Lege Artis Medicinae

[New era of anticoagulation]

LOSONCZY Hajna

SEPTEMBER 20, 2010

Lege Artis Medicinae - 2010;20(09)

[Two types of anticogulants have been introduced into the clinical practice and used succesfully for more than 60 years: the heparins and the cumarins. Blood coagulation is targeted by the two drugs on many sites, their inhibitory action is not specific. The hirudins as specific trombin inhibitors have been introduced later for specific indications. After the discovery of the exact structure of the clotting factors, the drug development could have been directed against its active center which made possible the development of more specific anticoagulants. Some attributes of an ideal anticoagulants: sufficient efficacy with safe administration, predictable therapeutic effect with fixed dosing, no need for monitoring, oral administration, to have a specific antidote, no food or drug interactions. New anticoagulants are inhibitors of the initiation of blood coagulation. Tissue factor pathway inhibitors; inhibitors of the propagation of clotting process: activated protein C; indirect factor Xa inhibitors (requiering antithrombin to its actions: pentasaccharide, idrabiotaparinux and ultra-low-molecular weight heparins); direct FXa inhibitors, acting without antithrombin: rivaroxaban and apixaban; and out of the direct oral thrombin inhibitors acting against fibrin-formation, dabigatran-etexilate are discussed.]

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[The multidisciplinary pathological examination of colorectal carcinomas - From the biopsy sample to the K-RAS mutation analysis]

BOGNER Barna

[BACKGROUND - The role of pathologist in the reporting of colorectal carcinomas (CRC) has dramatically changed in the past 20 years. This change has been generated by the enormous progress in the surgical, radiological, oncological and pathological techniques and their interactions. AIM - To interpret the role of pathologist in the colorectal multidisciplinary team. METHODS - The most important histopathological prognostic and predictive factors, the surgical planes, the involvement of circumferencial margin, the regression grade after neoadjuvant chemoradiotherapy were assessed in 964 patients treated with operable colorectal cancer during 2001-2007 in the County Hospital of Baranya and the four nearby city hospitals. RESULTS - Most of our patients (>75%) were treated with advanced stage tumors. The lymph nodes were harvested through careful slicing, visual inspection and palpation - accordingly the average lymph node count increased from 7.45 to 19.0. After using elastic fibre stain we detected twice as much vascular invasion then before. The results of the surgical quality after TME and APER were somewhat dissapointing. Although the ratio of the specimens resected in the mesoretal fascial plane was comparable to the international results (39.8%), the ratio of resections in the muscularis propria plane was unacceptably high (47.8%) and it was more pronounced (50-100%) between the low volume surgeons of the small city hospitals. The involvement of the circumferencial resection margin was affected by the advanced pT and pN stage, the vascular invasion, the surgical plane, the type and number of resection performed by the surgeons, the regression grade after preoperative chemoradiotherapy and the gender. CONCLUSIONS - In addition to the traditional histopathological features the pathologist has to investigate the quality features of the preopreative assessment, the surgical planes of excision and the grade of regression after neoadjuvant chemoradiation and feed back these results to the members of the CRC multidisciplinary team. The optimal treatment of the CRC can be achived only in this setting.]

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[Due to the progressive nature of the type 2 diabetes mellitus and treatment requires prolonged lifestyle and/or pharmacologic management, the long term efficacy, durability and safety of newer antihyperglycemic agents are important considerations. Metformin is the most common prescribed oral antihyperglycemic agent (OHA) for initial therapy. Often, initial single oral agent is not sufficient to maintain good glucose control, combination of OHA are usually required to manage patients with type 2 diabetes. Incretinbased therapies (e.g. dipeptidyl peptidase 4 (DPP 4) inhibitors and analogues of glucagon like peptide 1) are newer compounds available for the treatment of type 2 diabetes. Sitagliptin is a once-daily OHA with a novel mechanism of action that targets the incretin axis. Addition of sitagliptin to ongoing metformin therapy was well tolerated and resulted in significant glycemic improvement after 30-104 weeks of treatment in patients with type 2 diabetes.]

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