Search results

Clinical Oncology

FEBRUARY 28, 2020

[Non-surgical treatment of ovarian cancer]

PIKÓ Béla, LACZÓ Ibolya,, MARIK László

[The primary surgery with an optimal cytoreduction is an essential step during the treatment of the epithelial ovarian cancer because it determines the effectiveness of other therapeutic options as well. Immediately after the surgery a cytostatic infusion typically 40-42.5 degrees Celsius is pumped directly to the abdomen. During the systemic therapy the main point is the 6 months progression free survival because beyond this time the disease could be considered as platinum sensitive, inside this time as platinum refracter or resistant disease. The cytostatic treatment improved during the years from the alkylating agents through the platinum derivates to the administration of paclitaxel with several combinations of them and with more and more signifi cant results and less side effects. The most signifi cant targeted agents are the angiogenesis inhibitors (mainly the bevacizumab) and the PARP-inhibitors which prevents DNA repairs. In order to a PARP-inhibitor could be administered a platinum sensitivity is required while BRCA mutation not. Recently there are promising clinical researches with immunotherapy as well. The main benefi t of the hormonal therapy is the tolerability. Besides the signifi cant improvement in the systemic agents the role of radiotherapy is more and more decreasing, however the treatment of the whole peritoneal surface – mainly with the modern radiation techniques – could be an alternative solution for the chemotherapy. The palliative irradiation which relieve the symptoms could extend the drug-free period and the combination of radiation and chemotherapy could provide further possibilities.]

Clinical Neuroscience

SEPTEMBER 30, 2020

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Lege Artis Medicinae

JULY 01, 2020

[Persisting Hashimoto’s thyroiditis converting to Graves’ disease]

TÓTH Géza

[Graves’disease and Hashimoto’s thyroiditis are the two most important types of autoimmune thyroid dis­eases. Autoimmune hyperthyroidism commonly leads later on to hypothyroidism. The conversion from persisting Hashimoto-thyroiditis to hyperthyroidism is rare in the literature. The author presents the cases of two patients, whose Hashimoto’s thyroiditis treated with thyroxin for years, changed into Graves’ hyperthyroidism sponta­neously. CASE REPORT – The patients had been diagnosed with autoimmune hypothyroidism since several years. The clinical symp­­toms, the low peripheral hormone le­vels, the high level of antithyroid antibo­dies and the ultrasound imaging confirmed the hypertrophic form of Hashimoto’s thy­roiditis. After several years of high dose le­vothyroxin treatment, clinical symptoms of hyperthyroidism have appeared. After omit­ting the substitution, the thyroid hormone levelled off at high values and the level of anti-TSH receptor antibodies raised too. The diffuse, obviously increased blood flow of the thyroid glands, and in one of the patients the thyroid scan, confirmed the Graves’ disease. During the thyreostatic treatment, the symptoms of the patients disappeared, they became euthyreoid and the antibody levels decreased as well. The Graves’ disease and the Hashimoto’s thyroiditis have many common features. These immunological, ge­netic and other common features enable the mutual transition of these two diseases.]

Clinical Oncology

FEBRUARY 20, 2019

[Molecular subtypes and the evolution of treatment decisions in metastatic colorectal cancer]

RODRIGO Dienstmann, RAMON Salazar, JOSEP Tabernero

[Colorectal cancer (CRC) has clinically-relevant molecular heterogeneity at multiple levels: genomics, epigenomics, transcriptomics and microenvironment features. Genomic events acquired during carcinogenesis remain drivers of cancer progression in the metastatic setting. For example, KRAS and NRAS mutations defi ne a population refractory to EGFR monoclonal antibodies, BRAFV600E mutations associate with poor outcome under standard therapies and response to targeted inhibitors in combinations, while HER2 amplifi cations confer unique sensitivity to double HER2 blockade. Multiple rare gene alterations driving resistance to EGFR monoclonal antibodies have been described with signifi cant overlap in primary and acquired mechanisms, in line with a clonal selection process. In this context, sequential analysis of circulating tumor DNA has the potential to guide drug development in a treatment refractory setting. Rare kinase fusion events and complex alterations in genes involved in DNA damage repair have been described, with emerging evidence for targetability. On the other hand, transcriptomic subtypes and pathway activation signatures have also shown prognostic and potential predictive value in metastatic CRC. These markers refl ect stromal and immune microenvironment interactions with cancer cells. For example, the microsatellite instable (MSI) or POLE ultramutant CRC population is particularly sensitive to immune checkpoint inhibitors, while tumors with a mesenchymal phenotype are characterized by activation of immunosuppressive molecules that mandate stratifi ed development of novel immunotherapy combinations. In this manuscript we review the expanding landscape of targetable oncogenic alterations and signatures in metastatic CRC and discuss the clinical implementation of novel molecular diagnostic tests.]

