Lege Artis Medicinae - 2017;27(06-07)

Lege Artis Medicinae

JULY 20, 2017

[Interdisciplinary aspects of alcoholism and smoking from the perspective of primary care]

DARVAI László, RIHMER Zoltán, BALCZÁR Lajos, CSERHÁTI Zoltán, TÚRI Gergő, BÉLTECZKI Zsuzsa, KALABAY László, TORZSA Péter

[There is a complex and multi-directional relationship between alcoholism, smoking, depression, anxiety disorders, cardiovascular disorders and type 2 diabetes. They are risk factors not only for each other but - because of their relationship with depression - also for suicide. The effect of successful therapy of depression and anxiety plays a role not only in reducing suicide but also in reduction of alcoholism, cardiovascular morbidity and mortality, and smoking. Therefore, the effect of the appropriate specific treatments appears (even to a lesser extent) also in the field of another medical discipline. On the other hand, the reduction of smoking may be - in addition to decreasing mortality and morbidity of chronic obstructive pulmonary disease, lung cancer, ischemic heart disease, and so on - a causal factor in decreasing suicidal morbidity and mortality, as well as in decreasing morbidity of depression. The purpose of this article is to raise awareness of the relevant professions and healthcare financiers and decision-makers to these hidden benefits (appearing in other fields of expertise). The presented data justify not only the better funding for Mental Health Services but also the extension of the competence of primary care physicians to the mild and moderate (not psychotic and not suicidal) depression and anxiety disorders. ]

Lege Artis Medicinae

JULY 20, 2017

[We are witnessing a paradigm shift in the management of type 2 diabetes mellitus. Where to place the SGLT2 inhibitors?]

KIS János Tibor

[We are witnessing a paradigm shift in the management of type 2 diabetes mellitus. Instead of correcting carbohydrate parameters only, we need to concentrate on preventing cardiovascular complications as well. The onset of non-insulin formulations is also a shift from previous practice. The author examines the position of SGLT2 inhibitors in the changed therapeutic practice. ]

Lege Artis Medicinae

JULY 20, 2017

[Relationship between adipokinome and lipid parameters in Hungarian obese patients]

LŐRINCZ Hajnalka

[Since the prevalence of obesity has been dramatically increasing worldwide, a better understanding of obesity-related comorbidities leading to carbohydrate and lipid metabolism disorders has become essential. As an active endocrine organ, white adipose tissue secretes adipokines with diverse biological functions. We have found strong correlations between serum chemerin level and atherogenic lipoprotein sub-fractions in obese non-diabetic patients. To better characterize obese patients with and without manifest insulin resistance, we plan to determine serum levels of novel adipokines (omentin-1, vaspin, visfatin, lipocalin-2 and plasminogen activator inhibitor-1) and various oxidative stress markers including paraoxonase-1 activity, tumor necrosis factor-alfa and interleukin-6 levels, as well as low- and high-density lipoprotein subfractions in them and compare their data with lean individuals. We plan to determine correlations between the levels of novel adipokines and oxidative stress markers and lipoprotein subfractions. Furthermore, based upon our previous observations, we plan to study the potential alterations in the adipokine profile and the ratios of lipoprotein subfractions during a 5-year follow-up in obese patients. Our expected results may help to characterize the involvement of the adipokine profile in the regulation of lipoprotein metabolism. Early screening and treatment of lipid abnormalities may help to reduce the risk of cardiovascular events in obesity. ]

Lege Artis Medicinae

JULY 20, 2017

[Fulvestrant: long-term survival and quality of life in a patient with hormone receptor-positive advanced breast cancer]

PINTÉR Tamás

[INTRODUCTION - There are lot of evidence showing the efficacy of fulvestrant therapy in HER-2 negative, HR-positive advanced metastatic breast cancer. CASE REPORT - A 75-year-old female had a mastectomy, followed by series of adjuvant and radiotherapy about 30 years ago. Later cutan metastases were removed several times. The endocrine therapy had to be stopped because of intolerance. An ER, PR positive, HER-2 negative cutan metastasis was resected 7 years ago for the last time. During regular checkup, 5 years ago pulmonary nodule and bone metastases were found, - PET-CT disclosed multiple metastatic lymph nodes as well. We started fulvestrant and bisphosphonate therapy. Thereafter, as imaging revealed, the malignant disease has stabilized, the patient has a good performance status, her musculo-skeletal pain has a presumably degenerative origin. DISCUSSION - Reported case corroborates the potential efficacy of fulvestrant and ibandronate in hormone sensitive breast cancer with good prognostic markers, even in the case of metastases in soft tissue and bone. This case supports the data, that in patients with not progressive bone metastases the frequency of administration of parenteral bisphosphonates may be reduced to every 3 months. Advanced metastatic breast cancer may be converted to a chronic disease in properly selected cases, and it could mean long-term survival with a good quality of life.]

Lege Artis Medicinae

JULY 20, 2017

[Eosinophil granulomatous polyangiitis]

WITTMANN Zsófia, KARDOS Magdolna, FINTHA Attila, KERKOVITS Lóránt, AMBRUS Csaba

[Due to the high prevalence of kidney involvement, patients with systemic autoimmune disorders, also including small vessel vasculitides are frequently seen in neph-rology centers. Activated neutrophils attacking the wall of various blood vessel are key features in these diseases, leading to bleeding, occlusion, ischaemia and tissue necrosis. This latter finding is reflected in the term necrotising vasculitis. In this paper, we present a case of eosinophil ganulomatous polyangiitis (EGPA, formerly called Churg-Strauss syndrome), the least common form of ANCA associated small vessel vasculitides. We found it very interesting but not uncommon that our patient was admitted to the nephrology ward with vague symptoms that became more and more suggestive and typical for vasculitis during our observation, guiding us to the right diagnosis. Timely and appropriate immunosuppressive therapy based on immunology lab report and histology findings resulted in good response and remission of the disease in our patient. ]

Lege Artis Medicinae

JULY 20, 2017

[Aliennes and alien language in the Arrival (film)]

HORVÁTH Lajos, GÁSPÁR László Ervin, HORVÁTH Henrietta

[The paper aims to provide an integrative analysis of a science fiction film, Arrival. Even in the context of previous sci-fi films and their criticism, it is hard to define the genre of the movie. Maybe the movie Interstellar can be considered as the closest work. Suddenly appearing Aliens and the communication with them is the central problem of the movie. With the resource of context-free grammar and cosmological time-perception we analyze the situation outlined in the story. Can mechanism of human language acquisitions and language theory help us in the case of alien contact? Is it possible that the use of physical constants decrease the chance of basic misunderstandings? ]