Lege Artis Medicinae

[Attila Németh: Dostoevsky, the pathologist of the soul]

TÚRY Ferenc

MARCH 31, 2022

Lege Artis Medicinae - 2022;32(03)

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Lege Artis Medicinae

[Current issues in the peripartum management of diabetic women from the perspective of an internist-diabetologist]

KERÉNYI Zsuzsanna

[In pregnancy complicated with diabetes, treatment of hyperglycaemia is of fundamental importance during delivery in order to improve the outcome parameters of both the mother and the neonate. This is particularly important in the case of mothers with type 1 diabetes and of all mothers who require insulin treatment during their pregnancy. The use of antenatal steroids for women at risk of pre-term birth further complicates the treatment of hyperglycaemia in the period immediately before delivery and requires the appropriate change of insulin therapy. The requirement of nil per os in the delivery period necessitates proper fluid, glucose and insulin treatment in the pre-delivery hours. After surgical delivery the patients may also need infusion treatment until the first meal. As there is no unified guideline for the peripartum management of diabetes, the author re­views the international literature on the internal medicine issues concerning the peripartum treatment of pregnant women with diabetes. This study reviews the characteristics of insulin treatment of women with various types of diabetes before, du­ring and di­rect­ly after delivery. It presents a dosing schedule for women who needed an antenatal steroid treatment in the period before delivery due to premature birth for the purpose of lung maturation. The study also addresses the application and programming of pe­ripartum blood glucose tests, continuous interstitial glucose monitoring (CGM) and insulin pump treatment (CSII).]

Lege Artis Medicinae

[Clinical implication of arterial stiffness in the elderly]

BENCZÚR Béla

[Hypertension prevalence and cardiovascular risk gradually with age. However this aging process seems to take a more rapid course in some individuals, as reflected in the Early Vascular Aging (EVA) syndrome. Age and high blood pressure are the two main determinants of arterial stiffness which is the core of EVA: the impaired elasticity of the media layer of large elastic arteries (mainly the aorta), a process that can be measured by pulse wave velocity. In elderly hyperten­sives, large arteries stiffen and systolic and pulse pressures increase, due to wave reflections. Arterial stiffness has predictive value for future CV e.g. events, coronary artery dis­ease, stroke, and vascular dementia and even all-cause mortality. The concepts of EVA (Early Vascular Aging) and SUPERNOVA (Super­normal Vascular Aging, the opposite phenotype of EVA) help to understand why early target-organ damages develop in some individuals and why others remain much more “younger” than their chronologic age. New drugs are being developed to treat EVA when lifestyle intervention and conven­tional risk factor controlling drugs are not enough.]

Lege Artis Medicinae

[Nanobiophysics of new type coronavirus]

KISS Bálint, KIS Zoltán, PÁLYI Bernadett, KELLERMAYER Miklós

[The Covid-19 pandemic has swept across the world, causing a never seen burden on our health care systems and challenging biomedical research to give appropriate answers to the epidemic. Modern, one-particle biophysical methods ensure special insight to the characteristics of the cause of the epidemic, the SARS-CoV-2. The virus carries a crown-like layer of spike proteins, which plays a fundamental role in the process of infection. The topography structure and mechanical characteristics of native virions have been determined by atomic force microscopy. Spike proteins form a dynamic surface due to their flexibility and motility. Virions are surprisingly resistant to mechanical compression, and their structure is able to recover after mechanical perturbation. The global structure of the virus is resistant to heat effect, but spike proteins dissociate from the surface with higher temperatures. The mechanical and dynamic characteristics of SARS-CoV-2 contribute to its virulence. The applied one-particle biophysical methods play an important role in understanding and fighting with the more common virus infections. ]

Lege Artis Medicinae

[Screening and care of patients with lower extremity arterial disease in Hungary]

FARKAS Katalin, KOLOSSVÁRY Endre

[Lower extremity arterial disease, in addition to the worsening life quality due to the concerning complaints and the rist of amputation, entails high risk of cardiovascular morbidity and mortality. The prevalence of this disease in the Hungarian po­pulation is close to 600 000 people, based on an extrapolation of the international epi­demiological data. In the recent years two target studies started (i) to analyse the performance of screening for lower extremity arterial disease in a representative hypertensive population (ÉRV Program), and (ii) to analyse the data of patients in the whole Hungarian health insurance population with lower ext­remity amputation or revascularization (HUNVASCDATA study). The present review summarizes the outcomes of these two studies. Data analysis on national sample bears high importance, since any improvement in vascular care in Hungary rests entirely on this information. ]

Lege Artis Medicinae

[Analysis of utilization and territorial distribution of Hungary’s waiting list reduction programme ]

PÓNUSZ Róbert, BONCZ Imre, KOVÁCS Dalma, CSONKA Diána, GAZSÓ Tibor, MOLICS Bálint, LUDMAN István, ENDREI Dóra

[In Hungary, the systematic waiting-list reduction program (“X” financing code) started in 2015 aiming to significantly reduce the waiting times of most relevant waiting lists services. The aim of this study was to evaluate the utilization and the territorial distribution of cases financed under the “X-code” between 2015 and 2018. We designed a retrospective and quantitative research on data of the Hungarian National Health Insurance Fund. Relevant data contained all publicly financed X-code cases between 2015 and 2018. Since 2015, this code covered the financing of services related to the waiting list reduction program. Processed data informed about patients (age, sex, residency at county level), involved health care facilities (name, type and location among the counties) as well as all provided medical interventions. In the study period 27,716 cases (mean age 68.05 years) were financed, the majority of patients (63.1%) was female. Case numbers per 10,000 inhabitants were the highest in Counties Baranya (84.63), Somogy (60.17), and Zala (58.89). 71.6% of patients received primary care in their residence county. The most frequent intervention was cataract surgery. During Hungary’s waiting list reduction program high number of patients received medical services. We found significant inequalities in utilization of waiting lists interventions and in the institutional engagement.]

