Lege Artis Medicinae

[In the focus: malignant lung diseases]

MAGYAR Pál

DECEMBER 16, 2006

Lege Artis Medicinae - 2006;16(12)

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Lege Artis Medicinae

[Christmas]

FRENKL Róbert

Lege Artis Medicinae

[THE ROLE OF THE ENDOCANNABINOID SYSTEM]

JÁRAI Zoltán

[Cannabinoid research in the last two decades became one of the most important fields in medical science, mainly because of the discovery of the endocannabinoid system and the understanding of the close connections between this system and several important diseases and pathological states. The endocannabinoid system has been shown to be present and active in many tissues and organs including the central nervous, gastrointestinal and reproductive systems, liver, lungs and bones. Its role in eye function, malignant diseases, pain and inflammation has also been studied. This review gives a summary of all these results with special attention to the role of the endocannabinoid system in energy metabolism and cardiovascular regulation.]

Lege Artis Medicinae

[“The Good Fame of our Guild Depends on Us” A Discussion with Rheumatology Professor Béla Gömör]

dr. NEMESÁNSZKY Elemér

Lege Artis Medicinae

[DISCREPANCIES BETWEEN THE CLINICAL AND PATHOLOGICAL DIAGNOSES IN CASES OF MALIGNANT TUMOUR]

KOVÁCS Attila, ILLYÉS György, SCHÖNFELD Tibor, SCHAFF Zsuzsa

[INTRODUCTION - In Hungary, like in other countries, previously undiagnosed diseases are frequently discovered at autopsies despite the availability of modern diagnostic tools. The aim of this study was to determine the accuracy of clinical diagnosis in malignant tumour cases. METHODS - Between 1996 and 2006, 5005 autopsies were performed in our institute. Malignant tumour cases with differing clinical and pathological diagnoses were selected and revised with regard to the localization of the primary tumour and the type of diagnostic difference, i.e., false negative, false positive or difference in the tumour site. The proportion of tumours with clinically undetermined primary site that were subsequently recognized at autopsy was established. The causes of misdiagnoses and the appropriateness of therapy were also analysed with regard to whether diagnostic mistakes were made and whether these significantly affected disease outcome. RESULTS - Of 1495 autopsies 235 cases (16%) showed a difference between the clinical and the pathological tumour diagnosis and a further 74 cases (5%) had a clinically undetermined primary tumour. Of the misdiagnosed cases 57% were false negative, 23% were false positive and 20% differed in their localization. Autopsy clarified 75% of the clinically undetermined primary tumours. Overall, there was one misdiagnosis or undetermined primary localization for every 5 correct clinical diagnoses (309/1495, 21%). The most frequent misdiagnosed tumours were lung, liver and kidney cancers. Most (60%) misdiagnoses were due to factors independent from the clinician, so these in fact were not diagnostic errors. Out of the remaining 40%, the true diagnostic error had an adverse effect on disease outcome in 11%.. CONCLUSION - Despite of the use of modern diagnostic tools the rate of clinically misdiagnosed malignant tumours is high, therefore, autopsy will still play an outstanding role in the future in quality control of clinical activity and education.]

Lege Artis Medicinae

[Winter (beta test)]

NÉMETH István

[Beta Civil realism culminated Rated XVII. century Dutch painting, one of the most striking features of secular themes and motifs dominated everyday. Although in some cases also made sure the various biblical, mythological or allegorical representations being.]

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The methylation status of NKCC1 and KCC2 in the patients with refractory temporal lobe epilepsy

UNAL Yasemin, KARA Murat, GENC Fatma, OZTURK Aslan Dilek, GÖMCELI Bicer Yasemin, KAYNAR Taner, TOSUN Kursad, KUTLU Gülnihal

Purpose - Methylation is a key epigenetic modification of DNA and regarding its impact on epilepsy, it is argued that “DNA methylation may play an important role in seizure susceptibility and maintenance of the disorder”. DNA methylation status of KCC2 (SCL12A5) and NKCC1 (SCL12A2) associated with refractory temporal lobe epilepsy was investigated in our study. Materials and methods - Thirty-eight patients with temporal lobe epilepsy (TLE) who were diagnosed by video EEG monitoring and 32 healthy control subjects were included in the study. Twenty-three patients in TLE group were men and the remaining 15 were women. Among them, 27 had unilateral temporal focus (9 with right; 18 with left) and 11 patients had bilateral TLE. We analyzed promoter region methylation status of the KCC2 (SCL12A5) and NKCC1 (SCL12A2) genes in the case and control groups. Gene regions of interest were amplified through PCR and sequencing was accomplished with pyro-sequencing. Results - We found a significant relationship between TLE and methylation on the NKCC1. However, there was no association between TLE and methylation on the KCC2 gene. Also, we found no association between right or left and unilateral or bilateral foci of TLE. There was no relationship between TLE and methylation on the NKCC1and KCC2 genes in terms of mesial temporal sclerosis in cranial MRI, head trauma or febrile convulsions. Conclusion - The methylation of NKCC1 can be a mecha­nism of refractory temporal lobe epilepsy. There are limited findings about DNA methylation in TLE. Therefore, further studies with large sample sizes are necessary.

