Lege Artis Medicinae

[THE PATHOBIOLOGICAL BASES OF CANCER]

JENEY András

MAY 16, 2007

Lege Artis Medicinae - 2007;17(04-05)

[This communication intends to give an overview of the cell biological changes that maintain the underlying pathobiological events (invasive growth, metastasis formation, angiogenesis) of tumour progression. The multiple and continuously accumulating mutations of the cells affected by the etiological factors are collectively termed the malignant genotype of the tumour cells, which varies greatly on one hand, but, on the other hand, they are invariably related to an increased survival potential or invasive growth. Properties of the tumour cells produced by the malignant genotype, including immortalization, reduced apoptosis, uncontrolled proliferation, adaptation to hypoxia, resistance, metastatic potency and production of biopolymers harmful to the body are collectively termed the malignant phenotype. The malignant phenotype shows a remarkable variance among the tumours, also, certain forms are present in all stages, while others only appear in specific stages of tumour progression. Consequently, beside clinico-pathological examinations, the identification of the underlying malignant phenotype in each tumour allows a better prediction of tumour progression and a targeted planning of therapy.]

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[SEVERE GASTROINTESTINAL AND RENAL MANIFESTATIONS OF HENOCH-SCHÖNLEIN PURPURA]

GECSE Krisztina, ONDRIK Zoltán, KAIZER László, VARGA Erika, LONOVICS János, CZAKÓ László

[INTRODUCTION - Henoch-Schönlein purpura is a systemic small vessel vasculitis characterized by vascular and/or mesangial IgA deposits, primarily affecting the vasculature of the skin, joints, kidneys and gastrointestinal tract. Gastrointestinal findings of various severity occur in 50 to 85% of the cases. We report on a 70-year-old woman who developed ileocaecal invagination and upper gastrointestinal haemorrhage as manifestations of Henoch-Schönlein purpura. CASE REPORT - The patient presented with two days history of palpable purpuric rash localized on the lower extremities. Based on the result of the skin biopsy, which showed leukocytoclastic vasculitis, IgA and C3 deposits, Henoch-Schönlein purpura was suspected. On the second night after admission colicky abdominal pain, vomiting and diarrhoea developed. Radiological examination showed an ileocaecal invagination and since symptoms deteriorated caecum resection and ileo-ascendestomy was performed. On the third postoperative day the patient became oligo-anuric, which was attributed to her Henoch-Schönlein disease, and systemic steroid pulse therapy was given. One month after the admission the patient experienced haematochezia. Emergency upper endoscopy revealed petechiae, haemorrhagic erosions and mucosal oedema, primarily in the descending part of the duodenum. Since these lesions were also considered as presentations of Henoch-Schönlein disease, another bolus of parenteral steroid was administered. Upper endoscopy repeated 3 days later showed remarkable improvement of the gastric and intestinal lesions. CONCLUSION - Gastrointestinal symptoms are common manifestations of Henoch-Schönlein purpura, thus their recognition, in which endoscopy plays a crucial role, is of major importance. Methylprednisolone pulse therapy is an effective therapeutic option not only in the management of severe renal or joint symptoms, but also in the treatment of gastrointestinal manifestations.]

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