Lege Artis Medicinae

[The lost humanness]

FRENKL Róbert

JANUARY 27, 2009

Lege Artis Medicinae - 2009;19(01)

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[New guiding principles of the anti-platelet therapy in stroke-prevention]

SZAPÁRY László

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[New possibilities in the management of hepatocellular carcinoma]

DANK Magdolna

[The prognosis of primary hepatocellular carcinoma (HCC) has been poor until recently. Most patients are diagnosed at an advanced stage, with a poor liver function, thus therapeutic possibilities are limited. In high-risk patients, active surveillance and HCC screening is essential for early diagnosis. Experience with systemic chemotherapy has been disappointing with low response rates and high rates of adverse effects. Recently, novel treatment options have emerged, including the use of specific targeted agents, blockers of signaling pathways involved in hepatocarcinogenesis. Sorafenib, an oral multikinase- inhibitor is the first systemic agent to demonstrate survival benefit in advanced hepatocellular cancer. Several new, promising therapeutic options are being tested in clinical trials. The present review gives an overview of evolving diagnostic and therapeutic strategies.]

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[“Lump in one’s throat” - Diagnostic and therapeutic failures]

GERLINGER Imre

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[Cardiological data in amyloidosis]

ESETLEÍRÁS képekben

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[Saving Lives at the Cost of the Physician’s Life?]

BARANYAI Zsolt

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[NEUROFIBROMATOSIS, MALIGNANT MELANOMA AND HYPERTHYREOIDISM IN A HCV POSITIVE PATIENT]

FOLHOFFER Anikó, HORVÁTH Andrea, CSÁK Tímea, NÉBENFÜHRER László, TELKES Márta, IVÁNYI András, SZALAY Ferenc

[INTRODUCTION - Similar occirrence of neurofibromatosis and malignant melanoma is rare. We report a patient with neurofibromatosis, cutaneous melanoma, hyperthyreoidism and HCV positivity. CASE REPORT - A 43-year-old woman has been under care for neurofibromatosis for 16 years when she presented with increased serum ?- glutamyltransferase, alkaline phosphatase activity and anti-HCV antibody positivity at regular checkup. A pigmented lesion removed from her back histologically proved to be cutan melanoma. Interferon treatment was applied. She lost 8 kilograms in half a year which was caused not by the tumor progression, but hyperthyreoidism. A rapid clinical and laboratory improvement was observed for thyreostatic treatment and she regained her bodyweight. One year later she presented with a cough caused by pulmonary tumor. The tumor was surgically removed and histologically diagnosed as metastasis of melanoma. Cytostatic treatment was applied and she became asymptomatic. Four years after the diagnosis of melanoma she died of apoplexy. During the autopsy there was no sign of either melanoma or liver disease. CONCLUSIONS - The careful investigation of skin should be emphasised even in case of long established neurofibromatosis. The presented case shows an association of malignant melanoma and neurofibromatosis. In the background of loss of bodyweight even in a patient with history of malignant disease other causes should also be searched such as hyperthyreoidism especially during interferon therapy.]

Lege Artis Medicinae

[PAIN AND PAIN CONTROL IN RHEUMATOLOGY]

GAÁL János

[In developed industrial countries the overall population prevalence of chronic rheumatic pain is around 35%. A classification that is useful in everyday practice is based on the origin of musculoskeletal pain and lists pain associated with degenerative joint diseases, pain related to metabolic bone diseases, non-articular and soft tissue rheumatism, and pain due to inflammation. In chronic pain syndrome pain itself has lost its adaptive biological role, and presents as a pathogenetic factor in its own right, accompanied by significant vegetative and psychological symptoms. Therapeutic exercise is of basic importance in the management of rheumatic pain. It is supplemented by various pharmacologic and nonpharmacologic methods. The latter include, among others, fomentations, packs, balneo- and hydrotherapeutic methods, electro-, mechanoand thermotherapeutic approaches. Pharmacological therapy usually means the use of simple analgesics, non-steroidal antiinflammatory drugs, steroids, minor opiates, and, lately, also major opiates, which may be supplemented by adjuvant agents such as tricyclic antidepressants and anticonvulsive drugs. When indicating the most often used non-steroidal antiinflammatory drugs, their potential side effects should carefully be considered. Invasive pain-killing methods on the border area between anaesthesiology and rheumatology (epidural steroid administration, ganglionic blockade, intravenous regional blockade) are applied in cases that do not respond to conventional therapy, and sometimes also as successful first-line intervention.]

