Lege Artis Medicinae

[Efficiency of fulvestrant therapy in metastatic breast cancer]

TAKÁCSI-NAGY Zoltán

MARCH 22, 2012

Lege Artis Medicinae - 2012;22(03)

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Lege Artis Medicinae

[Colonizing the Body – Sways of Civilization]

ZSINKÓ-SZABÓ Zoltán, LÁZÁR Imre, TÚRY Ferenc

Lege Artis Medicinae

[On Charon’s boat]

NAGY Zsuzsanna

Lege Artis Medicinae

[Bacterial contamination and irritable bowel syndrome]

NOVÁK János

[Irritable bowel syndrome (IBS) is one of the most common gastrointestinal condition, which affects 10-15% of adults in developed countries. Recent observations have raised the possibility that disturbances in the gut microbiota and/or the accompanying low-grade inflammatory state might contribute to the etiology and symptomatology of irritable bowel syndrome. Some studies indicate that small intestinal bacterial overgrowth (SIBO), as confirmed by hydrogen breath tests (HBT), is more prevalent in patients with irritable bowel syndrome than in matched controls without IBS. Although the data are conflicting, this observation has led to the hypothesis that bacterial contamination was the primary cause of IBS. As a consequence of this hypothesis, a lot of therapeutic options have found their way into the armamentarium of those who treat patients with IBS. These agents include probiotics, prebiotics, antibiotics and anti-inflammatory agents. This paper describes the various mechanisms by which changes in the gut flora might contribute to IBS and also discusses the efficacy and safety of antibiotic therapies, especially rifaximin, for treating IBS/SIBO symptoms.]

Lege Artis Medicinae

[Epidemiological surveillance systems used by international organisations in military crisis management operations]

KOPCSÓ István, KISS Antal Zsolt

[Facing new challenges and growing requirements, the renewal and adjustment of doctrines, methods and technology is an indispensable progressive need for modern militaries. In order to achieve the maximal protection of troops and conservation of fighting strength, innovation is continuous and has greatly accelerated in the whole spectrum of Force Health Protection. Owing to the development of technology, portable capabilities that had been available only in the hinterland have become available in the military medical support area. Utilising mobile information technology solutions, the continuous, real-time information flow between the tactical level medical units and the higher level medical analysts and decision makers has become technically feasible, which results in a significant widening of epidemiological surveillance capabilities as well. We discuss the current challenges of expeditionary- type military operations and their general epidemiological aspects and the morbidity reporting and monitoring systems used in international military missions. Furthermore, we overview the milestones of the development of the NATO near-real-time epidemiological surveillance system, the NATO Deployment Health Surveillance Capability, which functions as a branch of the Budapestbased multinational NATO Centre of Excellence for Military Medicine.]

Lege Artis Medicinae

[Clinical aspects of ischaemic bowel disease]

DEMETER Pál

[Decreased blood flow through the intestines leads to mesenteric ischaemia, which is characterised by cellular damage due to the lack of oxygen and nutrients. Extensive collateralisation between splanchnic vessels serves as a protective mechanism against ischaemia. Intestinal ischaemia can be classified on the basis of its timing, location and the vessels involved. Acute mesenteric ischaemia can result from arterial embolisation, arterial or venous thrombosis, or vasoconstriction secondary to systemic circulation disorder associated with hypovolaemia. Chronic mesenteric ischaemia develops as a consequence of partial or complete occlusion of splanchnic vessels. Colonic ischaemia is mainly caused by a limited circulation disorder of the inferior mesenteric artery. Mortality rates for the various forms of acute mesenteric ischaemia are different. However, early diagnosis before bowel infarction might improve survival. This paper summarises the cilical aspects, diagnosis and therapeutic options of intestinal ischaemia.]

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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.

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Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

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[Operational Efficiency Investigation from APN Perioperative Perspective]

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[In the healthcare system operating theatres have to put great emphasis on quality work, patient safety and efficiency as well, and to achieve this, optimal utilization of theatres is extremely important. The results of researches in this topic in Hungarian and international literature draw attention to a lot of aspects. The study of perioperative periods, and the evaluation of the analysed processes show that theatres could be operated more effectively. As a result of this, more operations could be carried out and waiting time would also reduce. In order to increase the efficiency of the processes, APNs can play a prominent role at several points. According to the experience, the number of people using health care and the number of people waiting for surgery is increasing, which is further increased by the development of the ongoing SARS-CoV-2 (COVID-19) epidemic. Thereby, patients are not satisfied with the service. The work of APNs would also help increasing the contentment of patients during the operation procedures. Taking advantage of the multifunctional role of the nurse due to her knowledge and training, she actively participates in the operation, in the smooth running of the scheduled daily surgical program and contributes to the reduction of the number of missed, planned surgeries.]

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[Assessing Quality of life of Women with Cervical Cancer After Treatment]

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[To assess sexual function, functionality and quality of life in women with cervical cancer. Descriptive, cross-sectional, quantitative, non-random, purposive sampling of women (N=91) with FIGO stage I/II/III cervical cancer, more than 5 months after last treatment. The study used standard questionnaires with self-designed questions. Data were analysed using Microsoft Excel, descriptive and mathematical statistics (p<0.05). Completers who received radiotherapy scored significantly higher in functional status (p<0.05) and emotional function than those who did not receive radiotherapy (p<0.05). Completers with lower levels of emotional well-being were significantly more likely to have lower levels of sexual function and higher levels of gynaecological problems (p<0.05). Women affected by cervical cancer often experience somatic and psychological disturbances that reflect on quality of life associated with the disease and treatment.]