Lege Artis Medicinae

[Fulvestrant in late stage breast cancer]

BÍRÓ Mátyás, BÜDI László, AL-JAZAIRI Abdul Baki

APRIL 20, 2012

Lege Artis Medicinae - 2012;22(04)

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Further articles in this publication

Lege Artis Medicinae

[Benefits of the combination therapy of multiple cardiovascular risk factors and further advantage of the single-pill form]

CSÁSZÁR Albert

Lege Artis Medicinae

[Were the Middle Ages an Age of Darkness? ]

GAÁL Csaba

Lege Artis Medicinae

[Surveillance-examination in the department of internal medicine of a frequented hospital]

SCHAREK Petra, LÉTAY Erzsébet, KATONA Katalin, RÓKUSZ László

[OBJECTIVES - In November 2010, wescreened patients admitted to the MilitaryHospital, 1st Department of Internal Medi-cine for meticillin-resistant Staphylococcusaureusand Gram-negative, extended spec-trum beta-lactamase producing bacteria.We detected the prevalence of colonisationor infection by these strains during hospitalstay. METHODS - We compiled a datasheet toregister patient data and results. Swabsfrom one of the anterior nares, the throatand the rectal area were taken at admissionand discharge after informed consent of thepatients. Microbiological samples wereprocessed by current microbiology guide-lines. RESULTS - During the one-month studyperiod, 134 adult patients were admitted,105 of who consented to the examination.At admission, six patients (5.7%) carriedmeticillin-resistant Staphylococcus aureusand five patients (4.76%) carried extendedspectrum β-lactamase producing Esche-richia coli. In one patient (0.95%) nosoco-mial extended spectrum β-lactamase pro-ducing Enterobacter cloacaewas identifiedin the rectal sample. In two patients (1.9%),rectal colonisation by Streptococcus pyogeneswas detected. CONCLUSIONS - Screening patients formeticillin-resistant Staphylococcus aureusin our department is important because ofthe high rate of patients returning to thehaematologic department, and consideringthat 4.5% of patients admitted to ourDepartment were transported to surgicaldepartments in 2010. It is particularlyimportant to determine the sampling location. The prevalence of rectal colonisatonby extended spectrum β-lactamase produc-ing bacteria was in accordance with international data. We didn’t detect infectionprovoked by the examined bacteria duringthe study period.]

Lege Artis Medicinae

[Ethical Issues in Psychotherapy – Part I]

KOVÁCS József

Lege Artis Medicinae

[Roma cancer patients’ illness cognition and their attitudes toward medical treatment]

ROHÁNSZKY Magda, NÓTÁR Ilona, SZABÓNÉ Kármán Judit, KONKOLŸ Thege Barna

[INTRODUCTION - In this qualitative pilot study, our goal was to investigate the illness representation of gipsy cancer patients and to examine their attitudes toward medical treatment. SAMPLE AND METHODS - Deep interviews were made with 20 persons (60% female; Mage=39.2±15.1 years). The included participants approximately represented the group composition of the Hungarian Roma population. RESULTS - For most of our respondents, cancer is a frightening disease meaning some kind of punishment and the end of life. The potential causes of the disease usually remain completely incomprehensible. The participants proved to be very under-informed in relation to their treatment - even when compared to the low level of information among Hungarian cancer patients in general. In the face of the supporting presence of family members, our respondents often stated that there was nobody to share their deeper emotional problems with. About half of the patients reported on impolite and inefficient treatment attributed to prejudice against their Gipsy identity. However, deeper analyses revealed, that in most of these cases, mistreatment was a consequence of the general shortcomings of the health care system (e.g. lack of time) - being labelled as discrimination by our respondents. Almost every participant sees his/her only role in recovery merely in the participation in medical treatment - not attributing enough significance to life style changes and even less to alternative / complementary medicine. CONCLUSION - Special training to improve communication skills with gipsy patients is needed - especially for general practitioners. We also suggest preparing handouts to Roma cancer patients that provide easy-to-understand information on the medical treatments and health behaviours that serve the coping with cancer and their prevention.]

