Lege Artis Medicinae

[Sore throat]

HIRSCHBERG Andor

DECEMBER 20, 2007

Lege Artis Medicinae - 2007;17(12)

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[The effects of nebivolol therapy on respiratory function and quality of life]

BENCZÚR Béla

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[A CASE OF MISIDENTIFIED SYNCHRONOUS COLON CANCER]

CSERNI Gábor, BORI Rita, OLÁH Csaba, HAUSINGER Péter, TUSA Magdolna, MARKÓ László, SVÉBIS Mihály

[INTRODUCTION - Synchronous colorectal cancers are not uncommon, therefore, total colonoscopy is indicated even in cases of distally located large bowel carcinomas. CASE REPORT - An 84-year-old man had emergency surgery because of bowel obstruction and a node-negative carcinoma of the sigmoid colon was removed according to Hartmann. Before the reconstruction of bowel continuity, colonoscopy revealed a relatively small polypoid tumour in the right colon, unsuitable for colonoscopic polypectomy. Two localization clips were then inserted at the site of the endoscopic biopsy that later resulted in the diagnosis of adenocarcinoma. At the time of the reconstruction surgery, an appendectomy was also performed and, though the clips were not found, the polypoid tumour was removed through appendectomic orifice. The polyp thus removed, however, proved to be an adenoma. A repeated colonoscopy and biopsy confirmed both the localization clips and the malignant nature of the remaining right-sided lesion, which was finally removed with right hemicolectomy. CONCLUSION - Anatomic localization of rightsided colon cancers by colonoscopy is often imprecise. The correct identification of a malignant tumour may be compromised by a nearby benign lesion. If a lesion was labelled by some means, the localization sign should be identified both intraoperatively and during the gross pathologic work-up, asking for external help (e.g., radiology in case of a metal clip) if necessary.]

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[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

[THE ROLE AND METHODS OF IMPROVING INSULIN SENSITIVITY AND BETA-CELL FUNCTION IN TYPE 2 DIABETES]

GYIMESI András, TÁRNOK Enikő, TAYBANI Zoltán

[Increased knowledge on the pathogenesis of type 2 diabetes has considerably transformed the principles and practice of treatment. Insulin resistance and beta-cell dysfunction, the two main components of the pathogenesis both play a role in the conversion of normal glucose metabolism, through impaired glucose tolerance, into type 2 diabetes. Decreased insulin sensitivity, with or without beta-cell dysfunction, is present in the vast majority cases, therefore, its treatment is essential. Physical activity is known to improve insulin sensitivity. The primary action of the recommended first-line pharmacological agent metformin is the inhibition of hepatic glucose production but it also moderately stimulates muscle glucose uptake. Glitazones are insulin sensitizers that increase glucose uptake in muscle and adipose tissue and moderately decrease hepatic glucose production. Some evidence suggests that α-glucosidase inhibitors and also certain insulin secretagogues can improve the effect of insulin. Early detection of the pathologic state and an efficient treatment to improve both insulin sensitivity and beta-cell function are essential in order to slow the progression and prevent the development of complications in type 2 diabetes.]

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[PLEIOTROPIC FUNCTIONS OF ERYTHROPOIETIN]

NAGY Judit, KISS István

[Erythropoietin produced by the foetal liver and the adult kidney is the major stimulator of erythropoiesis. Erythropoietin production is regulated by hypoxic activation of erythropoietin gene transcription. Recently, new sites of erythropoietin production have been found mainly in the central nervous system and in the cardiovascular system. These tissues have a paracrine and/or autocrine system of erythopoietin. The pleiotropic function of erythropoietin in these systems is tissue and cell protection by several mechanisms including inhibition of apoptosis, attenuation of ischaemic or reperfusion injury, anti-inflammatory and antioxidative effects. Furthermore, it promotes vascular recovery and enhances neoangiogenesis. In vivo and in vitro studies have proved that systemically administered human erythropoietin can also provide tissue protection. However, adverse effects of erythropoietin treatment such as hypertension, hyperviscosity and thrombosis may override the beneficial effect of systemic erythropoietin treatment. There are preliminary data that erythropoietin analogues, e.g., asyaloerythropoietin or carbamylated erythropoietin can provide tissue protection without stimulating erythropoiesis.]

