Lege Artis Medicinae

[Primary non-hodgkin's lymphoma of the thyroid]

ÉSIK Olga1, NÉMETH György1, PÓCZA Károly2

JANUARY 27, 1993

Lege Artis Medicinae - 1993;3(01)

[Three cases of primary non-Hodgkin thyroid lymphoma from the past 30 years are reported, with particular regard to the diagnostics, staging, differential diagnostics, treatment, follow-up and survival. In stages IE and the relatively localized II E, surgical intervention (bilateral intra- or extra capsular thyroidectomy with selective neck node dissection) is indicated, followed by postoperative radiotherapy to the regional lymphatics (neck and upper mediastinum). Adjuvant chemotherapy is recommended be cause this is the only mode of treatment capable of reducing the occurrence of the distant relapses responsible for the majority of tumour-related deaths. The therapy in the advanced stages II E, III E and IV E does not differ essentially from the treatment of other nodal lymphomas: cytostatics are the main pillar of the therapeutic plan. The complementary use of irradiation is generally indispensable, but radical surgical intervention is no longer indicated.]

AFFILIATIONS

  1. Fövárosi Onkoradiológiai Központ
  2. Kórbonctani Osztály Uzsoki utcai Kórház Budapest

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Lege Artis Medicinae

[The beta-adrenoceptor blocking drugs]

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[The beta-blockers have been primary in cardiovascular pharmacology since the 1960's. Clinical experiences in the last 25 years have confirmed that the beta-adrenergic blockade is essential in treating the different forms of angina pectoris. Hypertension, hypertrophic cardiomyopathy, and all situations including acute myocardial infarction and some rhythm disturbances qualified by sympathetic overdrive. The beta-blockers have been shown in large scale clinical trials to reduce the cardio vascular morbidity and mortality associated with hypertension and post-infarction period. The possibility of using them as a combined therapy with a great number of other drugs without any difficulties, is very important. Toxicity is rare with beta-blockers and the side effect profile is generally good. Therefore, there is no question that the risk/benefit ratio is weighted toward the benefit. Nevertheless there are some problems such as hemodynamic profile, and effects on lipid metabolism, etc. Research has advanced from the first generation to the third generation with direct or indirect effects on the vascular bed, producing strong vasodilation. Because of the above mentioned facts, it is essential to know correctly the pharmacological effects and precise pharmacokinetics, of the beta-blockers. ]

Lege Artis Medicinae

[Vasocilator - Heart Failure Trial 1.]

MATOS Lajos

[After one year, the mortality rate was 12.1% in the hydralazine + isosorbide dinitrate group and 19.5% in the placebo group, representing a 38% reduction in mortality in those receiving active treatment, and 25.6% (hydralazine + nitrate) and 34.3% (placebo) after two years, and 36.2% (hydralazine + nitrate) and 46.9% (placebo) after three years. Over the entire follow-up period, there were 91 deaths in the prazosin-treated group (49.7%), 72 (38.7%) in the hydralazine + isosorbide dinitrate-treated group and 120 (44%) in the placebo group. In the hydralazine + nitrate group, left ventricular ejection fraction increased significantly at week 8 and at 1-year follow-up, but did not change between patients treated with prazosin or placebo.]

Lege Artis Medicinae

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[In the recent 10 years more and more data have been available concerning to the physiologic and pathophysiologic role of nitrogen monoxide. In this study on the basis of literature data the effects of nitrogen-monoxide are summarized, especially on immunobiological processes and the pathogenesis of certain diseases.]

Lege Artis Medicinae

[The microlithiasis as an "idiopathic" etiological factor in recidivous acute pancreatitis]

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[The authors report two cases of unknown etiology of multiple acute recidivous pancreatitis. The long established diagnostic procedures such as intravenous cholangiography and ultrasonography did not reveal any pathological, correctable etiological factor. Therefore in a symptom free period ERCP was perfor med, in which microlithiasis was found as a floating layer in the gallblader. Three years after cholecystectomy, the patients were symptom free, and recidivous pancreatitis has not occured. In connection with these cases the authours review the other possible etiolo gical factors, diagnostic procedures and the rapeutic possibilities in the „idiopathic" group.]

Lege Artis Medicinae

[Chronic thromboembolic pulmonary hypertension: diagnosis and treatment]

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[More than half of the cases of primary pulmonary hypertension belongs to the thromboembolic form which can successfully be treated by pulmonary thromboendarterectomy. The aim of the study was to demonstrate the selection of surgical candidates and the results of first operations. 22 patients were studied in the last 2 years in whom pulmonary systolic pressure was over 50 mm Hgby Doppler-echocardiography, and no cause could be identified and in whom transesophageal echocardiography was performed. Per fusion lung scan was carried out in 14, venous Doppler in 10 and pulmonary angiography in 7 cases. Out of 22 patients with suspected PPH an atrial septal defect (ASD) was found in 4 cases, chronic thromboembolic pulmonary hypertension (CTH-PH) in 10 patients and major vessel disease suitable for surgery was established in 6 of them. Acute pulmonary embolism was documented in the history of 2 and deep vein thrombosis in 6 out of the 10 cases. Patent foramen ovale was revealed in 5 of the 10 patients 2 of which led to fatal paradoxic embolism. ASD was closed in 3 cases. Two patients had successful pulmonary thromboendarterectomy followed by complete hemodynamic recovery. CTh-PH should be considered in any patient with effort dyspnea or signs of right ventricular overload for which no cardiac cause can be found, as successful surgical treatment may be possible. A diagnostic algorithm is proposed for the selection of surgical candidates. ]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

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Clinical Neuroscience

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Hypertension and nephrology

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