Lege Artis Medicinae

[On the screening for prostate cancer]

ROMICS Imre

NOVEMBER 20, 2010

Lege Artis Medicinae - 2010;20(11)

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Further articles in this publication

Lege Artis Medicinae

[Patient Safety, the Latest Trend in Improving the Quality of Healthcare]

BOGNÁR Ágnes

Lege Artis Medicinae

[Renal care - possibilities of complex organ protection]

WAGNER Gyula, AMMA Zoltán, JUHÁSZ László, KULCSÁR Katalin

[The authors analyse data of the last ten years of renal care. According to the principles of care they prefer to have contact at least once to all patients with an estimated clearance less than 60 ml/min, and on a regular basis to those with less than 30 ml/min. Their fundamental ambition is to develop the most favourable therapy for the patients together with general practitioners and with representatives of other specialities. The most important aim is to reduce cardio-renal morbidity and mortality. Early detection and effective treatment of target organ damage are the tools for this. It is clear from their previous work that it was not successful in the first period of care (2000-2005) especially in patients with diabetic nephropathy. Before the initiation of renal replacement therapy only half of the patients have been seen by a nephrologist. One-year-mortality after initiating dialysis was significant among patients who did not receive such care. Their medication was also not up-to-date. Through regular continuing medical education for general practitioners and in close collaboration with diabetologist colleagues the number of patients taken care of has doubled. Furthermore, the proportion of patients with hypertension or diabetes as an underlying disease among the patients receiving renal care increased to 68%. These findings may contribute to that their patients receive effective treatment taking the actual therapeutic recommendations into account. Hopefully it will be apparent in the hard end-points at the time of the analysis of the second period.]

Lege Artis Medicinae

[Waiting for a saviour - to the margin of a working paper]

KAPÓCS Gábor

Lege Artis Medicinae

[Clinical outcome 16 years after the IFN-beta-1b trial]

CSÉPÁNY Tünde

Lege Artis Medicinae

[Headache in everyday medical practice]

ERTSEY Csaba

[Headache is one of the most common complaints in clinical practice. The International Headache Society’s current classification distinguishes two major categories of headache: primary and secondary (symptomatic) headache types. The former types, which account for the majority of headaches, are caused by a functional disorder in a structurally intact nervous system and are characterised by stereotypical attacks that resolve - in most cases - spontaneously after a certain period, the duration of which is characteristic for each headache type. The diagnosis of primary headaches is based on a detailed history of the attacks and negative results on a neurological examination. At the first presentation of the patient, it should be determined whether a potentially serious or life-threatening condition might be present, whether the type of the patient’s headache can be ascertained according to the IHS’s criteria, and what kind of examinations are needed to establish the correct diagnosis. A detailed history is the cornerstone of the diagnosis of primary headaches and it cannot be substituted by instrumental examinations. The use of imaging and other examination methods is necessary for the diagnosis of secondary headaches, but if the patient’s history and the results of the neurological investigation are fully consistent with a primary headache type, instrumental examinations are unlikely to provide any additional information. Although establishing the correct diagnosis is often time-consuming, it is necessary for the efficient treatment.]

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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.

Clinical Neuroscience

[Vinpocetin in neurological diseases]

SZAPÁRY László, KÉSMÁRKY Gábor, TÓTH Kálmán, MISNYOVSZKY Melinda, TÓTH Tímea, BALOGH Ágnes, NAGY Krisztián, NÉMETH György, FEHÉR Gergely

[Introduction - Stroke is the third leading cause of death worldwide (following cardiovascular and cancer mortality) and associated with serious disability for the vast majority of patients. There is no salvage therapy for irreversibly damaged brain areas, improving the circulation of the surrounding hypoperfused territories may be associated with benefitial clinical states. Cerebral hypoperfusion may play a role in the pathogenesis of other kind of neurological diseases, improvement of global circulation may have a preventive effect on these conditions. Aims - The aim of our study was to review the experimental and clinical articles focusing on the role of vinpocetin in different neurological conditions. Results - Vinpocetin appears to have several different mechanisms of action that allow for its antiinflammatory, antioxidant, vasodilating, antiepileptic and neuroprotective activities in experimental conditions. On the other hand, several meta-analysis of the existing studies in acute stroke examining short and long term fatality rates with vinpocetin was unable to assess efficacy. In chronic cerebrovascular patients, vinpocetin improves impaired hemorheological variables, has significant vasodilating properties, improves endothelial dysfunction, neuroimaging studies showed selective increase in cerebral blood flow and cerebral metabolic rate, all of which are potentially beneficial in cerebrovascular disease and may improve cognitive functions. Summary - Based on the above mentioned results vinpocetin plays an important role both in basic research and in clinical management of different neurological diseases.]

Hungarian Radiology

[Régnier: Vanitas - Unusual story of a painting depicting a breast cancer woman]

GÖBLYÖS Péter, DRAGON Zoltán

Clinical Oncology

[Aspiration cytology in tumor diagnostics]

JÁRAY Balázs

[Aspiration cytology (fi ne-needle aspiration, FNA) has increasing role in cancer diagnostics. The review briefl y introduces the relevant methods, their place in the clinical protocolls to identify the given lesions, emphasising advantages and disadvantages. An overview is given on the acceptance of FNA worldwide, and also in Hungary based on private experiences. In certain cases examples are summarized how FNA can contribute to the identifi cation of the diseases, with some important comments, such as the limitations of the method. Finally, the expected results are evaluated, together with the possibilities to optimalize the outcome.]

Clinical Oncology

[Cardiovascular Side Effects of Anti-Cancer Therapies]

LANDHERR László, NAGY András Csaba, NAGYKÁLNAI Tamás