budapest Zalatnai street. 2
Phone +36 580 8660
gendiagnosztika.hu

Mom Park Medical Center order on:
Thursday at 16: 00-19: 00
Address 1123 Budapest, Alkotás ut 53. MOM Park floor. II
Phone +36 70 240 6666
www.mom-medical.com
E-mail: front.office@mom-medical.com

The Istenhegy private clinic, order on:
Friday at 07: 00-09: 00
Address 1125 Budapest, Istenhegyi street 31 / B.
Phone +36 1 224-5424 +36 1 224-5425
www.ihklinika.hu

PRICES »
For the visit,discussions and care there is two paths are available, the advanced registration is required for each option.

The OEP expense of the special examination performed publicly f unded , referrals by the general practitioner or the co-competent person. I lead the medicene-immunology Medical Specialties devition of the Saint Ladislaus Hospital. check-in with  the Central Hospital number. The first consultation is the most expensive, in this case the patient asked for 18,000 forints, at the dispatcher's counter, but the price is not completely unified. Further, if the patient was consulted by the the following: instrument, the imaging or laboratory examinations, the insurer does not cover the costs.