Lege Artis Medicinae

[Our Feasts]

NAGY Zsuzsa

JANUARY 21, 2006

Lege Artis Medicinae - 2006;16(01)

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[THE POSSIBILITIES OF USING PROBIOTICS IN DIGESTIVE DISEASES]

DEMETER Pál

[The mammalian intestinal tract contains a complex, dynamic and diverse society of microorganisms. The beneficial effects of developing a normal bacterial flora are: colonic resistance against pathogens, immunmodulation and intact intestinal barrier. Probiotics are live microbial supplements which beneficially affect the host by improving its intestinal microbial balance after oral administration. The health benefits of probiotics have been the subject of increased research interests. This paper gives a review of the literature that study the roles of probiotics in the prevention and treatment of antibiotic-associated diarrhea, traveller's diarrhea, irritable bowel syndrome, inflammatory bowel disease, Helicobacter pylori infection and hepatic encephalopathy. In human studies the examined probiotics are safe, tolerable and seem to be effective in conditions of diarrhea caused by antibiotics, traveller's diarrhea and pouchitis. In other above-mentioned conditions further randomized and controlled clinical trials are needed to evaluate their efficacy. Based on these results, in the research and manufacturing of genetically-engineered probiotic bacteria a major leap is expected.]

Lege Artis Medicinae

[The Mouldy Lizard The Depiction of Diphtheria in 20th Century Hungarian Prose]

PINTÉR László

Lege Artis Medicinae

[MODERN PRINCIPLES OF EARLY DETECTION, DIAGNOSIS AND TREATMENT IN LUNG CANCER]

OSTOROS Gyula, KOVÁCS GÁBOR, BÖSZÖRMÉNYI Nagy György, STRAUSZ János

[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.]

Lege Artis Medicinae

[In the focus: sleep disturbances]

HALÁSZ Péter, SZŰCS Anna

Lege Artis Medicinae

[THE ROLE OF THE CONSUMPTION OF HOT FOOD AND DRINK IN THE DEVELOPMENT OF OESOPHAGEAL SQUAMOUS CELL CARCINOMA]

SZÁNTÓ Imre, ENDER Ferenc, BANAI János, ALTORJAY Áron, SELI Artúr, FARSANG Zoltán, VÖRÖS Attila

[INTRODUCTION - Potential risk factors leading to the development of squamous cell carcinoma in the oesophagus have been analyzed and summarized in a number of epidemiological studies. Authors disagree as to the pathogenic significance of the individual risk factors in various populations. However, it is commonly accepted that alcohol abuse and smoking play a significant role in the development of this disease. Several reports have suggested a positive relationship between oesophageal squamous cell carcinoma and the consumption of hot food and drink. A recent publication, however, claims that the consumption of hot drink is not a pathogenic factor in itself. In our study we wished either to confirm or to rule out a positive relationship between the development of oesophageal squamous cell carcinoma and the history of consuming hot food or drink. PATIENTS AND METHODS - During the study period (1 January, 1993 - 31 September, 2004) 449 patients with oesophageal squamous cell carcinoma were examined in our endoscopy laboratory. Histories were taken according to a predefined scheme. The aim was to identify patients with a history of consuming hot food or drink and to determine their percentage within the study population. A group of 738 patients examined endoscopically for indications other than oesophageal cancer served as controls. RESULTS - In the control group a significantly higher proportion of patients tended to consume hot food or drink compared to patients with cancer. Among the patients with oesophageal tumour who consumed hot food or drink a higher proportion was addicted to smoking and alcohol compared to the control group. CONCLUSIONS - In our study population we failed to identify a positive relationship between the development of squamous cell carcinoma in the oesophagus and the habit of consuming hot food or drink. We suggest that consumption of hot food or drink may play some role in the development of oesophageal cancer if it is associated with simultaneous smoking and alcohol consumption.]

