Lege Artis Medicinae

[MOLECULARLY TARGETED BIOLOGICAL THERAPY IN THE TREATMENT OF SOLID TUMOURS]

LÁNG István, HITRE Erika

JANUARY 22, 2008

Lege Artis Medicinae - 2008;18(01)

[In part one of this article we reviewed the modern biological oncotherapy of breast cancer and colorectal cancer. Now we report on the biological therapies that target various kinase inhibitor pathways by monoclonal antibodies or by oral kinase inhibitors in gastrointestinal stromal tumours, pancreatic cancer, head and neck cancer, lung cancer and kidney cancer. Cell surface receptors (e.g., epidermal growth factor receptor in head and neck cancer) and ligands necessary for the growth of metastases (e.g., vascular endothelial growth factor in kidney cancer) can be blocked by specifically developed monoclonal antibodies. Small molecular weight oral kinase inhibitors, e.g., imatinib and sunitinib in gastrointestinal stromal tumour, erlotinib in pancreatic cancer, erlotinib and gefitinib in lung cancer, sunitinib and sorafenib in kidney cancer, sorafenib in hepatocellular cancer block intracellular signal transduction pathways. The mTOR inhibitor temsirolimus can be used in advanced renal cell carcinoma.]

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Lege Artis Medicinae

[TISSUE HORMONAL SHOCK: INTRACRINOLOGY - THE IMPORTANCE OF LOCALLY PRODUCED HORMONES IN THE PATHOGENESIS OF VARIOUS DISEASES]

SPEER Gábor, LAKATOS Péter

[This review describes the function and tissuespecific expression of the 11- and 17-beta-hydroxysteroid- dehydrogenase enzyme families as well as the aromatase and 1-alpha-hydroxylase enzymes. Recently, in situ formation of active steroids by these enzymes at the sites of their actions from biologically inactive precursors in the circulation have been demonstrated to play an important role in sex steroid-dependent neoplasms (such as breast and prostate cancer), and in some metabolic diseases (such as obesity, osteoporosis and insulin resistance). Tissuespecific Cushing syndrome (local hypercortisolism) may contribute to the pathogenesis of the latter group of diseases, suggesting that obesity may be considered the Cushing-syndrome of the omentum and that osteoporosis is the obesity of bone. Intracrinology is the science of alterations in tissue hormone synthesis catalysed by enzymes such as those mentioned above, which cannot be detected by measuring circulating hormone levels. The effects of local hormone production differ from those of the well-described autocrine, paracrine and endocrine actions. Based on the hormonal changes within various tissues, the pathogenesis of a number of diseases may be interpreted in a novel way.]

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[Most recent data on drug-eluting stents]

FÜLÖP Gábor, BERTA Balázs, MERKELY Béla

Lege Artis Medicinae

[Errors of the Amended Version]

dr. KALÓ Zoltán

Lege Artis Medicinae

[For another… - A thing or two on Hungary, in January 2008]

KAPÓCS Gábor

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[Liver transplantation in adulthood - For whom is it indicated and how they can get it in Hungary?]

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Delirium is a syndrome frequently encountered in intensive care and associated with a poor prognosis. Intensive care delirium is mostly based on general and palliative intensive care data in the literature. In this study, we aimed to investigate the incidence of delirium in coronary intensive care unit (CICU), related factors, its relationship with inhospital and follow up prognosis, incidence of age-related delirium and its effect on outcomes. This study was conducted with patients hospitalized in CICU of a tertiary university hospital between 01 August 2017 and 01 August 2018. Files of all patients were examined in details, and demographic, clinic and laboratory parameters were recorded. Patients confirmed with psychiatry consultation were included in the groups of patients who developed delirium. Patients were divided into groups with and without delirium developed, and baseline features, inhospital and follow up prognoses were investigated. In addition, patients were divided into four groups as <65 years old, 65-75 yo, 75-84 yo and> 85 yo, and the incidence of delirium, related factors and prognoses were compared among these groups. A total of 1108 patients (mean age: 64.4 ± 13.9 years; 66% men) who were followed in the intensive care unit with variable indications were included in the study. Of all patients 11.1% developed delirium in the CICU. Patients who developed delirium were older, comorbidities were more frequent, and these patients showed increased inflammation findings, and significant increase in inhospital mortality compared to those who did not develop delirium (p<0.05). At median 9-month follow up period, rehospitalization, reinfarction, cognitive dysfunction, initiation of psychiatric therapy and mortality were significantly higher in the delirium group (p<0.05). When patients who developed delirium were divided into four groups by age and analyzed, incidence of delirium and mortality rate in delirium group were significantly increased by age (p<0.05). Development of delirium in coronary intensive care unit is associated with increased inhospital and follow up morbidity and mortality. Delirium is more commonly seen in geriatric patients and those with comorbidity, and is associated with a poorer prognosis. High-risk patients should be more carefully monitored for the risk of delirium.

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