Lege Artis Medicinae

[The Curative Tokaji ]

MAGYAR László András1

MARCH 20, 2015

Lege Artis Medicinae - 2015;25(03)

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  1. Semmelweis Orvostörténeti Múzeum, Könyvtár és Levéltár

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Further articles in this publication

Lege Artis Medicinae

[Getting Experiences without Drugs – An Interview with School Psychologist Edit Lippai dr. on Current Dependencies]

NAGY Zsuzsanna

Lege Artis Medicinae

[Protection of gastrointestinal system in cardiovascular diseases]

FARSANG Csaba, TULASSAY Zsolt

[Cardiovascular preventive drugs (nonsteroidal antiinflammatory drugs, aspirin, inhibitors of platelet aggregation, anticoagulants) are among the most frequently used medicines all over the world. Gastrointestinal (GI) complications (hemorrhage, ulceration, perphoration) are among the most frequent side effects of these drugs, however, differences in their pharmacodynamics properties and other pleiotropic effects may substantially modify these unwanted events. Authors, based on international and Hungarian guidelines, summarize the most important data for GI protection, focusing on the use of H-2 receptor blockers and proton pump inhibitors.]

Lege Artis Medicinae

[Physician and Science 3. – The Objective Physician or the Remedy Machine ]

BÁNFALVI Attila

Lege Artis Medicinae

[The role of hypoxia in tissue regeneration and in development of amplified aggressive fenotypes in malignant cancer]

HUNYADI János

[Several diseases are accompanied by hypoxic stress; elimination of it is an important physiological process. Our body provides a protective function which delays damage and destruction by hypoxia. In case of necrosis, it provides the mop up of the damaged area. This security system starts the regeneration in cells of the hypoxic zone which surrounds the necrotic area, resulting in the survival of the cells in hypoxic environment and ensuring the handling of the necrosis. The key molecules of the system are the hypoxia-induced factor molecules. The review discusses the physiological role of tissue hypoxia and normoxia and its effects on tissue regeneration. The physiological system triggered by the hypoxia-induced factor plays an important role in embryonic development, in wound healing and in numerous diseases (eg. myocardial infarction, stroke, vaculities, etc). Unfortunately, this system also plays a key role in several malignant tumors by rising the development of cells with increased aggressive fenotypes as well. The physiological process of regeneration starts in the hypoxic tumor cells aided by the hypoxia-induced factor system. The process results in neovascularization, and in the case of tissue damage, in the mop up of the necrotic tissue and in the restoration of tissue oxygenisation. However, after the formation of the new vascular network, tumor cells accustomed to hypoxia will not die but keep their original uncontrolled proliferation and anaerobic nature. Moreover the malignant nature of the cells will be increased by the genetic changes generated by the system of hypoxia- induced factors. The role of the hypoxia-induced factor system in tumor progression is discussed by the example of one of the most malignant tumors, malignant melanoma.]

Lege Artis Medicinae

[Biosimilar insulins on the horizon]

JERMENDY György, KERPEL-FRONIUS Sándor

[Nowadays human insulins and insulin analogues are exclusively used in the clinical practice, when insulin therapy is needed. The patents of human insulins are expired and will expire soon for glargine, the first long-acting, basal insulin analogue preparation. The reliable production of biosimilar insulins is a new challenge for the pharmaceutical industry. Independently developed insulins with appreciable clinical efficacy have already become available in some countries where the quality criteria of regulatory process in place are less strict than in the European Union. The first approval for true biosimilar insulin, i.e. for biosimilar glargine was given in Europe in 2014. In this article, the characteristics of biosimilar insulins, especially the difficulties in the manufacturing process are reviewed in comparison with generic drugs. It is of note that potential efficacy and safety differences may occur due to even minor changes in the production, formulation and storage of the biological drugs. Therefore, biosimilarity should be investigated by detailed comparative pharmacokinetic and pharmacodynamic studies. Moreover, similar clinical efficacy and safety should be documented by randomized, comparative clinical trials. The potential impact of altered immunologic profile of biosimilar insulins should also be carefully monitored. ]

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[Aim of the research: Functional independence determines the elderly’s health and quality of life. In them cross-sectional study the authors analysed the associations between functional abilities (balance, gait, functional mobility, cognitive abilities), age, BMI and comorbidities and independency in older adults with cognitive impairment. Research and sampling methods: 110 elderly people were measured. Self-sufficiency was measured by the Katz-index, balance, and gait by the Tinetti Test and functional mobility by the Timed Up and Go Test. Correlations between variables were analysed with the Spearman’s rank-order correlation. Results: There was strong association between balance (r=0,557), gait (r=0,515), functional mobility (r=-0,647), and independency. It means the better the balance, gait, and functional mobility is, the higher the independency is. There was weak association between age, BMI, cognitive abilities, comorbidities and independency. Conclusion: Results show that preserving of the functional independence in older adults with cognitive impairment is a multidisciplinary task: physiotherapists and nurses should work together to complete doctors’ curative work of chronic diseases.]

