The effect of intranasal salmon calcitonin therapy on bone mineral density in idiopathic male osteoporosis without vertebral fractures--an open label study

The aim of this study was to examine the effect of intranasal salmon calcitonin therapy on bone mineral density (BMD) in idiopathic male osteoporosis without vertebral fractures. We conducted a randomized, open label, controlled trial in 71 male patients (mean age 59 +/- 6 years) suffering from idiopathic osteoporosis (femoral neck T-score < -2.5) without vertebral deformity. Patients in the control group (n = 31) received 400 IU Vitamin D + 1000 mg elemental calcium daily while the treatment group (n = 40) received 400 IU Vitamin D, 1000 mg elemental calcium plus 200 IU calcitonin nasal spray daily during alternate months. The study period was 18 months. Compared to controls, nasal calcitonin was associated with significant increases in bone mineral density at the lumbar spine (+3.5 +/- (-4.3%) vs. +0.83 +/- 6.4%, P = 0.04) and the femoral neck (+3.2 +/- 3.9% vs. +0.68 +/- 5.7%, P = 0.004). No significant difference was observed at the radius between the treatment groups (+1.4 +/- 8.8% vs. +1.4 +/- 10.9%, P = 0.98). Treatment was well tolerated with no premature discontinuations or significant side effects compared to the control group. We conclude that 200 IU salmon calcitonin nasal spray used daily, intermittently proved to be an effective and safe therapy in male idiopathic osteoporosis.     

Use of a recombinant pseudorabies virus to analyze motor cortical reorganization after unilateral facial denervation

A unilateral facial nerve injury (n7x) was found to influence the transcallosal spread of the attenuated strain of pseudorabies virus (PRV Bartha) from the affected (left) primary motor cortex (MI) to the contralateral MI of rats. We used Ba-DupLac, a recombinant PRV strain, for the tracing experiments since this virus was demonstrated to exhibit much more restricted transportation kinetics than that of PRV Bartha, and is therefore more suitable for studies of neuronal plasticity. Ba-Duplac injection primarily infected several neurons around the penetration channel, but hardly any transcallosally infected neurons were observed in the contraleral MI. In contrast, after right facial nerve injury, Ba-DupLac was transported from the primarily infected neurons in the left MI to the contralateral side, and resulted in the labeling of several neurons due to a transneuronal infection. These results reveal that a peripheral nerve injury induces changes in the Ba-DupLac infection pattern in the related cortical areas. These findings and the literature data suggest that this phenomenon may be related to the changes in the expression or to the redistribution of cell-adhesion molecules, which are known to facilitate the entrance and/or transmission of PRV into neurons.     

GABAB and CB1 cannabinoid receptor expression identifies two types of septal cholinergic neurons

Septohippocampal cholinergic neurons play key roles in learning and memory processes, and in the generation of hippocampal theta rhythm. The range of receptors for endogenous modulators expressed on these neurons is unclear. Here we describe GABA(B) 1a/b receptor (GABA(B)R) and type 1 cannabinoid receptor (CB(1)R) expression in rat septal cholinergic [i.e. choline acetyltransferase (ChAT)-positive] cells. Using double immunofluorescent staining, we found that almost two-thirds of the cholinergic cells in the rat medial septum were GABA(B)R positive, and that these cells had significantly larger somata than did GABA(B)R-negative cholinergic neurons. We detected CB(1)R labelling in somata after axonal protein transport was blocked by colchicine. In these animals about one-third of the cholinergic cells were CB(1)R positive. These cells again had larger somata than CB(1)R-negative cholinergic neurons. The analyses confirmed that the size of GABA(B)R-positive and CB(1)R-positive cholinergic cells were alike, and all CB(1)R-positive cholinergic cells were GABA(B)R positive as well. CB(1)R-positive cells were invariably ChAT positive. All retrogradely labelled septohippocampal cholinergic cells were positive for GABA(B)R and at least half of them also for CB(1)R. These data shed light on the existence of at least two cholinergic cell types in the medial septum: one expresses GABA(B)R and CB(1)R, has large somata and projects to the hippocampus, whereas the other is negative for GABA(B)R and CB(1)R and has smaller somata. The results also suggest that cholinergic transmission in the hippocampus is fine-tuned by endocannabinoid signalling.     

Continuing care of patients with cardiovascular risk in general practice: diabetic patients and their care

