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Lege Artis Medicinae

DECEMBER 15, 2017

[Long survival with multimodal therapy]

MÉSZÁROS Edina, LANDHERR László

[Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death in women worldwide. Approxi­mately two-thirds of cases are potencially sensitive to endocrine therapy. Fulvestrant is a selective estrogen receptor downregulator indicated for the treatment of postmenopausal women with estrogen receptor positive, locally advanced or metastatic breast cancer for disease relapse on or after adjuvant antiestrogen therapy, or disease progression on therapy with antiestrogen. We are reporting here a nearly ten-years-long sucessful combination of multiple treatment lines of anti-estrogen treatment, chemotherapy and radiotherapy in a case of a patient with hormone receptor positive, HER2 negative breast cancer with pulmonary metastases.]

Hypertension and nephrology

DECEMBER 10, 2017

[Place of rilmenidine therapy in reducing of sympathetic overactivity]

FINTA Ervin, KUN Edit, SIMONYI Gábor

[The sympathetic nervous system plays an important and widely investigated role in the pathogenesis of the hypertension and its concomitant diseases. Between the several types of antihypertensive drugs which can influence the sympathetic over activity, centrally acting agents, play an important role. Here some special aspects of the imidazoline I1 receptor agonist rilmenidine are reviewed.]

Lege Artis Medicinae

SEPTEMBER 20, 2017

[Effective fulvestrant treatment of indolent breast cancer in a patient with low compliance - a case report]

HÓDI Veronika

[In the explosive development of treatment of oncological patients, there are still patients who are not always cooperative even in their own treatment. The case report exemplifies that even in this case the endocrine treatment has its place in the hormone receptor positive breast cancer. ]

Hypertension and nephrology

OCTOBER 20, 2017

[Therapy of isolated systolic hypertension III.]

FARSANG Csaba

[In the elderly and very elderly (˃80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence/persistence to therapy. Using diuretics, ACE-inhibitors/ARBs with calcium antagonists, and in special cases diuretics and beta blockers are also suggested by recent European guidelines (ESH, HSH). The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages/disadvantages, so the optimal SBP may be around 130 mmHg.]

Hypertension and nephrology

OCTOBER 20, 2017

[ACEi or ARB? What are the results of the comparative analysis?]

BENCZÚR Béla

[Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are treatment options for patients with cardiovascular disease (CVD) or those with cardiovascular risk factors. The comparative efficacy and safety of ACEis and ARBs have been much debated. To compare the benefits of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in patients without heart failure a metaanalysis was carried out based on 254.301 subjects of 106 randomised trials. Meta-analysis included randomized trials of ACEis and ARBs compared with placebo or active controls and corroborated with head-to-head trials of ARBs vs ACEis. According to placebo controlled studies ACEis but not ARBs reduced all-cause mortality, cardiovascular mortality and MI. It seems that ACEis are more effective than ARBs. But this is only true if we take into account the trials before 2000. The analysis restricted to trials published after 2000 revealed similar outcomes with ACEis vs placebo and ARBs vs placebo. Head-to-head comparison trials of ARBs vs ACEis exhibited no difference in outcomes. The underlying causes and details are explained in this review.]

Lege Artis Medicinae

JULY 20, 2017

[Fulvestrant: long-term survival and quality of life in a patient with hormone receptor-positive advanced breast cancer]

