Lege Artis Medicinae

[An Exhibition Against Charlatanism in 1928]

KÖLNEI Lívia

MAY 16, 2007

Lege Artis Medicinae - 2007;17(04-05)

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Lege Artis Medicinae

[The 150th Anniversary of the Orvosi Hetilap (Medical Weekly)]

dr. KAPRONCZAY Katalin

Lege Artis Medicinae

[SERUM ALANIN AMINOTRANSFERASE VALUES AND CHRONIC HEPATITIS C - HOW MUCH IS “NORMAL”, AND WHO SHOULD BE TREATED?]

HUNYADY Béla

[Serum aminotransferases (= transaminases), especially alanin aminotransferase have been used in the diagnosis of liver diseases, including viral hepatitis, for decades. However, reliability of these biochemical markers was challenged in various respects by recent clinical studies. First, it has been shown not to be sensitive enough in screening for viral hepatitis in high risk populations (viral hepatitis may be present with normal values). Second, normal range is exceeded in a large number of subjects without genuine liver disease due to the increased proportion of people with metabolic disease (diabetes, dyslipidaemia) or high body weight, i.e., the upper limit of normal is too strict. Moreover, decision on treatment of patients with viral hepatitis infection and persistently normal aminotransferases poses a challenge for the clinician. Based on the current literature, this review attempts to provide guidelines for the everyday clinical practice.]

Lege Artis Medicinae

[Cataflam Art Salon Photographs on Pain]

Lege Artis Medicinae

[The significance of testing for microsatellite instability in colorectal cancer]

SZENES Mária, BALI Ottilia, RUZSA Ágnes, NAGY Gyöngyi, VATTAY Péter, VÖLGYI Zoltán, GASZTONYI Beáta

Lege Artis Medicinae

[THE PATHOBIOLOGICAL BASES OF CANCER]

JENEY András

[This communication intends to give an overview of the cell biological changes that maintain the underlying pathobiological events (invasive growth, metastasis formation, angiogenesis) of tumour progression. The multiple and continuously accumulating mutations of the cells affected by the etiological factors are collectively termed the malignant genotype of the tumour cells, which varies greatly on one hand, but, on the other hand, they are invariably related to an increased survival potential or invasive growth. Properties of the tumour cells produced by the malignant genotype, including immortalization, reduced apoptosis, uncontrolled proliferation, adaptation to hypoxia, resistance, metastatic potency and production of biopolymers harmful to the body are collectively termed the malignant phenotype. The malignant phenotype shows a remarkable variance among the tumours, also, certain forms are present in all stages, while others only appear in specific stages of tumour progression. Consequently, beside clinico-pathological examinations, the identification of the underlying malignant phenotype in each tumour allows a better prediction of tumour progression and a targeted planning of therapy.]

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Clinical Neuroscience

[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

JANSZKY József, HORVÁTH Réka, KOMOLY Sámuel

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]

Lege Artis Medicinae

[The importance of the control of osmoregulation in modern medical practice]

BODA Domokos

[The control of the osmoregulation has become of particular interest by progress in the following fields: 1. New research data showed that one of the main function of the cell is the maintenance of constant volume against extracellular and intracellular osmolar perturbations. It is regulated by loss or gain of electrolytes and non-ionic osmolytes mediated by membrane transport processes. 2. The activity of the vasopressin hormone is regulated by the newly discovered aquaporin water channel proteins. 3. Development of modern laboratory osmometers which enable precise determination of osmotic pressures of the fluids in the organism in clinical practice. New data on volume control of the cells and on aquaporin channels in various clinical conditions may provide safer treatment of fluid and electrolyte disturbances, the diagnostics and therapy of congenital and acquired nephrogenic diabetes insipidus and of the serum inappropiate ADH syndrome, as well as other pathologic conditions with water balance disturbances.]

