Lege Artis Medicinae

[THE HISTORY OF FLUOROQUINOLONES]

LUDWIG Endre

FEBRUARY 21, 2004

Lege Artis Medicinae - 2004;14(02)

[During the 40 year history of quinolones, from the first compounds (nalidixic acid, oxolinic acid, norfloxacin) suitable only for the treatment of mild urinary tract infections, an important group of antimicrobials was developed that can be used for the treatment of serious Gramnegative (ciprofloxacin, ofloxacin) and Grampositive (levofloxacin, moxifloxacin) infections. With the changes in the antimicrobial spectrum of the new derivatives it seems, that the clinical indications of the mainly anti-Gram-positive and the mainly anti-Gram-negative fluoroquinolones can be separated. We also learned the characteristics of their antibacterial activity that makes the optimal administration possible assuring the maximum clinical efficacy and the minimal development of bacterial resistance. The activity of fluoroquinolones can also be compromised by bacterial resistance so to preserve their clinical value it is important to follow the above mentioned principles in their use.]

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[Chirurgic treatment of pyogenic liver abscess]

PETRI András, HÖHN József, HÓDI Zoltán, WOLFÁRD Antal, BALOGH Ádám

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[ACUTE DERMATOMYOSITIS ASSOCIATED TO THE CARCINOMA OF THE PROSTATE]

TÁLLAI Béla, MORSHED Ali Salah, FLASKÓ Tibor, PONYI Andrea, DANKÓ Katalin, TÓTH Csaba

[INTRODUCTION - In some cases of polymyositis/ dermatomyositis (PM/DM) of autoimmune origin, different malignant tumours can initiate the difficult cascade mechanisms at cell level leading to the rapid weakness of the skeletal muscles. Till now, in the international literature only four cases of PM/DM associated with cancer of prostate has been reported. CASE REPORT - Authors present a case of a 57 yearold male patient, where weakness in patient's movements developed leading to total immobility in 3 months. Purple discoloration developed on his hand and face. Significantly elevated creatin kinase (CK) levels and blood sediment rate with mild anaemia were observed during laboratory examinations. Dysphagia and lack of appetite resulted in the loss 10 kgs in body weight. Both clinical evaluation, elevated serum CK level, skin symptomes, positive electromyography and muscle biopsy confirmed acute definitive dermatomyositis. Urological examination revealed a palpable hard area at the right lobe of the prostate. Prostate biopsy confirmed the presence of carcinoma in the right lobe of the prostate. There was no sign or symptome referring to either local propagation or distant manifestation. Therefore, radical prostatectomy was performed, the tumorous prostate and both seminal vesicles were removed. Histological examination proved malignant focus in the right lobe of the prostate. After the operation patient gradually became stronger, corticosteroid medication were decreased then stopped. Patient's original muscle power and movement recovered and his previous body weight was regained. During the regular control examinations all results of laboratory tests are in normal range. CONCLUSION - In the background of some autoimmune diseases malignant tumours can be revealed. It is rare when urological neoplasms initiative the process. In men with PM/DM commencing beyond 50 years of age it is necessary to think of the presence of prostate cancer, which can be cured by performing radical operation in appropriate time.]

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MATOS Lajos

Lege Artis Medicinae

[LARGE VESSEL MANIFESTATION OF GIANTCELL ARTERITIS]

KOLOSSVÁRY Endre, PINTÉR Hajnalka, ERÉNYI Éva, KOLLÁR Attila, FARKAS Katalin, KISS István, HARCOS Péter, SIMON Károly

[The diagnosis of giant-cell arteritis is a real challenge for clinicians. There are several reasons for the difficulties in establishing the diagnosis. This disease is associated to rare conditions, therefore most physicians lack clinical experience. This condition shows very heterogeneous manifestation, the intensity of the symptoms vary in time. Early diagnosis is of great importance in order to prevent ischemic complications. Among these complications one should emphasise the role of anterior ischemic optic neuropathy that may result in abrupt blindness. In this case report, we show a rare socalled large vessel manifestation of giant-cell arteritis. This form of the disease needs different approach in diagnosis where color duplex ultrasonography may have distinguished importance. The final verification of the diagnosis is based on histology. However the lack of all histological criteria do not exclude the presence of giant-cell arteritis.]

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[Coumarins have been widely used for the prevention of arterial and venous thromboembolism. The importance of oral anticoagulants has steadily increased in internal medicine and cardiology in the past 20 years. Coumarins are vitamin K antagonists by inhibiting the synthesis of vitamin K-dependent coagulation factors in liver cells. Since the average half-life of hydroxycoumarin is longer than that of aceno-coumarin, the INR of patients treated with hydroxy-coumarin is more stable, thus making it especially suitable for long-term anticoagulant treatment. The main indications of coumarin therapy include secondary prophylaxis of venous thromboembolism, and primary and secondary prevention of arterial thromboembolism, particularly embolic stoke, in patients with cardiovascular disorders. This review summarizes the most important clinical issues of long-term oral anticoagulant therapy including indications, contraindications, dosing, therapeutic range, and laboratory monitoring. Special emphasis is placed on the role of hydroxy-coumarin in longterm oral anticoagulant therapy.]