Lege Artis Medicinae - 2007;17(02)

Lege Artis Medicinae

FEBRUARY 22, 2007

[THE DIFFERENTIATION OF CHRONIC PANCREATITIS FROM PANCREATIC CANCER]

CZAKÓ László

[The poor prognosis of pancreatic cancer is mainly due to late diagnosis. The differentiation between pancreatic cancer and chronic pancreatitis is difficult, because the two diseases cause similar clinical symptoms and morphological alterations. Furthermore, chronic pancreatitis is associated with an increased risk of malignant transformation, thus the two diseases may be present simultaneously. The recent developments in molecular genetic tests and in imaging techniques, such as multidetector computed tomography, magnetic resonance cholangio- pancreatography, endoscopic ultrasoundguided fine needle aspiration and positron emission tomography/computed tomography, have fundamentally transformed the differentiation of the two disorders. This paper provides a systematic review of the recent evidence-based results concerning the differentiation of pancreatic cancer and chronic pancreatitis.]

Lege Artis Medicinae

FEBRUARY 22, 2007

[THE ROLE OF ENZYME REPLACEMENT THERAPY IN PANCREATIC DISEASES ASSOCIATED WITH MALDIGESTION]

TAKÁCS Tamás

[The pancreas synthesizes and secretes more than 20 digestive enzymes that hydrolyze the major nutritive components, i.e., carbohydrates, fat and protein, within the lumen of the small bowel. In several pancreatic diseases the secretory capacity of the pancreas gradually decreases and the release of pancreatic juice becomes blocked resulting in the characteristic symptoms of maldigestion. Pancreas-associated maldigestion is most often caused by chronic pancreatitis, which can be diagnosed primarily by imaging beside history and clinical symptoms. There is no decisive serological test. The goal of the treatment of pancreatic insufficiency is to reduce symptoms (bloating, abdominal pain, weight loss, and, most importantly, steatorrhea) and improve digestion. One way to do this is to replace pancreatic enzymes. The efficiency of the available enzyme preparations can be increased by the improvement of lipase activity.]

Lege Artis Medicinae

FEBRUARY 22, 2007

[CARDIOVASCULAR EFFECTS OF SULFONYLUREAS]

NIESZNER Éva, BARANYI Éva, PRÉDA István

[Sulfonylureas, used as base therapy in type 2 diabetes, specifically block ATP-dependent potassium channels (K+ ATP). While in pancreatic beta cells these channels have an essential role in insulin release, they are also involved in cardiovascular adaptive mechanisms. Ion channels with similar morphology may have different pathophysiological effects in the human body. This raises the question, is it necessary to count with some damage to the cardiovascular protective mechanism when using sulfonylurea to induce insulin secretion. Is this indeed a relevant clinical problem today? The answer may lay in the different organ-specific effects of sulfonylureas.]

Lege Artis Medicinae

FEBRUARY 22, 2007

[DIURETICS IN CARDIOLOGY: PRESCRIBE OR USE?]

NAGY Viktor

[Diuretics are essential therapeutic tools. They effectively reduce blood pressure and have been shown in numerous hypertension clinical trials to reduce both cardiovascular and cerebrovascular morbidity and mortality. In addition, they are important components of the treatment of heart failure with apparent signs of congestion. While thiazides are recommended in mild forms, loop diuretics are used in the severe stages of congestive heart failure. Loop diuretics and thiazides often induce hypokalaemia, which has been demonstrated to be not as benign as thought before. Diuretic-induced hypokalaemia seems to be aldosterone dependent. Aldosterone levels increase during diuretic therapy. Aldosterone antagonists are unique among diuretics in that they improve survival of patients with heart failure independent of their effect on sodium metabolism. Because of this, diuretic treatment lives its renaissance in cardiology.]

Lege Artis Medicinae

FEBRUARY 22, 2007

[ASSESSMENT OF THE QUALITY OF LIFE AND THE ATTITUDES TO AGEING OF ELDERLY PEOPLE]

TRÓZNAI Tibor, KULLMANN Lajos

[BACKGROUND - The WHOQOL-OLD questionnaire was developed in a multicultural way. The authors were involved in this work as members of the international task force. In order to improve services for the elderly by learning their attitudes to ageing, an Attitudes to Ageing Questionnaire (AAQ) was also developed by the working group. In the present study the authors assessed a sample of Hungarian elderly people by these two methods. Answers by elderly persons related to their quality of life, social and health conditions, as well as their attitude to ageing were analysed. PERSONS AND METHOD - A total of 333 (190 unhealthy and 143 healthy) persons over sixty years of age filled in the questionnaires either by themselves or through verbal interview. The participants’ compliance with the research was generally good. The study sample reflected the general features of the Hungarian elderly population. For statistical analysis the Microsoft SPSS for Windows version 11.0 programme was used. RESULTS - Better health condition, better mood, and a better ability for self-care improve the quality of life. Better attitudes to ageing are associated with better quality of life. CONCLUSIONS - The use of the WHOQOLOLD questionnaire is recommended in the daily practice to assess elderly Hungarians’ quality of life. The results highlight the significance of mental health in the development of the elderly persons’ attitude to ageing. The use of the new questionnaires may help change negative stereotypes related to ageing.]

