Lege Artis Medicinae

[Microscopic colitis]

BARTA Zsolt

FEBRUARY 21, 2008

Lege Artis Medicinae - 2008;18(02)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[The effect of rosuvastatin on the progression of atherosclerosis in symptom-free patients]

KÁPOSZTA Zoltán

Lege Artis Medicinae

[Errors from a Practicing Surgeon’s Perspective Errors and Complications in Abdominal Surgery]

DÓSA Ágnes

Lege Artis Medicinae

[Cardiovascular protection with telmisartan]

NAGY Viktor

Lege Artis Medicinae

[The End of the Story]

MAKÓ János

Lege Artis Medicinae

[Management of bleeding from oesophageal and gastric varices]

JÓZSA Andrea, SZÉKELY Iván, SIMON János, MÁHR Árpád, HORVÁTH László, HORVÁTH Andrea, FEJES Roland, SZÉKELY András, SZABÓ Tamás, MADÁCSY László

[INTRODUCTION – Variceal haemorrhage from the oesophageal or gastric wall is a major cause of death in patients with chronic liver disease. Over the past two decades many new treatment modalities have been introduced in the management of variceal bleeding, such as emergency endoscopy, band ligation and postintervention observation of the bleeding patients in subintensive care units. This study presents the results of state-of-the-art therapy applied in our department, comparing them to published data. PATIENTS AND METHODS – Clinical records of patients with variceal haemorrhage admitted to our department between January 1st 2001 and December 31st 2004 were reviewed. Six-week mortality, incidence of recurrent bleeding, transfusion requirement and length of hospital stay were the main parameters analysed. RESULTS – A total of 228 admissions (191 patients) due to variceal bleeding were recorded in the study period. Cirrhosis was of alcoholic origin in 92% of patients. Upper endoscopy was performed in 94% of patients within 4 hours and endoscopic therapy was also applied in all but 7 patients. Octreotide was administered in 4 patients, and portosystemic shunt was performed in 1 patient. Primary endoscopic haemostasis was achieved in 85% of cases, while rebleeding rate was 31%. The mean length of total hospital stay was 10.6 days, including an average of 2.6 days in subintensive care units. The mean transfusion requirement was 3.75 units of packed red cells. Six-week mortality rate was 14.9%. CONCLUSION – In comparison to international data, the six-week mortality rate among our patients was substantially lower than that in earlier reports, and nearly equals with recent leading results.]

All articles in the issue

Related contents

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.

Lege Artis Medicinae

[THE GENETICS OF INFLAMMATORY BOWEL DISEASE]

LAKATOS Péter László

[The pathogenesis of inflammatory bowel disease is only partly understood; various environmental and host factors (e.g., genetic, epithelial, immune and non-immune) are involved. It is a multifactorial polygenic disease probably with genetic heterogeneity; some genes confer susceptibility to IBD in general, while others specifically increase the risk of ulcerative colitis or Crohn's disease or affect location (localized or extensive) and/or behaviour (e.g., mild, severe, aggressive). This review presents recent advances in the genetics of inflammatory bowel disease including chromosome segments newly recognized to be involved in inflammatory bowel disease as well as the role of NOD2/CARD15, SLC22A4/A5 and DLG5. The increasing genetic information provides, for the time being, a better understanding of the pathogenesis of the disease thus setting a basis for potential targets for therapeutic intervention. In the future, however, genetics may also help in refining the diagnosis or predicting disease course.]

Clinical Neuroscience

[Cerebral sinusthrombosis and ulcerative colitis - two cases]

ILNICZKY Sándor, DEBRECZENI Róbert, KOVÁCS Tibor, SZIRMAI Imre

[Inflammatory bowel diseases (IBD) - ulcerative colitis and Crohn’s disease - are associated with increased risk for thrombotic complications both in the arterial and venous system. Cerebral sinus thrombosis is a rare but potentially fatal consequence of these diseases. Modern imaging methods made this uncommon complication of IBD more frequently recognized. The link between IBDs and thrombosis has been extensively studied. Inherited coagulation disorders (APC resistance, antithrombin III and protein-S deficiency), acquired diseases (antiphospholipid syndrome), and the frequent use of corticosteroids were suspected. Two cases of ulcerative colitis associated with cerebral sinusthrombosis successfully treated are reported. The connection between IBD and thrombotic complications and the therapeutic risks are discussed as well.]

