Lege Artis Medicinae

[Calcitonin-secreting ovarian strumal carcinoid]

ÉSIK Olga1, NÉMETH György1, SZEPESHÁZI Károly2

NOVEMBER 30, 1992

Lege Artis Medicinae - 1992;2(11)

[On the basis of a case report, the clinical picture, pathologic characteristics and possible histogenesis of ovarian strumal carcinoid are discussed. A 3 mm strumal carcinoid, i.e. thyroid tissue intimately mixed with a calcitonin-secreting neuroectodermal tumour, was found in a mature ovarian cystic teratoma of a 38 year old woman. Although the thyroid component demonstrated a typical normal light microscopic appearance, no thyroglobulin and thyroxine were found immunohistochemically. Immunoreactive calcitonin was demonstrated within the tumour cells, even in the transitional zone of the biphasic tissue elements. No amyloid was detected. The argentaffin and argyrophilic reactions were negative. The close relationship between functionally imperfect thyroid tissue and a neuroendocrine marker-secreting tumour seems to be concordant with the theory of the existence of a pluripotential stem cell capable of differentiating multidirectionally.]

AFFILIATIONS

  1. Uzsoki utcai Kórház Fővárosi Onkoradiológiai Központ, Budapest
  2. Jahn Ferenc Délpesti Kórház Patológiai Osztály Budapest

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[The beta-adrenoceptor blocking drugs]

KÉKES Ede

[The beta-blockers have been primary in cardiovascular pharmacology since the 1960's. Clinical experiences in the last 25 years have confirmed that the beta-adrenergic blockade is essential in treating the different forms of angina pectoris. Hypertension, hypertrophic cardiomyopathy, and all situations including acute myocardial infarction and some rhythm disturbances qualified by sympathetic overdrive. The beta-blockers have been shown in large scale clinical trials to reduce the cardio vascular morbidity and mortality associated with hypertension and post-infarction period. The possibility of using them as a combined therapy with a great number of other drugs without any difficulties, is very important. Toxicity is rare with beta-blockers and the side effect profile is generally good. There fore, there is no question that the risk/benefit ratio is weighted toward the benefit. Nevertheless there are some problems such as hemodynamic profile, and effects on lipid metabolism, etc. Research has advanced from the first generation to the third generation with direct or indirect effects on the vascular bed, producing strong vasodilation. Because of the above mentioned facts, it is essential to know correctly the pharmacological effects and precise pharmacokinetics, of the beta-blockers.]

Lege Artis Medicinae

[Plasma Exchange]

JÁKÓ János, SCHOPPER János

[As a technique, is one of the indispensable means of supportiv therapy. Possibilities and approaches representing new trends of up to date therapy are offered by its application. Such approaches are, the nonsubstitutive application of IVIG, or exploiting the advantages of the functioning LAK and TIL cells. However, the authors also point out dangers of this technique, therefore plasma exchange should be applied only after thorough consideration. ]

Lege Artis Medicinae

[A new operative technique in the internal carotid artery surgery]

ENTZ László, MOGÁN István, JÁRÁNYI Zsuzsa, PAPP Sándor, NEMES Atilla

[The primary author spent one year at the Vascular Department of Nurenberg Town Hospital where an opportunity presented it self to get acquainted with a new surgical method. The eversion endarterectomy of the carotid artery has been developed by the Nurenberg team in 1985. Since that time more then 1500 operations of this type was performed. Using the experiences gained in Nurenberg, the author introduced this new method at the Budapest Cardiovascular Surgery Clinic as well, and from January 1, 1991 until June 30, 1992, 213 operations were performed. Concerning short term results the new method is acceptable compared to the traditional methods. Owing to the method being a new one, long term results can only be read about from 2 authors. After a five year postoperative period restenosis of 1,3 percent was found after 212 operations by Kieny and after 105 operations, a 1.9 percent was reported by Kasprzak. These results seem to be encouraging if they are compared to the 10–25% restenosis rate of traditional operations. ]

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[APSAC Intervention Mortality Study]

MATOS Lajos

[Within 30 days of the infarct, 12.2% of the placebo group and 6.4% of the APSAC group had died. The active agent reduced mortality at 30 days by a mean of 47.5% (21-65%) within a 95% confidence interval. Side effects and adverse effects were rare.]