Lege Artis Medicinae

FEBRUARY 22, 2007

[DIFFUSE LARGE B-CELL NON-HODGKIN LYMPHOMA OF UNUSUAL LOCALISATION]

RESS Zsuzsa, ILLÉS Árpád, MATOLCSY András, TANYI Miklós, SZÖVÖRDI Éva, GERGELY Lajos

[INTRODUCTION - Diffuse large B-cell lymphoma frequently has bone involvement, but primary bone lymphoma is rare (around 4% of primary extranodal lymphomas). Long bones are most often affected, followed in frequency by the ribs, vertebrae, and pelvic bones. The main symptom is bone pain. CASE REPORT - The case of a young man is presented whose disease started with lumboischialgia. Since rheumatological treatment did not relieve the symptoms, MRI was performed, which showed a tumour with massive iliac bone destruction. Three months after the initial symptoms a surgical biopsy from the right ilium showed diffuse large B-cell lymphoma. Soon after acute renal insufficiency developed and the patient was put on haemodialysis. Based on the findings the disease was staged as Ann Arbor IV/B (bone and kidney), ECOG PS 3, International Prognostic Index 4. On the basis of the preliminary histological findings, reduced-dose CHOP chemotherapy was given, which resulted in a significant improvement of the renal function and haemodialysis could be abandoned. This was followed by 6 additional cycles of Rituximab-CHOP treatment and further 2 cycles of Rituximab-DHAP salvage chemotherapy with intrathecal prophylaxis, and, finally, since no response could be detected, R-IVAC treatment was given. After an initial response, the disease became progressive, and the patient died 9 months after the diagnosis was made from a disseminated chemoresistant disease. Autopsy confirmed extensive infiltration of the right iliac bone, kidneys, bone marrow, spleen, supraclavicular and abdominal lymph nodes, pancreas, scalp and brain. CONCLUSIONS - This case was chosen to be presented because of the unusual localisation of the diffuse large B-cell lymphoma, the initial diagnostic difficulty, and the very rapid progression despite the application of several aggressive chemotherapy schemes. A primary bone large B-cell lymphoma represents a diagnostic challenge with its rheumatological symptoms thus delaying diagnosis.]

Lege Artis Medicinae

FEBRUARY 22, 2007

[A RARE, HISTOLOGICALLY COMPLEX LIVER TUMOUR]

HIDVÉGI Judit, BAJTAI Attila, VARGA Árpád

[INTRODUCTION - Among the primary malignant tumours of the liver, hepatoblastoma is extremely rare in adults in contrast to its frequency in children. Only 23 such cases have been published to date. Mixed tumour of the liver and carcinosarcoma of the liver are used as synonyms for adult hepatoblastoma. The tumours have both mesenchymal and epithelial components (hepatocellular or cholangiocellular carcinoma) with focal bone and/or cartilage formation. CASE REPORT - A 78-year-old woman was admitted to the surgery department with increasing anaemia and persistent abdominal pain. An emergency operation was performed. Her peritoneal cavity was filled with blood due to the rupture of a tumour that occupied the right lobe of the liver. The neoplasm could only be removed partially. Despite an intensive care, the patient's state could not be stabilized and she died a day after the operation. The histological diagnosis was carcinosarcoma of the liver with an AFP- and cytokeratin-positive epithelial component and a spindle cell component positive for vimentin. The osteogen sarcoma found in the tumour was strongly positive for the S-100 protein. DISCUSSION - The authors review the hypotheses for the formation of adult primary hepatoblastoma, a combined tumour, they describe their various types and the immunohistochemical tests that are used in their identification.]

Lege Artis Medicinae

FEBRUARY 22, 2007

Lege Artis Medicinae

FEBRUARY 22, 2007

[EFFECT OF END-OF-LIFE EDUCATION ON MEDICAL STUDENTS’ AND HEALTH CARE WORKERS’ DEATH ATTITUDE]

HEGEDÛS Katalin, ZANA Ágnes, SZABÓ Gábor

[INTRODUCTION - The aim of our research was to evaluate the effect of courses for health care workers and medical students that deal with death, dying and bereavement and that of courses on hospice care of dying patients. The goal of the courses is to make communication on death more open by exploring critical issues related to fear of death to reduce inner anxiety and to improve attitude to dying patients. PARTICIPANTS AND METHOD - Participants (n=168) completed Neimeyer and Moore's Multi-dimensional Fear of Death Scale (MFODS) and Shortened Beck Depression Questionnaire (BDI) on the first and last day of the courses. In case of health care workers a follow-up survey was also performed 2 to 3 months after the course (n=32). RESULTS - The most significant factors of fear of death are: fear for significant others, fear of the dying process and fear of premature death. Overall fear of death scores are reduced as an effect of the courses, the alteration of the components of fear of death depends on the participants’ gender, age and profession as well. Improvement was observed in both groups in attitudes that can be related to the increase of knowledge on the quality care of dying patients like fear from the process of dying and fear from conscious experience of death. CONCLUSION - Besides education containing training as well it is important to strengthen the support function of workplaces in caring for the mental health of the health care staff. Furthermore it is important during gradual education that students participate in courses that aim to achieve opened communication in the most anxiety-evoking issues.]

Lege Artis Medicinae

FEBRUARY 22, 2007

Lege Artis Medicinae

FEBRUARY 22, 2007

Lege Artis Medicinae

FEBRUARY 22, 2007