Lege Artis Medicinae

[A Pioneering Endeavour Stem Cell Transplantation in 1971]

dr. KÖVES Péter

MAY 21, 2006

Lege Artis Medicinae - 2006;16(05)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[ANTICOAGULATION IN OBSTETRICS]

DOMJÁN Gyula, GADÓ Klára

[The risk of thrombosis is increased about 5 to10 times during pregnancy and in the puerperium. Beside the classic risk factors, this is also due to special obstetrical causes. Delivery, especially Cesarean section further increases susceptibility to thrombosis. Prophylactic or therapeutic anticoagulant treatment can significantly reduce maternal and fetal morbidity and mortality. Just like in the non-pregnant state, subcutaneous low molecular weight heparin or intravenous or subcutaneous unfractionated heparin is recommended in pregnancy if anticoagulation is indicated. Warfarin is contraindicated in the first trimester because of its teratogenicity and also in the third trimester because of its long-lasting effect. Heparin does not cross the placenta, but its long-term administration may cause several side effects. Dosage, starting time and duration of the treatment depend on the measure of the risk of thrombosis. In certain cases (such as antiphospholipid syndrome) anticoagulant therapy is supplemented by low-dose acetylsalicylic acid. The date of delivery can be electively planned to minimalize bleeding and thrombotic complications. Vaginal delivery is preferred because of its lower risk of bleeding compared to Cesarean section. Intensity of anticoagulant therapy in the peripartum period should depend on the risk of thrombosis. The third phase of delivery should be actively driven by giving oxytocin to avoid bleeding complications. Since anticoagulant therapy is often continued during breast-feeding, it is important to know that neither warfarin, nor heparin is secreted in milk. When planning the treatment, each case requires individual consideration based on the type and number of risk factors, gestation time and, importantly, compliance of the patient.]

Lege Artis Medicinae

[“I Can Bear with It”]

GYIMESI Andrea

Lege Artis Medicinae

[THE COMPLEX EFFECT OF TREATMENT TARGETING THE OESTROGEN RECEPTORS IN POSTMENOPAUSAL WOMEN]

TAKÁCS István, LAKATOS Péter

[Hormone depletion after menopause results in the dramatic increase of the incidence of a number of diseases. It should seem reasonable to substitute female hormones to prevent or treat these disorders. However, hormone replacement therapy has not fulfilled the expectations in its current form. While the first large, prospective, randomized, controlled primary prevention trial showed a beneficial effect of hormone replacement on bone fracture and colorectal cancer, the incidence of cardiovascular diseases and breast cancer increased. The overall effect of treatment was assessed by the so called global index. Based on the global index, the overall health risk exceeded benefits from 5 years use of combined oestrogen plus progestin among healthy postmenopausal women. In another study, oestrogen alone did not affect the incidence of coronary heart disease or colorectal cancer, neither was the increase in breast cancer rate significant. Similarly to combination therapy, the beneficial effect on bone fracture rate and the adverse effect on the incidence of cerebrovascular events have remained. Overall, oestrogen monotherapy had no effect on the global index. There is not enough data available yet to draw a conclusion on the overall effect of fitooestrogens that also target oestrogen receptors and tibolon, a steroid hormone with tissue-specific effects. Raloxifene, a selective oestrogen receptor modulator considerably decreases the rate of vertebral fractures. In a study it also decreased the number of peripheral fractures in a subgroup of patients with severe vertebral fractures. It reduced the rate of cardiovascular and cerebrovascular events in patients at increased cardiovascular risk. The incidence of breast cancer dropped both in the original 4-year study period and in its 4-year extension. Based on the beneficial change of the global index, it is only raloxifen that can currently be recommended for the complex treatment of postmenopausal women.]

Lege Artis Medicinae

[The impact of oral ketoconazole therapy on the outcome of pregnancy - A population-based case-control study]

KAZY Zoltán, PUHÓ Erzsébet, CZEIZEL Endre

Lege Artis Medicinae

[Requiem - For the fiftieth anniversary of the foundation of the Institute for Postgraduate Medical Education]

FORGÁCS Iván

All articles in the issue

Related contents

Clinical Neuroscience

Simultaneous subdural, subarachnoideal and intracerebral hAemorrhage after rupture of a peripheral middle cerebral artery aneurysm

BÉRES-MOLNÁR Anna Katalin, FOLYOVICH András, SZLOBODA Péter, SZENDREY-KISS Zsolt, BERECZKI Dániel, BAKOS Mária, VÁRALLYAY György, SZABÓ Huba, NYÁRI István

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo­gical examination excluded mycotic etiology of the aneu­rysm and “normal aneurysm wall” was described. The brain stem haemorrhage – Duret bleeding – was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.