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[The restructuration of Hungarian oncological attendance and medicinal fi nancing resulted in the more intensive participation of clinical oncologists in the therapy of patients with ovarian cancer. The aim of the authors was not to defi ne the taxative therapeutic recommendations, but to give an overview on the development of the therapy and to introduce the deliberation aspects and therapeutic alternatives. While the primary and secondary prevention have developed in case of cervical cancer - with the possibility of eradication - the improvement of surgical techniques and clinical oncological treatments may result in the decrease of mortality in ovarian cancer. It is important to emphasis that only the appropriately aligned application of the two therapeutic modalities can lead to the desired outcome. It has become clear by the end of the ‘90s, that paclitaxel-carboplatin combination is the standard chemotherapy against ovarian cancer. Alternative cytostatic treatments like intraperitoneal treatment and triplets were not breakthroughs. The dose intensive treatment increased the survival rates besides good tolerability, however the results require further confi rmation. Neoadjuvant therapy should be considered in case of patients with advanced and metastatic disease in selected cases. Recently, therapeutic use of angiogenesis inhibition comes with signifi cant improvement. Bevacizumab is the fi rst of targeted therapies, and studies on the effectiveness of similar compounds are under way.]

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[Nowadays, with the continuously in creasing demand for targeted diagnostics and therapy, we are approaching an ideal stage when the most effective treat ment for a given patient could be selected. However, some basic problems are still waiting to be solved. One major hurdle is the heterogeneity, the formation of subclones with different signifi cance during progression, but with the capacity to overgrow after the failure of the initial therapy. The importance of this phenomenon is refl ected in the daily practice where targeted therapy is allowed to treat only locally extended or metastatizing tumors. Therefore, it is not as to nishing, that the clinical success is usually tem po rary, the disease in spite of the good response at the beginning will progress. The main reason is the resistancy against the carefully analysed and applied therapeutic drugs, which has several options (e.g. new mutations, crosstalks between pathways, faults of feed-backs, etc.). This review focuses on the acquired resistancy with some relevant examples. Among the open questions we can recall e.g. the resistancy in combination therapy, or the suggested link between resistancy and progression including the potential use of drug rechallenge.]

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REINDL Ildikó

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Hungarian Radiology

[The value of multislice computed tomography in the diagnosis of pulmonary embolism and in differential diagnostics]

BODROGI Nándor, BARANYAI Tibor

[INTRODUCTION - The multislice CT (MSCT) pulmonary angiography has been used increasingly in the diagnosis of pulmonary embolism with worldwide application and nowadays it can be considered as a gold standard technique. At the author's department a single slice CT has been used from 1993 and a 10 slice CT system with 24 detector-lines was installed in 2004. The authors summarize the advantages of MSCT in the diagnosis and differential diagnosis of pulmonary embolism and its role in the follow-up of cases and the significant increase of the diagnostic safety. PATIENTS AND METHODS - 2576 chest MSCT examinations were performed between 16 February 2004 and 20 June 2005. In 261 cases pulmonary MSCT angiography was made due to suspected pulmonary embolism. In 7 cases the indication of the CT was different, but due to the findings (pulmonary embolism) this group of patients is discussed in this paper. 268 cases were evaluated retrospectively. In 12 patients, CT could not be performed due to contrast agent allergy or because of seriously impaired renal function. In 2 cases it was not possible to establish a venous access. The therapeutical result was monitored upon the request of the clinicians. The pulmonary MSCT angiography was performed in accordance with a detailed acquisition and reconstruction protocol. In the reprocessing stage the 2D (MPR) reconstruction in different directions was an important step. In addition, three-dimensional MIP was used and VRT reconstruction was also made, if needed. Bolus tracking was applied in order to achieve a good contrast phase. RESULTS - In 116 out of 268 cases pulmonary embolism was detected by pulmonary MSCT angiography. In 7 patients pulmonary embolism was not the primary diagnosis. Pathological changes could not be detected in 55 cases (20.5%) and embolism was not proven later in these patients. No false negative study was recognized. In one case, after the death of the patient the autopsy failed to prove the presence of pulmonary embolism, this represents one false positive diagnosis. In 97 patients pulmonary embolism was not detected, however other findings were found relating to the complains of the patients and thus proper therapy could be introduced. CONCLUSION - Pulmonary MSCT angiography proved to be a highly accurate method for the diagnosis and for exclusion of pulmonary embolism and also in the evaluation of its extent. MSCT can be used in monitoring the result of the therapy. In addition, MSCT gives an opportunity to detect other acute pathological conditions of the chest, thus value of the study is significant in the differential diagnosis.]