Acta medica Hungarica最新文献

The authors studied the distribution of the paracetamol conjugation in a Hungarian population (53 adult Caucasian persons). The data indicated that the excretion of paracetamol glucuronide and sulphate were not normally distributed. Bimodality were apparent in both conjugation pathways: 15.1% of subjects was relatively extensive glucuronidators, and the 24.5% of subjects was extensive sulphatators. Monitoring the ratios of various urinary paracetamol conjugates/paracetamol may be useful as a tool for determining the glucuronide and sulphate conjugation capacity in humans.

The treatment of clinically overt metastatic breast cancer, despite several treatment modalities (biological response modifiers, megatherapy with autologous bone marrow transplantation, growth factors, new agents, etc.) is in a static phase. In the decision-making one has to consider the patient's age, her menstrual state, the metastatic site, previous adjuvant and/or postoperative treatment modalities. Roughly there are two treatment forms, the hormonal and the cytostatic ones. Endocrine therapy should be given as follows: 1. only for low risk group, 2. gestagen or antiestrogen therapy is the choice for the first step, 3. if there is a progression in 3 months, the hormonal treatment should be changed to cytostatic combination, 4. if there is a progression beyond 3 months further hormonal therapy can be considered. The efficacy of endocrine therapy is 30%. In patients with advanced breast cancer chemotherapy provides a response rate of 30 to 60%, however total survival of the patients does not improve substantially. Doxorubicin containing regimens are more effective, however no response in total survival can be obtained. New plant alkaloids and altered treatment forms will probably influence survival. Taking all these into consideration one has to decide on the quality of life of the breast cancer patients.

Increasing knowledge of fragile bone has been gained by non-invasive mineral assessments. Its future importance seems to be twofold. First by, it seems likely that patients with low bone mineral will be treated to try to increase this bone mineral or at least to keep it steady. Secondly, in the presence of osteoporosis special strategies must be taken into consideration. In many locations osteoporotic fractures may need special solutions. It seems that osteosynthesis with plates and screws which have their definite indications in younger patients may be replaced by alternatives, such as cerclage wiring and intramedullary implants. Polymethylmethacrylate has been a good adjunct to strengthen screw fixation and to fill defects after compression of fragile cancellous bone.

A tumour and its environment constitute a three-dimensional (3D) phenomenon. Consequently, adequate management of the target volume (tumour + safety zone) is feasible only with a 30 treatment planning and irradiating system. The more precise planning and dose delivery involved in such a 30 treatment lead to an improved therapeutic effectiveness.

Hypothyroidism is known to be associated with abnormalities of kidney function; recently, low atrial natriuretic peptide (ANP) plasma levels have been reported. Aim of the study was to asses ANP, sodium and water responsiveness to an acute saline load. Twelve patients with established primary hypothyroidism and 9 control subjects were studied. ANP was determined in plasma by RIA with extraction, prior to and after the infusion of saline, 500 ml/h for 4 hours. On a similar albeit liberal sodium diet hypothyroid patients excreted less sodium and water (74 +/- 33 (SD) mumol/min and 0.69 +/- 0.15 ml/min, respectively) than control subjects (110 +/- 52 mumol/min; P < 0.05 and 1.06 +/- 0.53 ml/min; P < 0.025, respectively). However, the infusion of saline resulted in a 3-fold increase of sodium output and more than 2-fold increase in urine flow. The exaggerated responsiveness in sodium excretion in patients with hypothyroidism was associated with significantly decreased pre-infusion ANP plasma levels (16.1 +/- 11.1 pg/ml vs. 44.4 +/- 14.4 pg/ml; P < 0.001) and also with sluggish response to the volume expansion (+24% vs. +48%). A significant correlation was found between serum T4 levels and plasma ANP concentrations in 8 patients (r = 0.689; P < 0.05). Although hypothyroid patients tend to retain sodium on a liberal salt diet, their kidney is capable of vigorously eliminating excess sodium when challenged with an acute saline load. This exaggerated responsiveness of sodium excretion can be demonstrated in spite of a sluggish response in ANP. Subnormal ANP levels in hypothyroidism are probably the result of thyroid deficiency.

A semi-longitudinal study of the cholesterol profiles at various stages of pregnancy was conducted. The study involved 49 pregnant women who showed no physical signs of obesity, were neither hypertensive nor diabetic, and had a mean age of 24.7 +/- 4.5 (mean +/- SD). The results showed a progressive increase in the serum total and high-density lipoprotein (HDL) cholesterol levels from 4.02 +/- 0.39 mmol/L (mean +/- SD) and 1.81 +/- 0.15 mmol/L, respectively, at 3 months, to 5.59 +/- 0.51 mmol/L and 2.46 +/- 0.18 mmol/ in the ninth month of pregnancy. These represent a 39 +/- 11% and a 35 +/- 10% increase in total and HDL cholesterol, respectively, over the 3-month level. The levels of total and HDL cholesterol however decreased to 4.08 +/- 0.40 mmol/L and 1.89 +/- 0.17 mmol/L, respectively, a month after delivery. The most significant (P < 0.05) month to month increase was recorded between the 6th and the 7th month for both total and HDL cholesterol. The proportion of HDL cholesterol remained fairly constant at 43 +/- 3 to 45 +/- 4% throughout the period of pregnancy covered, and one month after delivery. This suggests a proportional increase in all lipoprotein fractions. It is concluded that the observed changes are normal physiological events.

