Lege Artis Medicinae

[“A Suggestive Force is Needed to Cure” A Discussion with Internist Professor András Leövey]

SZEKANECZ Zoltán

MARCH 21, 2008

Lege Artis Medicinae - 2008;18(03)

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Further articles in this publication

Lege Artis Medicinae

[Cure Without Borders]

FÖLDES Mária Éva

Lege Artis Medicinae

[Chased health]

BÁNFALVI Attila

Lege Artis Medicinae

[Holistic approach to cardiovascular prevention]

VÁLYI Péter

[Cardiovascular diseases, primarily the organic manifestations of atherosclerosis, such as coronary artery disease, ischaemic stroke, and peripheral arterial diseases, represent the largest healthcare problem in the developed countries, since the mortality, disability, and need for hospitalisation caused by them constitute a bigger burden than that caused by all other diseases combined. A modern, holistic approach to cardiovascular prevention should consider the complete cardiovascular continuum, including genetic predisposition, social-economicalcultural background, environmental factors, the integrated effect of atherosclerotic risk factors, the inhibition of progression of functional and morphologic damages that have already developed, and, if possible, the promotion of regression. Besides targeting the individual, prevention at the public and social level is also important.]

Lege Artis Medicinae

[Modern surgical treatment of lung cancer]

AGÓCS László

[Lung cancer is one of the most malignant human cancers because of its high incidence and high mortality rate. The 5-year relative survival rate for lung cancer at the initial diagnosis is 5-15%. Stage I or stage II non-small cell lung cancer (NSCLC) are considered early stage disease. Unfortunately, these two stages combined account for only 25 to 30% of tumours at the initial detection. At present, surgical resection remains the recommended treatment for patients with stage I and II NSCLC. Despite negative preoperative staging studies including mediastinoscopy, as many as one fourth of the patients will be found at surgery to have an occult N2 or one nodal station positive metastatic – stage IIIA – disease. Multimodality therapy is preferred for all subsets of stage IIIA patients. In stage IIIB and IV, surgical resection is possible and indicated only in selected cases, including Pancoast tumours, T4N0,1M0 tumours, the presence of satellite nodules in the same lobe, and certain solitary metastases. Patients with clinical stage T1-2 N0 small cell lung cancer (SCLC) may benefit from surgery for confirmation of diagnosis and improved local control when combined with chemotherapy. The mortality and morbidity rates of surgery in the treatment of lung cancer are reasonably low.]

Lege Artis Medicinae

[The aims and latest results of clinical toxicological analysis]

RÓNA Kálmán

[Almost 80 percent of poison-related deaths are caused by drugs. The overwhelming majority of today's clinical toxicological work is comprised of cases of toxic level drug overdose, drug mixups, adverse effects during therapeutic drug administration, as well as intoxication from drug abuse. A prerequisite of adequate therapy of intoxication is the qualitative and quantitative determination of the compounds causing it. The two elements of systematic toxicological analysis are the screening test and the confirmatory test. The review touches on the toxicologic use of the hyphenated chromatographic-spectroscopic instruments and on the alternative biological matrices. It is known that the effects and toxic side-effects of many drugs show substantial interindividual differences even in the same doses. One of the possible causes of this phenomenon is a genetically determined polymorphic drug metabolism. Some pharmacogenetically determined anomalies in drug administration, particularly enzyme inhibition and induction, are of clinical toxicological importance.]

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Related contents

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

[In memoriam András Fazekas MD 1941-2012]

VOLT munkatársai

Clinical Neuroscience

Valproic acid associated pleuropericardial effusion: case report

DEMIR Figen Ulku

Introduction - Valproic acid is an effective antiepileptic and mood stabilizer used in the treatment of many neurological and psychiatric disorders. Although there are frequently seen side effects, effusions between layers of pleural and pericardial membranes are rare to be seen. Case - Pleuropericardial effusion was detected in a 23 years old woman who was under valproic acid treatment because of epileptic seizure. After 1 year of valproic acid treatment, patient complained of dyspnea. As all the researches intended on etiology were usual, valproic acid has been thought to be responsible for the matter. Control examination after 1.5 months regarding the end of treatment revealed complete recovery of pleuropericardial effusion. Discussion - Pleural and pericardial effusions are rarely seen complications related to the use of valproic acid. It must also be kept in mind that valproic acid causes a potential for such side effects which can be blamed etiologically when the other possibilities for patients are excluded.

Clinical Neuroscience

Risk factors related to intracranial infections after transsphenoidal pituitary adenomectomy under endoscope

XU Yifan, HE Yuxin , XU Wu, LU Tianyu, LIANG Weibang, JIN Wei

Background – Up to now, the risk factors related to intracranial infections after transsphenoidal pituitary adenomectomy remain controversial. Purpose – To analyze the risk factors related to intracranial infections after transsphenoidal pituitary adenomectomy under an endoscope, and to provide evidence for preventing and controlling the occurrence and development of infections. A total of 370 patients receiving endoscopic transsphenoidal pituitary adenomectomy in our hospital from January 2014 to October 2017 were selected. The risk factors related to postoperative intracranial infections were analyzed. The hospitalization lengths and expenditures of patients with and without intracranial infections were compared. Of the 370 patients, 18 underwent postoperative intracranial infections, with the infection rate of 4.86%. Intraoperative blood loss >120 mL, cerebrospinal leakage, diabetes, preoperative use of hormones, macroadenoma as well as surgical time >4 h all significantly increased the infection rate (P<0.05). Preoperative use of antibacterial agents prevented intracranial infection. Compared with patients without intracranial infections, the infected ones had significantly prolonged hospitalization length and increased expenditure (P<0.05). Discussion – It is of great clinical significance to analyze the risk factors related to intracranial infection after endoscopic transsphenoidal pituitary adenomectomy, aiming to prevent and to control the onset and progression of infection. Intracranial infections after endoscopic transsphenoidal pituitary adenomectomy were affected by many risk factors, also influencing the prognosis of patients and the economic burden.