Journal of Nursing Theory and Practice

[Experiences with the combined use of Versiva, non-adhesive foam dressing and Curiosa gel in chronic wound care]

BOROS Katalin Gyöngyi, TAKÁCS Tibor, VARGÁNÉ TERHES Anita, CSERNUS Mariann

[Up-to-date wound care is a kind of teamwork that requires modern bandage, a high degree of theoretical knowledge and a strong sense of vocation. The authors describe the complete healing of a patient’s diabetic foot ulcer with all these three factors present. Patients suffering from all the complications of diabetes can often have faith only in the dedicated medical staff. An old patient having almost lost his vision can be treated successfully for diabetic foot ulcer in the period of 11 months due to modern wound management and vascular surgery. With the presentation of this case the authors wish to emphasise the need for devoting more time to medical training concerning modern wound care, and to improve the psychological management of the affected patient. ]

Lege Artis Medicinae

[Actual questions of the longterm anticoagulant therapy]

SAS Géza

[In the last few years we have witnessed some changes in the area of the chronic oral anticoagulant therapy. The nomenclature of the anticoagulant drugs has been modified and concern has arisen about the possible vascular calcification in patients on long-term warfarin therapy. Because of the novelty of the “new” anticoagulants (dabigatran etc.) has been lost, instead of their previous acronym (NOAC) the DOAC (direct oral anticoagulants) term has been accepted for their marking. Experimental and clinical data suggested that vitamin K-antagonists (VKA) in addition to the coagulation factors disturb the production of other proteins, too. By inhibiting the matrix Gla protein (MGP), the chronic warfarin therapy promotes the calcification in media of the arteries as it was shown in women participating in routine mammography. However, the clinical importance of this observation is dubious, because the incidence of acute coronary events is not increased in cases of warfarin therapy in patients with atrial fibrillation. Notwith­standing, in addition to the bleeding complications we have to take into account of the possible harmful vascular calcification, too, at the indication of chronic coumarin therapy. Therefore, this therapy should be applied only in proper cases, such as non-valvular atrial fibrillation with a high risk of ischaemic stroke or unprovoked venous thromboembolic disease with a high risk of recurrence. The results of the Swedish anticoagulant register show that the efficacy and safety of the well-managed coumarin therapy may be superior to the treatments with DOACs. However, DOACs are indispensable in certain cases in which a previous “probe” coumarin treatment is unfounded.]

Clinical Neuroscience

[Guillain–Barré syndrome in childhood]

KOLLÁR Katalin, LIPTAI Zoltán, ROSDY Beáta, MÓSER Judit

[Background - Guillain-Barré syndrome (GBS) is clinically well known since 1916. It can occur at any age. Its main characteristic is acute rapidly ascending flaccid paresis. It is a neuro-immunologic disorder with heterogeneous background. In Hungary we could not find reports about big paediatric population with GBS. Patient and method - We analysed retrospectively the data of 38 children diagnosed and treated with GBS at the Neurological Department of Paul Heim Children’s Hospital or at the Paediatric Department of St. László Hospital from January 2000 till April 2008. We analysed the clinical characteristics, seriousness of clinical signs, laboratory results, and electrophysiological features of them as well documented the preceding illness. We observed the effectiveness of our treatment; we measured the speed and time of the healing process and documented the residual clinical signs. Results - 35 children could be classified as having acute inflammatory demyelinating polyneuropathy (AIDP), 2 as having acute motor axonal neuropathy (AMAN) and 1 as Miller-Fisher syndrome. By those patients who at the very beginning did not show the characteristic clinical signs, electrophysiology helped in establishing the diagnosis. By one child spinal MRI with gadolinium supported our diagnosis. Those children, who lost their ambulation, got immunotherapy: intravenous immunoglobulin (IVIG) or plasmapheresis (PEX). Both method seemed to be effective. None of our patients died. All were cured. By five patients residual clinical symptoms could be found. Conclusion - The disease process, the relative incidence of each subtype of GBS is nearly similar to that in Western Europe and North America according to the literature. By the currently used immune therapy most of the pediatric patients recover fully within a short time.]