Lege Artis Medicinae

[Capsaicin as a Therapeutic Molecule ]

SCHNEIDER Imre

SEPTEMBER 20, 2015

Lege Artis Medicinae - 2015;25(08-09)

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Lege Artis Medicinae

[Perioperative management of patients taking new oral anticoagulants - dabigatran in focus]

MÁRK László

[Appearance of new oral anticoagulants (NOAC) on the market requires a basically new approach from the doctors compared to vitamin K antagonists (VKA), the only oral anticoagulants used for several decades. These new drugs are at least as effective in the prevention of thrombotic events as the old ones and have the advantage that no regular laboratory monitoring is needed. Compared to the VKA a different management is required also in the perioperative care of patients taking NOAC. There is no need for bridge therapy, i.e. low-molecular-weight heparin (LMWH). The smaller surgical procedures can be performed 24 hours after the last dose of NOAC if it is administered once a day or 12 hours in case of agents administered twice a day. When a large surgical procedure is planned the drug should be stopped 24-96 hours before. The therapy should be resumed 6-8 hours after the procedure in low, 48-72 hours later in high bleeding risk cases. In a Canadian prospective study a protocol was used in which the stopping and resumption of dabigatran was recommended based on the bleeding risk and its half-life depending on the renal function. In 541 surgeries (60% with standard, 40% with increased bleeding risk) the occurrence of serious bleeding events was 1.8%, that of minor bleedings 5.2%. During the study one thrombotic event (TIA) occurred (0.2%). At the end of the article the author also makes a recommendation for stopping and resuming dabigatran therapy in case of tooth extraction, endoscopic biopsy and cholecystectomy.]

Lege Artis Medicinae

[Pleiotrop effect of rosuvastatin: clinical revelance of decreasing the mean platelet volume]

PUKOLI Dániel, SEMJÉN Judit, SZÉKELY Anita, RAJDA Cecília

[INTRODUCTION -Activated platelets play a key role in the patomechanism of cardiovascular diseases. One biomarker of platelet activation is mean platelet volume (MPV). Increased MPV level is connected to higher cardiovascular risk. Statins are frequently used in vascular diseases. We examined the effect of rosuvastatin on platelets in serum. METHODS - The patient were divided in medium risk and high risk (suffering ischaemic stroke) groups. Altogether parameters (total-, HDL, LDL-cholesterol, MPV) of 66 patients were examined before and after rosuvastatin treatment. RESULTS - Rosuvastatin decreased the cholesterol and MPV levels in both groups. This effect was greater in the high risk group. DISCUSSION - According the our findings rosuvastatin decreases the MPV both in hypercholesterolaemic and ischaemic stroke patients. The high LDL level causes increased platelet activation leading to increased thrombosis. This cascade worsens the underlying pathways in cardiovascular diseases. We found that aspirin taken together with rosuvastatin has a greater effect on decreasing the MPV. This probably doubles the antithrombotic effect. ]

Lege Artis Medicinae

[Scientific Medicine and Complementary Medicine: Unresolvable Opposites or Mutually Supportive Systems? ]

PIKÓ Bettina

Lege Artis Medicinae

[Evaluation of body image by means of body shape test and the priming phenomenon]

