Lege Artis Medicinae

[The True Salieri]

MALINA János

APRIL 21, 2006

Lege Artis Medicinae - 2006;16(04)

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Lege Artis Medicinae

[METABOLIC “X” SYNDROME: “XYNDROME” - POSITIONS AND OPPOSITIONS]

MATOS Lajos

[The idea of a constellation of abnormalities linked to insulin resistance as a key component was pioneered and summarized by Reaven in 1988 under the name of “X” syndrome. Based on the various elements of the syndrome, several synonyms have been proposed, including “deadly trio”, “deadly quartet”, “central fat syndrome”, “insulin resistance syndrome”. To avoid the confusion of this entity with “cardial X syndrome”, an established syndrome in cardiology, and instead of the rather long “metabolic X syndrome”, I have proposed the term “Xyndrome”. Irrespective of how it is called, this syndrome has come into the focus of clinical research; using the keyword “metabolic syndrome” to search in the index of the National Library of Medicine, 15.661 citations pop up, and in February 2006 only, 168 papers were published in this field. In spite of this, several international scientific organizations have recently claimed that metabolic syndrome has not been unambiguously defined, its diagnostic criteria are contradictory, and finally, the syndrome as an entity has no more value in predicting cardiovascular risk than the sum of its individual components has, therefore, the use of this notion in the clinical practice is not recommended. There are, however, opposing opinions emphasizing the importance of abdominal obesity - today considered to be most essential element -, data from recent research, and the didactic advantage that the use of this notion has improved complex treatment of its various components. It is crucial to understand that “syndrome” is not more - and not less, either - than a clustering of symptoms and findings, and should not be treated as a distinct disease. The emergence of the notion of metabolic syndrome, however, has been a step forward in the medical concept in that metabolic and cardiovascular diseases are now dealt with in a more complex way, which warrants the maintenance of this notion and the increase of our understanding by continuing research in this field.]

Lege Artis Medicinae

[Gastrointestinal bleeding in infancy and childhood - Recommendation of the College of Paediatrics]

ARATÓ András, VERES Gábor, DEZSŐFI Antal

Lege Artis Medicinae

[THE LONG ACTING INSULIN ANALOGUE DETEMIR IN THE DIABETOLOGICAL PRACTICE: EVIDENCE AND POTENTIALS]

TAMÁS GYULA, KERÉNYI ZSUZSA

[Insulin detemir is a neutral, soluble, long-acting insulin analogue in which the amino acid threonineB30 has been removed and the LysB29 acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to dihexamerisate and reversibly bind to human albumin upon administration. This brand new principle (self association and albumin binding) ensures slow absorption and a prolonged and consistent metabolic effect without a marked peak for up to 24 hours in patients both with type 1 and type 2 diabetes mellitus. Results of large clinical trials have shown that detemir can be efficiently used as basal insulin, supplemented with human regular insulin or aspart insulin taken before the main meals, in both type 1 and type 2 diabetes. Available data clearly demonstrate that the use of this insulin is associated with decreased variability of the fasting blood glucose values. In some of the studies the risk of (mostly nocturnal) hypoglycaemic episodes also dropped. It is important to note that patients using insulin detemir gained less or no weight compared to the group of patients treated with neutral protamine Hagedorn (NPH) insulin. Evaluation of long-term and wide-spread application of detemir needs further observations. Such trials are being conducted worldwide.]

Lege Artis Medicinae

[To Reward Performance... An Interview with Gyula Szegedi, Member of the Academy, by Elemér Nemesánszky, LAM’s Editor-in-Chief]

NEMESÁNSZKY Elemér, GYIMESI Andrea

Lege Artis Medicinae

[SOME FORMS OF SECONDARY OSTEOPOROSIS: DIAGNOSIS AND TREATMENT]

GENTI György, PÉNTEK Márta, LICKER-FÓRIS Edit

[Secondary causes of bone loss are not often considered in patients, who are diagnosed as having osteoporosis. There are many causes of secondary osteoporosis, including endocrine diseases, renal disorders, transplantation, glucocorticoid therapy, inflammatory rheumatic diseases etc. This article gives an overview on the most frequent and in the everyday practice important forms of secondary osteoporosis. The first principle is the correct diagnosis and the adequate treatment of the underlying disease. In the prevention and treatment of secondary bone loss similar principles are followed as in the primary forms. Calcium, Vitamin D, personalized, well-aimed physical therapy and continuous physical activity are the basic treatment of secondary osteoporosis. Active form of Vitamin D, which does not require calcium combination, has to be applied in advanced age, in impaired renal function, and in case of ineffective therapy with cholecalciferol. Evidence based data suggest that bisphosphonates (alendronate and risedronate) are the most effective antiresorptive agents in the prevention and treatment of glucocorticoid- induced osteoporosis and in osteoporosis associated with rheumatoid arthritis. To prevent secondary hyperthyreoidism during bisphosphonate treatment, a calcium intake of 1000 1500 mg/d and an 800 IU/d of cholecalciferol are recommended. Ibandronate (150 mg once a month), a new bisphosphonate will be available soon. Parathyroid hormone (teriparatide) is an anabolic agent, that enhances bone formation. Its recent introduction offers new options in the treatment of patients with established osteoporosis.]

