Lege Artis Medicinae

[The Saga Novel of Philosophy ]

KELEMEN Gábor

JUNE 20, 2016

Lege Artis Medicinae - 2016;26(05-06)

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Further articles in this publication

Lege Artis Medicinae

[Neurological symptoms in a patient with treated multiple myeloma]

ZOMBORI Tamás, PIUKOVICS Klára

[INTRODUCTION - Meningeal infiltration by multiple myeloma is rare. Its incidence among cases of multiple myeloma is 1%. CASE REPORT - Multiple myeloma was diagnosed in a 53-year-old woman in December 2014. After chemotherapy, the disease was treated with autologous bone marrow transplantation in June 2015. Remission was observed through two months, but in August the patient was hospitalized due to severe headache with neck stiffness. Meningitis or viral encephalitis were suspected following her investigation. She was taken to the Intensive Care Unit because of a progression to status epilepticus. The EEG-examination revealed generalized slow wave activity and a right temporal epileptiform focus manifesting rarely. Clinical brain death developed on the 17th day in hospital. DISCUSSION - Although meningeal infiltration is infrequent in multiple myeloma, the present case report draws attention to this possibility. ]

Lege Artis Medicinae

[A Potion for All Ailments – Gaetano Donizetti ]

KÖVES Péter

Lege Artis Medicinae

[Music therapy in hospice care]

KOLLÁR János

[The study gives a short review of some music therapy methods can be applied on the field of hospice care. Its aim is drawing the attention to the topic and enhancement of the method in the hospice movement in Hungary. The results of research works support the idea of applying both active and receptive music therapy for ensuring advantageous results in high quality care provided for dying patients. Properly chosen musical interventions applied by qualified music therapists within a therapeutic relationship are able to improve amongst others the quality of life of dying people by ensuring their inner peace, reducing the feeling of pain and anxiety and supporting their psychical-spiritual development. Besides the dying patients, hospice workers and the relatives of the patients can also experience the benefits of music therapy. ]

Lege Artis Medicinae

[Miles and the Dust ]

LENGYEL Dávid

Lege Artis Medicinae

[The role and scope of screening and diagnosing obstructive sleep apnea syndrome by the family physician]

ANNUS János Kristóf, ÁDÁM Ágnes, BECZE Ádám, CSATLÓS Dalma, LÁSZLÓ Andrea, KALABAY László, SZAKÁCS ZOLTÁN

[Diagnosis and treatment of sleep disorders play an increasingly important role in everyday clinical practice of family physicians. Obstructive sleep apnea syndrome (OSAS) is a significant disorder of this disease group due to its relatively high incidence rate and increasing risk of adverse medical outcomes in the course of time. The prevalence of OSAS is 2-4% in the general population. It is characterized by obstructive apneas and hypopneas mostly with desaturations and/or arousals caused by the repetitive collapse of the upper airway during sleep. Besides impairing sleep efficacy and daytime neurocognitive functions, OSAS increases cardiovascular risk as well. The typical clinical presentation is an excessive daytime sleepiness and loud snoring interrupted by brief pauses of breathing. It can be a risk factor for treatment-resistant and/or non-dipper hypertension, nocturnal cardiac arrhythmias, stroke, cognitive decline and depression. The importance of OSAS is presented by the fact that - according to the latest related Hungarian law reforms - risk evaluation of the disorder is part of the medical assessment of suitability for a driving license. The family physician’s tasks are to recognize the clinical symptoms, identify high-risk patients with potential complications who need adequate treatment and eventually guide them to sleep-diagnostic centers. ]

