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Lege Artis Medicinae - 2004;14(05)
Content
Lege Artis Medicinae
MAY 20, 2004
Lege Artis Medicinae
MAY 20, 2004
[POSSIBILITES AND DIFFICULTIES OF COLORECTAL CANCER SCREENING IN HUNGARY]
[The frequency of colorectal cancer is increasing all over the world. It is the second most frequent oncological disease leading to death in both sexes in Hungary. The main part of colorectal cancer develope after the age of 50. In case of patients having higher risk we have to calculate with the earlier appearance of the tumour and detectable molecular genetic disorders. The development of colorectal cancer needs a long time. Before the appearance of the cancer, precancerous processes (adenomas, polyps) can be detected in the large intestine. The development of colorectal cancer can be prevented by the removal of the adenomas (polypectomy). There are many different and efficient methods to detect the precancerous and early disorders. For increasing the compliance to screening programs the common efforts of the society, the National Health Care Services and medical doctors are necessary. The education of the population and the medical services would also be helpful. The colorectal cancer screening programs are costeffective and supported by the different health services independently from the type of the insurance. Screening the patients having higher risk is one of most important task. In these cases the use of colonoscopy is the most frequent method for the screening and follow up as well.]
Lege Artis Medicinae
MAY 20, 2004
[RIFAXIMIN IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY - A MULTICENTRIC STUDY]
[INTRODUCTION - Hepatic encephalopathy is a well-known neuropsychiatric syndrome occurring in patients with either acute or chronic liver diseases. Rifaximin, a non-absorbable antibiotic is accepted for the treatment of hepatic encehalopathy. Our aim was to investigate the efficacy and the safety of rifaximin in cirrhotic patients with hepatic encephalopathy in Hungary. PATIENTS AND METHODS - 49 patients (25 male and 24 female) with hepatic encephalopathy stage I., II. and III. were involved into the study. Patients were treated with rifaximin for seven days. The daily dose was 3x400 mg in tablets. The severity of hepatic encephalopathy was characterised by hepatic encephalopathy index (HEi) calculated as a score of five parameters; mental state, asterixis, ammonia level, number connection test and critical flicker frequency. Pretreatment and postreatment HEi were compared. RESULTS - The study was completed in 46 patients. The treatment was suspended in 2 patients who died in liver failure and in one because of oesophageal variceal bleeding. The plasma ammonia level decreased from 103.7 ± 46.4 μmol/L to 67.7 ± 32.3 μmol/L (p=0,007) during the treatment. The hepatic encephalopathy index improved in 39 (85%) patients, worsened in 4 (9%) and no change was observed in 3 cases (6%). Improvement was observed in patients both with Child B and Child C stages. Loose stool in two patients and nausea in one patient were the only registered side effects. No severe adverse event related to the study medication was observed. CONCLUSIONS - Rifaximin is an effective and safe medicine for the treatment of hepatic encephalopathy.]
Lege Artis Medicinae
MAY 20, 2004
Lege Artis Medicinae
MAY 20, 2004
[THE RELATIONSHIP BETWEEN GASTROESOPHAGEAL REFLUX DISEASE AND DAYTIME SLEEPINESS]
[INTRODUCTION - Recent studies have shown a potential relationship between gastroesophageal reflux disease and daytime sleepiness. The increased sleepiness is one of the symptoms due to decreased daytime performance caused by the breathing difficulties during sleep. The aim of this study was to analyse the potential relationship between gastroesophageal reflux disease (GERD) and daytime somnolence. PATIENTS AND METHODS - The Epworth Sleepiness Scale was used to assess daytime somnolence for 134 patients undergoing upper panendoscopy and it was correlated to the severity of the endoscopic findings, according to the Savary-Miller classification. Data was analysed witf multivariant linear and logistic regression analysis. RESULTS - A positive tendency was found between reflux disease and daytime somnolence along with the severity of GERD. In the case of the more severe type - Savary-Miller III - the increase of daytime somnolence was significantly higher (p<0,05), than in the case of nonerosive type wich represents the mildest degree of reflux disease. CONCLUSION - According to the results of the study the more severe forms of GERD can influence the effect on daytime somnolence.]
