Acta medica Hungarica最新文献

The author gives a survey of literature on bone tumours in childhood and a comparison with his own work. Introducing four cases he concluded, that the survival rate of malignant bone tumours are increasing, the autologous bone transplantation seems to take priority against prosthesis in childhood, and the autologous bone transplantation is more reliable method, than the homologous one.

New immunoactive therapies, plasmapheresis, intravenous steroid pulse infusion and intravenous immunoglobulins were examined for efficacy on the basis of large casuistics of myasthenia gravis. The best results were achieved with combination of these procedures. Indications of the new methods: (i) respiratory crisis of any character (myasthenic, cholinergic or mixed oscillating crisis); (ii) the patients' preparation for thymectomy; (iii) post-thymectomy therapy aimed at improving the patients condition, at avoiding relapses, at shortening the time of steroid therapy and at repressing cholinergic drug therapy; (iv) patients of old age in crisis-prone state. The new methods, together with thymectomy, steroid therapy and immunosuppression, represent a very efficient and promising new way toward modern therapy of myasthenia gravis.

The present study was performed in order to evaluate the frequency and clinical features of polyphasic and protracted forms of HA infection. Out of 297 adult HA patients admitted to our hospital, 12.5% and 8.4% were polyphasic and protracted, respectively, in clinical course. 21.6% of the polyphasic patients had more than one relapses. The rates of symptomatic relapse during the follow-up of the polyphasic and protracted HA infections were 51% and 56%, respectively, One % of all HA patients presented a cholestatic pattern. Three % of all the patients had to be readmitted for hospital treatment. The outcome of disease was benign in all HA patients, though, complete recovery sometimes needed six months.

The author reports on the progress made in the treatment of bone tumours in the last two decades. There is a short description of new entities like the solid form of aneurysmal bone cyst; dedifferentiated and clear-cell chrondrosarcoma; low malignant central osteosarcoma; periosteal and high-grade surface osteosarcoma, which have recently been reported in the literature. The response to the chemotherapy in osteosarcoma and the problems of limb-saving surgery in bone tumours are discussed.

Experience with more than 500 tumour cases operated in one year in the National Institute of Neurosurgery and the relevant oncological literature point to an important role of neurosurgery in the treatment of cerebral tumours. After reviewing the dramatic advances of neuroimaging and neurosurgical methods the main problems of neuro-oncology will be brought to light and the new directions of brain tumour research will be shown.

One hundred male insulin-dependent diabetic patients, aged 16 to 85 (mean 51.9) years, with albumin excretion ranging from normal to gross excess were examined for glomerular and tubular functional alterations by estimating urinary levels of albumin and indicator proteins of tubular damage. Urine protein 1 (UP1), a newly-discovered low-molecular weight alpha-2 glycomicroglobulin, together with alpha 1-microglobulin was used to assess tubular function. 19% of the patients showed increased albumin excretion with normal levels of tubular proteins (glomerular proteinuria), 11% excreted only tubular proteins in excess (tubular proteinuria), while 40% had a mixed pattern of both increased albumin and tubular proteins (glomerulotubular or mixed proteinuria). 30% had normal albumin and tubular protein excretion in urine. UP1 was found to be a more sensitive indicator of tubular abnormality than alpha 1-microglobulin. It is concluded that, although glomerular changes may be responsible for the proteinuria seen in most diabetics (mixed proteinuria), in a small but significant proportion of diabetics, tubular functional alteration may occur before, or in the absence of, glomerular dysfunction, and may warn of subclinical tubular abnormality. This finding may have a direct bearing on the development and course of progression of diabetic nephropathy, and may question the reliability of the present prognostic interpretation of microalbuminuria.

One hundred ninety patients with germ cell line testicular tumours were treated according to the modified Einhorn scheme. The response rate was 67.9%. The most favourable results were found in the embryonal histologic type (RR = 76.9%) in the biological markers (beta-HCG and AFP) negative (RR = 97.4%) and in the minimal pulmonary extent group (RR = 94.1%). The authors treated 112 patients with including these VPB-resistant germ cell testicular tumour and those with recurrence after this treatment. The patients' mean age was 28.8 (limits 19 to 44) years. Patients were given Vepeside (100 mg/m in infusion for days 1-5), Adriablastin (40 mg/m in infusion on day 1) and Cisplatin (20 mg/m in infusion) for day 1-5. The treatment resulted in CR with 18 patients (16.1%) and PR with 42 (37.5%) (RR = 53.6%). The best results were obtained with the seminoma patients who were marker-negative and had small-volume metastasis. CR developed in 4 of 7 seminoma patients (57%) and in 7 of 25 marker-negative individuals (28%), and PR developed in 11 patients (44%) (RR = 72%). Out of 12 patients with small volume metastatis four (33%) showed CR and five revealed PR (41.7%), their RR turned out to be 74.6%. The average remission period was 37 (range 4-70) months in CR but merely 6.1 (range 2-38) months in PR. It can be stated that fairly good results can be achieved with second-line VpAP treatment in case of resistance developed to primary VPB therapy or subsequent relapse. The efficacy of combined chemotherapy of Vepesed+Holoxan +/- Adriablastin as third-choice was studied in advanced testicular cancer patients refractory to, or recurrent after, first- and second-line cytostatic therapy. Between September 1981 and January 1988 49 evaluable patients were treated with Vepesid (VP-16213--100 mg/m2 days 1-5), Holoxan (40 ml/kg days 1-5), hydration, urine-alkylation + Uromitexan +/- Adriablastin (40 mg/m day 1). The single dose of Uromitexan was 20% of the daily dose of Holoxan, and the patients received it i.v. just prior to Holoxan administration (h 0), the 4 and 8 h later. Two patients got into CR and 10 to PR. The rate of remission was 24.5%. The most severe side effect was leukopenia. The elevation of BUN and se. creatinine was transient and mild. In those cases where Holoxan was not included in the first- or second-line regimens, when combined with Vepesid and Adriablastin as third-choice therapy one could achieve further improvement. In case of CR the prolongation of life is also noteworthy. The first-, second- and third-line therapy plus salvage RLA and/or pulmonary metastasectomy achieved long-term survival only in one quarter of the patients.

Intravenous administration of magnesium has proved to have beneficial effect in acute myocardial infarction. Magnesium seems to act at different levels of the cardiovascular system. Of the greatest importance is the direct influence of Mg2+ on the cardiomyocyte which includes: reduction of cytoplasmatic calcium overload, protection of mitochondria against calcium influx, and diminution of cellular potassium, magnesium and ATP depletion. By means of these effects, or by its direct action on myocardium, Mg2+ inhibits the origin of postinfarctional dysrhythmias. Furthermore, magnesium reduces afterload by decrease in vascular resistance, and improves coronary flow. The mechanism underlying the protective effect of magnesium remains complex and poorly understood. Nevertheless, Mg2+ therapy is effective, undemanding, and easy to procure. Expectably, intravenous administration of Mg2+ may become a routine part of myocardial protection in acute myocardial infarction.

Operative treatment of gynaecological tumours includes exploration, staging and removal of tumour for both therapeutic and diagnostic purposes for advanced processes the optimum conditions of postoperative supplementary treatment are to be developed. In contrast with the earlier view suggesting that a malignant tumour of a given organ is always the same in every case, nowadays tumour heterogeneity is emphasized. Multicentrical co-operative surgical research should widen our knowledge. Well-designed and well-equipped centres should be made available for our patients suffering from gynaecological malignancies; gynaecological oncology needs well-planned functioning special clinics/wards.