Lege Artis Medicinae

[Rosarium parvulorum Rosary for the Small Ones – Crown of Sonnets]

Dr. KIRÁLY Péter

DECEMBER 16, 2006

Lege Artis Medicinae - 2006;16(12)



Further articles in this publication

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[Gastro-oesophageal reflux that occur at night has special clinical features and thus require extra attention. During sleep most anti-reflux mechanisms diminish, which results in prolonged contact between gastric acid and oesophageal mucosa compared to reflux during the day. Nighttime reflux symptoms adversely affect quality of life, vitality, physical and mental health. A further important consequence is the potential exacerbation of respiratory disorders such as asthma and sleep apnea. There is increasing interest in the association between nocturnal reflux and certain extra-oesophageal symptoms, including reflux laryngitis and chronic cough. An increased risk of erosive damage and adenocarcinoma of the oesophagus are also observed among patients who report nocturnal reflux symptoms. The primary goal of treatment is to improve quality of life and reduce the risk of complications by decreasing the time of acid contact with oesophageal mucosa. Nighttime reflux symptoms are much more difficult to control than daytime symptoms. Treatment guidelines generally recommend lifestyle changes as the initial approach in managing nocturnal symptoms, however, this is successful in only a small proportion of patients. Evidence-based reviews and meta-analyses favour the use of proton pump inhibitors in the treatment of gastro-oesophageal reflux disease and reflux-oesophagitis. Proton pump inhibitors are the most efficient acid-suppressing agents and thus diminish the harmful effect of acidic gastric reflux on the oesophageal mucosa. In addition, by decreasing the volume of gastric acid, they reduce the tendency to reflux.]

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[Improvements in symptom-limited exercise performance over 8 h with once-daily tiotropium in patients with COPD]


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[While severe asthma associated with high morbidity affects a relatively small proportion of all patients with asthma, it requires special attention and innovative treatment approaches. Although asthma is by definition characterized by reversible airflow obstruction, the obstruction becomes fixed to some extent and refractory to corticosteroids with the progression of the disease. The underlying change in this phenotype is airway wall remodelling. In allergic asthmatic patients who remain symptomatic despite highdose inhaled corticosteroid therapy, blockade of IgE with omalizumab confers appreciable clinical benefit. Chronic severe asthma is also accompanied by a marked increase in TNFproduction that might contribute to corticosteroid resistance. In accordance with this, TNF blockade with entanercept has been shown to improve asthma controll and at the same time to reduce bronchial hyperresponsiveness. Identification of new susceptibility genes, such as ADAM33, will provide further targets for therapy, which in turn can result in the development of treatment tools that modify the natural course of asthma and reverse the changes associated with airway remodelling, rather than simply suppress inflammation and dilate the airways.]

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[“The Good Fame of our Guild Depends on Us” A Discussion with Rheumatology Professor Béla Gömör]


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[Beta-receptor blocking agents are considered a well defined class of drugs for treating hypertension and heart failure. Nebivolol, a thirdgeneration beta-blocker that combines marked beta-1-receptor selectivity with a vasodilator and antioxidant effect, has relatively recently become available in Hungary. The vasodilator effect of nebivolol has proved to be mediated by the endothelial NO pathway. Due to its neutral metabolic effect, nebivolol can safely be used in patients with glucose intolerance or lipid disorder. Nebivolol is a safe and well tolerated antihypertensive agent. Based on the results of recent clinical trials, nebivolol is also indicated for the treatment of heart failure.]

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Related contents

Lege Artis Medicinae

[Group therapy for alcohol-dependent patients using autobiography reconstruction]


[A group therapy method was built on results of previous researches using narrative psychological approaches. Our primary technic was narative restructuring. Alcohol addicted patients’ language expression mode of their autobiographies was modulated similar to recovering ones’. We supposed it had therapeutic effect, that could be measured by the Hopelessness Scale (HS) and the Means Ends Problem Solving Test (MEPS). We recorded the tests before and after the therapeutic process, and the differences of their datas were compared (t-test) to similar ones from control persons, who participated in any other group therapy. Significant difference was experienced. Our method reduced hopelessness and increased problem solving more effectively, than other group therapies.]

