Lege Artis Medicinae

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JULY 14, 2007

Lege Artis Medicinae - 2007;17(06-07)

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Lege Artis Medicinae

[Clinical consensus conference on COPD]

TAMÁSI Lilla

Lege Artis Medicinae

[THE SAFETY OF TREATMENT WITH PEGYLATED INTERFERON-ALPHA-2A AND RIBAVIRIN IN PATIENTS WITH CHRONIC HEPATITIS C INFECTION, BASED ON HUNGARIAN EXPERIENCE]

WERLING Klára, DALMI Lajos, GERVAIN Judit, HORVÁTH Gábor, NAGY István, NEMESÁNSZKY Elemér, RIBICZEY Pál, TELEGDY László, VARGA Márta, TORNAI István, TULASSAY Zsolt

[INTRODUCTION - Adverse effects of treatment for chronic C virus hepatitis present an important problem both for the patient and the clinician. The reduction of drug doses or the suspension of therapy lessen the likelihood of recovery. PATIENTS, METHODS - Between 2001 and 2004, 66 patients with chronic hepatitis C received 180 μg pegylated interferon-alpha-2a per week and 800-1200 mg ribavirin per day, 6 of whom for 24 weeks and 60 patients for 48 weeks. During treatment, patients were closely followed in order to recognize any adverse effects early. RESULTS - Of the patients treated for 48 weeks, 48.3% developed adverse effects, with changes in the differential in 41.7%, and anaemia, low platelet count, neutropenia in similar rates. Further side effects included cardiac complications, skin symptoms, persisting high fever, autoimmune thyroiditis and liver failure, altogether in 9 cases. Dose reduction or temporary suspension of pegylated interferon-alpha-2a was necessary in 21 cases (31.7%), while complete cessation of this treatment was decided in 7 cases, most of them because of blood count changes. The 1000 to 1200 mg per day ribavirin had to be reduced in 30.8% of patients, while treatment was stopped in 3 cases. Long-term virological remission occurred in 48% of patients who received treatment for 48 weeks, whereas no such result was observed among any of those treated for 24 weeks. CONCLUSION - Adverse effects of variable severity developed in nearly half of the patients with chronic hepatitis C infection who received antiviral treatment for 48 weeks, but treatment had to be stopped in only a small proportion of this group. Early treatment of adverse effects can prevent the need to cease therapy and may improve its efficiency.]

Lege Artis Medicinae

[ALTERATIONS IN MYOCARDIAL CONTRACTILE PROTEIN COMPOSITION IN DIASTOLIC HEART FAILURE]

PAPP Zoltán, BORBÉLY Attila, ÉDES István

[Disturbances in ventricular relaxation may lead to the development of diastolic heart failure. The analysis of left ventricular endomyocardial biopsy specimens may help understand the underlying structural and functional changes. Such analyses have lead to the recognition that at the optimal sarcomere length of the Frank- Starling mechanism (i.e., at 2.2 μm), passive force values of the cardiomyocytes are significantly higher in individuals with diastolic heart failure than in healthy controls. As a probable explanation to this finding, increased expression of the stiffer N2B isoform of the myofilamental titin protein, at the expense of the more elastic N2BA titin isoform, has been recognized. Moreover, decreased phosphorylation of the contractile proteins was also suggested to contribute to the development of diastolic heart failure. These changes together, and along with an increase in extracellular collagen content, may greatly contribute to the relaxation disturbance observed in diastolic heart failure.]

Lege Artis Medicinae

[Medicine: a Ship on the Sea of Culture – The “Cheap Drug Debate” and its Cultural Aspects]

dr. BÁNFALVI Attila

Lege Artis Medicinae

[THE USE OF DIRECT VASODILATORS AND DIGITALIS IN CHRONIC HEART FAILURE]

DÉKÁNY Miklós

[For the optimal treatment of heart failure patients with systolic dysfunction, supplementation of the standard diuretics plus neurohormonal antagonists treatment with the direct vasodilator combination dihydralazine+nitrate, as well as with digitalis may be necessary. Addition of hydralazine/dihydralazine+nitrate to the treatment of chronic heart failure is recommended if ACE-inhibitors or angiotensin-receptor blockers cannot be administered. Beta blockers should also be used in these cases. If symptoms persist or worsen, addition of this combination to the standard therapy is reasonable. Supplementation with digitalis, mostly digoxin should be considered in similar conditions. It can be especially beneficial for patients with high-ventricular-rate atrial fibrillation. To achieve maximal survival benefit, the dose of digoxin must not exceed 0.125 mg/day. Low body weight or muscle mass, significantly reduced renal function may make further dose reduction necessary. If renal function is severely limited, digitoxin instead of digoxin may be used.]