Clinical Neuroscience

The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients

YAZAR Tamer, YAZAR Olgun Hülya

Aim - In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. Method - The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. Results - In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. Conclusion - In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

Clinical Neuroscience

[Clinical neurophysiological methods in diagnosis and treatment of cerebrovascular diseases]

NAGY Ildikó, FABÓ Dániel

[Neurophysiological methods are gaining ground in the diagnosis and therapy of cerebrovascular disease. While the role of the EEG (electroencephalography) in the diagnosis of post-stroke epilepsy is constant, quantitative EEG para-meters, as new indicators of early efficiency after thrombolysis or in prognosis of patient’s condition have proved their effectiveness in several clinical studies. In intensive care units, continuous EEG monitoring of critically ill patients became part of neurointenzive care protocols. SSEP (somatosesnsory evoked potencial) and EEG performed during carotid endarterectomy, are early indicative intraoperativ neuromonitoring methods of poor outcome. Neurorehabilitation is a newly discovered area of neurophysiology. Clinical studies have demonstrated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of stroke patients. Brain computer interface mark the onset of modern rehabi-litation, where the function deficit is replaced by robotic tehnology. ]

Clinical Neuroscience

[Antiepileptic drugs as mood stabilizers: what did we learn from the epileptology?]

RAJNA Péter

[Author summarizes the practical aspects of psychiatric application of mood stabilizing antiepileptic drugs. He observes how to transfer experiences taken from the “epileptological” practice into the psychiatric care of bipolar patients. He shortly demonstrates the relevant information on the mechanisms of action, controversies and possible clinical effects influenced by the seizure inhibiting effect of the concerning molecules. By the opinion of the author the clinical importance of pharmacokinetic parameters are underestimated in the psychiatric practice. Therefore - as an original approach in the literature - he summarizes the detailed clinical indications of serum level measurements of antiepileptic drugs applied in psychiatry as mood stabilizers. The therapeutic experiences in epilepsy added a lot of practices for the most effective dosing, building, tapering and exchange of the mood stabilizer antiepileptics. Drug interactions (appear among the psychotropic drugs or with the commonly used medicines). As in any chronic therapies the main condition of patient's compliance is the lacking or very mild presence of the applied therapy. The paper discusses the most frequently occurring and drug-specific side effects in table forms. Using the term of “relative therapeutic potential” the need of balance between the efficacy (influenced by the choice and dosing) and the tolerance are pointed. Rules of application can change significantly in special populations like in pregnancy, obesity, chronic diseases or in chronic comorbide states and in case of polytherapy. As for the special therapeutic effects, the experiences are not completed even in group of antiepileptics: we have larger and more favorable knowledge on the traditional drugs (carbamazepine and valproates) and on lamotrigine (from the newer generation) but promising but not enough information exists on the newest antiepileptic molecules. Further targeted studies are needed for the identification and positioning of antiepileptic drugs in the palette of mood stabilizing pharmacotherapy and for the definition of evidence based, individually tailored and lifelong applied highly effective combinations of the mood stabilizing pharmacotherapy containing antiepileptic agents.]

Lege Artis Medicinae

[IMMUNOLOGICAL ASPECTS OF PREGNANCY FAILURES - NOVEL THERAPEUTIC APPROACHES]

FÜLÖP Vilmos

[Recurrent miscarriage and failure of in vitro fertilization and embryo transfer affect millions of women annually. It is one of the great problems of the medical community that in as many as 75% of these failures their cause is never established. Considering that recurrent abortions may have several causes including anatomical, morphological, genetic, medical, bacteriological as well as immunological abnormalities it is inevitable to pursue these kinds of examinations and tests. One part of the immunological background can be explained by autoimmune diseases while the other part of it is associated with immunopathological factors. Currently available practical testing batteries that can directly assess immunological background, as well as their importance are covered. Recently developed and mainly immunology based treatments are also described. The results generally show that immunoglobulin products can be used safely in pregnancy. In the author's institute the efficacy of this therapy has been 93.5% in cases of immune-mediated abortion. As an alternative to intravenous immunoglobulin (IVIG) therapies, partner specific platelet suspension can be used only in selected cases with proven immunological background. Therapy monitoring, that is, assessment of the functional efficacy of IVIG is possible by determining FcR blocking antibodies in the maternal serum. Based upon the functional percentage of serum blocking activity the dosage and number of treatments can be changed.]