Lege Artis Medicinae - 2012;22(04)

Lege Artis Medicinae

APRIL 20, 2012

[The diabetic foot syndrome: pathomechanism, clinical picture, current treatment and prevention]

JERMENDY György

[Diabetic foot syndrome is a characteristic late complication of diabetes mellitus. It can develop in patients with type 1 as well as type 2 diabetes mellitus, especially in case of a long duration of diabetes and sustained poor metabolic state. Diabetic neuropathy plays a pivotal role in the pathomechanism, but vascular symptoms might also contribute to the complex clinical picture. For making the diagnosis, evaluation of complaints, performing physical examination and using simple tests for identifying both distal, somatosensory neuropathy and potential angiopathy are of great importance. Therapeutic approaches aim to achieve proper glycaemic control, as well as to ameliorate symptoms of neuropathy, improve peripheral blood supply by medicines, angioplasty or intervention radiological methods, fight against infections and off-load the foot. Surgical intervention might also be necessary, and in severe cases, amputation might be needed. The diabetic foot syndrome increases mortality risk in patients with diabetes. Complaints related to diabetic foot syndrome are often resistant to treatment and tend to recur. Thus, prevention with long-term, good metabolic control and protection of the foot are of particular importance.]

Lege Artis Medicinae

APRIL 20, 2012

[Inhibitors of the renal sodium-glucose cotransporter: possible new drug in armamentarium of diabetologists]

BECHER Péter, PATAI Árpád, MÁJER Katalin

[An important aim of diabetologists is prescribing modern antidiabetic drugs with not only glucose lowering but also an insulin sensitivity increasing property with weight loss without hypoglycaemic episodes and with positive effects on the pancreatic β-cells. A selective inhibition of the renal sodium-glucose cotransporter 2 protein leads to glucosuria, reduces HbA1c and body weight without hypoglycaemias. This benefits can also moderate the cardiovascular risk in diabetic patients. At the moment this molecules are under examination in different phase clinical studies. It seems that the first drug from this group for the clinical use will be the molecule dapagliflozin. The main side effect may be a vulvovaginal mycotic infection.]

Lege Artis Medicinae

APRIL 20, 2012

[Treatment of hepatocellular carcinoma by liver transplantation: results in Hungary]

GÖRÖG Dénes, VÉGSŐ Gyula, DOROS Attila, GERLEI Zsuzsa, FEHÉRVÁRI Imre, NEMES Balázs, KÓBORI László

[INTRODUCTION - Hepatocellular carcinoma is an internationally accepted indication for liver transplantation in selected cases. The aim of this study was to present treatment results of patients diagnosed with hepatocellular carcinoma and put on the waiting list between 1995 and 2010. PATIENTS AND METHODS - Sixty patients were put on the waiting list, 23 of who died or became unfit for operation while waiting for transplantation. Liver transplantation was performed in 37 patients. Pathological examination revealed no tumour in 3 of the explanted livers, whereas incidentalomas were detected in 4 livers that were explanted because of cirrhosis. Thus, in total 38 patients were examined. RESULTS - Four patients died within 3 months of surgery because of arterial circulatory problems or graft dysfunction and 14 patients died thereafter, including seven whose tumour recurred. There was no recurrence of tumours in the early state among the 25 patients meeting the Milan criteria, and the overall 1-, 3-, and 5-year survival rates with an average follow-up period of 39 months were similar to those after transplantation because of viral cirrhosis: 72%, 72% and 67% vs. 78%, 71% and 67%, respectively. Survival rates after tumours beyond the Milan criteria were significantly lower (69%, 38%, 23%). CONCLUSION - Early-state (T1,T2) hepatocellular carcinoma that has developed following cirrhosis and is unsuitable for resection can be efficiently treated with liver transplantation, but our results do not support the use of transplantation for the treatment of tumours that do not fit the Milan criteria.]