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Clinical Neuroscience

[THORACIC MENINGOCELE]

FEKETE Tamás Fülöp, VERES Róbert, NYÁRY István

[Herniation of the meninges through a defect of the spinal canal is a spinal meningocele, and is usually located dorsally in the lumbosacral region. Meningoceles are usually part of a complex developmental disorder, or of a systemic disease, or it can be iatrogenic, as well. We report a very rare case of a true anterior thoracic meningocele.]

Lege Artis Medicinae

[To Create a True “Well-Being”]

GYIMESI Ágnes Andrea

Clinical Oncology

[Pregnancy and cancer]

NAGY Zsuzsanna, SZILLER István, VALTINYI Dorottya, HORVÁTH Orsolya

[The joint appearance of pregnancy and cancer is rare. It is highly recommended that the tumorous pregnant should be managed by a multidisciplinary team. The early diagnosis is very important, but it is not easy, because the symptoms of pregnancy and cancer are rather similar. Imaging diagnosis has to avoid ionizing radiation (e.g. PET/CT). The same is true for chemotherapy in the fi rst trimester, due to the increased risk of developmental abnormalities. Consequently, radiation therapy is not allowded throughout the pregnancy, and the chemotherapy in the fi rst trimester is a strong indication for the interruption of pregnancy. Surgery, with good practice, usually can be performed without complications. Chemotherapy, given in the second and third trimester generally follows the standard protocols with a low frequency of developmental errors. Early delivery should not be encouraged, except the delay has a hazardous effect on the mother and/or on the child. The pregnant should be informed about all steps to be an active part of the fi nal decision.]

Lege Artis Medicinae

[Central nervous system hemorrhage in Wegener’s granulomatosis]

SZABOLCSI Orsolya, SZÁNTÓ Antónia, ZEHER Margit

[In our case a 41-year-old man with following symptoms: non-productive coughing, fever, difficulty in breathing and weight loss was examined in February 2007, and on the basis of chest X-ray, CT and bronchoscopy, the possibility of neoplasm or tuberculosis cropped up. After the applied therapy (steroid, antibiotics, tuberculostatic drugs) the symptoms became more severe, i.e. hematuria and epistaxis were manifested. A tissue biopsy was carried out during bronchoscopy and the histological examination revealed granulomatous reaction. Meanwhile, the presence of c-ANCA was proved, and Wegener’s granulomatosis (WG) was diagnosed. In March 2007, sudden somnolence and left side hemiplegia developed, and a large haemorrhage was recognised on CT scan in the right fronto-temporal region, with regard to the haemorrhage, the patient had to undergo a neurosurgical operation. We started to treat him in April 2007 by intravenous steroid and 600 mg of cyclophosphamide (Cyc), and he regained the ability to walk again. In October 2007, the Cyc treatment was terminated, and we administered a maintenance therapy with methotrexat. During the regular medical check-up, a chest X-ray indicated a second attack in March 2008, which was confirmed by the chest CT, the clinical symptoms, increased anti-PR3 levels and c-ANCA positivity as well. The flair of the disease was established. Consequently, in April 2008 we decided on plasmapheresis therapy synchronised with Cyc. After that, we started an azathioprine maintenance therapy and he got rid of all the activation symptoms. We can say that with the adequate therapy started in good time and with the regular medical check up of the patient a good result can be achieved. It is true even in the case of WG disease associated by severe complication, for example central nervous hemorrhage.]

Hungarian Radiology

[Ultrasound of the acute pediatric scrotum]

BRIAN D. Coley

[Proper evaluation of the acute scrotum, like any condition, starts with a history and physical examination by an experienced clinician. Often this is all that is needed to arrive at an accurate diagnosis, which then allows prompt and appropriate treatment. However, the true nature of the underlying disease producing scrotal pain is not always clear, and the consequences of error (testicular loss) are undesirable. Ultrasound is the single most useful imaging tool for imaging the scrotum. While nuclear medicine studies can help assess blood flow, the combination of anatomic detail provided by modern ultrasound equipment and the ability to assess blood flow and perfusion with color Doppler makes ultrasound invaluable. Properly performed and interpreted, ultrasound provides very high sensitivity and specificity for acute scrotal conditions. Understanding of the conditions that produce acute scrotal pain in children will improve one’s diagnostic abilities. The most important diagnosis to consider is testicular torsion, since untreated this will result in testicular death. While testicular torsion can occur at any age, it is most common in the perinatal and peripubertal age groups. Torsion of a testicular appendage is a frequent cause of scrotal pain in prepubertal males. The sonographic findings can mimic epididymitis, but diligent and focused sonographic examination can make the diagnosis. Epididymitis typically affects postpubertal males, but can be seen in younger patients with functional or anatomic urinary tract anomalies. Sonographic evaluation of the post-traumatic painful scrotum can help to differentiate injuries that can be managed conservatively and those that require surgery. Less common causes of scrotal pain include hernias and hydroceles, vasculitis, and idiopathic edema. Understanding the characteristic sonographic features of these conditions allows the examining physician to make more accurate and confident diagnoses. It is hoped that this review article will help to promote this understanding.]