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Hungarian Radiology

[Results of breast cancer screening and clinical mammography at the Kenezy Breast Center, Debrecen between 2002-2003]

SEBŐ Éva, SARKADI László, KOVÁCS Ilona, VAJDA Olga

[INTRODUCTION - Breast cancer screening has been started in January 1. 2002. in Hungary in the course of the National Health Program. Breast cancer is the main cause of death among women’s malignant tomors, and the aim of the project is to reduce this mortality. The chance of survival is highly increased by the early detection of the disease. Kenezy Breast Center was connected to this project. PATIENTS AND METHODES - Females between 45-65 years without symptoms participated in the project. Paralel to this women with symptoms, sometimes with palplable masses were clinically examined. Screening mammography films were read by two radiologists and the complementary examinations of the breast and the axillary lymph nodes - ultrasonography, guided biopsy (FNAB, core biopsy) - were performed always by the same doctor. Results of the two projects were compared. RESULTS - The incidence of malignant breast cancer was 4‰ in the screening and 1,5% in the clinical group. 46.5% of the malignant breast cancers revealed by the clinical examinations was diagnosed in the group of women between the age of 45 to 65 years. This is the age when most women are involved in the screening program. 7.3% of the tumors was diagnosed in the 40- 44 year age-group and 11.3% among women aging 66-77 years. The rate of malignant tumors smaller than 1.5 cm was 49.1% according to screening records and 36% in the clinical trial. In both groups, tumor size of 1.5 cm proved to be a critical limit regarding to the development of metastases, mainly in the axillary region. Above this size, metastases were more frequent. CONCLUSIONS - Both breast screening program and clinical exams are of great significance. Based on the data obtained during two years, authors found that women below the age of 40 and above the age of 65 should also be involved in the screening program. Detection of breast tumor is possible at an early stage by screening. In the case of small tumors (smaller than 1.5 cm) the development of axillary metastases is less likely than in the case of larger ones. The lack of metastases in the axillary lymph nodes offers better prognosis according to the published scientific data, which reinforces the importance and necessity of the screening programs.]

Lege Artis Medicinae

["Nowadays we know a great deal about the microscopic detail" - but do we know more about Axolotl than Antal Szerb?]

GÁCS ZSÓFIA

[In Antal Szerb’s novel, The Pendragon Legend, which was first published in 1934 (its first English translation came out in 1963), the excentric Earl of Gwynedd experiments with strange creatures. Rea­ding the book based on mystic elements as well as their mockery, the reader gets quite a bizarre knowledge of axolotls. In this re­view, a detailed history of this amphi­bian (Ambystoma mexicanum) in Western scientific research is offered; beside the scientific data, of which presumably Antal Szerb was aware, the main trends in the axolotl studies of the recent decades, both their successes and failures, are also de­fined.]

Lege Artis Medicinae

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Clinical Neuroscience

[Status epilepticus and its treatment - Update 2013]

GYIMESI Csilla, JUHOS Vera, HORVÁTH Réka, BÓNÉ Beáta, TÓTH Márton, FOGARASI András, KOMOLY Sámuel, JANSZKY József

[Our study provides an overview of the results and guidelines published on the treatment of status epilepticus in the last five years. In recent years, as a result of scientific observations and collected data, the definition of and treatment approach to status epilepticus have been refined and novel therapeutic methods have been developed. The updated guidelines provide guidance in everyday medical practice. However, only a relatively small number of randomized studies are available on status epilepticus, especially in second-line treatment and third-line treatment, thus it is difficult to transfer the newest methods into clinical practice and into updates to treatment protocols. Due to the nature and epidemiology of the disease, the treatment of status epilepticus remains a daily challenge for healthcare providers. The key points of an effective treatment are: expeditiously initiating appropriate therapy, concurrent causal treatment and anticonvulsant therapy, early detection of nonconvulsive status epilepticus, as well as avoiding "overtreatment" and side effects.]