Lege Artis Medicinae
MAY 20, 2004
[IDENTIFYING HELICOBACTER PYLORI WITH DNA-BASED ASSAYS]
[The DNA-based assays have the potential to be a powerful diagnostic tool given its ability to specifically identify H. pylori DNA. Markers used include general H. pylori structures and pathogenetic factors like ureaseA, cagA, vacA, iceA. DNA or bacterial RNA for polymerase chain reaction (PCR) assays can be collected from gastric biopsy, gastric juice, stool, buccal specimens. PCR can yield quantitative and genotyping results with sensitivity and specificity that approaches 100%. A clear trend in the direction of the determination of quantitative H. pylori infection by real-time PCR can be observed. Fluorescent in situ hybridisation (FISH) and restriction fragment length polymorphism (RFLP) are suggested for routine antibiotic resistance determination. To identify the DNA structure of organism and its virulence factors may be feasible by using oligonucleotide microarray specifically recognising and discriminating bacterial DNA and various virulence factors. DNA based H. pylori diagnosis yields higher sensitivity, however, specificity requires sophisticated labour environment and associated with higher costs.]
Lege Artis Medicinae
MAY 20, 2004
[CURRENT STATUS OF THE DIAGNOSTICS AND THERAPY OF UROLOGICAL TUMOURS]
[Significant amount of urological patients have malignant disease. Prostate cancer is the second most frequent cancer in males associated with high mortality and decreased quality of life. Hence the importance of early diagnosis. Furthermore, diagnostical protocols, operative and conservative therapeutic modalities are summarised. Hematuria is the most frequent sign of bladder cancer. Diagnostical, surgical and adjuvant therapeutical differencies of the superficial and muscle invasive bladder cancers are discussed. The urinary deviation after cystectomy could be associated with complications therefore regular follow up of patients is necessary. The standard therapy of renal cancer is surgical. Unfortunately its mortality has not change during past years. Testicular cancer is the disease of young males. If diagnosed early, most cases are curable. Therapy is complex, involving surgical, chemoand radiation therapy as well. Penis cancer is a rare disease, but highly malignant. In advanced stage patients are incurable.]
Lege Artis Medicinae
MAY 20, 2004
[NEUROFIBROMATOSIS, MALIGNANT MELANOMA AND HYPERTHYREOIDISM IN A HCV POSITIVE PATIENT]
[INTRODUCTION - Similar occirrence of neurofibromatosis and malignant melanoma is rare. We report a patient with neurofibromatosis, cutaneous melanoma, hyperthyreoidism and HCV positivity. CASE REPORT - A 43-year-old woman has been under care for neurofibromatosis for 16 years when she presented with increased serum ?- glutamyltransferase, alkaline phosphatase activity and anti-HCV antibody positivity at regular checkup. A pigmented lesion removed from her back histologically proved to be cutan melanoma. Interferon treatment was applied. She lost 8 kilograms in half a year which was caused not by the tumor progression, but hyperthyreoidism. A rapid clinical and laboratory improvement was observed for thyreostatic treatment and she regained her bodyweight. One year later she presented with a cough caused by pulmonary tumor. The tumor was surgically removed and histologically diagnosed as metastasis of melanoma. Cytostatic treatment was applied and she became asymptomatic. Four years after the diagnosis of melanoma she died of apoplexy. During the autopsy there was no sign of either melanoma or liver disease. CONCLUSIONS - The careful investigation of skin should be emphasised even in case of long established neurofibromatosis. The presented case shows an association of malignant melanoma and neurofibromatosis. In the background of loss of bodyweight even in a patient with history of malignant disease other causes should also be searched such as hyperthyreoidism especially during interferon therapy.]
Lege Artis Medicinae
MAY 20, 2004
Lege Artis Medicinae
MAY 20, 2004
Lege Artis Medicinae
MAY 20, 2004
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