Lege Artis Medicinae

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MATOS Lajos

DECEMBER 20, 2007

Lege Artis Medicinae - 2007;17(12)

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Lege Artis Medicinae

[The Pictures of Paul Klee ]

Lege Artis Medicinae

[MYELODYSPLASTIC SYNDROMES - NEW THERAPEUTIC OPTIONS]

GADÓ Klára

[Myelodysplastic syndrome is a heterogeneous group of acquired clonal disorders of the haematopoietic stem cell characterized by ineffective haematopoiesis, peripheral cytopenia, and a high risk of progression to acute leukaemia. It is a common malignant disease with an increased incidence in the elderly population. Classification is based on a 1999 WHO recommendation, in which morphological features as well as clinical and cytogenetic characteristics are taken into account. Combined with the International Prognostic Scoring System (1997), it is suitable to predict prognosis and response to therapy. Clinical features include symptoms caused by anaemia, infections, and bleeding. Diagnosis is based on peripheral cytopenia and dysplastic morphology, as well as normal or increased cellularity in the bone marrow, with more than 10% of dysplastic cells. The verification of cytogenetic abnormalities is important both for confirming the diagnosis and predicting the prognosis. When designing the treatment strategy, it is essential to take the risk of leukaemia into account. On the other hand, the general state of the patient and the presence of accompanying diseases should also be considered. The goal of the treatment is to increase cell count and to decrease transfusion requirement, eventually to improve quality of life. Supportive therapy is an essential part of the management. In addition, growth factors, immunosuppressive and immunomodulatory agents, low-dose chemotherapy may be applied. Today, cure can only be achieved by allogenic stem cell transplantation. Recent findings in the epigenetic intracellular regulation allowed the definition of new therapeutic targets to develop drugs such as inhibitors of DNA methyltransferase and histone deacetylase.]

Lege Artis Medicinae

[Saying Farewell]

KISS Erika

Lege Artis Medicinae

[Nobel prize for the genetic modification of stem cells]

SARKADI Balázs

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[Sore throat]

HIRSCHBERG Andor

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[NEPHROPATHY CAUSED BY PHYTOTHERAPY - LESSONS LEARNED]

KAKUK György

[Modern medical science, the ‘officially’ recognised medicine, relies on evidence based medicine, in contrast to the ancient, empirical practice that is gradually gaining ground in the population. This is now referred to as complementary alternative medicine. Alternative medicine has been present throughout the whole history of medicine and gaining popularity these days. Complementary medicine with its various branches and methodology, however, remains controversial - even in some aspects hazardous - due to the lack of scientifically valid evidence. The article deals in detail with the severe side effects of phytotherapy, with an illustration of the so-called ‘chinese herb nephropathy’, an ailment that afflicted more than 100 women on diet in Belgium. For two consecutive years these women took plant extracts labelled Stephania tetranda and Magnolia officinalis plus fenfluramin, diaethylpropion, cascara powder, acetazolamide, extracts of belladonna and meprobamate. The results: chronic renal failure, precancerous urinary tract conditions and aortic valve damage. Detailed analysis suspects the toxic substance of aristolochic acid found in one of the herbs to be the likely cause for the organ and tissue damage. These cases illustrate the need for the cautious approach towards phytotherapy and suggest that in the case of complementary medicine therapy one can not ignore the results of evidence based medicine. In this article, we critically analyse the state of modern and alternative medicine and emphasize that two separate types of medicine does not exist - only one, that has to integrate the methods of complementary medicine that are acceptable, and at the same time charlatan practice must not prevail.]

Lege Artis Medicinae

[County level mortality data of urogenital system in Hungary between 2010-2014]

KISS István, PAKSY András

[According to The International Statistical Classification of Diseases and Related Health Problems (10th Revision, ICD 10; XIV), urogenital diseases resulted in an average 910 yearly deaths in Hungary from 2010 through 2014, less than 1% of the cumulative mortality rate. Out of all urogenital conditions, kidney and bladder diseases were the leading cause of death, accounting for nearly 85 percent of all deaths in the examined period. It should be noted that mortality due to urogenital cancers, renovascular hypertonia, diabetic nephropathy, congenital malformations and pathologies related to childbirth and pregnancy are excluded from consideration in the present review. As the Hungarian Central Statistical Office does not disclose the causes of death by age and gender at its county-level data, this paper reports gender-specific mortality rates. Due to the fact that the county-level mortality rate of urogenital diseases is low and the yearly standard deviation is high, the five-year overall mortality rate of 2010-2014 is presented. Hungarian counties differ greatly in terms of mortality from urogenital diseases. The number of deaths per 100 000 population ranges between 6.74 in Békés county and 16.38 in Fejér county. Counties within the same region may exhibit substantially different mortality rates. An overall 7.01 deaths per 100 000 population was reported in Győr-Moson-Sopron county, whereas among residents of the neighbouring Vas county the rate was reported as 14.73 per 100 000 population. The observed variations prevail even when standardised mortality rates are compared and thus the differences in the counties’ age distributions are accounted for. Regional differences become more apparent when only the deaths caused by kidney diseases are analysed out of all urogenital pathologies. In this case, two- or threefold differences are observed between the respective Hungarian counties. Major disparities are still present between counties within the same region. For example, the number of deaths per 100.000 population is 3.74 in Hajdú-Bihar county, and 8.04 in Jász-Nagykun-Szolnok county, respectively. The diagnosis frequency of kidney diseases has a strong positive correlation with case fatality, but it may not fully account for all regional variations in mortality rates. Regional characteristics of dialytic care and the accessibility of dialytic facilities is not related to patient mortality. ]