Lege Artis Medicinae

[MODERN TREATMENT OF COLORECTAL CANCER]

KALMÁR Katalin1, HORVÁTH Örs Péter1

FEBRUARY 21, 2008

Lege Artis Medicinae - 2008;18(02)

[The incidence of colorectal cancer has dramatically increased in the past decades, rendering it the second most frequently diagnosed cancer in the Western world. Disease outcome can be improved both by early diagnosis, e.g., through the introduction and extension of screening programs, and by increased therapeutic efficiency. The latter is achieved by increasing the radicality of interventions in surgical oncology to total mesorectal excision, thereby significantly decreasing the frequency of local recurrence. High ligation of the inferior mesenteric artery aims to enhance the efficiency of lymphadenectomy. With the introduction of techniques that spare vegetative nerves, the quality of life will not be adversely affected by the increased radicality. Another direction of progress in colorectal surgery is the increased use of minimally invasive approaches, such as local excision by transanal endoscopic microsurgery or laparoscopic methods. Increased acceptance of a multimodality approach, i.e., combined application of surgical and oncological methods in the treatment of colorectal cancer, has been a great step forward recently. Beyond the long-applied adjuvant treatments, the pre-surgical use of neoadjuvant chemo-radiotherapy has become standard for locally advanced rectal cancers. Adjuvant and neoadjuvant chemotherapy also supplements the surgery of metastases with improving results and impressive long-term survivals. A very important prerequisite for tailored multimodality treatment is reliable staging, which is facilitated by the wider availability of endorectal ultrasound.]

AFFILIATIONS

  1. Pécsi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Klinika

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Lege Artis Medicinae

[LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA: CASE REPORT]

PINCZÉS István, KOVÁCS Attila, KARDOS Magdolna, GARA Ákos, GYŐRY Gabriella, SZALAY Ferenc, SPEER Gábor

[INTRODUCTION - Primary neoplasm of the great blood vessels is rarely reported. The tumour most commonly presents in the inferior vena cava. In general, the prognosis is very poor, since intimal sarcomas metastasise early, and mural sarcomas grow silently and remain hidden for a long time. Also, because this type of tumour is so uncommon, it is often not considered for diagnosis. CASE REPORT - We report on the case of a 77- year-old woman with progressive symmetric oedema of the lower limbs. The investigations revealed a tumour thrombus that obliterated the inferior vena cava in its entire length. No surgery was possible because of the advanced stage of the disease. Later, Budd-Chiari syndrome developed and the patient died of progressive hepatic failure. The tumour was initially thought to be that of extravascular origin breaking into the vein. However, autopsy revealed a primary tumour of vascular origin, which histologically proved to be a leiomyosarcoma. CONCLUSION - Today, the recognition of the insidiously growing vascular mural sarcomas is assisted by an entire diagnostic arsenal. It is important, however, that the possibility of this rare disease is considered in time to permit surgical removal, the only treatment that can prolong survival. The authors would like to contribute to this by presenting this rare clinical case.]

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[Pregnancy and insulin resistance: theoretical and clinical issues]

BARANYI Éva, WINKLER Gábor

[During pregnancy, metabolic changes occur physiologically, which are enhanced by the presence of gestational or praegestational diabetes. The basis of these changes is the increasing insulin resistance throughout pregnancy, which in diabetics may result in hyperglycaemia with undesirable clinical consequences and complications. These complications can be prevented in diabetic pregnant women by maintaining the physiological metabolic state typical of healthy pregnant women. Thus the aim of the treatment is to achieve a normoglycaemic state throughout pregnancy. In most cases this is only possible by the use of insulin, along with appropriate dietary measures. Intensive insulin regimes are successfully used in the metabolic control of pregnant diabetic women, and the use of insulin analogues and insulin pump may also be considered.]

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SZEGEDI Andrea, KISS Flóra, GAÁL János

[Psoriasis is one of the most common dermatological disorders. It is an immune-mediated chronic inflammatory disease that primarily affects the skin and the joints, and substantially reduces the quality of life. It occurs worldwide, with a prevalence of about 2% in developed countries. Today numerous studies are continuously published on psoriasis. Important progress has been made especially on its genetics, pathomechanism and comorbidity. In the past few years, several efficient therapeutic approaches have been developed and applied. With the appearance of biological therapies, the inflammatory process can be targeted more selectively than before. The paper reviews most recent data on the pathogenesis, immunological background, comorbidity and reduced quality of life associated with psoriasis, and presents therapeutic approaches with special focus on recent advances. The increased knowledge allows of a more efficient treatment and care of patients with proriasis, thus significantly increasing their quality of life.]