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[Evaluation of Verapamil for Efficacy, Safety and Tolerability in the management of Hypertension]

MATOS Lajos

[Once-daily administration of IsoptinSR tablets reduced diastolic blood pressure below 90 mm Hg in 74.4% of patients, and diastolic pressure normalised in 85-87% of patients taking one and a half tablets daily. Quality of life, according to the six-item scale used by the authors, was markedly improved by the end of the treatment period. Side effects were noted as constipation (5%), oedema of the limbs and headache (1-1%). Treatment had to be discontinued in 4.3% of cases due to manifest side effects. ]

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UJLAKI Mátyás, MAGYAR Péter, KARLINGER Kinga

[Among cervical (neck) region tumours, the thyroid lesions and the metastatic lymph nodes are the most detectable with conventional B-mode ultrasonography (US). The use of MRI and CT scans are limited because of the cost, and in case of CT, the radiation. With the introduction and constant development of sonoelastography, we have in our hands a new imaging procedure which is cheap, fast and harmless, yet giving more information to the examiner than conventional US. The elastographic examination of thyroid lesions is a more explored area than the elastographic visualisation of cervical lymph nodes. The ‘off-line’ elastography showed the highest accuracy allowing to calculate and analyse the strain index of cervical lymph nodes - strain index > 1.5 (85% sensitivity, 98% specificity) - but the ‘off-line’ processing of US elastograms is still too time consuming to be used in busy clinical settings. During the examinations of the thyroid gland both real-time and off-line processed strain imaging were used. An Italian team made a great leap forward as they standardized the degree of distorsion under the application of the external force. Then using the Ueno and Itoh elasticity score they achieved remarkable accuracy with real-time sonoelastography (P <0.0001). On the other hand only those organs are suitable for the US elastography characterization which can be slightly compressed, consequently the examination of a lesion with calcified shell cannot give useful information. Near to the pulsating arteries substantial amounts of decorrelation noise may appear and the examiner has to pay attention what structures are in the ROI box since the sonoelastography method assumes computations relative to the average strain inside the box. To detect a follicular carcinoma in the thyroid gland remains a big challenge. Despite of the limitations most researchers agree on the fact that sonoelastography is a perfect tool to use in addition to the conventional US examination. B-mode US combined with sonoelastography raised the accuracy in differentiation in all cases. With this modality it is also possible to deduce the number of cases when healthy lymph nodes or tissue peaces are taken for biopsy during FNAB.]

Lege Artis Medicinae

[Primary non-hodgkin's lymphoma of the thyroid]

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[Three cases of primary non-Hodgkin thyroid lymphoma from the past 30 years are reported, with particular regard to the diagnostics, staging, differential diagnostics, treatment, follow-up and survival. In stages IE and the relatively localized II E, surgical intervention (bilateral intra- or extra capsular thyroidectomy with selective neck node dissection) is indicated, followed by postoperative radiotherapy to the regional lymphatics (neck and upper mediastinum). Adjuvant chemotherapy is recommended be cause this is the only mode of treatment capable of reducing the occurrence of the distant relapses responsible for the majority of tumour-related deaths. The therapy in the advanced stages II E, III E and IV E does not differ essentially from the treatment of other nodal lymphomas: cytostatics are the main pillar of the therapeutic plan. The complementary use of irradiation is generally indispensable, but radical surgical intervention is no longer indicated.]

Ca&Bone

[The effect of intranasal salmon calcitonin therapy on bone mineral density in idiopathic male osteoporosis without vertebral fractures]

TÓTH EDIT, CSUPOR EMŐKE, MÉSZÁROS SZILVIA, FERENCZ VIKTÓRIA, NÉMETH Lóránd, VARGHA Péter, HORVÁTH CSABA

[INTRODUCTION -The aim of this study was to examine the effect of intranasal salmon calcitonin therapy on bone mineral density in idiopathic male osteoporosis without vertebral fractures. MATERIALS - The randomised, prospective, controlled trial involved 71 male patients (mean age 59±6 years) suffering from idiopathic osteoporosis (lumbal spine and femoral neck T-score <-2.5) without vertebral deformity. Study design: Treatment protocol: Patients in the control group (n=31) received 400 IU Vitamin D + 1000 mg elemental calcium daily while the treatment group (n=40) received 400 IU Vitamin D, 1000 mg elemental calcium and 200 IU calcitonin nasal spray daily, by an intermittent monthly dose. METHODS - 1. Osteodensitometry: lumbar spine (L2-4) and femoral neck were measured by dual photon absorptiometry (LUNAR DPX-L, USA), whereas non-dominant radius was measured by single photon absorptiometry (NK 364, Gamma, Hungary). 2. Roentgenomorphorphometry was done onthoracic IV to lumbar IV spines and deformity indeces were calculated. The treatment period was 18 months. Examinations were performed at baseline and at the end of treatment.The primary end-point was the change of bone density measured by osteodensitometry. Secondary end-points included the side effects of medication. RESULTS - Nasal calcitonin was associated with significant increase in bone mineral density at the lumbar spine (+3.5±4.3% vs. +0.83±6.4%, p=0.04) and the femoral neck (+3.2±3.9% vs. -0.68±5.7%, p=0.004). No significant difference was observed at the radius between the treatment groups (+1.4±8.8% vs. +1.4±10.9%, p=0.98). No osteoporotic fractures occurred in the treated group, but there were 3 fractures in the control group. Treatment was well tolerated with no premature discontinuations nor significant side effects compared to the control group. CONCLUSION - 200 IU salmon calcitonin nasal spray used daily, intermittently proved to be an effective and safe therapy in male idiopathic osteoporosis.]