All articles in the issue

Related contents

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

[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

Creutzfeldt-Jakob Disease: A single center experience and systemic analysis of cases in Turkey

USLU Ilgen Ferda, ELIF Gökçal, GÜRSOY Esra Azize, KOLUKISA Mehmet, YILDIZ Babacan Gulsen

We aimed to analyze the clinical, laboratory and neuroimaging findings in patients with sporadic Creutzfeldt-Jakob disease (CJD) in a single center as well as to review other published cases in Turkey. Between January 1st, 2014 and June 31st, 2017, all CJD cases were evaluated based on clinical findings, differential diagnosis, the previous misdiagnosis, electroencephalography (EEG), cerebrospinal fluid and cranial magnetic resonance imaging (MRI) findings in our center. All published cases in Turkey between 2005-2018 were also reviewed. In a total of 13 patients, progressive cognitive decline was the most common presenting symptom. Two patients had a diagnosis of Heidenhain variant, 1 patient had a diagnosis of Oppenheimer-Brownell variant. Seven patients (53.3%) had been misdiagnosed with depression, vascular dementia, normal pressure hydrocephalus or encephalitis. Eleven patients (87%) had typical MRI findings but only 5 of these were present at baseline. Asymmetrical high signal abnormalities on MRI were observed in 4 patients. Five patients (45.4%) had periodic spike wave complexes on EEG, all appeared during the follow-up. There were 74 published cases in Turkey bet­ween 2005 and 2018, with various clinical presentations. CJD has a variety of clinical features in our patient series as well as in cases reported in Turkey. Although progressive cognitive decline is the most common presenting symptom, unusual manifestations in early stages of the disease might cause misdiagnosis. Variant forms should be kept in mind in patients with isolated visual or cerebellar symptoms. MRI and EEG should be repeated during follow-up period if the clinical suspicion still exists.

Clinical Neuroscience

Life threatening rare lymphomas presenting as longitudinally extensive transverse myelitis: a diagnostic challenge

TOLVAJ Balázs, HAHN Katalin, NAGY Zsuzsanna, VADVÁRI Árpád, CSOMOR Judit, GELPI Ellen, ILLÉS Zsolt, GARZULY Ferenc

Background and aims – Description of two cases of rare intravascular large B-cell lymphoma and secondary T-cell lymphoma diagnosed postmortem, that manifested clinically as longitudinally extensive transverse myelitis (LETM). We discuss causes of diagnostic difficulties, deceptive radiological and histological investigations, and outline diagnostic procedures based on our and previously reported cases. Case reports – Our first case, a 48-year-old female was admitted to the neurological department due to paraparesis. MRI suggested LETM, but the treatments were ineffective. She died after four weeks because of pneumonia and untreatable polyserositis. Pathological examination revealed intravascular large B-cell lymphoma (IVL). Our second case, a 61-year-old man presented with headache and paraparesis. MRI showed small bitemporal lesions and lesions suggesting LETM. Diagnostic investigations were unsuccessful, including tests for possible lymphoma (CSF flow cytometry and muscle biopsy for suspected IVL). Chest CT showed focal inflammation in a small area of the lung, and adrenal adenoma. Brain biopsy sample from the affected temporal area suggested T-cell mediated lymphocytic (paraneoplastic or viral) meningoencephalitis and excluded diffuse large B-cell lymphoma. The symptoms worsened, and the patient died in the sixth week of disease. The pathological examination of the presumed adenoma in the adrenal gland, the pancreatic tail and the lung lesions revealed peripheral T-cell lymphoma, as did the brain and spinal cord lesions. Even at histological examination, the T-cell lymphoma had the misleading appearance of inflammatory condition as did the MRI. Conclusion – Lymphoma can manifest as LETM. In cases of etiologically unclear atypical LETM in patients older than 40 years, a random skin biopsy (with subcutaneous adipose tissue) from the thigh and from the abdomen is strongly recommended as soon as possible. This may detect IVL and provide the possibility of prompt chemotherapy. In case of suspicion of lymphoma, parallel examination of the CSF by flow cytometry is also recommended. If skin biopsy is negative but lymphoma suspicion remains high, biopsy from other sites (bone marrow, lymph nodes or adrenal gland lesion) or from a simultaneously existing cerebral lesion is suggested, to exclude or prove diffuse large B-cell lymphoma, IVL, or a rare T-cell lymphoma.