INTRODUCTION: Both types of diabetes mellitus are conditions with high cardiovascular risk. AIMS: This work was aimed to study the frequency of cardiovascular risk factors, macrovascular and microvascular complications and to assess the results of continuous diabetes care in an adult population with type 1 and type 2 diabetes. Method of the study was a questionnaire survey, altogether 400 patients, 49 with type 1 and 351 with type 2 diabetes, were enrolled to it. RESULTS: Frequency of cardiovascular complications, obesity, hypertension and dyslipidemia was higher in type 2 diabetes, smoking and microvascular complications were more frequent in type 1 diabetes. The ratio of conservative intensive and conventional insulin therapy in type 1 diabetes was 70% and 30%, respectively. Treatment methods used in type 2 diabetes were: diet only: 8%, oral antidiabetic therapy: 78%, antidiabetic agent and insulin: 7%, insulin therapy 7%. Ratios of the patients having at least three laboratory results were: fasting blood glucose: 50%, postprandial blood glucose: 30%, haemoglobin A(1C): 10%. Ratios of patients reached the target results were in type 1 and type 2 diabetes were: fasting blood glucose: 27% vs. 14%, postprandial blood glucose: 26% vs. 18%, haemoglobin-A: 29% vs. 34%. Ratios of the patients in micro- and macrovascular risk category were: fasting blood glucose: 59% vs. 68%, postprandial blood glucose: 54% and 53%, haemoglobin-A(1C): 40% vs. 27%. CONCLUSIONS: Frequency of investigations to estimate glycemic control as well as ratio of patients reached target values were rather low, ratio of patients in micro- and macrovascular risk category was high. For these reasons there is a need for a more intensive continuous diabetes care to reach better results.     

Isolation and therapeutic use of human stem cells

Nowadays, adult stem cells are the main target of biological research. Stem cell specific markers allow the extraction in enough quantity and high purity of multipotent cells from organic tissues, and their usage instead of the ethically reprehensible embryonal stem cells in experimental therapeutic purposes is also possible. The key point in the development of a new, stem-cell based therapeutic methodology is the determination of stem cell specific cell surface or cytoplasmatic antigens that makes reliable stem cell identification possible. Bone marrow derived multipotent stem cells can already be suitably identified, and other, more or less organic tissue-derived stem cell specific markers are also available. The first therapeutic interventions have been already done in diseases such as myocardial infarction or diabetes mellitus, and led to promising results.     

Etiologic factors of malignant melanoma in young adults

BACKGROUND: Malignant melanoma is the most aggressive type of skin cancers, involving the cutis and the mucosa. Its incidence keeps increasing dramatically in the last decades. It appears rarely in childhood. The main environmental risk factors are: excessive sun exposure and severe sunburns in both childhood and adolescence. Skin phototype, number of nevi, presence of congenital nevi (especially giant congenital nevi) and non-melanoma skin cancer in previous history refer to increased risk. Investigations of genetical factors have come to the front. The role of hormonal influences and traumas are recurring questions. AIM: The presence of melanoma typically concerns the middle-aged population. The purpose of this study was to determine the main risk factors, etiology factors and predisposing pediatric conditions in development of melanoma in young adulthood (under the age of 30). METHOD: A total of 70 new, histologically verified melanoma patient under 30 years were examined between 1993-2003 with a retrospective study. Results of questionnaire based survey and clinical data base about melanoma risk factors were also analysed. RESULTS: 5% of patients had giant congenital nevi, although in half of the patients (19/40) more than 20 moles were found. On the basis of patients' histories 57.5% of melanomas developed on a nevus existing from birth or childhood. 30% of melanomas developed on a pigmented brown alteration which rose on the normal skin. About 1/3 of patients had fair skin type and almost all patients (38/40) suffered from erythematous sunburn at first sunbath. Melanoma developed mostly on the trunk and lower extremities. 51.5% of patients belonged to Stage I (Breslow thickness below 1 mm in 33%). CONCLUSION: There were 70 young (under 30 years) patients were treated for malignant melanoma at the Dermatology Department of the National Institute of Oncology in Budapest from 1993 till 2003. The incidence of melanoma under the age of 30 was 3.3%. In young adulthood the main risk factors were the number of atypical nevi and repeated or severe sunburns in childhood. The skin type was also an important risk factor. 50% of the melanomas in young women developed on the trunk. Authors could not prove any relationship among hormonal factors, pregnancy and the development of the melanoma.     

Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion for peritoneal carcinomatosis caused by recurrent inflammatory myofibroblastic sarcoma: a case report and review of the literature

Peritoneal carcinomatosis is a fatal diagnosis, associated with poor prognosis and quality of life. Survival is usually estimated in month. Traditionally surgery for peritoneal carcinomatosis was indicated only for palliative effort. Advances in tumour biology, cytoreductive surgery and pharmacology have improved the approach for this condition. An aggressive combined approach to peritoneal surface malignancy involves peritonectomy and intraperitoneal perioperative hyperthermic chemotherapy. Cytoreductive surgery reduces carcinomatosis to microscopic residual disease so that intraperitoneal hyperthermic chemotherapy is able to eradicate cancer. Hyperthermic chemotherapy enhances the cytotoxicity of the drugs and increases their penetration into the cancerous tissue. Careful patient selection is crucial for this multimodality approach. Quantitative prognostic indicators are useful in the assessment of outcome, like peritoneal cancer index and completeness of cytoreduction score. Cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy improves survival but is associated with significant morbidity and mortality. This review is based on a case report of a 22-year-old female patient who had peritoneal carcinomatosis of inflammatory myofibroblastic sarcoma and was treated by cytoreductive surgery and intraperitoneal hyperthermic chemotherapy at our department.