Lege Artis Medicinae

[OUR EXPERIENCE WITH BORTEZOMIB-BASED THERAPY OF MULTIPLE MYELOMA BASED ON THE FIRST 60 PATIENTS]

MIKALA Gábor, BÁTAI Árpád, CEGLÉDI Andrea, CSUKLY Zoltán, DOLGOS János, HALM Gabriella, JÁNOSI Judit, KAPÁS Balázs, LOVAS Nóra, LUEFF Sándor, PETŐ Mónika, REMÉNYI Péter, SIPOS Andrea, TÓTH Zsuzsanna

JANUARY 20, 2007

Lege Artis Medicinae - 2007;17(01)

[INTRODUCTION - Bortezomib, a first-in-itsclass proteasome-inhibitor drug was registered in 2004 for the salvage treatment of relapsed and/or refractory multiple myeloma. We have been using this drug in our department for the treatment of myeloma patients since 2005. PATIENTS AND METHODS - In this retrospective study, treatment results (response rate, response duration, survival) as well as the complications and side effects were analysed based on 60 myeloma patients treated over a period of 18 months. The patients received at least one full cycle of non-first-line bortezomib-based (predominantly combinational) therapy. RESULTS - At least minimal laboratory and/or clinical response was observed in 47 of the 56 patients who could be analysed. Clinically meaningful (at least partial remission) response was seen in 41 of 56 patients. Immune-fixation negative complete remission was achieved in six patients. Median progression-free survival of our patient population was 13 months (10.8-14.8 months, n=49, adjusted for patients lost in the first 6 weeks and for those with less than 6 weeks of follow-up). As for overall survival, the median has not been reached, while treated patients had an 80.3% probability of survival at one year. CONCLUSIONS - Based on the treatment results of 60 myeloma patients, bortezomibbased therapy is clearly effective in relapsed and/or refractory myeloma.]

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Lege Artis Medicinae

[PREVALENCE OF OSTEOPOROSIS IN PATIENTS WITH COLLES’ FRACTURE]

NAGY József, BÁLINT Géza, TAKÁCS Katalin, WINKLER Valéria, RATKÓ István, BÁLINT Péter

[INTRODUCTION - Studies suggest that Colles’ fracture is the earliest of the osteoporotic fractures, and thus may be the first indication of the disease. PATIENTS AND METHODS - Fifty-seven consecutive patients with Colles’ fracture who presented between 1st of October 2003 and 1st of February 2004 at the traumatology out-patient clinic of Semmelweis Hospital, Kiskunhalas were screened for osteoporosis. RESULTS - Of the 43 postmenopausal women, 41 was found to have osteoporosis by DEXA scan, but only one was aware of her disease and received treatment. Out of these 41 patients 15 had fractures previously, 9 of whom had more than one. None of the four premenopausal women had osteoporotic DEXA measurement values. All of the 10 male patients had osteoporosis, 6 had previous fractures, 5 of them more then once. One patient required surgery, there was a prolonged fracture healing in 10 cases, and reflex sympathetic dystrophy developed in 3 patients. CONCLUSION - Since in this study more than 95% of postmenopausal women with Colles’ fracture had underlying osteoporosis, the authors conclude that DEXA scanning of these patients is recommended. Based on the results, it seems that screening for osteoporosis is indicated for both men and women after radius fracture.]

Lege Artis Medicinae

[The 19th General Assembly of the Hungarian Society on Geriatrics and Gerontology Zalakaros, 9-11 November 2006]

RUSZWURM Andrea

Lege Artis Medicinae

[On the Market]

dr. RIESZ Tamás

Lege Artis Medicinae

[SELF-PERCEIVED HEALTH AND PSYCHOSOCIAL WORK ENVIRONMENT. - STUDY AMONG HEALTH CARE STAFF IN SUBOTICA, SERBIA]

