Lege Artis Medicinae

[Treatment of endodermal thyroid cancers]

ÉSIK Olga1, NÉMETH György1

MAY 27, 1992

Lege Artis Medicinae - 1992;2(05)

[Following staging procedures, differentiated thyroid cancers i. e. papillary and follicular carcinomas, are surgically treated with intra- or extracapsular total thyroidectomy (depending on the anatomical extent of the disease) and selective lymphnode dissection. Postoperative complementary use of adjuvant external and systemic radiotherapy is the general practice. External irradiation decreases local/regional relapses in all cases. Radioiodine treatment decreases local/regional/ distant recurrences in cases of tumour cells capable of iodine uptake. Life-long thyroxine medication is required, with a TSH-suppressive dose for relapse prevention and hormone substitution. This treatment regimen, a careful follow-up, and adequate rescue therapy are the prerequisites of the generally excellent patient prognosis, i. e. a survival probability measurable in decades. In anaplastic carcinoma following extracapsular total thyroidectomy and lymph node dissection, external irradiation is always indicated. Chemotherapy has a benefical effect on survival. Hormone replacement therapy is necessary to substitute for the missing metabolic effect of the thyroid. This combined modality treatment leads to some improvement with regard to the prognosis of this poor-risk type of cancer. ]


  1. Fővárosi Onkoradiológiai Központ, Uzsoki utcai Kórház, Budapest



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Lege Artis Medicinae



["Programmed cell death" I read with great interest and attention Dr. Béla Szende's excellent communication on the biological and pathological significance of programmed cell death (apoptosis). Although the phenomenon of apoptosis (albeit under a different name) has been described for more than twenty years, its importance in the regulation of tissue homeostasis has only been recognized in the last few years. In 1991, for example, Jean Claude Ameisen and Andre Carpon of the Pasteur Institute in Lille put forward their hypothesis that apoptosis explains the qualitative and quantitative deficiency of helper T cells in HIV-infected patients.]

Lege Artis Medicinae

[Malnutrition syndrome in childhood part II.]

BAKSAI László, PHILIP W. H. Esker

[Malnutrition is a chronic nutritional disorder resulting from insufficient intake of caloric energy and/or some fundamental nutrients. Since it is the most common public health problem in the world it has a great impact on pediatric morbidity and mortality. The etiology is extremely complex. When one considers the less severe symptoms and signs caused by vitamin-, mineral-, and trace element deficiencies, it is apparent that not only children living in underprivileged countries are affected. In the course of making the diagnosis an assess ment of the nutritional status should also be made, especially considering the above-mentioned marginal nutritional deficiencies. The most common manifestation of nutritional disorders is anemia, which is mostly caused by lack of iron, vitamin B12, folic acid and can be complicated by infections. Nutritional requirements can be affected by several drugs. That is why this medication-nutrition interaction has to be kept in mind during treatment. The interaction of malnutrition and infection is very important, primarily for three reasons: mechanisms by which infection complicates the metabolic and nutritional status of the host; importance of suboptimal nutritional status on susceptibility and severity of intercurrent infections; clinical and therapeutic implication of these interactions. ]

Lege Artis Medicinae

[Operative Hysteroscopy]


[Many thousands of hysterectomies are perfor med each year in women suffering from menorrhagia resistant to medical treatment but having, no demonstrable uterine abnormality. Hysteroscopy, the up to date diagnostic and therapeutic method can help to get advance in the diagnosis and therapy in these situations. In addition to permitting more precise diagnoses to be made, hysteroscopy allows the endometrium to be treated selectively under direct vision. The full thickness of the endometrium may be ablated using laser or resectoscope. The benefits of selective endometrial destruction versus hysterectomy are enormous. Patients undergoing endometrial ablation are frequently delighted with the short hospital stay, and the cost of this procedure is lower than the cost of hysterectomy. Many Müllerian fusion defects are amenable to hysteroscopic treatment. Patients with certain types of Müllerian defects undergoing hysteroscopic septotomy will enjoy as high a rate of reproductive success as those receiving more traditional procedures while avoiding the risks, the subsequent caesar sections, and the high cost. ]

Lege Artis Medicinae

[Transvaginal ultrasonography of embryo development in prematurity, sono-embryology I. The embryo and its appendages]

