A hyperthyreosis kezelésének ritka mellékhatásai

Absztrakt A szerzők hyperthyreosis miatt gondozott beteg esetét ismertetik, akinél a kezelés során propiltiouracil indukálta vasculitis igazolódott renalis érintettséggel, amely a gyógyszerelhagyást követően, illetve kortikoszteroidterápia mellett rendeződött. Ezt követően tiamazolkezelés során agranulocytosis alakult ki lázas állapottal. A vérképeltérések normalizálódása után átmeneti lítium-karbonát terápiát követően a hyperthyreosis sikeres műtéti megoldására került sor. A hyperthyreosis kezelésében alkalmazott gyógyszerek ilyen súlyos mellékhatásainak halmozott előfordulása ritka, amely jól mutatja, hogy ezen gyakori kórkép kezelése is tartogat kihívásokat a klinikus számára. Orv. Hetil., 2016, 157(22), 869–872

Statinok és az emésztőrendszeri daganatok

The antitumour effect of statins has already been proven in animal experiments and human cancer cell lines in several gastrointestinal cancers. The chemopreventive mechanism is not completely clarified but the enhancement of oxidative stress, increased autophagy, altered expression of pro- and antiproliferative proteins and their influence on intracellular signaling pathways may play a role. Randomized studies, however, failed to confirme the expected results obtained from experimental studies. The goal of this review is to summarize the data available in the literature regarding the chemopreventive effects of statins on several gastrointestinal cancers. Results of clinical trials suggest that 10-20 mg statin daily has no or minimal antitumour effect. Chemopreventive effect of hydrophilic statins could not be detected but it seems to be significant in the case of hydrophobic statins. There are only few data available on the long-term daily use of 30-40 mg statins. Further long-term evaluation of the effect of statins regarding gastrointestinal cancers is needed, and an analysis of compound- and dose-related subgroups would be beneficial. Chemoprevention with statins cannot yet be accepted as standard medical practice. Use of statins as chemopreventive agents cannot be a substitute for regular oncological screening or surveillance. Orv. Hetil., 2014, 155(18), 687-693

A karnitin észterek profilszerű meghatározásának jelentősége a humán karnitin metabolizmus vizsgálatában = Determination of the carnitine ester profiles as a tool in study of human carnitine metabolism

Primer karnitin hiányban megfigyeltük, hogy a drámaian csökkent karnitin észter szintek a karnitin kezelés hatására csak mérsékelten emelkedtek. Heterozigóta családtagokban egy közel proporcionális csökkenés volt az észterekben. Az SLC22 TC haplotípust nem találtuk hajlamosító tényezőnek. Vizsgáltuk a karnitin észter profilt tünetmenetes celiákiásokban, ulceratív colitisben és felnőtt Crohn betegekben. Beteganyagunkban az IGR2096a_1T és IGR2198a_1 C ellélok hajlamosítónak adódtak Crohn betegségre. A karnitin profil vizsgálata a IGR2230a_1 genotípusban nem mutatott eltérést. Elsőként vizsgáltuk az irodalomban a karnitin észterek profiljának alakulását a terhesség folyamán egészen a szülésig. A vizsgálatok dinamikus rendszert fedtek fel: átalakult a terhes nő karnitin profilja a graviditás során nem-terhes nőkhöz viszonyítva. Vizsgáltuk az SLC22A4 C6607T és a RUNX1 G24658C variánsokat rheumatoid arthritisben. Nem találtunk hajlamosító polimorfizmust vagy specifikus eltérést a karnitin észter profilban sem. Interleukin 23 receptor variánsokat tanulmányoztuk rheumatoid arthritises betegekben és megfigyeltük az allélok megosztott hajlamosító természetét. Megfigyeltük, hogy a gén 3?UTR C2370A allélikus variánsa hajlamosító gén relabáló-remittáló típusú multiplex sclerosisban. Vizsgáltuk az apolipoprotein A 5 gén T-1131C, T1259C, IVS3-476A, és C56G variánsai és a triglicerid szintek alakulását, megfigyeltük, hogy több allél hajlamosító variáns strokeban és metabolikus szindrómában | We observed dramatic decrease of the carnitine esters in primary carnitine deficiency which underwent a moderate increase on the effect of carnitine supplementation. In heterozygous relatives a proportional decrease of carnitine esters could be observed. We did not found the SLC22 TC haplotypes to confer risk. The carnitine ester profile was investigated n asymptomatic celiac disease patients, ulcerative colitis, and adult Crohn subjects. In our patients IGR2096a_1T and IGR2198a_1 C alleles were susceptibility genes for Crohn disease; the carnitine profile was normal in IGR2230a_1 genotype. We examined the carnitine ester profile during pregnancy first in the literature. We found a very dynamic system: in pregnant woman the carnitine ester profile was changed comparing with non-pregnants, and was further modified during the progress of pregnancy. We studied the SLC22A4 C6607T and RUNX1 G24658C variants in rheumatoid arthritis and could not establish their susceptibility nature, nor we could detect change in the carnitine ester profiles. In rheumatoid arthritis and in remitting-relapsing form of multiple sclerosis we found the functional variants of the interleukin 23 receptor as shared susceptibility factors. We studied the association of T-1131C, T1259C, IVS3-476A, and C56G variants with the plasma triglycerides, and could verify a susceptibility nature for some of the in stroke and metabolic syndrome