PIKÓ Bettina, PICZIL Márta

[INTRODUCTION - Studies have shown that work environment has a significant impact on workers’ health status and their reactions to stress, which may contribute to the development of illness, or, among health care staff, to burnout syndrome. The goal of the present study was to look at the relationship between psychosocial work environment and self-perceived health in a sample of health care staff living in Szabadka (Subotica, Serbia). METHODS - There were 253 health care workers in the study group. The majority were registered nurses, head nurses and assistants (together, 80.1%). Self-reported data were collected using a questionnaire on self-perceived health, frequency of psychosomatic symptoms, work shift pattern, and psychosocial work environment (e.g., the frequency of emotionally provoking situations or the level of dissatisfaction with work). RESULTS - Health care workers reported frequent experience of emotionally provoking situations. However, they often lack a connection network that would provide effective social support in these situations. In addition to the frequent occurrence of emotionally provoking situations and the lack of social support, voluntarily chosen extra work, shift work, and the low level of work satisfaction influence negatively their self-perceived health. CONCLUSIONS - The psychosocial work environment has a significant impact on the health care workers’ self-perceived health and the occurrence of psychosomatic symptoms. It would be necessary for health care workers to learn skills and techniques that help them cope with emotionally hard situations.]

Lege Artis Medicinae

[Geriatry in the focus]

BOGA Bálint

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[The restructuration of Hungarian oncological attendance and medicinal fi nancing resulted in the more intensive participation of clinical oncologists in the therapy of patients with ovarian cancer. The aim of the authors was not to defi ne the taxative therapeutic recommendations, but to give an overview on the development of the therapy and to introduce the deliberation aspects and therapeutic alternatives. While the primary and secondary prevention have developed in case of cervical cancer - with the possibility of eradication - the improvement of surgical techniques and clinical oncological treatments may result in the decrease of mortality in ovarian cancer. It is important to emphasis that only the appropriately aligned application of the two therapeutic modalities can lead to the desired outcome. It has become clear by the end of the ‘90s, that paclitaxel-carboplatin combination is the standard chemotherapy against ovarian cancer. Alternative cytostatic treatments like intraperitoneal treatment and triplets were not breakthroughs. The dose intensive treatment increased the survival rates besides good tolerability, however the results require further confi rmation. Neoadjuvant therapy should be considered in case of patients with advanced and metastatic disease in selected cases. Recently, therapeutic use of angiogenesis inhibition comes with signifi cant improvement. Bevacizumab is the fi rst of targeted therapies, and studies on the effectiveness of similar compounds are under way.]

Clinical Neuroscience

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[Aims - Primary spinal tumors are rare diseases and there are less objective data in the international literature. We analyzed the epidemiology and clinical consequences of primary spinal tumors based on the clinical experience of the National Center for Spinal Disorders. Methods - Demographic and clinical data of 300 patients treated in our institute between 1995 and 2007 was collected retrospectively and analysed. Results - Beyond the relatively more frequent pathologies (chordoma, myeloma multiplex) we treated in our hospital some of the very rare types of tumors (spinal leiomyosarcoma, synovial sarcoma). Primary spinal tumors are most often located in the lumbosacral region causing most frequently (73%) local or radiating pain. Modern therapy of these patologies is based on the surgical intervention. Mean operation time was 130 minutes, mean blood loss was 650 ml in our pratice during these often technically challenging surgeries. We found a significant association among the operation time, the blood loss and the extension of the tumor (p<0.01). Histology (p<0.0001), severity of symptomes (p<0.05) and blood loss (p<0.05) were significantly related to mortality. Local recurrence was more than 5-fold in case of patients previously operated in another institute (p<0.0001). Conclusions - We successfully determined some significant prognostic factor on clinical behavior of primary spinal tumors performing a large scale retrospective study. Long time follow up of the patients and completion of our database with prospective data are planned for the future.]

Clinical Neuroscience

[MORTALITY OF HOSPITALIZED STROKE PATIENTS IN HUNGARY; 2003-2005]

GULÁCSI László, MÁJER István, KÁRPÁTI Krisztián, BRODSZKY Valentin, BONCZ Imre, NAGY Attila, BERECZKI Dániel