Lege Artis Medicinae

[Mummies An Exhibition in the Hungarian Natural History Museum]

SZIKOSSY Ildikó, dr. PAP Ildikó, dr. VÁSÁRHELYI Tamás

Hungarian Immunology

[Immunology of Felty’s syndrome]

BÁLINT Géza, BÁLINT Péter

[Felty’s syndrome can be regarded as “super-rheumatoid” disease. Immungenetically the syndrome is much more homogenous, than rheumatoid arthritis. HLA-DRB1*0401 antigen is present in 83% of the patients. Felty’s syndrome develops usually after a longer course of rheumatoid arthritis, in 1% of rheumatoid patients. Rheumatoid arthritis patients with long lasting unexplained neutropenia can be diagnosed having Felty’s syndrome, even without detectable splenomegaly. On the contrary, rheumatoid arthritis with splenomegaly, but without present or previous neutropenia with unexplained origin cannot be regarded as having Felty’s syndrome. Inspite of the fact, that the arthritis of Felty’s syndrome can be inactive, because of the neutropenia and increased risk of recurrent infections, the patients should be kept under tight supervision, and should be properly treated, if required. Immunologically Felty’s syndrome is characterized by rheumatoid factor positivity in 95-100%, ANA positivity in 50-100%, antihistone positivity in 63-83%. Antibodies against dsDNA rarely, but against ssDNA frequently occur. No anti Sm and interestingly no anti Ro and anti La antibodies can be detected inspite of the high incidence of associated Sjögren’s syndrome. Immunoglobulin levels are higher and complement levels are lower, than in rheumatoid arthritis. Circulating immuncomplex level is usually high. Non-specific antineutrophil anticitoplasmatic antibodies can be found in high percentage. The neutropenia of Felty’s syndrome can be either caused by increased IgG neutrophilic binding activity or by inhibition of the granulocytes colony growing in the bone marrow, by peripheral blood mononuclear cells. Expansion of large granular lymphocytes can be seen in 30-40% of patients with Felty’s syndrome. Large granular lymphocyte syndrome is not rarely associated with rheumatoid arthritis. The neutrophil account is normal or elevated in this syndrome, but splenomegaly occurs. These cases are called as pseudo Felty’s syndrome. The patients with Felty's syndrome suffering from recurrent infections required treatment even if the arthritis is inactive. Methotrexate treatment should be started first, if this treatment fails, other disease modifying drugs or colony stimulating factor can be given. There is no experience with other biological treatments. In treatment of resistant cases splenectomy is indicated. Non-steroid anti-inflammatory drugs should be better avoided.]

LAM Extra for General Practicioners

[ANALYSIS OF THE KNOWLEDGE ON CERVICAL CANCER AND ATTENDANCE INDICATORS OF CERVICAL SCREENING]

VAJDA Réka, KARAMÁNNÉ Pakai Annamária, ÉLIÁS Zsuzsanna, SÉLLEYNÉ Gyuró Mónika, TAMÁS Péter, dr. VÁRNAGY Ákos, KÍVÉS Zsuzsanna

[OBJECTIVE - The study aims to explore knowledge on cervical cancer and cervical screening among women with 9-14 yearold daughters, and learning the attitudes towards screening, the motivation of attendance at or absence from screening. DATA AND METHODS - A quantitative, cross-sectional study was conducted using our own questionnaire in the town Nagyatád in 2012. Study participants included women who had 9-14 year-old daughters and a registered home address in Nagyatád. We received valid responses from 186 people (response rate: 75.3%). RESULTS - The interviewed women’s knowledge on cervical cancer differed significantly depending on their age, education, marital status, and economic activity. Only 45 women with higher education (p=0.043) were considered to be well informed on the subject. However, their willingness to participate in cancer screening was more favorable than their knowledge, 96.2% of the women claimed to attend an annual cancer screening. The average age of respondents was 20.92 years at first visit. CONCLUSIONS - Although the participation rate was much higher compared with that in previously published studies, it is of great importance to increase the mothers’ knowledge on cervical cancer and the factors that promote its development, so that they can pass their knowledge to their children and strengthen their protection against one of the most common sexually transmitted viral infection and the development of cervical cancer.]