CSABAY László, SZABÓ István, NÉMETH János, PAPP Zoltán

[The authors performed serial examinations by a high resolution transvaginal transducer during the first trimester of pregnancy to show the most important stages of the early embryonal development. This is a preliminary study to a prospective, detailed screening programme in the first trimester of pregnancy. The earliest sign of pregnancy can be detected at the 29–31st days of menstrual age using vaginal transducer. During the 5th week the (secondary) yolk sac can be seen, which is an unambiguous evidence of an intrauterine pregnancy. The living embryo can be de monstrated on 36–38th days with the help of the pulsation of the embryonic heart tube. Certain embryonic structures appear in a defined order (developmental „calendar"). The physiologic midgutherniation can be observed during 7–11th weeks. Transvaginal sonography has gained popularity only recently due to technical advances. The main fields of use became gynaecology and early pregnancy, for there is no need to have a full bladder, for the lack of disturbing tissue layers. This method is essentially a combination of the bimanual gynaecological and the ultrasound examination. ]

Lege Artis Medicinae

[Effects of drugs on permanent pacemakers]


[Several antiarrhythmics can alter pacing thresholds. Especially, the Class 1 C drugs may increase the threshold. Corticosteroids and sympathomimetic agents lower the threshold. Some drugs must be avoided in pacemaker dependent patients. The potential pacemaker-drug interaction must always be considered when prescribing a new drug. Significant clinical sensing problems have not been recognized with antiarrhythmic drugs. The sensor function of rate responsive pacemakers can be altered by concomitant drug therapy. ]

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Long-term follow-up results of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastoma multiforme patients. The importance of MRI information in survival: Single-center experience

LUKÁCS Gábor, TÓTH Zoltán, SIPOS Dávid, CSIMA Melinda, HADJIEV Janaki, BAJZIK Gábor, CSELIK Zsolt, SEMJÉN Dávid, REPA Imre, KOVÁCS Árpád

Introduction - Glioblastoma multiforme (GBM) is the most common malignant primary anomaly of central nervous system. The GBM infiltrates the nearly sturctures from the initial tumor and its metastatic attribution is well known. The aim of our single-centered retrospective study was to introduce the importance of postoperative medical imaging confirmation of total tumor resection for patient with GBM combined concomitant and adjuvant chemoradiotherapy on a 10 year long patient follow up. Methods - From January 2006 to April 2015 we registered 59 patients with newly diagnosed GBM at the University of Kaposvár Health Center Institute of Diagnostic Imaging and Radiation Oncology. The histological diagnosis was confirmed by a proficient neuropathologist (World Health Organisation WHO; grade IV astrocytoma). According to histological status if the ECOG performance status of patients allowed it the mutidisciplinary oncoteam recommended adjuvant chemoradiotherapy all features strictly by Stupp protocol. (60 Gy dose on the gross tumor volume and 2-3 cm margin for the clinical target volume with parallel 75 mg/m2 TMZ. Four weeks after monotherapial phase patients had to recieve 6 cycles of TMZ first cycle with 150 mg/m2 up to 200 mg/m2). The irradiation was carried out by a conformal three dimensional planning system. Results - 59 patients with the median age of 63 (range 17-84) year. Our sample counted 34 male patients and 25 woman patients. 14 patients underwent gross total tumor resection while, 39 patients underwent partial resection and the rest from our sample 6 patients passed through biopsy. Statistical analysis showed a lengthier survival among males than females, with a median survival of 13 months for males and females, the OS of 26.209 for males, meanwhile 15.625 for females. However, the difference is not considerable (log-rank p=0.203). Our study found that the estimated survival of patients at least 50 years old is significantly shorter at a median survival of 12 months (log rank p=0.027) than that of patients below 50 years of age at a median survival of 23 months. The longest estimated median survival was calculated with patients of ECOG '0' condition (16 months). However, no significant difference was found in the estimated survival of patients of different ECOG conditions (log-rank p=0.146). Based on the extent of surgery, complete resection resulted in the longest average survival of 36.4 months, followed by 21.5 months among patients with biopsy, and 15.8 months among patients with partial resection. Different surgical procedures, however, did not result in significant differences in survival (log-rank p=0.059). The overal survival of patients who had complete resection confirmed by MRI compared with the overal survival of patients with residual tumor confirmed by MRI as well we can estimate that there is significant difference between these two groups (p=0,004). Conclusion - Despite complex and intense treatment, recurrence is inevitable and causes relatively rapid death. In our analysis complete resection, as defined from the neurosurgeon’s report and postoperative MRI, resulted in an independently significant improvement in OS. Our results are the evidences that the treatment of patients with glioblastoma multiforme in Hungary is at least on the same level as any other developed European countries.

Clinical Neuroscience

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Lege Artis Medicinae

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[Prognostic significance of invasion in glioblastoma]


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