[The aim of our research was to assess the incidence and the 12- and 24-month mortality of hospitalized stroke in Hungary. We analyzed the rate of mortality after stroke and compared it to the standard mortality rate of the population. To assess the incidence we extracted the data of “new” stroke patients (ICD- 10 diagnoses: I60-64) hospitalized in May 2003 from the database of the National Health Insurance Fund Administration. We regarded those as “new” patients who had not been treated with these primary or secondary diagnoses in the previous 24 months. Data were collected by sex and age (age groups: 25-44, 45-64, 65 and over). We analyzed the patients' survival on the basis of their April 2004 and April 2005 data. The incidence of the “new” hospitalized stroke patients was higher in men than in women; the incidence in the age group of 65 and over was 2112/100.000 in males and 1582/100.000 in females, the corresponding values in the 45-64 age group were 623 vs. 366 per 100.000, respectively. In 2003 more than 42 thousand “new” stroke patients were hospitalized in Hungary of whom over 10 thousand died in the first year, followed by a further 2 thousand in the second year. Women’s survival is more favourable than men's: in the first year it is 71.47% vs. 69.24% (65+ group), and 88.18% vs. 83.16% (45-64 group); in the second year the corresponding values are 66.95% vs. 61.62% (65+), and 85.45% vs. 80.90% (45-64), respectively. The risk of death in the first year after stroke, compared to the standard population, is 5.17- fold in women and 4.70-fold in men in the total sample, and 10-15-fold in the 45-64 group. There are large differences by gender, particularly in men of the working age groups (25-44, 45-64), whose mortality is twice as high as that of women of the same age.]

Clinical Neuroscience

[Temozolomide chemotherapy of patients with recurrent anaplastic astrocytomas and glioblastomas]

SIPOS László, VITANOVICS Dusan, ÁFRA Dénes

[Introduction - Anaplastic astrocytomas and glioblastomas are the most frequent and most malignant hemispherial tumours. Unfortunately, astrocytic tumours are of infiltrative character and radical removal is not possible. Recurrent malignant gliomas are rarely suitable for reoperation. In most of the cases of recurrent gliomas chemotherapy is the last choice. Patients and method - Seventy-five consecutive patients with recurrent malignant astrocytomas and glioblastomas had been treated at our institute with per os temozolomide for five days every month. The patients received two to 16 courses of chemotherapy. The toxicity, quality of life, response to chemotherapy and survival data were analysed. Results - Out of 75 patients four were excluded following the first treatment due to myelotoxicity, and allergic reactions. Among the patients treated with temozolomide in seven cases complete response, 17 partial response, 14 progressive disease were observed. In 33 cases the disease stabilized and out of them in 27% a significant neurological improvement was detected. The time to progression was 6.8 months and the median survival time 8.75 months for patients with glioblastoma and with malignant astrocytoma or malignant mixed oligoastrocytoma 9.45 and 11.15 months, respectively. The overall survival for patients with originally lower grade glioma was 70.32 and for patients with glioblastoma multiforme 17.43 months. Conclusions - Temozolomide chemotherapy in patients with recurrent malignant astrocytoma and glioblastoma proved to be efficacious and similar good results were achieved as with a nitrosourea based combined chemotherapy. Even in those patients who received previous chemotherapy temozolomide is well tolerated and a relatively long time to progression was achieved in cases of recurrent malignant gliomas. In a few number of patients where BCNU had been previously failed with temozolomide stable disease was achieved. Temozolomide seems to be a promising drug in the chemotherapy of malignant gliomas and can be applied as a second line chemotherapy, as well.]

Lege Artis Medicinae

[TREATMENT OF ANAEMIA IN A PATIENT WITH SMALL CELL LUNG CANCER]

TAMÁSI Lilla, WOLLÁK András

[INTRODUCTION - Anaemia is a common complication among patients with malignant tumours, and is due to the disease itself or to the oncologic treatment. Anaemia worsens the patient’s quality of life and hampers anti-cancer treatment in the appropriate intervals and doses. Erythropoiesis stimulating protein therapy in the anaemia of oncologic patients raises the haemoglobin level, reduces the need for red blood cell transfusion and improves quality of life. This drug has recently become accessible in Hungary for the treatment of chemotherapy-induced anaemia in patients with small cell lung cancer. CASE REPORT - In this paper the case of a 64- year-old woman with small cell lung cancer who survived for more than 2 years is presented. Two-line chemotherapy was administered together with irradiation and darbepoetin alpha supportation. The successful treatment of anaemia with darbepoetin alpha permitted the administration of chemotherapy in the necessary intervals and doses. CONCLUSIONS - The adequate use of erythropoiesis stimulating protein facilitates the management of patients with small cell lung cancer, and improves their quality of life.]