Lege Artis Medicinae

[Immuno-oncology therapy in patients with non-small cell lung cancer]

CSÁNKY Eszter

[Despite decades of smoking cessation programs, and lung cancer screening programs, mortality due to bronchial cancer leads the mortality statistics among cancer deaths worldwide. Platinum-based chemotherapy has not fundamentally altered the effectiveness of treating non-small cell lung cancer (NSCLC). One of the newest approaches to the use of immunotherapeutic treatments in recent years is the so-called. use of immune checkpoint blocking agents. PD-1 and PD-L1 blockers of this type have been subjected to a large number of clinical trials in lung cancer and were reported by the tumor III.b / IV. stage. Last year, in 2018, we again came up with a milestone in the treatment of lung cancer immuno-oncology, as compared to the previous stage, III.a / III.b Durvalumab con­solidation therapy for non-small cell lung cancer after inoperative, non-chemo-radiotherapy phase I, is based on the results of the PACIFIC clinical trial. PACIFIC was a triple-phase, randomized, double-blind, placebo-controlled, multicentre study to evaluate the efficacy and safety of durvalumab consolidation therapy, irresistible, III. patients with non-small cell lung carcinoma who have not progressed after platinum-based chemo-radiotherapy. The PD-L1 expression level of the tumor was not an admission criterion. In the study, 713 patients were randomized to durvalumab and placebo for 2:1, progression-free survival (PFS) and over­all survival (OS) as their primary endpoint. Summarizing the results of the study, durvalumab provided significant benefit to patients at both endpoints. PFS and OS values were also significantly longer for durvalumab than placebo, and the safety profile of durvalumab was consistent with previous PD-1, PD-L1 inhibition tests.]

Ca&Bone

[The role of alfacalcidol in the prevention of osteopenia following renal transplantation]

BERCZI Csaba, ASZTALOS László, KINCSES Zsolt, BALOGH Ádám, LŐCSEY Lajos, BALÁZS György, LUKÁCS Géza

[AIM - The aim of this prospective study was the long-term evaluation of the effect of calcium and alfacalcidol treatment on calcium metabolism in patients with renal transplantation. METHODS - Patients were divided in two groups. Patients in Group 1 (n=159) received calcium substitution, while patients in Group 2 (n=81) were treated with alfacalcidol. Serum Ca, P, Mg, alkaline phosphatase (AP) and PTH levels were determined before and after transplantation regularly for three years. Femur neck and lumbar vertebral bone mineral densities (BMD) were measured at the same time after transplantation. RESULTS - After transplantation the mean serum calcium level significantly increased, while the mean serum phosphate level significantly decreased in both groups. After the operation the PTH levels decreased in both groups and it was found to be more pronounced in the alfacalcidol group.The majority of patients had osteopenia in the follow-up period. Between the third month and the third year after transplantation, BMD increased by 9.4% in Group1, and decreased by 4% in Group 2 at the lumbar spine. At 3 years the mean BMD value at the femoral neck was increased by 6.5% in Group 1, and by 6.7% in Group 2, compared to the 3-month values.The change in BMD was only significant at the lumbar spine, in Group 1 (p=0.019). During the follow-up period osteonecrosis was diagnosed in 6 patients in Group 1 and in 9 cases in Group 2. CONCLUSION - Alfacalcidol treatment decreased secondary hyperparathyroidism more rapidly and effectively, which was also indicated by the more pronounced decrease of serum PTH levels. During the 3 years follow-up period, BMD increased in both groups except for the lumbar spine in Group 2, however, the majority of the patients still had osteopenia.The study could not demonstrate a superiority of alfacalcidol over calcium supplementation in the prevention of posttransplantational osteopenia.]

Lege Artis Medicinae

[What is worth to know about COVID-19 for (not only) a cardiologist]

HEPP Tamás, CSÉKE Balázs, BENCZÚR Béla

[SARS-CoV-2 virus infection sprang from Wuhan the capital of the Chinese Hubei province, at the end of 2019 and caused a worldwide pandemic with 1.5 million confirmed cases and claimed almost 100 000 victims until the beginning of April, 2020. First analyses of Chinese COVID-patients confirmed that diabetes, hypertension, and cardiovascular diseases were highly prevalent among SARS-CoV2 infected patients, and might be associated with poor outcome. As previously shown for SARS-CoV-1, SARS-CoV-2 similarly utilizes ACE2 as receptor for viral alveolar cell entry. A suspicion has arisen that the widely used ACE-inhibitor/ARB therapy could be potentially harmful for patients suffering from COVID-19 infection as these agents upregulate the ACE2-expressions. From the other point RAAS-blockade might be beneficial due to fact that ACE2 counters the deleterious effects of Angiotensin II. Authors provide a comprehensive over­view of the most recent literature and summarize the link between COVID-19 and car­diovascular disease. It is important to em­phasize that there are no available hu­man evidences confirming if the RAAS-in­hi­bitor therapy were harmful or helpful in pa­tients suffering from COVID-19.]

Lege Artis Medicinae

[NON-PHARMACOLOGICAL TREATMENT OF CHRONIC HEART FAILURE]

MERKELY Béla, RÓKA Attila

[Heart failure has a poor prognosis despite the advances in pharmacological treatment. The utilization of non-pharmacological treatment with appropriate indications significantly improves the quality of life and life expectancy of these patients. Cardiac resynchronization therapy with biventricular pacemaker has a clinically proven efficacy in the treatment of heart failure associated with intraventricular dyssynchrony. Implantable cardioverter- defibrillators decrease the mortality from sudden cardiac death. Heart transplantation is needed in cases refractory to therapy. There are several other non-pharmacological treatment approaches, including mechanical circulatory assist devices, total artificial heart and ultrafiltration, whose routine application is not recommended due to limited clinical experience, but the initial results are promising.]