Lege Artis Medicinae

[Why are the screening facilities in Hungary unexploited?]

DÖBRŐSSY Lajos, KOVÁCS Attila, DÖBRŐSSY Bence, BUDAI András, BONCZ Imre, MARGITAI Barnabás, KOÓS Tamás

OCTOBER 20, 2010

Lege Artis Medicinae - 2010;20(10)

[In Hungary, as a component of the National Public Health Programme, the “supply side” of the organised mass screening for early detection of some cancers has been established which would be capable of carrying out - in time periods set by the state-of-the-art - the regular screening of the population eligible by age. Unfortunately, the stated objectives of the programme have not fulfiled because the “demand side”, that is the compliance of the target population with the offered screening has remained far below the expectations. As a consequence, both the effectiveness and economic viability of the programme are damaged. The paper is to single out the possible causes: crudeness of concept of “organised screening”, the limited accessibility of sevices, anomalies of hralth care system, and, above all, some psychological side-effects of screening process.]



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[Postmenopausal changes of immune system-related genes expression in human bone tissue]

BALLA Bernadett, KÓSA P. János, KISS János, PODANI János, TAKÁCS István, LAZÁRY Áron, BÁCSI Krisztián, NAGY Zoltán Zsolt, SPEER Gábor, LAKATOS Péter

[INTRODUCTION - The molecular and cellular interactions between the immune system and bone tissue have been established. Sex hormone deficiency at the time of menopause has multifunctional role by influencing growth, differentiation and metabolism of the skeletal and the immune system. We have used non-parametric and multidimensional expression pattern analyses to determine significantly changed mRNA profile of immune system-associated genes in postmenopausal (POST) and premenopausal (PRE) non-osteoporotic bone. MATERIALS AND METHODS - Ten bone tissue samples from POST patients and six bone tissue samples from PRE women were examined in our study. The transcription differences of selected 50 genes were analyzed in Taqman probe-based quantitative real-time RT-PCR system. RESULTS - Mann-Whitney test indicated significantly down-regulated transcription activity of 3 genes (CD14, HLA-A, ITGAM/CD11b) and upregulated gene expression of 6 genes (C3, CD86, IL-10, IL-6, TGFB3, TNFSF11/RANKL) in POST bone. According to the canonical variates analysis results, the groups of postmenopausal and premenopausal women are separable by genes coding for cytokines, co-stimulators and cell surface receptors affected in antigen presentation and T cell stimulation which have high discriminatory power. CONCLUSIONS - Based on a complex gene expression patterns in human bone cells, we could distinguish POST and PRE states from an immunological aspect. Our data might provide further insight into the changes of the intersystem crosstalk between immune and skeletal system, as well as local immune response in the altered microenvironment of POST bone.]

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[Pancreatic carcinoma mimicking primary retroperitoneal fibrosis]

RÉDEI Csaba, ESZES Noémi, HAJNAL Péter, MÁTÉ Miklós, SIMON Károly, TÓTH Julianna, POZSÁR József, TOPA Lajos

[INTRODUCTION - One of the defining feature of pancreatic ductal adenocarcinoma (PDA) is the presence of extensive desmoplasia. The volume of stroma production can be disproportionate relative to mass of the tumor. Primary retroperitoneal fibrosis (PRF) is characterized by progressive accumulation and spread of connective tissue in the retroperitoneal space often leading to entrapment of ureters and/or the distal part of the duodenum. The large amount of stroma can mimic the radiologic features of PRF. We present a case when the diagnosis of pancreatic ductal adenocarcinoma was delayed because of the tumor showed retroperitoneal spread and imaging studies were distinctive for PRF. CASE REPORT - The past medical history of the 77 year old patient was significant for chronic renal failure of postrenal origin diagnosed one year before. The abdominal CT-scan performed six month ago was unremarkable except for focal stricture and upstream dilation of both ureters. After a relatively uneventful course during the past six months, the patient presented with abdominal distension and vomiting of five days period. Abdominal CT-scan revealed an extensive infiltration of the retroperitoneal space by a tissue with radiologic features characteristic for PRF. The fibrotic tissue involved the prerenal fascia, both ureters, and the third part of the duodenum. Duodenoscopy disclosed complete duodenal obstruction caused by an external compression at the level of ligament of Treitz. At surgery, a hard, fibrous tissue extending form the hepatic hilum down to the pelvis have been seen. The infiltrating tissue also entrapped the distal duodenum leading to its obstruction. Histologic evaluation of specimens taken at surgery showed features of fibroplastic PDA. CONCLUSION - PDA may present as an extensive retroperitoneal fibrosing process without detectable intrapancreatic tumor on radiologic studies. Obsructive signs of any retroperitoneal organ (ie. ureters, duodenum) should raise the possibility of retroperitoneally expanding PDA.]

Lege Artis Medicinae

[Successful localization of an insulinoma with angiography]

BAKÓ Barnabás, LÁZÁR István, TARKÓ Erzsébet, OROSZ Péter

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Lege Artis Medicinae


NAGY László

[Controlled clinical studies on statins have produced evidence that the aggressive lowering of LDL-cholesterol (LDL-C) level reduces the mortality rate of ischaemic heart disease. About 40% of treated patients achieve the cholesterol target level. The observance of medication instructions on a daily basis (compliance) and willingness for long-term taking of the drug (persistence) are crucially important to avoid severe complications. In the long term, patients take only about 50% of their medicines according to the instructions. As a result of the generally poor compliance and persistence in taking the medications, the decrease in morbidity and mortality observed in clinical studies do not occur under real-life conditions. Patients with poor compliance (<80%) will experience only a minimal health benefit and the cost-effectiveness of the therapy will markedly decrease. For patients with poor persistence who discontinue their treatment before benefits at the clinical endpoints could manifest, the resources invested into the therapy will be lost. Both compliance and persistence deteriorate as the number of concurrently taken medicines increases. Since less than 50% of the programmes aimed at improving patient co-operation are successful, therapeutic decisions should preferably be made by taking into consideration the expected compliance/persistence already at the time of choosing the medication. By widening the use of fixed-dose combination therapies, the efficiency of treatment can substantially be increased in patients who concurrently take several medicines and require aggressive lowering of blood pressure or LDL-C level.]


[The concept of adherence and its significance in osteoporosis]


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[INTRODUCTION - In the past 15 years new antipsychotic drugs have come forward with higher efficacy in the treatment of schizophrenia. These new medications are safer and have less side-effects. It is now established that longacting maintenance therapy is favourable than intermittent therapy CASE PRESENTATION - The author introduces the case of a male schizophrenic patient who was hospitalized three times over ten years. He discontinued maintenance therapy because of lack of symptoms first time, then because of severe side-effects and then he stopped seeing his psychiatrist. However after a new acute episode his treatment was changed to longacting injectable risperidone with a success. With maintenance therapy the patient is now symptom-free and went back to work. CONCLUSION - Continuous long-acting injectable therapy proved to be successful in the prevention of symptom recurrence and with its application patient compliance has improved and smaller doses have become sufficient to maintain stedy-state.]