Clinical Neuroscience

[Endoscopic, posterior transseptal pituitary surgery - Learning curve of the surgical technique and equipment in 61 operations]

BELLA Zsolt, FÜLÖP Béla, CSAJBÓK Éva, MAGONY Sándor, VALKUSZ Zsuzsa, HERCZEGH Szilvia, JÓRI József, BODOSI Mihály, CZIGNER Jenő, BARZÓ Pál

[Introduction - The removal of hypophyseal tumor by transsphenoidal pituitary surgery using microsurgical instruments was first performed over 100 years ago. Operating techniques for this surgery are constantly being renewed, first by using a microscope and later on with the use of an endoscop. The authors provide an overview of the minimal invasive posterior transseptal-transsphenoidal aproach with the combined utilization of classical techniques with the assistance of the endoscop. Method - Sixty-one patients (33 female, 28 male, 21-84 yrs) were treated for sellar region tumor resection using an endonasal transsphenoidal aproach with the help of an endoscop. Follow ups were performed within 2-21 months. Results - Total tumor resection was successful in 91.8%, and partial resection in 8.2% of the patients. The rate of complications using the endoscop method was not higher compared to that of the classical microscopic method. There was no major bleeding in any of the cases. Adverse events such as minor epistaxis occurred in 4.9%, transitional diabetes insipidus in 6.5%, inraoperative CSF leak in 16.67%, postoperative CSF leak in 11.5% and meningitis in 8.2% of the patients. After the operation the pathological hormonal production stoped in all patients except in two patients who were acromegalic. However their GH level normalized and they did not require further treatment, the IGF-1 still remained high. Conclusion - The success of the surgical treatment is based on both, the proficient pre- and postoperative endocrinological care, and the minimal invasive surgical technique. The endoscop was used partially or continuously during the operation for better visualization of the operation field in multiple angles (30°, 45°). It was useful in differentiating between normal and tumorous glandular tissue, and also offered an enhanced view of the intrasellar (via hydroscopy) and parasellar region. Moreover the endoscopic method is able to decrease the operating time, reduce blood loss. In different stages of the surgery, depending on the anatomical and pathological situation, switching back and forth from microscope to endoscop technique, gives us the benefit of a clearer view in each situation.]

Lege Artis Medicinae

[CHEMOPREVENTION OF COLORECTAL CANCER]

LAKATOS Péter László

[Colorectal cancer is the second leading cause of cancer mortality in developed countries; in Hungary, the mortality has almost tripled in the past four decades. A decrease in mortality can only be expected from a consistently applied diagnostic and management strategy, including preventive measures. Primary prevention is defined as dietary, medicinal and lifestyle actions that can reduce the risk of developing cancer in people with average risk. Secondary prevention is the prophylactic treatment of high-risk patients or praecancerous lesions; tertiary prevention is the prevention of recurrence in patients cured of colorectal cancer. Drugs or dietary supplements used for chemoprevention block, delay or reverse the process of carcinogenesis. The most important drugs used for chemoprevention are aspirin and nonsteroidal anti-inflammatory drugs. Long-term administration of these drugs reduces the risk of developing colorectal cancer or adenoma both in the high-risk and in the average-risk population. The risk-lowering effect seems to be in positive correlation with the dose and the duration of use. Other chemoprophylactic drugs such as calcium, folate, oestrogen and antioxidants, as well as 5-aminosalicylates in patients with ulcerative colitis are also discussed in this review. Based on the current knowledge, chemoprophylaxis of colorectal cancer is recommended as secondary prevention in patients at high risk (e.g., familial adenomatous polyposis, extensive ulcerative colitis). In contrast, based on adverse event profile and cost-effectiveness analysis, primary prevention with chemopreventive drugs is currently not recommended in the averagerisk population.]