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[Purpose of review: To describe the clinical role of CDK 4/6 inhibitors in hormone receptor-positive (HR+) metastatic breast cancer (HR+MBC) as well as current controversies and evolving areas of research. Recent fi ndings: Palbociclib, ribociclib, and abemaciclib are each approved in combination with an aromatase inhibitor or fulvestrant for HR+MBC. Abemaciclib is also approved as monotherapy for pre-treated patients. Key questions in the fi eld include whether all patients with HR+MBC should receive a CDK 4/6 inhibitor up front versus later line, impact on overall survival, role of continued CDK 4/6 blockade, mechanism of clinical resistance, and treatment sequencing. Summary: The development of CDK 4/6 inhibitors has changed the therapeutic management of HR+MBC. Additional research is needed to determine optimal treatment sequencing, understand mechanisms governing resistance, and develop novel therapeutic strategies to circumvent or overcome clinical resistance and further improve the outcomes of patients with MBC.]

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[Dendritic cells represent a multifunctional cell population classified to myeloid (mDC) and plasmacytoid (pDC) types. Both subsets circulate in the peripheral blood and are found in lymphoid and also in non-lymphoid tissues, where they act as sensors of environmental changes. Upon activation by a wide range of stimuli they undergo morphological and functional transition and give rise to professional antigen presenting cells, which migrate to lymphoid organs. A newly identified precursor subset of human dendritic cells has recently been identified as professional type I interferon producing cells (IPC) with multiple functional activities. With their capacity of priming, instructing and regulating various pathogen- and tumor-specific immune responses, IPC/pDC act as a link between innate and adaptive immunity. The role of pDC in the pathogenesis of various diseases is well established, and these cells also emerge as novel candidates of immunomodulation.]

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[Immunotherapy of lungcancer – an update]

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[Ten years ago the median survival of small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC) was less than one year. In the case of SCLC the situation did not change. There are revolutionary new possibilities in the treatment of NSCLC (histology based cytotoxic chemotherapy, molecular targeted therapy etc.). Unfortunately there is no signifi cant development in treatment strategy of SCLC in the last 30 years. Nowadays in NSCLC immune check point inhibitor therapy is a novel treatment method in the clinical praxis as well. The integration of the PD axis and the CTLA4 inhibitors in the complex therapy of the management of NSCLC is a new challenge. The pembrolizumab monotherapy in fi rst line setting is a new standard of care with high PDL1 expression. In second line setting the pembrolizumab, nivolumab and atezolizumab widely used in clinical praxis as well. In locally advanced disease of NSCLC after radiochemotherapy the durvalumab maintenance monotherapy showed a signifi cant progression free survival benefi t, comparing to placebo. We have got new treatment possibilities in the treatment of SCLC as well. The results of clinical trials with antibody conjugate therapy are promising. The nivolumab monotherapy and the combination treatment of nivolumab + ipilimumab gave promising results as well. In the treatment of SCLC and NSCLC there is a need for biomarker selected therapy (tumor mutational burden [TMB], DLL3, cMyc etc.). Based on the new positive results of the clinical trials there is a possibility to transform lung cancer from a subacute disease to a chronic illness.]

Lege Artis Medicinae

[Antibiotic treatment of intra-abdominal infections, focusing on secondary peritonitis]

PULAY István, KONKOLY THEGE Marianne

[The morbidity and lethality of intra-abdominal infections are still high. Their first-line therapies include surgical or image-guided interventions. Adjuvant therapy with a broad-spectrum antibiotic is crucial for the treatment of polymicrobial infections. As initiation of the therapy is urgent, the antibiotic must be chosen empirically. Pathogens of community-acquired and nosocomial intra-abdominal infections are greatly different. The type of microbes, the general status of the patients, and the severity of their disease determine the choice of antibiotic or antibiotic combination. Using an adequate initial antibiotic decreases postoperative mortality and morbidity. Emerging new pathogens and the resistance of known germs against multiple antibiotics complicates the selection of the antiinfective therapy. Tigecycline is a new tetracyclin-derivative that offers a novel therapeutic option owing to its broad spectrum and efficiency against “problematic bacteria”. The current guidelines facilitate the selection of an empirical therapy, but they do not replace the individualised therapeutic approach.]