Clinical Neuroscience

Stress-induced corticosterone rise maintain gastric mucosal integrity in rats

LUDMILA Filaretova, MARINA Myazina, TATIANA Bagaeva

Background - To investigate contribution of glucocorticoids to the maintenance of gastric mucosal integrity during stress we predominantly used ulcerogenic stress models. Using these models we demonstrated that glucocorticoids released in response to the ulcerogenic stimuli attenuated their harmful action on the gastric mucosa. Purpose - In the present study we hypothesized that mild stressors does not damage the gastric mucosa due to gastroprotective action of glucocorticoids released in response to these stressors. Methods - To verify the hypothesis the effects of normally non-ulcerogenic mild stimuli (15-30 min cold-restraint) on the gastric mucosal integrity have been studied under the circumstances of inhibition of the hypothalamic-pituitaryadrenocortical axis in rats. The hypothalamic-pituitary-adrenocortical axis was inhibited by: 1) fast inhibitory action of metyrapone, inhibitor glucocorticoid synthesis; 2) fast inhibitory action of NBI 27914, the selective antagonist of cortricotropin- releasing factor receptor type 1; 3) delayed inhibitory action of a single pharmacological dose of cortisol injected one week before the onset of stress stimulus. Results - Each of these pretreatments significantly decreased 15-30 min cold-restraint-produced corticosterone levels: 37.2±1 vs 22.5±1.2 (p<0.05) after metyrapone; 52.1±0.9 vs 41.4±1 (p<0.05) after NBI, and 64.2±4.2 vs 16.7±1.5 (p<0.05) after cortisol pretreatment. The inhibition of stress-induced corticosterone rise resulted in an ap - pearance of gastric lesions after the onset of these mild stressors in rats. Conclusions - The results suggest that in rats with inhibited stress-induced corticosterone rise normally non-ulcerogenic stimuli are transformed into ulcerogenic ones and confirm the hypothesis. The findings further support for the point of view that glucocorticoids released during acute stress are gastroprotective factors.

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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]

Hungarian Radiology

[Differential diagnosis of malignant cervical lymph nodes with real-time ultrasonographic elastography and Doppler ultrasonography]

KEMAL Arda, NAZAN Ciledag, PELIN Demir Gumusdag

[PURPOSE - Real-time ultrasonographic elastography is a new imaging technique which is used in characterizing the difference in hardness between pathologic and normal tissue. The purpose of our study was to evaluate the diagnostic performance of real-time ultrasonographic elastography and Doppler ultrasonography (DUS) individually and combined in differentiation of benign and malignant cervical lymph nodes (LN). PATIENTS AND METHODS - Fifty-one patients (12 men, 39 women) referred for fine-needle aspiration or surgical biopsies of suspected cervical lymph nodes were examined with gray scale ultrasonography, power DUS, and realtime ultrasonographic elastography. During DUS examination vascularity and resistance index (RI) values were evaluated. A five-group elastographic colour code pattern was used to evaluate the ultrasonographic elastograms for LN (pattern 1, an absent or a very small hard area; pattern 2, hard area <45%; pattern 3, hard area ≥45%; pattern 4, peripheral hard and central soft areas; pattern 5, hard area occupying entire solid component with or without soft rim). In addition, strains of LN and surrounding muscles were measured on elastograms, and the muscle-to-LN ratio (strain index) was calculated. Real-time ultrasonographic elastography and DUS results were compared with the final diagnosis obtained by fine-needle aspiration cytology analysis and/or by surgical pathology. The diagnostic potential of the examined criteria for malignancy was evaluated with univariate analysis and multivariate generalized estimating equation regression p≤0.05 indicated statistical significance. RESULTS - A strain index higher than 2.45 and colour pattern 4-5 had high utility in malignant LN classification with 93.8% sensitivity, 89.5% specificity (p<0.001). The results were significantly better than those obtained by using DUS characterization - that is, RI greater than 0.57 - which had 78.9% sensitivity (p<0.001). CONCLUSION - Real-time ultrasonographic elastography had 93.8% sensitivity and 89.5% specificity in the differentiation of benign and malignant cervical LN in patients referred for fine-needle aspiration or surgical biopsies with suspicion of malignancy. Real-time ultrasonographic elastography and DUS in addition to gray scale ultrasonography may improve the differential diagnosis of LN.]

Lege Artis Medicinae

[A simple method to demonstrate urate crystals in formalin fixed tissue]

BÉLY Miklós, KRUTSAY Miklós

[In our previous study we refuted the thesis that sodium urate crystals are not, or only rarely detectable in formalin-fixed histological samples because they dissolve in the aqueous formalin solution. Our observations indicate that dissolution of urate crystals is primarily caused by haematoxylineosin staining. Undeniably, however, urate crystals are partially dissolved in the aqueous solution of formaldehyde, and thus a small amount of urate deposits may totally dissolve from tissue samples. The aim of the present study was to identify those steps of the staining procedure that are responsible for the dissolution of urate crystals. We found that the dissolution of urate crystals during the course of staining was caused by the combined effects of haematoxylin staining, treatment with 1% aqueous lithium carbonate solution and dehydration with acetone. As the simplest histological method for the detection of urate crystals, we recommend examining unstained sections (mounted with Canada balsam) of formalin-fixed, paraffin-embedded tissue samples in polarised light. According to our previous study, about two thirds of urate crystals remain detectable on unstaied sections, whereas haematoxylin-eosin stained sections of the same tissue samples (derived from patients with gout) did not contain urate crystals. In the samples where urate crystals could be detected in haematoxylin- eosin stained sections using polarised light, the unstained sections contained much more crystals, which shows that dissolution is greatly decreased on unstained sections.]