Carcinoid daganatok

The authors review the most important clinical aspects of carcinoid tumors. Carcinoid tumors originating in neuroendocrine cells are rare, usually slowly-growing neoplasms, however, they may present as aggressive and rapidly progressing tumors. Epidemiologic data indicates that their prevalence is gradually increasing, which may be explained, at least in part, by the development and wider use of advanced diagnostic methods. A considerable proportion of patients with neuroendocrine tumors are symptom-free, whereas others may have carcinoid syndrome or symptoms of other endocrine syndromes. Early diagnosis may be established by the measurement of biochemical markers (serum chromogranin A, urinary 5-hydroxyindoleacetic acid) and advanced localization methods. A considerable number of patients are diagnosed at the late stages of the disease; in these cases surgical cure is not possible but surgical and/or interventional radiologic procedures which reduce tumoral mass should be still considered. The most effective drugs for symptomatic treatment of carcinoid tumors are somatostatin analogues; in addition to their beneficial effect on clinical symptoms they may stabilize tumor growth for many years and, less frequently, may produce tumor regression. The use of chemotherapeutic agents is considered in patients with aggressive, rapidly growing and advanced tumors; initial findings with temozolomide and thalidomide in clinical trials raise the possibility that these chemotherapeutic agents may prove to be new therapeutic options. Radioisotope-labeled peptide receptor therapy with 131 I-MIBG, 90 Y-DOTA-TOC or 177 Lu-DOTA-TOC may offer a highly effective option for patients with progressive and advanced stage of neuroendocrine tumors. Initial observations obtained in clinical trials with some tyrosine kinase inhibitors, antibodies against tyrosine kinases, and with inhibitors of mammalian target of rapamycin (mTOR) support the possibility that at least some of these new agents may have a role in future treatment options in patients with advanced neuroendocrine tumors

Neuroendokrin daganat májmetasztázisainak teljes és tartós remissziója szomatosztatinanalóg-kezelés hatására

Somatostatin analogues represent a major treatment modality in the therapy of neuroendocrine tumors. Their efficacy is well documented in the inhibition of hormone secretion; however, novel data seem to underline their effectiveness in tumor regression, as well. In this report authors present a case of type 1 neuroendocrine tumors of the stomach associated with liver metastases. Somatostatin analogue treatment resulted in a complete regression of the primary tumor and the metastases within two years. This case draws attention on the importance of somatostatin analogue treatment not only in the control of hormonal symptoms but also in the inhibition of tumor growth. Orv. Hetil., 2011, 152, 407-410

Alterations of glutathione S-transferase and matrix metalloproteinase-9 expressions are early events in esophageal carcinogenesis

AIM: To investigate the role of glutathione S-transferase (GST) and matrix meta lloproteinase-9 (MMP-9) expressions in the development and progression of reflux esophagitis-Barrett's meta plasia-dysplasia-adenocarcinoma sequence in the esophagus. METHODS: GST and MMP-9 expressions were analyzed in 51 paraffin-embedded tissue samples by immunohistochemistry including patients with reflux esophagitis (n = 7), Barrett's metaplasia (n = 14), Barrett and esophagitis (n = 8), Barrett and dysplasia (n = 7), esophageal adenocarcinoma (n = 8) and a control group without any histological changes (n = 7). Immunostaining was determined semiquantitatively. Statistical analysis with one-way ANOVA, LSD test and correlation analysis were performed. P value of < 0.05 was considered significant. RESULTS: GST expression was significantly higher while MMP-9 expression was significantly lower in control group compared to Barrett's metaplasia and the other groups. No major changes were observed between Barrett, esophagitis, and Barrett and concomitant esophagitis. Barrett and concomitant dysplasia, and adenocardnoma revealed a significant lower expression of GST and higher levels of MMP-9 compared to all other groups. Adenocarcinoma showed almost no expression of GST and significantly higher levels of MMP-9 than Barrett and concomitant dysplasia. Alterations of GST and MMP-9 were inversely correlated (r 0.82). CONCLUSION: Decreased GST and increased expression of MMP-9 in Barrett's meta plasia-clysplasiaadenocarcinoma sequence as compared to normal tissue suggest their association with esophageal tumorigenesis. Loss of GST and gain of MMP-9 in Barrett with dysplasia compared to non-clysplastic metaplasia indicate that these alterations may be early events in carcinogenesis. Quantification of these parameters in Barrett's esophagus might be useful to identify patients at higher risk for progression to cancer. (c) 2007 The WJG Press. All rights reserved

