Lege Artis Medicinae

[RHEUMATIC DISEASES AND MALIGNANCIES - PARANEOPLASTIC SYNDROMES]

SZEKANECZ Éva, ANDRÁS Csilla, KISS Emese, TAMÁSI László, SZÁNTÓ János, SZEKANECZ Zoltán

SEPTEMBER 15, 2006

Lege Artis Medicinae - 2006;16(08-09)

[Numerous malignancies may be associated with musculoskeletal symptoms. In paraneoplastic syndromes, the rheumatic disease is related to the tumour development and the removal or treatment of the underlying malignancy results in the improvement of rheumatic symptoms. Sometimes it is the bad responsiveness of the rheumatic disease to conventional therapies that calls the attention to an underlying malignant condition. Therefore, in case of an unusual disease course a thorough search for malignancies is indicated. The authors give a thematic review on the most common paraneoplastic rheumatic syndromes and discuss the general diagnostic and therapeutic guidelines.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[MENOPAUSE AND CARDIOVASCULAR RISK]

MASSZI Gabriella

[The physiological changes of menopause are associated with an increase in cardiovascular risk. Cardiovascular diseases lead mortality statistics also in women. Several physiological effects of oestrogen are thought to be protective for the circulatory system. The reasonable idea of hormone replacement therapy, however, has not met the expectations. This article reviews the relevant studies and discusses the possible causes of failure. The second part focuses on the issue of prevention. The Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women, a recommendation developed in the US, is delineated. Hungarian data are provided based on results of the Menokard programme. The paper gives an overview of hormone replacement therapy and cardiovascular prevention in postmenopausal women.]

Lege Artis Medicinae

[A new simple tool for tonometric determination of the pCO2 in the gastrointestinal tract]

BODA Domokos, TÁLOSI Gyula, KASZAKI József

Lege Artis Medicinae

[Clinical Evidence György Jermendy: Evidence-Based Diabetic Care]

dr. KAUTZKY László

Lege Artis Medicinae

[THE PRACTICE AND RESULTS OF OSTEOPOROSIS MANAGEMENT IN HUNGARY]

POÓR Gyula

[Osteoporosis poses a major public health problem worldwide due to the extreme number of patients and to the deterioration of quality of life, disability, excess mortality and costs associated with consequent fractures. Representative studies of the author’s group have previously shown that the average bone mineral density values of the Hungarian population are among the lowest in Europe while the prevalence of vertebral fractures is among the highest in international comparison. This revelation has led to the development of a National Osteoporosis Programme, the key element of which being the setting up of a network of osteoporosis centres that are based on the collaboration of various medical specialists, the availability of advanced diagnostic tools and outstanding therapeutic opportunities. On describing the 10-year activity of the centres, the main diagnostic, prevention and management approaches of osteoporosis are discussed. According to the WHO classification the diagnosis of osteoporosis is based on a low bone mineral density finding supported by the laboratory and radiological exclusion of other metabolic bone diseases and secondary forms of osteoporosis. According to the up-to-date treatment guidelines of osteoporosis, when considering medical treatment, preference should be given to patients with high fracture risk in giving drugs with extensive antifracture efficacy that has been confirmed by studies of evidencebased medicine. Among these drugs the most important are the antiresorptive bisphosphonates that have widely been used in Hungary and the bone forming teriparatide that is expected to gain wider use in the near future with the introduction of public health insurance financing. The efficacy of these specific antiosteoporotics is increased by supplementation with calcium and vitamin D. The internationally acknowledged Hungarian osteoporosis management system offers to Hungarian patients outstanding standards for the prevention and management of osteoporosis.]

Lege Artis Medicinae

[Mummies An Exhibition in the Hungarian Natural History Museum]

SZIKOSSY Ildikó, dr. PAP Ildikó, dr. VÁSÁRHELYI Tamás

All articles in the issue

Related contents

Hungarian Immunology

[Malignancies in systemic autoimmune diseases and due to immunosuppressive therapy]

SZEKANECZ Éva, ANDRÁS Csilla, KISS Emese, TAMÁSI László, SZÁNTÓ János, SZEKANECZ Zoltán

[There is an increased risk for secondary tumor development in some, mostly systemic, rheumatic diseases. Among immunosuppressive agents used in antirheumatic therapy, there is enough data available to support that cyclophosphamide and azathioprine are oncogenic. However, the role of methotrexate, cyclosporine A and anti-TNF agents in tumorigenesis is rather controversial. Authors describe those systemic diseases and immunosuppressive drugs, which may increase the development of malignancies.]

Lege Artis Medicinae

[SECONDARY MALIGNANCIES IN RHEUMATOID ARTHRITIS]

SZEKANECZ Éva, SZŰCS Gabriella, KISS Emese, SZABÓ Zoltán, SZÁNTÓ Sándor, TARR Tünde, SZÁNTÓ János, SZEKANECZ Zoltán

[INTRODUCTION - Survival data for rheumatoid arthritis (RA) have improved during the past years. Due to longer life expectancy, more attention has to be paid to prevention and treatment of long-term sequelae, including secondary malignancies. Incidence of malignant lymphoproliferative diseases and bronchial cancer is higher in a number of rheumatic diseases including RA. Some drugs nowadays very rarely used in RA - primarily cyclophosphamide and azathioprine - may further increase cancer risk. According to several large meta-analyses, biological therapy may also increase the risk of lymphomas, however, as these agents are used for the treatment of active, refractory arthritis, benefit may override such risks. PATIENTS AND METHODS - Altogether 516 RA patients managed at our department were assessed for the incidence and type of secondary malignancies. Although the absolute number of RA patients with a tumor was relatively small, we compared our cohort to the Health for All database and calculated standard incidence ratios (SIR). RESULTS - We identified 13 cases of malignancy (11 females and 2 males) in 516 RA patients (2.5%). In two patients, cancer developed before the onset of RA. RA patients with malignancy had an even higher female predominance (5.5 to 1) than usual. Mean age at onset of RA was 51.4 years, while age at the diagnosis of malignancy was 61.8 years. Mean duration of RA at the time of cancer diagnosis was 11.2 years. Five patients died, 4 due to the underlying malignancy. In the fifth patient, the tumor was considered cured but the patient died of amyloidosis. Among the 8 surviving patients, mean survival is 7.3 years until now, while overall survival of all 13 cancer patients is 4.7 years. Regarding types of malignancies, there were 6 cases of bronchial cancer, 2 cases of follicular thyroid cancer, and one cutaneous B cell lymphoma, one breast cancer, one gall bladder cancer, one colorectal cancer, and one pancreatic cancer. In comparison to the Health for All database, the overall SIR of all malignancies in RA was 1.12 (CI 0,91-1,33), varying between 2.2 and 70.7 among different tumor types. Only one cancer patient received cyclophosphamide therapy and some received methotrexate or anti-TNF agents. CONCLUSION - We identified 13 cases of malignancy among our RA patients. In RA, secondary tumors including bronchial cancer and lymphomas are more common than in the general population. Adequate treatment and monitoring of these patients may help us to lower the risk of malignancies secondary to RA]

Clinical Neuroscience

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.