Lege Artis Medicinae


NAGY Judit, KISS István

DECEMBER 20, 2007

Lege Artis Medicinae - 2007;17(12)

[Erythropoietin produced by the foetal liver and the adult kidney is the major stimulator of erythropoiesis. Erythropoietin production is regulated by hypoxic activation of erythropoietin gene transcription. Recently, new sites of erythropoietin production have been found mainly in the central nervous system and in the cardiovascular system. These tissues have a paracrine and/or autocrine system of erythopoietin. The pleiotropic function of erythropoietin in these systems is tissue and cell protection by several mechanisms including inhibition of apoptosis, attenuation of ischaemic or reperfusion injury, anti-inflammatory and antioxidative effects. Furthermore, it promotes vascular recovery and enhances neoangiogenesis. In vivo and in vitro studies have proved that systemically administered human erythropoietin can also provide tissue protection. However, adverse effects of erythropoietin treatment such as hypertension, hyperviscosity and thrombosis may override the beneficial effect of systemic erythropoietin treatment. There are preliminary data that erythropoietin analogues, e.g., asyaloerythropoietin or carbamylated erythropoietin can provide tissue protection without stimulating erythropoiesis.]



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[INTRODUCTION - Synchronous colorectal cancers are not uncommon, therefore, total colonoscopy is indicated even in cases of distally located large bowel carcinomas. CASE REPORT - An 84-year-old man had emergency surgery because of bowel obstruction and a node-negative carcinoma of the sigmoid colon was removed according to Hartmann. Before the reconstruction of bowel continuity, colonoscopy revealed a relatively small polypoid tumour in the right colon, unsuitable for colonoscopic polypectomy. Two localization clips were then inserted at the site of the endoscopic biopsy that later resulted in the diagnosis of adenocarcinoma. At the time of the reconstruction surgery, an appendectomy was also performed and, though the clips were not found, the polypoid tumour was removed through appendectomic orifice. The polyp thus removed, however, proved to be an adenoma. A repeated colonoscopy and biopsy confirmed both the localization clips and the malignant nature of the remaining right-sided lesion, which was finally removed with right hemicolectomy. CONCLUSION - Anatomic localization of rightsided colon cancers by colonoscopy is often imprecise. The correct identification of a malignant tumour may be compromised by a nearby benign lesion. If a lesion was labelled by some means, the localization sign should be identified both intraoperatively and during the gross pathologic work-up, asking for external help (e.g., radiology in case of a metal clip) if necessary.]

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Lege Artis Medicinae



[Increased knowledge on the pathogenesis of type 2 diabetes has considerably transformed the principles and practice of treatment. Insulin resistance and beta-cell dysfunction, the two main components of the pathogenesis both play a role in the conversion of normal glucose metabolism, through impaired glucose tolerance, into type 2 diabetes. Decreased insulin sensitivity, with or without beta-cell dysfunction, is present in the vast majority cases, therefore, its treatment is essential. Physical activity is known to improve insulin sensitivity. The primary action of the recommended first-line pharmacological agent metformin is the inhibition of hepatic glucose production but it also moderately stimulates muscle glucose uptake. Glitazones are insulin sensitizers that increase glucose uptake in muscle and adipose tissue and moderately decrease hepatic glucose production. Some evidence suggests that α-glucosidase inhibitors and also certain insulin secretagogues can improve the effect of insulin. Early detection of the pathologic state and an efficient treatment to improve both insulin sensitivity and beta-cell function are essential in order to slow the progression and prevent the development of complications in type 2 diabetes.]

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Clinical Neuroscience


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Lege Artis Medicinae



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[Biosimilar erythropoesis stimulating agents - from registration to clinical practice]

KISS István

[The original patent drugs appear immediately on expiry of all rights in generic and biosimilar drugs in the pharmaceutical market, favorable supply option which helps in the rational management of medicines, mainly for generic drugs cheaper to allow more patient care. Of course, this is a well-organized legal and regulatory framework, thoughtful strategy can be successful in every respect. In another non-identical molecular structure biosimilar drugs in different immunogenicity of knowledge and risk is not defined in clinical practice and therefore the risk is still underestimated and not well regulated in the world, and increasing the number reported is the antibody formation case of a biosimilar erythropioetin also. The immunogenicity of original biological and of biosimilar drugs in identifying, defining a prominent role in the post-marketing surveillance, pharmacovigilance, and the special methods of control of immunogenicity. The original and the biosimilar medicines interchangeability, marketability of the assets relating to the regulations are not uniform in Europe or the European registration scheme is an important new biosimilar medicinal products, is that the medicinal product, the documentation is not expected to be accompanied by a risk management plan, as well as action to ensure the safety (pharmacovigilance) as part of the collection and reporting of adverse reactions to the official. It is important that the professional management of renal anemia guidelines - the practice of nephrology erythropoietin therapy - clearly define the biological medicines (originator and biosimilar erythropoietin) application requirements and suggestions. Consequently, this summary wants to draw attention to the therapeutic potential of biosimilar drugs, generic drugs to distinguish between explicit and the potential risks and the need to reduce the risks of professional and health policy decisions.]

Clinical Neuroscience



[Even tough the central nervous system (CNS) of gastropods has long been used as a model for studying different neuronal networks underlying behaviors, there is only little information on the molecular components of the extracellular matrix (ECM) of the nervous tissue. Therefore, the aim of the present study was to identify some of the ECM molecules by acid-base histochemistry. Staining with alcian blue at strong acidic pH, and with acridine orange at different pH and salt concentrations was carried out on cryostat sections taken from CNS preparations of adult specimens of the terrestrial snail, Helix pomatia, and the aquatic species, Lymnaea stagnalis, in order to visualize mild (carboxyl) and strong (sulphate) acidic groups, which are characteristic for different glucosaminoglycans. According to our findings, sulphated proteoglycans were abundant in the periganglionic sheath of both species, and they also occurred in the neuropil of Helix, whereas they were absent in Lymnaea. The interperikaryonal space contained mainly carboxyl residues, which might refer to the presence of hyaluronic acid. It is concluded that the ECM of the snail CNS, similarly to that in vertebrates, is partly composed of polymer macromolecules of different chemical properties. It is suggested that adaptation to environmental conditions and/or altered neuronal plasticity are responsible for the differences found in chemical characters of the ECM molecules between the two snail species.]