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Lege Artis Medicinae

[The Endless Experiment – Positivist Thoughts about Attila Bánfalvi’s Publication ‘The Faith of Faithlessness’ ]

BRYS Zoltán

[Contrary to Attila Bánfalvi's position, I try to argue that within a narrow range of validity, the experimental-positivist knowledge creation methodology provides more secure, evolvable and useful knowledge than the knowledge creation procedures of some schools of complementary and alternative medicine (CAM).]

LAM Extra for General Practicioners

[Acute hepatitis caused by herpes simplex virus 1]

PATYI Márta, SEJBEN István, VÁGÓ Tibor, CSERNI Gábor, KISS Antal Zsolt, KISS József Zoltán

[INTRODUCTION - Herpes simplex virus is a rare and severe disease, which is often lethal, especially in children and those who underwent transplantation. Rapid diagnostic help determines therapy and facilitates recovery of the patient. CASE REPORT - The authors present a case of a 46-year-old patient with no underlying disease, in whom the diagnosis of hepatitis caused by herpes simplex-1 virus was suggested after histological evaluation of a blind liver biopsy specimen. The diagnosis was later confirmed by immunomorphological examination. The patient’s hepatitis resolved following acyclovir therapy, but he developed nosocomial pneumonia, sepsis caused by Candida albicans and anuria. The patient recovered due the joint efforts of an infectologist, a pathologist, an intensive care specialist and a nephrologist. CONCLUSION - During examination of the patient, immune suppression was not indicated either by HIV-serology or bone marrow biopsy. thus the findings were presumably explained by a generalised infection in an immunocompetent host. In the case described, histological examination of the liver biopsy was a life-saving procedure, because it allowed timely and efficient treatment.]

Lege Artis Medicinae

[Gambling Passion of Dostoevsky’s Heroes]

LŐRINCZ Jenő

Lege Artis Medicinae

[Diagnostic challenges in our adolescent patient with lymphoma]

MAGYARI Ferenc, RAJNAI Hajnalka, BARNA Sándor, MILTÉNYI Zsófia, VÁRÓCZY László, CSOMOR Judit, UDVARDY Miklós, ILLÉS Árpád

[OBJECTIVES - Unclassifiable B-cell lymphoma, which shows intermediate features typical for both diffuse, large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma (HL) is a novel category of diffuse, large B-cell lymphomas (DLBCL/HL), described in the WHO classification in 2008. This rare type of lymphomas presents peculiar clinical, morphological and immunophenotypical patterns, previously called gray-zone lymphomas. CASE REPORT - In December 2011 a 17- year old boy was diagnosed with mixedcellularity subtype of classical HL on the basis of left inguinal lymph node biopsy. Staging examinations revealed a IV/BXS (abdominal bulky) stage disease with unfavourable prognosis. Because of the unusally extended disease (nodal-extranodalbulky), a histological revision was performed. After a half course of ABVD chemotherapy the patient’s symptoms disappeared and the sizes of the involved lymph nodes decreased. On the basis of the histological revision, the diagnosis was changed to DLBCL/HL, so the treatment was modified to R-CHOP-14 regimen. After 3 cycles of R-CHOP-14 a complete metabolic remission (CMR) was achieved, which was confirmed by a 18FDG-PET/CT scan. Staging examinations after further 4 cycles of RCHOP- 14 therapy showed that the patient was still in CMR, but a PET-negative large mass (7×3 centimeter) still remained visible in the abdominal region. Considering this residual tumour and the agressive subtype of lymphoma the patient was referred for an autologous haemopoietic stem cell transplantation (AHSCT). After 2 cycles of R-DHAP regimen, successful CD34- positive stem cell collection was performed in August 2012. In September 2012, a RLAM-BEAM conditioning was performed followed by AHSCT. Posttransplantation 18FDG-PET/CT scan revealed further morphological regression, no symptom of the underlying disease appeared and the patient is in complete remission for 15 months. CONCLUSIONS - This case exemplifies that in case of atypical clinical findings and unusual progress of the disease it might be worthwile to re-evaluate the case and the (histological) diagnosis, which requires a close cooperation between the clinician and the pathologist.]

Clinical Oncology

[Recent strategies in the chemoterapy of soft tissue tumors]

PÁPAI Zsuzsanna, KISS Nóra

[Conventional adjuvant therapy is, in most cases, either the well-known standard doxorubicin monotherapy or the combination of doxorubicin + ifosfamide. No clear guideline has been developed yet - adjuvant therapy is recommended in cases with high grade, larger than 10 cm, sarcoma, where surgery hasn’t been suffi ciently radical, and adjuvant radiotherapy may not be advisable. In locally advanced tumors, due to the requirements of limb salvage, isolated limb perfusion is recommended. As a new compound, hafnium-oxide nanoparticles (NBTXR3) can be useful in local therapy: combining intratumoral injection and radiotherapy may be a fl agship initiative, however further investigations are necessary. In the treatment of metastatic tumors, beside the standard methods, new, targeted treatments are becoming more and more prevalent: in leiomyosarcomas trabectedine, pazopanib and olaratumab; in liposarcomas trabectedine and eribulin; in synovial sarcomas pazopanib; and in imatinib-resistant GIST, sunitinib and regorafenib. Soft tissue sarcomas are rare tumors categorized as heterogeneous histological subtypes. In their treatment, it is key to customize the treatment based on these subtypes and interdisciplinary collaboration with the orthopedic surgeon, the pathologist and the radiotherapist to determine the suitable therapy for each individual.]