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[New clinical guidelines for the diagnosis and treatment of lung cancer contain important advancements. It is necessary therefore that these novelties are widely known by health care professionals. With an existing X-ray screening network in Hungary, we have a unique chance to discover lung malignancies in an early stage in the population. Annual screening is recommended in risk groups over 40 years of age using a nation wide established digital screening network technology. In the therapy of small cell lung cancer there has been no major advance in the past ten years. However, by today, the number of small cell lung cancer patients represent only about 15% of all lung cancer cases. There have been advancements in other fields of the therapy of non small cell lung cancer. Third generation cytotoxic agents used in a platinum based chemotherapy protocol improved quality of life, response rate and survival time. Radiochemotherapy used in locally advanced stages also represented a step forward. In early stage of non small cell lung cancer it has been revealed that significantly improved survival time can be reached with adjuvant combined cytotoxic chemotherapy. Based on these results adjuvant chemotherapy became part of the therapeutic protocol. The use of molecular targeted chemotherapy in the clinical practice of non small cell lung cancer treatment is also a novelty. New therapeutic approaches are epidermal growth factor inhibitors, angiogenesis inhibitors, antivascular, signal transduction modifiers, apoptosis inducing, eicosanoid signal transduction modifiers and immunotherapeutic drugs. Placebo controlled trials have proved the effectiveness of the epidermal growth factor tyrosine kinase inhibitor erlotinib in the second and third line therapy of non small cell lung cancer and can be administered in the European Union in this indication. The improvement in the complex care of lung cancer patients in Hungary is characterized by the gradual increase in the prevalence data, meaning the gradual increase of the number of lung cancer patients still alive.]

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[Colorectal cancer is one of the leading cancer-related death worldwide. The optimal treatment duration of metastatic colorectal cancer depends on the individual treatment aim and it should be decided by an onco-team and by the patient. In this review several actual issues will be discussed, like the optimal duration of therapy to reach the secondary resection, the accepted response rate and best treatment strategy in case of non-operable colorectal cancer. Furthermore, emphasis is given to the most useful endpoints to evaluate different therapeutic approaches.]

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[POSSIBILITES AND DIFFICULTIES OF COLORECTAL CANCER SCREENING IN HUNGARY]

ÚJSZÁSZY László, SIMON László, HORVÁTH Gábor, TAM Beatrix

[The frequency of colorectal cancer is increasing all over the world. It is the second most frequent oncological disease leading to death in both sexes in Hungary. The main part of colorectal cancer develope after the age of 50. In case of patients having higher risk we have to calculate with the earlier appearance of the tumour and detectable molecular genetic disorders. The development of colorectal cancer needs a long time. Before the appearance of the cancer, precancerous processes (adenomas, polyps) can be detected in the large intestine. The development of colorectal cancer can be prevented by the removal of the adenomas (polypectomy). There are many different and efficient methods to detect the precancerous and early disorders. For increasing the compliance to screening programs the common efforts of the society, the National Health Care Services and medical doctors are necessary. The education of the population and the medical services would also be helpful. The colorectal cancer screening programs are costeffective and supported by the different health services independently from the type of the insurance. Screening the patients having higher risk is one of most important task. In these cases the use of colonoscopy is the most frequent method for the screening and follow up as well.]

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[Background and purpose - Intraventricular subependymomas are rare benign tumors, which are often misdiagnosed as ependymomas. To review the clinicopathological features of subependymomas. Patient selection and methods - Retrospective clinical analysis of intraventricular subependymomas and systematic review of histological slides operated on at our center between 1985 and 2005. Results - Twenty subependymomas presented at the median age of 50 years (range 19-77). Two (10%) were found in the third, three (15%) in the forth, and 15 in the lateral ventricles. There was male preponderance (12 vs. 8). Ataxia (n=13) and papilledema (n=7) were the most common clinical presentations. Fifteen patients underwent gross total resection, and five had subtotal resection. None of the cases showed mitotic figures, vascular endothelial proliferation or necrosis. Cell proliferation marker MIB-1 activity (percentage of positive staining tumor cells) ranged from 0 to 1.4% (mean 0.3). Two cases were treated with preoperative radiation therapy (50 Gy) before the CT era, three other patients received postoperative radiation therapy for tumors originally diagnosed histologically as low grade ependymomas. Three patients (15%) died of surgical complication between one and three months postoperatively, and three patients died of unrelated causes in eight, 26 and 110 months. Fifteen patients were alive without evidence of tumor recurrence at a median follow-up time of 10 years. Conclusion - Subependymomas are low-grade lesions and patients do well without adjuvant radiotherapy. Small samples from more cellular areas may be confused with low grade ependymomas, and unnecessary radiotherapy may follow. Recurrences, rapid growth rates should warrant histological review, as hypocellular areas of ependymomas may also be a source of confusion.]

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