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[Atypical forms of the gastroesophageal reflux disease]

KIS János Tibor, NEMESÁNSZKY Elemér

[There is growing interest in the gastroenterology literature towards gastroesophageal reflux disease (GERD) these days. The prevalence of the disease is much higher than estimated earlier and it frequently appears in atypical forms. Literature data suggests that 30-40% of the individuals suffer from gastroesophageal reflux disease. A broad spectrum of presentation of gastroesophageal reflux disease exists, e.g. noncardiac chest-pain, ear-nose-throat symptoms, pulmonary symptoms, dental erosions, chronic cough and hiccups. Atypical forms often cause diagnostic and treatment difficulties. Authors analyze the frequency, morbidity and the pathomechanism of the extraesophageal manifestations, based on self-experience. The main goal of the review is to help to establish the diagnosis of GERD, to recognize its atypical signs and to outline the diagnostic steps to be taken. Most up-to-date treatment strategies are also presented. By the demonstration of interesting cases, authors emphasize the diagnostic importance of intragastric pH-monitoring.]

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[SEVERE NECROTISING PRIMARY VASCULITIS]

GRIGER Zoltán, SZÁNTÓ Antónia, SZABÓ Nóra Anna, SOLTÉSZ Pál, ZEHER Margit

[INTRODUCTION - Vasculitis is an inflammatory disorder of the vessels, often associates with necrosis. The primary (idiopathic) form caused by distinct immunological mechanisms, the secondary form caused by infection, tumor, drugs or systemic autoimmune disease. CASE REPORT - 57-year-old smoking female patient with a medical history of the left ankle fracture. Four days earlier had sore throat, at admission was febrile and generally weak and had severe pain in her lower extremities. Physical examination revealed numerous livid alterations in both lower extremities, necrotic change of some toes and new onset of diastolic hypertension. Elevated serum transaminase levels, severe thrombopenia, anemia, leukocytosis suggested the possibility of thrombotic thrombocytopenic purpura and vasculitis. Tests ruled out septic embolism, therefore we applied high dose steroid treatment and plasma exchange. Meanwhile the results fulfilled the classification criteria of polyarteritis nodosa (vasculitis, livedo reticularis, polyneuropathia and new onset of diastolic hypertension), accordingly we synchronized the treatment with fractionally administered intravenous cyclophosphamide. The process revealed responsive to therapy and the substantive function of the legs remained after surgical removal of the necrotic areas. CONCLUSIONS - Early rapid diagnosis of vasculitis is fundamental and we emphasize the significance of the efficient treatment.]

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[Evidence in the presentation of factors influencing the development of pressure ulcers]

CSERNUS Mariann

[The development and healing of pressure ulcers depends on a combination of several factors. The factors related to the patient (physical impacts, biological and psychosocial factors), as well as the influencing factors arising in relation to the lingering wound (e.g. the content, situation, size and blood supply of the sore, the condition of the wound bed, the presence of infection, the response to treatment) are all closely related to the patient’s general condition and the underlying disease. An important role is also played by the factors associated with the healthcare personnel (ability, professional qualifications, attitude), and the healthcare system (level of technical and economic advancement, preventive and wound care equipment, quality assurance, training). The author has set out to give a detailed description of these factors, supported by professional evidence. ]

Lege Artis Medicinae

[SEVERE NECROTISING PRIMARY VASCULITIS - CASE REPORT]

GRIGER Zoltán, SZÁNTÓ Antónia, SZABÓ Nóra Anna, SOLTÉSZ Pál, ZEHER Margit

[INTRODUCTION - Vasculitis is an inflammatory disorder of the vessels, often associates with necrosis. The primary (idiopathic) form caused by distinct immunological mechanisms, the secondary form caused by infection, tumor, drugs or systemic autoimmune disease. CASE REPORT - 57-year-old smoking female patient with a medical history of the left ankle fracture. Four days earlier had sore throat, at admission was febrile and generally weak and had severe pain in her lower extremities. Physical examination revealed numerous livid alterations in both lower extremities, necrotic change of some toes and new onset of diastolic hypertension. Elevated serum transaminase levels, severe thrombopenia, anemia, leukocytosis suggested the possibility of thrombotic thrombocytopenic purpura and vasculitis. Tests ruled out septic embolism, therefore we applied high dose steroid treatment and plasma exchange. Meanwhile the results fulfilled the classification criteria of polyarteritis nodosa (vasculitis, livedo reticularis, polyneuropathia and new onset of diastolic hypertension), accordingly we synchronized the treatment with fractionally administered intravenous cyclophosphamide. The process revealed responsive to therapy and the substantive function of the legs remained after surgical removal of the necrotic areas. CONCLUSIONS - Early rapid diagnosis of vasculitis is fundamental and we emphasize the significance of the efficient treatment.]