Lege Artis Medicinae

[The significance of testing for microsatellite instability in colorectal cancer]

SZENES Mária, BALI Ottilia, RUZSA Ágnes, NAGY Gyöngyi, VATTAY Péter, VÖLGYI Zoltán, GASZTONYI Beáta

MAY 16, 2007

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

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Lege Artis Medicinae

[SERUM ALANIN AMINOTRANSFERASE VALUES AND CHRONIC HEPATITIS C - HOW MUCH IS “NORMAL”, AND WHO SHOULD BE TREATED?]

HUNYADY Béla

[Serum aminotransferases (= transaminases), especially alanin aminotransferase have been used in the diagnosis of liver diseases, including viral hepatitis, for decades. However, reliability of these biochemical markers was challenged in various respects by recent clinical studies. First, it has been shown not to be sensitive enough in screening for viral hepatitis in high risk populations (viral hepatitis may be present with normal values). Second, normal range is exceeded in a large number of subjects without genuine liver disease due to the increased proportion of people with metabolic disease (diabetes, dyslipidaemia) or high body weight, i.e., the upper limit of normal is too strict. Moreover, decision on treatment of patients with viral hepatitis infection and persistently normal aminotransferases poses a challenge for the clinician. Based on the current literature, this review attempts to provide guidelines for the everyday clinical practice.]

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[Cataflam Art Salon Photographs on Pain]

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[What does it mean to be a doctor today?]

BANAI János

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[Salicyl Therapy, Homeopathy, Medical History ]

dr. GROÁK Lajos

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[A Brief Compendium of Unusual Remedies Scatotherapy]

dr. MAGYAR László András

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[Interdisciplinary approach of vestibular system impairment]

PONGRÁCZ Endre

[In the first part of this review the definition of vertigo/dizziness was discussed. The major difference between the two signs is the exsistence of the direction, which is specific for vertigo. Dizziness is a frequent complaint in the clinical practice. Its frequency is increasing with advance of age, to intimate the play of declining cognitive process in the pathogenesis of its. The popular health significance of vertigo is in the rowing number of the patients. The onset of the most cases with acute vertigo appears between secundums and minutes so the patients will be provided in circumstances of emergency department. First of all three form schould be take into account: neuronitis vestibularis, benign paroxysmal positional vertigo and Meniere syndrome. Without tipical periferal signs of vertigo, central cause should be searched, principally stroke (lysis possibility). The differential diagnose of the different dizzeness/vertigo forms according to the elapsed time of the onset or congenital and acquired nystagmus was created in tables. The recommendations of the therapy of acute and chronic dizziness/ vertigo syndroms are, lack of results of evidence based trials doubtful. The more often used drugs based on clinical trials are discussed as vinpocetine, betahistine and piracetam. The in vitro and in vivo data suggest that the last molecule is eligible to use both in periferal and central type of vertigo syndroms.]

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[Treating breast cancer patients with fulvestrant - could it be more efficacious?]

NAGY Zsuzsanna

[Fulvestrant, as an estrogen-receptor antagonist, effectively decreases the estrogen effect, which is a key factor in the development, growth and progression of the breast cancer. Its clinical advantage can appear even after several lines of unsuccessful chemo- or hormonal therapy. In our invasive ductal carcinoma cases, the clinical benefit was obvious over 40%. According to recent data using a higher dose better results can be obtained. The same is expected if the drug would be applied at an earlier stage of the disease.]

Clinical Oncology

[CDK 4/6 Inhibitors in Breast Cancer: Current Controversies and Future Directions]

SPRING M. Laura, WANDER A. Seth, ZANGARDI Mark, BARDIA Aditya

[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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[MODERN TREATMENT OF COLORECTAL CANCER]

KALMÁR Katalin, HORVÁTH Örs Péter

[The incidence of colorectal cancer has dramatically increased in the past decades, rendering it the second most frequently diagnosed cancer in the Western world. Disease outcome can be improved both by early diagnosis, e.g., through the introduction and extension of screening programs, and by increased therapeutic efficiency. The latter is achieved by increasing the radicality of interventions in surgical oncology to total mesorectal excision, thereby significantly decreasing the frequency of local recurrence. High ligation of the inferior mesenteric artery aims to enhance the efficiency of lymphadenectomy. With the introduction of techniques that spare vegetative nerves, the quality of life will not be adversely affected by the increased radicality. Another direction of progress in colorectal surgery is the increased use of minimally invasive approaches, such as local excision by transanal endoscopic microsurgery or laparoscopic methods. Increased acceptance of a multimodality approach, i.e., combined application of surgical and oncological methods in the treatment of colorectal cancer, has been a great step forward recently. Beyond the long-applied adjuvant treatments, the pre-surgical use of neoadjuvant chemo-radiotherapy has become standard for locally advanced rectal cancers. Adjuvant and neoadjuvant chemotherapy also supplements the surgery of metastases with improving results and impressive long-term survivals. A very important prerequisite for tailored multimodality treatment is reliable staging, which is facilitated by the wider availability of endorectal ultrasound.]

LAM Extra for General Practicioners

[NON-HDL-CHOLESTEROL AND ITS SIGNIFICANCE]

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[The role of LDL-cholesterol in cardiovascular risk has been established in a number of studies. According to current recommendations, therefore, the primary goal of lipidlowering therapy is reducing the level of LDL-cholesterol. Of lipid-lowering drugs, statins are the most efficient in reducing cardiovascular risk. According to large studies on statins, however, there is a significant residual risk even in patients receiving aggressive treatment. It is well known that many patients continue to have dyslipidaemia despite statin therapy, and not all patients with cardiovascular disease have elevated LDL-cholesterol levels. These observations indicate that lipids other than LDL-cholesterol also have a role in the development of atherosclerosis. A growing attention is paid to non-HDL-cholesterol as a cardiovascular risk factor. Calculating non-HDL-cholesterol target is easy: LDL-cholesterol measurement plus 0,8. Non-HDL-cholesterol incorporates a number of atherogenic lipoprotein particles [VLDL-cholesterol, IDL-cholesterol, LDL-cholesterol, and lipoprotein(a)]. As the atherogenic effect of apoB-containing lipoproteins (LDL, IDL-C és VLDL) is significant, they may be stronger predictors of coronary heart disease (CHD) risk than LDL-cholesterol is. Considering the strong correlation between apoB and non-HDLcholesterol and the limitations of apoB measurement (standardisation, cost), non- HDL-cholesterol is a more useful parameter and therapeutic target, especially if triglyceride levels are greater than 2.26 mmol/l.]