PINTÉR Tamás

[INTRODUCTION - There are lot of evidence showing the efficacy of fulvestrant therapy in HER-2 negative, HR-positive advanced metastatic breast cancer. CASE REPORT - A 75-year-old female had a mastectomy, followed by series of adjuvant and radiotherapy about 30 years ago. Later cutan metastases were removed several times. The endocrine therapy had to be stopped because of intolerance. An ER, PR positive, HER-2 negative cutan metastasis was resected 7 years ago for the last time. During regular checkup, 5 years ago pulmonary nodule and bone metastases were found, - PET-CT disclosed multiple metastatic lymph nodes as well. We started fulvestrant and bisphosphonate therapy. Thereafter, as imaging revealed, the malignant disease has stabilized, the patient has a good performance status, her musculo-skeletal pain has a presumably degenerative origin. DISCUSSION - Reported case corroborates the potential efficacy of fulvestrant and ibandronate in hormone sensitive breast cancer with good prognostic markers, even in the case of metastases in soft tissue and bone. This case supports the data, that in patients with not progressive bone metastases the frequency of administration of parenteral bisphosphonates may be reduced to every 3 months. Advanced metastatic breast cancer may be converted to a chronic disease in properly selected cases, and it could mean long-term survival with a good quality of life.]

Clinical Neuroscience

JULY 30, 2017

[Calcium ion is a common denominator in the pathophysiological processes of amyotrophic lateral sclerosis]

PATAI Roland, NÓGRÁDI Bernát, MESZLÉNYI Valéria, OBÁL Izabella, ENGELHARDT József István, SIKLÓS László

[Amyotrophic lateral sclerosis (ALS), the most frequent motor neuron disease is characterized by progressive muscle weakness caused by the degeneration of the motor neurons in the spinal cord and motor cortex. However, according to the recent observations, ALS is a rather complex syndrome which frequently involves symptoms of cognitive impairment. Therefore, ALS cases can be interpreted in a clinico-pathological spectrum spanning from the classical ALS involving only the motor system to the fronto-temporal dementia. The progression of the disease, however, manifested in the degeneration of the upper and lower motor neurons, is based on the same complex pathobiology. The main elements of the pathomechanism, such as oxidative stress, excitotoxicity, immune/inflammatory processes and mitochondrial dysfunction are well described already, which operate in orchestrated way and amplify the deleterious effect of each other. It is assumed that calcium ions act as a catalyst in this interaction, hence each of the individual mechanisms has strong, positive and reciprocal calcium dependence thus may combine the individual pathological processes into a unified escalating mechanism of neuronal destruction. This review provides an overview of the role of calcium in connecting and amplifying the major mechanisms which lead to degeneration of the motor neurons in ALS. ]

JUNE 20, 2017

Antihypertenive effect of rilmenidine. Evaluation of the Hungarian multicenter VERITAS study

FARSANG Csaba

The VERITAS study showed that in hypertensive patients the imidazoline I1 receptor agonist, rilmenidine significantly decreased the office blood pressure as well as the blood pressure measured by ambulatory blood pressure monitoring (ABPM). The white-coat reaction and left ventricular hyperthrophy (LVH) were also decreased. Ain a separate study involving hypertensive subjects rilmenidine significantly increased baroreflex sensitivity. This effect may contribute - mainly during daytime - to the antihypertensive effect.

Lege Artis Medicinae

MAY 20, 2017

[Fulvestrant treatment of breast cancer in a patient with severe comorbidities - a case report]

BÁNHEGYI Róbert János, NAGY Ágnes Krisztina, LIPPAI Zsuzsanna, FÜLÖP Ferenc, RAJTÁR Mária, PIKÓ Béla

[Today, despite the increasing number of targeted and immunotherapeutic agents in oncology, the endocrine therapy is still an effective and manageable modality with acceptable safety profile in the treatment of hormone receptor positive breast cancer, especially in patients with multiple severe comorbidities. We present a case of successful treatment with fulvestrant of a woman with breast cancer and non-Hodgkin lymphoma, diabetes and heart failure, that emphasizes the need of personalized treatment. ]

Hypertension and nephrology

MAY 20, 2017

[Isolated systolic hypertension in children and young adults I.]

FARSANG Csaba

[Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg, is defined as isolated systolic hypertension. Its prevalence increases with age up to >90% in patients aged >90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a license for use in children: angiotensin converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta-blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (>80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence / persistence to therapy. Using diuretics, ACE-inhibitors / ARBs with calcium antagonists, and when needed diuretics and beta-blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages / disadvantages, so the optimal SBP may be around 130 mmHg.]