KOVÁCS Gyöngyvér Xénia, PRIEVARA Dóra Katalin, PIKÓ Bettina

[INTRODUCTION - Body image plays a significant role in the way how the individuals evaluate their own health and in the motivation for health promotion and disease prevention. Consumer culture provides controversial messages for the population, on one hand it motivates to try foods of high calories, on the other hand it also supports the thin body for the ideal. Not surprisingly, besides obesity, eating disorders and distorted body image disorders also tended to increase during the past decades. Therefore, it would be relevant to investigate the background variables of body image. METHODS - One hundred and sixty seven healthy working adults participated in our study that included a self-completed, voluntary and anonymous questionnaire with a focus on the so called body shape test. First, based on projecting figures on slides, the participants evaluated their own figure and the ideal one as perceived by them. Then we projected figures of skinny models. After this they re-evaluated themselves. The goal of this investigation was to detect the priming effect of projecting slim figures that is frequently used in the media. RESULTS - Based on the projection of the skinny models, there was a change in 55.6% of the sample in the evaluation of one’s own figure. On a Likert-type scale of 1-7 points, previously they had evaluated themselves with an average of 3.23 points (thinness scale) that turned into 3.35 after the projection of the skinny models. In addition, their view about their own ideal body (4.57 points), and about female and male ideal body also changed into a slimmer one. These changes were statistically significant (p < .001) by paired t-test both for men and women. Finally, men and women did not show significant difference in the evaluation of female and male ideal body. CONCLUSIONS - These results justified the role of the pictures’ priming effect in body image both in terms of the perception of one’s own figure and the ideal body. The change was particularly relevant in the case of evaluation of one’s own figure due to the choice of the slimmer body as compared to the view of the ideal body. Evaluation of female and male ideal body was similar to the first projection of the pictures as compared to what they would think as ideal for themselves. After the projection images of the female and male ideal body moved to the slimmer figures in a smaller account as compared to the own ideal body image. All these suggest that pictures projected by the media may have a significant role in the population’s body image. Clarifying the phenomenon may help in health promotion and dieting related disease prevention. ]

Lege Artis Medicinae

[Hungarian Health Politics: Currently and in a Historical Perspective ]

BALÁZS Péter

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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

[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

Clinical Neuroscience

[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

RÓZSA Csilla

[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

Hungarian Radiology

[Gynecological malignancies: review of the radiological diagnostics and image-guided therapy - Onco Update 2008]

FORRAI Gábor, BODOKY György

[The recent results of diagnostical imaging of gynecological tumours and the actual place of interventional radiological methods are discussed. Systematical reviews of articles published during the last year (2007) have been availed to discuss: cervical cancer, endometrial cancer, ovarian cancer, general and special imaging of the female pelvis, different uterine fibroid ablation methods (embolisation and high-intensity focused ultrasound [HIFU]). Experience of gynecological tumour imaging is growing rapidly, therefore, even the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are making their way into the daily routine. Some examinations become obsolete during the course of time and thus their further application should be avoided. In the meanwhile, some modalities prove their worth and become indespensable during the investigation of a given pathology.]

Lege Artis Medicinae

[THE POTENTIAL ROLE OF THE SEMICARBAZIDESENSITIVE AMINE OXIDASE ACTIVITY IN THE DEVELOPMENT OF DIABETIC RETINOPATHY]

DURA Eszter

[Recent data suggest that the copper-containing semicarbazide-sensitive amine oxidase enzyme (SSAO) may play a role in vascular endothelial damage through conversion of certain endogenous monoamines, such as methylamine, into cytotoxic aldehydes, hydrogen peroxide and ammonia. SSAO is present in various human tissues and in the serum. Elevated SSAO activities have been reported in patients with both types of diabetes mellitus. We have demonstrated that the activity of serum SSAO is significantly higher in type 2 diabetic patients with high-risk proliferative diabetic retinopathy compared to those without retinopathy. Our clinical results support the hypothesis that elevated SSAO activity may be involved in the pathogenesis of microvascular diabetic late complications, such as retinopathy. The enzymatic conversion of the endogenous monoamines (e.g. methylamine, aminoacetone) into toxic aldehydes and hydrogenperoxide may be one of the possible mechanisms of the development of microangiopathy. Also, the vascular adhesion protein-1 (VAP-1) function of the molecule can cause leukostasis and leukocyte activation through increased leukocyte adhesion, resulting in worsening of the capillary circulation and hypoxia. Further prospective, larger studies are needed to elucidate the role of the possible association between serum SSAO activity and highrisk proliferative retinopathy in patients with type 2 diabetes. The pharmacological manipulation of SSAO activity might be an interesting new concept for prevention and treatment of diabetic retinopathy.]