Lege Artis Medicinae

APRIL 20, 2012

[Surveillance-examination in the department of internal medicine of a frequented hospital]

SCHAREK Petra, LÉTAY Erzsébet, KATONA Katalin, RÓKUSZ László

[OBJECTIVES - In November 2010, wescreened patients admitted to the MilitaryHospital, 1st Department of Internal Medi-cine for meticillin-resistant Staphylococcusaureusand Gram-negative, extended spec-trum beta-lactamase producing bacteria.We detected the prevalence of colonisationor infection by these strains during hospitalstay. METHODS - We compiled a datasheet toregister patient data and results. Swabsfrom one of the anterior nares, the throatand the rectal area were taken at admissionand discharge after informed consent of thepatients. Microbiological samples wereprocessed by current microbiology guide-lines. RESULTS - During the one-month studyperiod, 134 adult patients were admitted,105 of who consented to the examination.At admission, six patients (5.7%) carriedmeticillin-resistant Staphylococcus aureusand five patients (4.76%) carried extendedspectrum β-lactamase producing Esche-richia coli. In one patient (0.95%) nosoco-mial extended spectrum β-lactamase pro-ducing Enterobacter cloacaewas identifiedin the rectal sample. In two patients (1.9%),rectal colonisation by Streptococcus pyogeneswas detected. CONCLUSIONS - Screening patients formeticillin-resistant Staphylococcus aureusin our department is important because ofthe high rate of patients returning to thehaematologic department, and consideringthat 4.5% of patients admitted to ourDepartment were transported to surgicaldepartments in 2010. It is particularlyimportant to determine the sampling location. The prevalence of rectal colonisatonby extended spectrum β-lactamase produc-ing bacteria was in accordance with international data. We didn’t detect infectionprovoked by the examined bacteria duringthe study period.]

Lege Artis Medicinae

APRIL 20, 2012

[Insulin self-titration in type 2 diabetes mellitus: burden or solution?]

TAKÁCS Róbert

[INTRODUCTION - Observational studies have verified that even in routine diabetes care, up to 1.3% reduction in HbA1c can be achieved with the initiation of a long-acting basal insulin analogue. We can get the same results in our patients using an insulin titration algorithm and close diabetological control. CASE REPORT - Metformin therapy of a 68-year old, moderately obese woman with type 2 diabetes was complemented by a long-acting basal insulin analogue (insulin glargine). Before initiation of insulin therapy, the patient received thorough dietetic and diabetic education by a qualified dietician and a diabetes nurse. The starting dose of insulin was 10 U, and then the patient was asked to increase the dose by 2 U every 3rd day depending on the mean of self-monitored fasting plasma glucose values in the previous 2 days. With the aid of a titration algorithm, optimal carbohydrate metabolism has been verified by laboratory parameters assessed 3 months later. CONCLUSION - Insulin self-titration based on appropriate patient education and close professional control makes a relatively simple therapeutic system the optimal decision in terms of a rapid and chronic normalisation of glucose control in a large patient group.]

Lege Artis Medicinae

APRIL 20, 2012

Lege Artis Medicinae

APRIL 20, 2012

[Roma cancer patients’ illness cognition and their attitudes toward medical treatment]

ROHÁNSZKY Magda, NÓTÁR Ilona, SZABÓNÉ Kármán Judit, KONKOLŸ Thege Barna

[INTRODUCTION - In this qualitative pilot study, our goal was to investigate the illness representation of gipsy cancer patients and to examine their attitudes toward medical treatment. SAMPLE AND METHODS - Deep interviews were made with 20 persons (60% female; Mage=39.2±15.1 years). The included participants approximately represented the group composition of the Hungarian Roma population. RESULTS - For most of our respondents, cancer is a frightening disease meaning some kind of punishment and the end of life. The potential causes of the disease usually remain completely incomprehensible. The participants proved to be very under-informed in relation to their treatment - even when compared to the low level of information among Hungarian cancer patients in general. In the face of the supporting presence of family members, our respondents often stated that there was nobody to share their deeper emotional problems with. About half of the patients reported on impolite and inefficient treatment attributed to prejudice against their Gipsy identity. However, deeper analyses revealed, that in most of these cases, mistreatment was a consequence of the general shortcomings of the health care system (e.g. lack of time) - being labelled as discrimination by our respondents. Almost every participant sees his/her only role in recovery merely in the participation in medical treatment - not attributing enough significance to life style changes and even less to alternative / complementary medicine. CONCLUSION - Special training to improve communication skills with gipsy patients is needed - especially for general practitioners. We also suggest preparing handouts to Roma cancer patients that provide easy-to-understand information on the medical treatments and health behaviours that serve the coping with cancer and their prevention.]

Lege Artis Medicinae

APRIL 20, 2012