Lege Artis Medicinae

[The Blast Splits the Moment ]

NAGY Zsuzsa

FEBRUARY 05, 2016

Lege Artis Medicinae - 2016;26(01-02)

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[Chemo-radiotherapy of colorectal tumours has become a successful field in oncology. The cornerstone of the treatment has remained the 5- FU containing regimes, however the improvement of administration protocols (e.g. continuous infusion, oral administration) and the addition of biomodulating agents has improved efficacy considerably. The recent availability of newer agents, like irinotecan and oxaliplatin has significantly improved survival of advanced (metastatic) colorectal cancer, extending up to 20 months average survival, also being a consequence of the more aggressive treatment of hepatic and lung metastases. The adjuvant chemotherapy of Dukes’ C tumours has become standard, while the treatment of high-risk B2 tumours is also recommended. Neoadjuvant/adjuvant chemo-radiotherapy improves the prognosis of rectal tumours, however the optimal regime has not yet been determined. The combination of two or more agents is superior to monotherapy and the route and sequence of administration may also influence efficacy. The biological agents of the near future including cetuximab (directed against epidermal growth factor receptor) and bevacizumab (a monoclonal antibody to vascular endothelial growth factor) may further improve survival in poor prognosis patients. The use of the new drugs is limited at the moment by their high costs.]

Clinical Neuroscience

[CT- and image fusion guided 125I stereotactic brachytherapy of acoustic neurinoma: three cases]

VIOLA Árpád, MAJOR Tibor, VALÁLIK István, SÁGI Sarolta, MANGEL László, SPELLENBERG Sándor, HÁVEL János, JULOW Jenő

[Gamma knife and multi leaf collimator Linac have recently gained significant space in the treatment of acustic neurinomas. As our neurosurgical department does not own gamma knife or Linac, we have successfully pursued the 125Iodine interstitial irradiation of three acustic neurinomas. Our patients were elderly people with poor general condition, therefore we decided to undertake interstitial irradiation because of the low tolerance for surgery. The follow-up period until March 2002, lasted five, 23 and 40 months in the three cases. At the end of the follow-up period the audiometrical examination stated slight enhancement of hearing in case one and case two. In case one, the tumor volume, as measured on the control MRI was 5.32 cm3, which meant a 21% shrinkage in contrast to the 6.74 cm3 target volume at the brachytherapy. In case two, the shrinkage was even more apparent. The tumor volume measured on the control MRI examination was 6.64 cm3, which was a 42% shrinkage of the 11.45 cm3 target volume at the moment of brachytherapy. Due to financial reasons, gamma knife and Linac are not available for many countries and neurosurgical institutes. In the absence of the above mentioned radiosurgical methods, we have shown brachytherapy as a new alternative and solution in the treatment of acoustic neurinoma in three patients.]

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[We heard it - we'll pass it on]

NAGY András László

[A good number of doctors are participating in the growing number of forums, attending doctors' club debates to ask questions of the people in charge, trying to get first-hand information... But it is not without risk if one wishes to broaden one's horizons, to get to know the thoughts of the moment, the questions of one's colleagues, the doubts of one's colleagues that need to be answered. Those who not only wish to use their knowledge and understanding among colleagues, but also wish to solve their existential problems and solve their dilemmas on the basis of the information they have just gained, may be at a loss.]

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[The importance of hormone replacement therapy in primary and secondary cardiovascular prevention]

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[There has been increasing expectation in hormone replacement therapy (HRT) as a potentially useful preventive intervention. Observational studies indicated 50% relative risk reduction on ischaemic heart disease among current HRT users. Unfortunately, this has not been justified by the results of the large scale, prospective, placebo controlled, double blind secondary prevention trials. Even these trials underscored the potential adverse effects of hormone replacement therapy (thromboembolic complications, gall bladder disease). No results of completed primary prevention trials are available for the moment. Based on these data the AHA/ACC Science Advisory of 2001 recommends: HRT should not be recommended for secondary prevention There are insufficient data to suggest that HRT should be initiated for the sole purpose of primary prevention of cardiovascular diseases.]

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[An important aim of diabetologists is prescribing modern antidiabetic drugs with not only glucose lowering but also an insulin sensitivity increasing property with weight loss without hypoglycaemic episodes and with positive effects on the pancreatic β-cells. A selective inhibition of the renal sodium-glucose cotransporter 2 protein leads to glucosuria, reduces HbA1c and body weight without hypoglycaemias. This benefits can also moderate the cardiovascular risk in diabetic patients. At the moment this molecules are under examination in different phase clinical studies. It seems that the first drug from this group for the clinical use will be the molecule dapagliflozin. The main side effect may be a vulvovaginal mycotic infection.]