Search results

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.

Hypertension and nephrology

OCTOBER 23, 2019

[GLP-1 receptor agonists in the treatment of type 2 diabetes]

WINKLER Gábor

[The glucagon-like peptide (GLP)-1 receptor agonists and somewhat later, the sodium-glucose cotransporter (SGLT) -2 inhibitors have brought new perspectives in the antihyperglycemic treatment of type 2 diabetes. The article overviews clinicopharmacologic characteristics of the GLP-1 receptor agonist group, their glycemic and non-glycemic effects, results of the cardiovascular endpoint studies as well as their place in the recent therapeutic guidelines. It is proven, that both glycemic and weight reducing effect is greater of the long-acting (non-prandial) coumpounds as compared to that of the short acting (prandial) derivates, further, that in studies with cardiovascular endpoints they reduced the relative risk of the composite endpoint of non-fatal myocardial infarct, non-fatal stroke and cardiovascular death. Due to the favolurable glycemic and non-glycemic properties their use is advised already in the early course of type 2 diabetes, as combination of the metformin therapy.]

Hypertension and nephrology

APRIL 08, 2017

Lege Artis Medicinae

SEPTEMBER 22, 2013

[Lixisenatide: a new GLP-1-receptor agonist with mainly prandial effect for the treatment of patients with type 2 diabetes]

JERMENDY György

[Recently, lixisenatide, a new incretin mimetic GLP-1-receptor agonist with a mainly prandial effect has been registered for the treatment of patients with type 2 diabetes mellitus. The amino acid sequence of lixisenatide and that of human native GLP-1 is 50% identical. Due to its altered amino acid sequence and conformation, lixisenatide is resistant to inactivation by DPP-4. Lixisenatide is a specific agonist of GLP-1- receptors and its binding has a pharmacologic GLP-1-agonist effect. Lixisenatide is used subcutaneously, its normal daily dose is 1×20 μg. It is mostly used in combination with metformin, but it can be also used to supplement sulfanylurea or basal insulin therapy. Clinical efficiency of lixisenatide has been investigated in the phase-III GetGoal trials. In these trials, adequate glycaemic control and a marked decrease in postprandial blood glucose values were observed. During lixisenatide therapy, a decrease in body weight and no substantial increase in the risk of hypoglycaemia were observed, whereas transient gastrointestinal side effects might occur after initiation of treatment. Lixisenatide as an add-on treatment to basal insulin should be considered as a new treatment approach in the management of type 2 diabetes.]

Lege Artis Medicinae

FEBRUARY 22, 2013

[A remarkably successful therapy with gliclazid treatment in type 2 diabetes mellitus]

KIS János Tibor

[INTRODUCTION - Sulfonylureas have become sidelined as second-line preparations as their use has been associated with an increased occurrence of weight gain and hypoglykaemia. In the case reported, however, therapeutic goals have been achieved with the use of gliclazid. CASE REPORT - A 45-year-old man with type 2 diabetes mellitus was using a metformin XR preparation. His HbA1c level was high and his main complaint was distention. His abdominal complaint was also obstructing his diet. Because of the high HbA1c level and overweight I initiated incretin-mimetic treatment. Due to the worsening of abdominal complaints I replaced the treatment with gliclazid, after thoroughly informing the patient. With gliclazid treatment the patient's abdominal complaints subdued, he was able to maintain his diet, lost 14 kg in three months and the parameters of his carbohydrate metabolism normalised. CONCLUSION - In case of abdominal complaints, a repeated anamnesis of the diet can reveal metformin intolerance. In such cases, the use of gliclazid can lead to therapeutic success with no gastrointestinal adverse effects.]

Lege Artis Medicinae

NOVEMBER 22, 2012

[The role of the DPP-4 inhibitor sitagliptin in the therapy of type 2 diabetes, in light of the new guidelines]

HIDVÉGI Tibor

[Type 2 diabetes has become a global public health problem, threatening the economies of all nations, as a consequence of rapid urbanisation, changing eating habits, sedentary lifestyle and obesity. Asian populations tend to develop diabetes at younger ages and lower body mass index compared with Caucasians. The latest guidelines of the American Diabetes Association and the European Association for the Study of Diabetes recommend lifestyle interventions as the first step for patients with newly diagnosed type 2 diabetes. The widely used metformin remains one of the first-line drugs for type 2 diabetes. If monotherapy alone does not achieve or maintain the target HbA1c level, addition of a second oral agent is recommended as a second step. The highly selective dipetidyl peptidase-4 inhibitor sitagliptin and metformin are efficient and well tolerable. The complementary effects of sitagliptin and metformin lead to an efficient, safe and long-term improvement in glycaemic control.]