A gastrooesophagealis refluxbetegség keletkezésének újabb szempontjai

A gastrooesophagealis refluxbetegség (GERD) kialakulásában az alsó nyelőcsősphincter (LES) elernyedése és a csökkent LES-tónus mellett a fokozott hasűri nyomás is szerepet játszhat. Célkitűzés: Annak vizsgálata, hogy az éveken át tartó, foglalkozással járó fokozott hasűri nyomás, hasprés, erőlködés növeli-e a GERD kialakulásának kockázatát. Módszer: A refluxtüneteket kérdőív segítségével kontrollcsoporthoz viszonyítva hivatásos énekesek, fúvós hangszeren játszó művészek és üvegfúvók között értékelték. Eredmények: A hivatásos énekesek között a gyomorégés, a regurgitatio és a rekedtség a lényegességi szintet meghaladóan gyakrabban fordult elő ( p <0,001), mint a kontrollcsoportban. A fúvós hangszeren játszók között a gyomorégés ( p <0,05) és a regurgitatio ( p <0,01), míg az üvegfúvóknál a regurgitatio ( p <0,01) gyakoribb volt, mint a kontrollcsoportban. A refluxos tünetek összefüggtek a foglalkozással eltöltött idővel ( p <0,05). Következtetések: Eredményeik arra utalnak, hogy azon foglalkozások esetén, ahol tartósan fokozott a hasűri nyomás, a refluxtünetek gyakrabban fordulnak elő. Ilyen szempontból a GERD foglalkozási ártalomnak is tekinthető. | In addition to lower esophageal sphincter (LES) relaxations and decreased LES tone, increased intra-abdominal pressure can also play role in the pathogenesis of gastroesophageal reflux disease (GERD),. Aim: To analyze the correlation between occupation-related increased intra-abdominal pressure or straining (experienced for years) and the prevalence of GERD symptoms. Methods: Reflux symptoms were analyzed through a questionnaire among professional singers, wind players and glassblowers in comparison with controls. Results: Heartburn, regurgitation and hoarseness were significantly more frequent among professional singers than in controls (P<0.001). Among wind players heartburn (P<0.05) and regurgitation (P<0.01), among glassblowers regurgitation (P<0.01) were significantly more frequent in comparison with control subjects. Reflux symptoms correlated significantly with the duration of professional activity (P<0.05). Conclusions: Results suggest that reflux symptoms are more frequent among subjects with occupation-related increased intra-abdominal pressure. GERD seems to be a work-related disease in this aspect

A bélgázok jelentősége = Bowel gases

A haspuffadás az emésztőrendszeri betegségek gyakori tünete. A betegek többségének meggyőződése, hogy panaszukat a bélgázok fokozott termelődése okozza. Az elmúlt években végzett klinikai vizsgálatok, különösen a gázterheléses vizsgálatok eredményeként mind többet tudunk a bélgázok szabályozásáról, a tünetképzésben betöltött szerepükről. Bár egyes kórképek egyértelműen a gázok szabályozásának zavaraival függnek össze, funkcionális bélbetegségekben, mindenekelőtt az irritábilis bél szindrómában a kérdés sokkal összetettebb. A gázok szabályozásának zavara, kóros reflexek és a visceralis hiperszenzitivitás azok a fő tényezők, amelyek a puffadás érzetéhez vezetnek ebben a betegcsoportban. A bélgázok kórélettani folyamatainak tisztázását célzó további vizsgálatok várhatóan megteremthetik az optimális kezelés alapjait is. | Abdominal bloating is one of the most common symptoms in patients with different gastrointestinal disorders. The majority of patients usually attribute this complaint to increased intestinal gas volume. Recent experimental studies using the gas challenge test help us to better understand the gas dynamics and tolerance in humans. Although there are some clinical conditions that are clearly related to impaired gas dynamics, the role of gases in functional gastrointestinal disorders especially in irritable bowel syndrome is much more complicated. Impaired gas handling, abnormal reflexes and visceral hypersensitivity seem to be the main factors resulting in abdominal bloating in this group of patients. Further clinical studies are needed to clarify the pathophysiologic mechanisms of intestinal gas and this may contribute to the evaluation of optimal therapy

Az irritábilis bélszindróma kezelésének új lehetőségei = Novel therapeutic approaches in the treatment of irritable bowel syndrome

Az irritábilis bél szindróma (IBS) kezelése a változatos tünetek, a társuló neuropszichiátriai kórképek miatt nem könnyű feladat. Bár számos, különböző támadáspontú szert alkalmazunk a betegség kezelésére, a mai napig kevés olyan gyógyszer van, amelynek hatékonyságáról, biztonságosságáról és tolerabilitásáról egyértelmű bizonyítékok állnak rendelkezésre. Az IBS multikauzális jellegéből adódóan a visceralis hiperszenzitivitással, a motilitással, az agy-bél tengely szabályozási zavaraival kapcsolatos kutatások eredményei, a folyamatokban központi szerepet játszó neurotranszmitterek, ezek receptorainak megismerése teremtette meg az új kezelési lehetőségek alapját. Bár napjainkban néhány gyógyszert (alosetron, tegaserod) már törzskönyveztek egyes országokban IBS-ben, az új készítményekkel kapcsolatban még több, nagy betegszámú vizsgálatra van szükség. The treatment of irritable bowel syndrome due to the heterogeneous clinical symptoms and coexisting psychiatric disorders is still controversial. Although several agents with different mechanisms of action are widely used in clinical practice, there are only few drugs available with strong evidence of their efficacy, safety and tolerability at present. The etiology of irritable bowel syndrome is considered to be multifactorial: experimental and clinical research on visceral hypersensitivity, motility and brain-gut axis involving its neurotransmitters and receptors created the foundation of novel therapeutic approaches. Albeit nowadays several drugs (alosetron, tegaserod) have been registered in a few countries for the treatment of irritable bowel syndrome, further large clinical trials are required related to the new chemical entities