Mitotic delay (MD) often occurs in cells of donors exposed in vivo to genotoxic agents. To investigate individual sensitivity with genetic background, author measured the 3-methyl-cholanthrene (MC)-induced MD in cultured human skin fibroblasts (FBs) and in peripheral blood lymphocytes (PBLs) obtained from a 4-year-old patient with Down's disease. Samples from a 10-year-old healthy subject served as controls. Skin samples were obtained during surgical intervention. The induced MD was calculated from the mitotic index (MI) which was expressed in per cent of the control; at various times up to 18 h after treatment. Cells were treated with 10(-7), 10(-6) and 10(-5) M MC (with S-9 liver homogenate). At passage 10, the average MI (+/- SE) was 8.32 +/- 0.43%, and 7.85 +/- 0.64% for the healthy and for the Down's FBs, respectively; and it was 4.89 +/- 0.59%, and 4.92 +/- 0.72% for the healthy and for the Down's PBLs, respectively. MD was characterized as 50% MI of control (MD50). The MD50 values were the most expressed when cells were treated with 10(-5) M MC. No difference was found in MD of healthy and Down's fibroblasts. For Down's lymphocytes, on the other hand, MD was approximately 30% longer than for healthy cells. This result agrees well the reported increased SCE and decreased DNA-repair data obtained in PBL of Down patients.

This report deals with a patient with concealed Wolff-Parkinson-White syndrome in whom both narrow and wide QRS tachycardias were observed. The simultaneous occurrence of various QRS morphology during supraventricular tachycardia results in a challenging diagnostic ECG problem. The cycle length during tachycardia with left bundle branch block was longer than the cycle length during narrow QRS supraventricular tachycardia and with functional right bundle-branch block. Electrophysiologic studies revealed an increased V-A conduction time during tachycardia with left bundle branch block. These studies suggested the presence of a concealed left-sided anomalous pathway. Differentiation between intra- and extranodal re-entry and therapeutic modalities are also discussed.

The success of surgery performed for pulmonary carcinoma is based on the selection of the patients for operation. Cytological or histological verification of the tumour prior to surgery is important as concerns the choice of the type of surgery and the complex antitumour therapy. It is currently considered that patients with tumours in stages I, II and IIIa are suitable for surgery. Operations are also performed in cases involving solitary cerebral metastases, and centrally-lying tumours which reach the bifurcation carina or the lower portion of the trachea (T4) are similar rarely resectable. The basic operation for pulmonary carcinoma is lobectomy. In selected cases of squamous cell carcinomas in stage T1N0, atypical wedge resection too may be considered. Extended surgery is also performed, depending on the size of the tumour. For all types of tumours, it is essential to take a sample from the lymph nodes for accurate staging. Prospective randomized clinical trials on 288 patients undergoing resection for pulmonary cancer revealed that extended medistinal lymphadenectomy improved the 5-year survival rate in cases of adenocarcinomas and squamous cell carcinoma, involving lymph node metastases. Intraoperative cytological examinations or frozen sections are extremely important as concerns the indication of extended mediastinal lymphadenectomy and adjuvant antitumour treatment.

Hepatitis B virus (HBV) markers were studied with Sorin RIA kits in serum samples from 390 patients suffering from histologically confirmed chronic liver disease. On the basis of negative HBsAg, anti-HBs, anti-HBc tests, HBV infection was excluded in 235 of the cases. The diagnosis was fatty liver and/or alcoholic hepatitis in 52%, while chronic active hepatitis and/or liver cirrhosis only in 21.7%. Part or present HBV infection was proven in 155. In 53% of these cases the diagnosis was chronic active hepatitis and/or liver cirrhosis, whereas fatty liver and alcoholic hepatitis occurred in 27.7%. Detailed HBV marker analysis was performed in 76 patients. Previous infection without replication (positive anti-HBs and/or anti-HBc and/or anti-HBe) was proven in 48 cases, 12 patients had active HBV infection (positive HBsAg, HBe, IgM anti-HBc), while in 16 cases HBV integration (positive HBsAg, anti-HBc, anti-HBe) was proven. HBsAg-IgM complex seropositivity was shown in every case with active HBV replication. Because of therapeutic, prognostic and epidemiologic reasons, the significance of detailed HBV serology in chronic liver diseases is stressed.