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[Emergent radiotherapy is requested in 3-5% of all malignancys either presenting as initial manifestation of an unknown tumor or due to the progression of a malignancy under treatment/follow up. In this situation high degree of suspicion, timely diagnosis and adequate treatment for tumor-related complications are crucial, in order to prevent life-threatening or disabling conditions, such as vena cava superior syndrome, spinal cord compression or increased intracranial pressure. After prompt recognition, fast diagnostics and general management are needed to achive stable status. Radiotherapy commenced in some hours can markedly reduce morbidity and mortality and affects the outcome. There are few evidences based recommendations available, but the differential approach according to the tumor type should be considered (i.e. chemotherapy for lymphomas and SCLC causing SVCS, and sugery in certain case of spinal cord compressions). Prognosis and life expectancy should be taken into account and the goals of care have to be explored during initial evaluation. For patients with poor prognosis short course irradiation must be performed with palliative dose, meanwhile in the case of longer life expectancy the fi rst fraction of emergent radiation can be continued with selective techniques up to curative doses, which may improve the survival and quality of life.]

Lege Artis Medicinae

[MANAGEMENT OF CUTANEOUS MALIGNANT MELANOMAS]

OLÁH Judit

[Malignant melanoma, the disease originating from pigment cells of the skin, mucous membrane, eye and rarely from other tissues, shows increasing incidence in the Caucasian population. The Hungarian statistical data correspond with the data of other countries. In the early stages of malignant melanoma surgical removal of the tumor is often curative, but patients with disseminated tumors have a poor survival rate. Regrettably, in Hungary the majority of melanoma patients are diagnosed with advanced tumors, with nodal or systemic metastasis. Physicians working in other fields of medicine have a great responsibility in patient education and in early detection of susceptible pigmented lesions. Diagnosis and treatment of malignant melanoma requires an experienced dermatologist. The clinical diagnosis of melanoma is aided by several new techniques, like digital dermatoscopy. In recent years, surgical therapy of malignant melanoma has changed: today we routinely perform sentinel node biopsy. This type of surgical technique requires experience. In advanced disease the use of chemotherapy and immunotherapy requires onco-dermatological experience. Educating the public and physicians provides the basis for prevention. Survival rate is mainly dependent on the quality of primary care which determines survival rate, therefore it is essential that patients with melanomas are followed up in onco-dermatological centers.]

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[Multiple sclerosis (MS) is the most common chronic disease of the central nervous system in young adults. No curative therapy is known. Currently, six drugs are available that can reduce the activity of MS. The first-line drugs can completely reduce the activity of the disease in nearly two-thirds of the patients. In the remainder, who suffer from breakthrough disease, the condition of the patient worsens, and secondline therapies must be used. The second-line drug natalizumab exhibits almost double efficacy of the first-line drugs, but also have less favourable adverse effects. As a severe side-effect for instance, natalizumab carries the risk of the development of progressive multifocal leucoencephalopathy (PML), caused by a polyoma virus, the JC virus. There are three major risk factors for PML: an anti-JCV antibody status, a long duration of natalizumab treatment and prior immunosuppressant therapy. The lowest-risk group (1:14 286) comprises of patients who are anti-JCV antibody-negative, in whom the prior immunosuppressant use and duration of natalizumab therapy do not influence the risk of PML. With no prior immunosuppressant treatment, the incidence of PML increases to 1 in 192 patients after 2 years among those who are anti-JCV antibody-positive. These data may lead the physician to decide to discontinue natalizumab treatment. The half-life of natalizumab is three months; during this time other therapies can not be administered and the patients encounter the rebound effect: as the patients receiving natalizumab therapy displayed a high disease activity before treatment, the rebound effect can lead to relapses. After the termination of natalizumab secondline disease-modifying therapy with fingolimod may be introduce; no PML cases occur in response to fingolimod treatment. In the large majority of patients taking natalizumab who do not develop PML, this drug is highly effective and can prevent the progression of MS. The benefit of therapy and the risk of PML must be considered on an individual basis, with regard to the disease activity, the progression and the MRI activity, before natalizumab therapy is implemented.]