Lege Artis Medicinae

NOVEMBER 15, 2019

[The association between advanced age and peripheral arterial disease]

KOLOSSVÁRY Endre, FARKAS Katalin

[The high-income countries are characterized by the aging of the residents (epidemiological transition) and the change of the disease patterns that are recognized in the population (epidemiological transition). In that sense, considering the cardiovascular diseases in the last few decades, a decline of mortality of acute, fatal conditions (stroke, myocardial infarction) is notable. All these factors contributed to the recognition of the importance of peripheral arterial disease and related problems in the aging popula­tion of the affected people. The high prevalence, the decline of quality of life associated with compromised lower limb circula­tion, the risk of the limb loss, the challenge of rehabilitation and the high mortality represent a significant and increasing burden to the healthcare. The review aims to analyse the relation of the aging population and peripheral arterial disease, addressing the aspects of epidemiology, diagnostics, and therapy. ]

Clinical Neuroscience

SEPTEMBER 30, 2019

Role of positioning between trunk and pelvis in locomotor function of ambulant children with and without cerebral palsy

SANZ-MENGIBAR Manuel Jose, SANTONJA-MEDINA Fernando

Purpose - To understand if children with and without cerebral palsy share the same lumbar postural control threshold on the sagittal plane for the transition between each walking locomotor stage. Method - Observational analysis of sagittal trunk-pelvis kinematics of 97 children with cerebral palsy and 73 with typical development, according to their locomotor stage. Results - Among children with typical development, all average and minimum measurements of the sagittal lumbar curve during the gait events were correlated with age and the locomotor stages of development. Among children with cerebral palsy, there were significant correlations between all average and minimum values of the sagittal lumbar curve and locomotor stages of development but not age. Conclusions - We conclude that, for the same locomotor level, there are no common postural patterns between children with typical development and those with spastic bilateral cerebral palsy for the position between trunk and pelvis in the sagittal plane. Maximal lordosis reduction between trunk and pelvis may change with age or even training, but does not make a positive effect on the locomotor level, while basal and maintenance capacities could explain locomotor function. Trials that failed to assess quality of movement may now have a better understanding of how different interventions improve posture towards the next functional level.

Lege Artis Medicinae

SEPTEMBER 10, 2019

[Anti-allergic agents and ICAM-1-antibodies for the control of upper respiratory infections]

SZABADKA Hajnalka

[Rhinoviruses are responsible for more than 50 percent of upper respiratory infections. It is well-established that the „Intercellular Adhesion Molecule 1” (ICAM-1) plays a crucial role in the adhesion of rhinoviruses and the relevant secondary bacterial pathogen Haemophilus influenzae to the epithelial cells of the respiratory tract. Both rhinoviruses and H. influenzae enhance the expression of ICAM-1 promoting their own attachment and mutually promoting that of the associated pathogen. It was experimentally shown that anti-ICAM-1 antibodies will inhibit infection by both rhinoviruses and H. influenzae. Since some anti-allergic agents - desloratadine and levocetirizine - also inhibit the expression of ICAM-1, their use may be beneficial in controlling some respiratory infections ]

Lege Artis Medicinae

OCTOBER 20, 2018

[On nursing in a different way - What are we talking about? ]

SÖVÉNYI Ferencné, PERKÓ Magdolna, FEDINECZNÉ Vittay Katalin

[Using an uncustomary approach to nursing history, authors review the intensive development process in the 1990s that resulted in the transition of nursing from an occupation to profession in Hungary. An occupa­tion attains professional status if its practitio­ners have access to education and training of a considerable duration, it has independent professional organisation, an ethical code of its own and is regulated by law. The article addresses these factors discussing at length the history and development of nurs­ing education and training in Hungary, subsequently it describes the process arching from practical nursing to the appearance of nursing science, an intrinsic part of which was the birth of a scientific nursing journal “Nővér”. The relevant and effective legislation on nursing and nursing practice is re­viewed comprehensively and the efforts to establish professional nursing organisations are described. It is maintained that framework conditions had to be established as a necessary precondition for nursing to professionalise itself on its own and become a vocation highly regarded by society. ]

Clinical Oncology

FEBRUARY 10, 2018

[EMT (Epithelial-Mesenchymal transition) – CSC (Cancer Stem Cells)]

KOPPER László

[The effi cacy of the antitumor therapy is usually limited due to the resistance against the chemotherapy. One of the most important reason of the secunder resistance is the intratumoral heterogeneity, which is the consequence of the variety tumor phenotypes in the same tumor. Such clonal heterogeneity develops during the tumor growth or tumor therapy. The cancer stem cells (CSC), according to the concept, can determine the progression of the tumor, including metastatization, which probably the major enemy for clinical oncology. This activity of CSC, in tumors with epithelial origin, is supported by a change from epithelial to mesenchymal phenotype (epithelial-mesenchymal transition); but not entirely. The CSC phenotype is very similar to characteristic of the normal stem cells, as resistance, self-renewal etc. The mechanisms of these concepts is known only partially, but the technical advances contribute to the identifi cation of key genetic and epigenetic regulatory pathways. If such improvement becomes real, we can be much ahead both with markers and therapeutic targets.]

Clinical Oncology

SEPTEMBER 10, 2017

[Treatment of the relapsed epithelial ovarian cancer ]

BOÉR Katalin

[Ovarian cancer remains the most lethal gynaecological cancer and most patients present with advanced FIGO stage disease. Despite optimal upfront surgery and the administration of front-line paclitaxel-carboplatin chemotherapy, approximately two-third of ovarian cancer patients will relapse in the fi rst 3 years. In the last years, the goal in the treatment of ovarian cancer has shifted to maintenance therapy, trying to extend the progression free intervals of the patients. Remarkable advances in the knowledge of molecular biology of relapses led to the introduction the combination of antiangiogenic agent bevacizumab and chemotherapy, which showed to be effective in all phases of the disease, in fi rst-line therapy, as maintenance therapy, and in platinum-sensitive and platinum-resistant recurrence as well. Very recently, a new maintenance therapy, olaparib monotherapy has been introduced into clinical practice to treat platinum-sensitive, relapsed, high-grade serous ovarian cancer. Despite progresses in this therapy, are still some areas of controversy on how to manage epithelial ovarian cancer relapses. The aim of this manuscript is to give an overview on the management of relapsed ovarian cancer in the context of new available therapeutic modalities.]