Lege Artis Medicinae

[The Curative Tokaji ]

MAGYAR László András1

MARCH 20, 2015

Lege Artis Medicinae - 2015;25(03)


  1. Semmelweis Orvostörténeti Múzeum, Könyvtár és Levéltár



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]


[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 ]


Lege Artis Medicinae

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


[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]


[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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Neurological disorders in liver transplantation

YUKSEL Hatice , AYDIN Osman, ARI Derya , OTER Volkan , AKDOGAN Meral , BIROL BOSTANCI Erdal

Liver transplantation is the only curative treatment in patients with end-stage liver failure. It has been associated with neurological disorders more frequently than other solid organ transplantations. We aimed to detect neurological disorders in liver transplantation patients and determine those that affect mortality. One hundred eighty-five patients, 105 with and 80 without neurological disorders, were included in this study. The follow-up was categorized into three periods: preoperative, early postoperative and late postoperative. We analyzed all medical records, including demographic, laboratory, radiological, and clinical data. Neurological disorders were observed in 52 (28.1%) patients in the preoperative period, in 45 (24.3%) in the early postoperative, and in 42 (22.7%) in the late postoperative period. Hepatic encephalopathy in the preoperative and altered mental state in the post­operative period were the most common neurological disorders. Both hepatic encephalopathy (37.5%) and altered mental state (57.7%) caused high mortality (p=0.019 and 0.001) and were determined as indepen­dent risk factors for mortality. Living donor transplantation caused less frequent mental deterioration (p=0.049). The mortality rate (53.8%) was high in patients with seizures (p=0.019). While mortality was 28.6% in Wilson’s disease patients with neurological disorders, no death was observed in patients without neurological disorders. We identified a wide variety of neurological disorders in liver transplantation patients. We also demonstrated that serious neurological disorders, including hepatic encephalopathy and seizures, are associated with high morbidity and mortality. Therefore, in order to avoid poor outcomes, hepatic encephalopathy should be considered as a prioritization criterion for liver transplantation.

Clinical Oncology

[Treatment of hepatocellular carcinoma - today]


[The hepatocellular carcinoma (HCC) is one of the main causes of cancer-related death globally, and at the same time, it is the main event leading to death in cirrhotic patients. In the etiology of HCC, the non-alcoholic liver disease may be an important cause besides the viral cirrhosis. The HCC’s staging systems (Child-Pugh scores, Cancer of the Liver Italian Programme/CLIP, Barcelona Clinic Liver Cancer/ BCLC) play an important role in predicting the prognosis and determining the appropriate therapy. In Europe, the treatment strategy is based on the BCLC staging system. Screening of cirrhotic patient is also important because curative therapy is available only for the early-stage HCC. Several therapeutic options exist in the intermediate stage disease; among them the radiofrequency ablation (RFA), the transarterial chemoembolization (TACE) and the percutan ethanol injection (PEI) are most important. For the advanced disease, the only approved systemic therapy is sorafenib, which has been well-tolerated and yielded a substantially relative improvement in overall survival. For patient in end-stage disease with impaired liver function or a poor performance status, only supportive care is recommended.]

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[Associated factors of independency in older adults with cognitive impairment living in a long term care institute]


[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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[Curative experiments on depression patients with Elysione]

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[Emergency radiotherapy in oncology]

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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.]