LAM Extra for General Practicioners

JUNE 20, 2012

[INSULIN SELF-TITRATION IN TYPE 2 DIABETES MELLITUS: BURDEN OR SOLUTION?]

TAKÁCS Róbert

[INTRODUCTION - Observational studies have verified that even in routine diabetes care, up to 1.3% reduction in HbA1c can be achieved with the initiation of a long-acting basal insulin analogue. We can get the same results in our patients using an insulin titration algorithm and close diabetological control. CASE REPORT - Metformin therapy of a 68-year old, moderately obese woman with type 2 diabetes was complemented by a long-acting basal insulin analogue (insulin glargine). Before initiation of insulin therapy, the patient received thorough dietetic and diabetic education by a qualified dietician and a diabetes nurse. The starting dose of insulin was 10 U, and then the patient was asked to increase the dose by 2 U every 3rd day depending on the mean of self-monitored fasting plasma glucose values in the previous 2 days. With the aid of a titration algorithm, optimal carbohydrate metabolism has been verified by laboratory parameters assessed 3 months later. CONCLUSION - Insulin self-titration based on appropriate patient education and close professional control makes a relatively simple therapeutic system the optimal decision in terms of a rapid and chronic normalisation of glucose control in a large patient group.]

Lege Artis Medicinae

APRIL 20, 2012

[Insulin self-titration in type 2 diabetes mellitus: burden or solution?]

TAKÁCS Róbert

[INTRODUCTION - Observational studies have verified that even in routine diabetes care, up to 1.3% reduction in HbA1c can be achieved with the initiation of a long-acting basal insulin analogue. We can get the same results in our patients using an insulin titration algorithm and close diabetological control. CASE REPORT - Metformin therapy of a 68-year old, moderately obese woman with type 2 diabetes was complemented by a long-acting basal insulin analogue (insulin glargine). Before initiation of insulin therapy, the patient received thorough dietetic and diabetic education by a qualified dietician and a diabetes nurse. The starting dose of insulin was 10 U, and then the patient was asked to increase the dose by 2 U every 3rd day depending on the mean of self-monitored fasting plasma glucose values in the previous 2 days. With the aid of a titration algorithm, optimal carbohydrate metabolism has been verified by laboratory parameters assessed 3 months later. CONCLUSION - Insulin self-titration based on appropriate patient education and close professional control makes a relatively simple therapeutic system the optimal decision in terms of a rapid and chronic normalisation of glucose control in a large patient group.]

LAM Extra for General Practicioners

DECEMBER 15, 2011

[METFORMIN - BUT WHAT ELSE IS IN THE BOX?]

KISS Zsófia, KIS János Tibor

[Metformin is currentlly the most commonly prescribed oral antidiabetic drug for the treatment of patients with type 2 diabetes mellitus. Its administration is limited by the contraindications and the possible gastrointestinal side effects. In Hungary, metformin is currently available in numerous forms, among which the extended-release tablets are distinguished because of their tolerability. The authors summarise the most recent data about the favourable features of metformin, help clinicians to choose the appropriate preparation of metformin, and highlight the administration procedures that help to avoid gastrointestinal side effects.]

Lege Artis Medicinae

NOVEMBER 20, 2011

[The role of metformin in the glucose-lowering therapy of patients with type 2 diabetes]

JERMENDY György

[Metformin is the oral antidiabetic drug of choice for patients with type 2 diabetes. Its effect is predominantly based on the reduction of insulin resistance by inhibiting hepatic glucose production. Metformin can be used as an initial oral antidiabetic drug at the start of, or in case of the failure of lifestyle modifications. Metformin is also used in dual or triple oral antidiabetic combinations, however, its use should not be suspended even if initiation of insulin therapy is indicated in patients with type 2 diabetes. Metformin does not increase bodyweight and the risk of hypoglycaemia, and recent data suggest that it decreases the risk of tumour development. Today, an extended- release (XR) formulation is also available besides the traditional one, which not only simplifies the treatment, but might also reduce the incidence of gastrointestinal adverse effects.]