Lege Artis Medicinae

[Atopic dermatitis today]

SZALAI Zsuzsanna

MARCH 20, 2005

Lege Artis Medicinae - 2005;15(03)

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Lege Artis Medicinae

[NON-DIFFERENTIATED COLLAGENOSIS]

BODOLAY Edit, SZEGEDI Gyula

[The authors provide a review on non-differentiated collagenosis (NDC) or, as it is called by another terminology, undifferentiated connective tissue disease (UCTD), outlining the clinical and serological alterations of the disease and give a definition of NDC. NDC is a pathological state when patients present clinical symptoms and serological alterations characteristic of a polysystemic autoimmune disease that cannot be explained by any other disease, where the symptoms however do not meet the diagnostic criteria of any other polysystemic autoimmune disease. NDC is a dynamic state and in 25-30% of the cases it may differentiate into CTD but in 40- 50% it remains in NDC stage and in 10-20% of the cases the patient may achieve remission. Differentiation is most frequent in the first two years of NDC. Patients should be treated and followed up in NDC state as well. The NDC stage is very important, since with the discovery of new autoantibodies, by employing new gene technology and by the follow-up and the treatment of the patients, our main aim is the earliest possible detection of differentiation into a definite polysystemic disease.]

Lege Artis Medicinae

[Flu - Avian flu - Is pandemy a danger?]

BUDAI József

Lege Artis Medicinae

[THE EFFECT OF SEXUAL HORMON ALTERATIONS ON THE FREQUENCY OF OEDEMATOUS ATTACKS IN PATIENTS WITH HEREDITARY ANGIONEUROTIC EDEMA]

FELVINCI Réka, VISY Beáta, NÉMETH Éva, VARGA Lilian, JAKAB László, FARKAS Henriette

[INTRODUCTION - Changes in the body's hormonal equilibrium may alter the frequency of angioedema attacks in patients with hereditary angioneurotic edema. We assessed the relations between the angioedema attacks and puberty, menstruation, anticoncipient pill taking, pregnancy, delivery and menopausa. We also studied the possible impact of an embryo with hereditary angioneurotic edema on the frequency of attacks during pregnancy. PATIENTS, METHODS AND RESULTS - 53 female patients were included in the study. Data was surveyed by a questionnaire and detailed gynecological examination. We pointed out that the frequency of the attacks increased in 34% of the patients during puberty, in 58% of the patients at the time of menstruation and in 63% of the contraceptive pill users. In 36% of the women the frequency decreased in the postmenopausal state. In case the pregnancy affected the disease, the embryo with hereditary angioneurotic edema increased the number of attacks during pregnancy. CONCLUSION - Our analysis shows that conditions with sexual hormon alterations have an effect on the number of edematous attacks, therefore patients with hereditary angioneurotic edema need more attention both in nursing and therapy when they are in a life-period of hormonal change. Our results offer the oppurtunity of a better prediction of edematous attacks thus the oppurtunity of better therapy and better quality of life.]

Lege Artis Medicinae

[Successful rifaximin therapy for the prevention of travelers’ diarrhea]

NEMESÁNSZKY Elemér

Lege Artis Medicinae

[Diabetes: in the focus]

WINKLER Gábor

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Intracranial localization of Ewing’s sarcoma is considerably very rare. Herein, we present clinical and neuroimaging findings regarding a 4-year-old boy with intracranial Ewing’s sarcoma. He was born prematurely, suffered intraventricular haemorrhage, posthaemorrhagic hydrocephalus developed, and a ventriculoperitoneal shunt was inserted in the newborn period. The patient endured re­gular follow ups, no signs of shunt malfunction nor increased intracranial pressure were observed. The last neuroima­ging examination was performed at 8 months of age. Upon reaching the age of 4 years, repeated vomiting and focal seizures began, and symptoms of increased intracranial pressure were detected. A brain MRI depicted a left frontoparietal space-occupying lesion infiltrating the superior sagittal sinus. The patient underwent a craniotomy resulting in the total excision of the tumour. The histological examination of the tissue revealed a small round blue cell tumour. The diagnosis was confirmed by the detection of EWSR1 gene translocation with FISH (fluorescent in situ hybridization). No additional metastases were detected during the staging examinations. The patient was treated in accordance to the EuroEwing 99 protocol. Today, ten years onward, the patient is tumour and seizure free and has a reasonably high quality of life.

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[NON-INVASIVE CORONARY ANGIOGRAPHY BY MULTISLICE COMPUTED TOMOGRAPHY]

PRÉDA István, KERECSEN Gábor, MAUROVICH-HORVAT Pál

[This review summarizes the diagnostic spectrum, ways of application and methodological difficulties of multislice computed tomographic (MSCT) coronary angiography. The non-invasive assessment of cardiac and coronary anatomy is now possible with computed tomographic coronary angiography using the modern 16 to 64-slice technology. This technique finds its main use today in the screening of patients with moderate probability of having coronary artery disease (atypical chest pain). Its negative predictive value varies between 97% and 99%, thus, a negative result of this non-invasive outpatient procedure can reduce the possibility of coronary artery disease to the minimum. Other important diagnostic applications include the follow-up of patients with coronary artery bypass, accurate diagnosis of coronary artery anomalies, and the simultaneous examination of the heart and great vessels. The future development of the technique is directed to coronary plaque characterization, particularly the detection of vulnerable plaques. The radiation exposure is relatively low (7-13 mSv), comparable with that of invasive coronary angiography.]

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[Malignant melanoma belongs to the group of relatively easily manageable tumors; if detected and removed early, it rarely metastasizes. Although the visible nature of the primary tumor provides opportunity for early diagnosis, there is a signifi cant portion of patients who receive proper management only with substantial delay. The fact that there are annually 300-400 patients with metastatic disease in Hungary, can be mostly attributed to public unawareness about melanoma, and consequent delay in seeking medical treatment. Metastatic melanoma remains - even today - an incurable disease. Molecular genetic research, however, resulted in revolutionary changes in melanoma management. Today, apart from the classic pathological prognostic factors, information regarding specifi c molecular modifi cations (such as in the expression of the BRAF, NRAS, c-KIT genes and proteins) are inevitable for the setting up of a personalized oncological treatment plan. By targeting members of the MAPK signal transmission pathway (using BRAF- and MEK-inhibitors), signifi cant improvement could be achieved in metastatic melanoma. Similarly, new drugs targeting specifi c immune checkpoint regulators (such as CTLA-4 and PD-1/PD-1L) provide previously unprecedented survival benefi t for melanoma patients. In this review the most recent developments in the fi eld of melanoma management are summarized.]

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[The hepatocellular carcinoma (HCC) is one of the main causes of cancer-related death globally, and at the same time, it is the main event leading to death in cirrhotic patients. In the etiology of HCC, the non-alcoholic liver disease may be an important cause besides the viral cirrhosis. The HCC’s staging systems (Child-Pugh scores, Cancer of the Liver Italian Programme/CLIP, Barcelona Clinic Liver Cancer/ BCLC) play an important role in predicting the prognosis and determining the appropriate therapy. In Europe, the treatment strategy is based on the BCLC staging system. Screening of cirrhotic patient is also important because curative therapy is available only for the early-stage HCC. Several therapeutic options exist in the intermediate stage disease; among them the radiofrequency ablation (RFA), the transarterial chemoembolization (TACE) and the percutan ethanol injection (PEI) are most important. For the advanced disease, the only approved systemic therapy is sorafenib, which has been well-tolerated and yielded a substantially relative improvement in overall survival. For patient in end-stage disease with impaired liver function or a poor performance status, only supportive care is recommended.]

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