Toll-like receptor 4 and NOD2/CARD15 mutations in Hungarian patients with Crohn's disease: Phenotype-genotype correlations

AIM: To determine common NOD2/CARD15 mutations and TLR4 D299G polymorphism in Hungarian patients with CD. METHODS: A total of 527 unrelated patients with CD (male/female: 265/262, age: 37.1 (SD 7.6) years) and 200 healthy subjects were included. DNA was screened for possible NOD2/CARD15 mutations by denaturing high-performance liquid chromatography (confirmed by direct sequencing). TLR4 D299G was tested by PCR-RFLP. RESULTS: NOD2/CARD15 mutations were found in 185 patients (35.1%) and in 33 controls (16.5%, P< 0.0001). SNP8/R702W (10.8% vs 6%, P = 0.02), SNP13/3020insC (19.4% vs 5%, P< 0.0001) and exon4 R703C (2.1% vs 0%, P = 0.02) mutations were more frequent in CD, while the frequency of SNP12/G908R was not increased. The frequency of TLR4 D299G was not different (CD: 9.9% vs controls: 12.0%). Variant NOD2/CARD15 allele was associated with an increased risk for CD (OR(het) = 1.71, 95% CI = 1.12-2.6, P = 0.0001, OR(two-risk alleles) = 25.2, 95% CI = 4.37-, P< 0.0001), early disease onset (carrier: 26.4 years vs non-carrier: 29.8 years, P = 0.0006), ileal disease (81.9% vs 69.5%, OR = 1.99, 95% CI = 1.29-3.08, P = 0.02, presence of NOD2/CARD15 and TLR4: 86.7% vs 64.8%), stricturing behavior (OR = 1.69, 95% CI = 1.13-2.55, P = 0.026) and increased need for resection (OR= 1.71, 95% CI: 1.13-2.62, P = 0.01), but not with duration, extraintestinal manifestations, familial disease or smoking. TLR4 exhibited a modifier effect: age of onset in wt/TLR4 D299G carriers: 27.4 years vs NOD2mut/TLR D299G: 23 years (P = 0.06), in NOD2mut/wt: 26.7 years. CONCLUSION: These results confirm that variant NOD2/CARD15 (R702W, R703C and 3020insC) alleles are associated with earlier disease onset, ileal disease, stricturing disease behavior in Hungarian CD patients. In contrast, although the frequency of TLR4 D299G polymorphism was not different from controls, NOD2/TLR4 mutation carriers tended to present at earlier age. (C) 2005 The WJG Press and Elsevier Inc. All rights reserved