[Recovery rate in differentiated thyroid cancer. Experiences of one of the Hungarian clinical centers]. / A differenciált pajzsmirigyrákban szenvedo betegek gyógyulási esélyei. Egy hazai centrum tapasztalatai.

INTRODUCTION AND AIM: The worldwide incidence of differentiated thyroid cancer (DTC) has markedly increased during the last few decades. According to the international guidelines, principles of DTC management are in transformation. The aim of our work was to evaluate patients' current likelihood of recovery. METHOD: Data of 380 patients treated between 1/Jan/2005 and 1/May/2016 at the PTE KK Ist Department of Internal Medicine were retrospectively analyzed. Female/male ratio was 306/74. Median age at diagnosis was 46 years (13-86 years), while median follow-up time was 55 months (0-144 months). Response to therapy was evaluable in 337 patients. Statistical analysis was done using SPSS (version 22.0). RESULTS: Based on the prevalence of papillary (PTC) and follicular (FTC) carcinomas (79/21%), moderate iodine deficiency has to be considered in this region. PTC patients were significantly younger and were diagnosed in earlier tumor stage. The ratio of lymph node and distant metastases was 35%/4% in PTC and 15%/14% in FTC. Radioiodine treatment was performed in a total of 542 times. 264 patients with PTC were followed up. 59% of patients were tumor-free, in 20% uncertain response, in 7% incomplete biochemical response, in 14% incomplete structural response were diagnosed and 6 patients died. Patients with FTC (n = 73) were tumor-free in 59%, uncertain response was found in 10%, incomplete structural response was diagnosed in 31%, while 10% of the patients died. CONCLUSIONS: In summary, although DTC has a favorable prognosis, in 31% of FTC patients and in 14% of PTC patients, tumor-free status was not achieved. During the median 55-month follow-up period, the disease-specific mortality was 10% in FTC and 2% in PTC. Orv Hetil. 2018; 159(22): 878-887.

[Vitamin D and calcium in the mirror of clinical evidence]. / D-vitamin és kalcium a klinikai evidenciák tükrében.

The biological mechanisms, ecological and observational studies indicate increased morbidity and mortality in vitamin D deficiency, while the controlled, randomized supplementation trials - carried out mostly in vitamin D deficient patients - have shown no or some marginal benefits, mostly in preventing institutionalized elderly individuals' falls and fractures. Clarity is also disturbed by that the primary end points of intervention studies were generally not extraskeletal. The ideal serum 25-hydroxyvitamin D levels also considerably controversial: there is clearly a J-curve, but the optimal range is uncertain. All of these uncertainties appear also in the vitamin D guidelines which are, however, concordant in that they do not recommend (i) a population-wide screening and (ii) vitamin D supplementation with extraskeletal aim - beyond the prevention of falls. Certain studies suggest that calcium supplementation increases the incidence of cardiovascular events, while others show a neutral effect in this respect. There are several ongoing vitamin D studies directly designed for extraskeletal events. Orv. Hetil., 2016, 157(31), 1242-1247.

[HDL, or non-HDL: that is the question. Possibilities of pharmacological treatment in residual dyslipidaemia]. / HDL vagy non-HDL: az itt a kérdés. A residualis dyslipidaemia gyógyszeres kezelésének lehetoségei.

Instead of LDL-cholesterol, non-HDL-cholesterol is proposed as a secondary lipid target when triglyceride level is above 2.3 mmol/L. Non-HDL-cholesterol target values are 0.8 mmol/L higher than those for LDL-cholesterol in the same cardiovascular risk category. Currently, the main issue of lipidology is the degree by which the cardiovascular risk can be reduced with the treatment of residual dyslipidemia that exists under statin therapy. In such a role the examined agents have essentially failed despite their more or less profound effect on HDL-cholesterol and/or non-HDL-cholesterol. The largest loser has been the nicotinic acid. The results of cardiovascular, otherwise controversial fish oil studies cannot be considered convincing because of the administered low doses. In a combination with statin (i) ezetimibe may have role if the LDL-cholesterol target cannot be reached with statin monotherapy, or (ii) fibrates, in case of large increase of triglyceride level, or in less severe hypertriglyceridemia if it is associated with considerable decrease in HDL-cholesterol level. Potential further possibilities are: (i) cholesterol ester transfer protein inhibitors that dramatically raise HDL-cholesterol, while reduce LDL-cholesterol, or (ii) proprotein convertase subtilisin/kexin 9 inhibitors that markedly decrease LDL-cholesterol even on the top of statin.

Efficacy and safety of recombinant human parathyroid hormone (1-84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study.

BACKGROUND: Hypoparathyroidism results in impaired mineral homoeostasis, including hypocalcaemia and hyperphosphataemia. Treatment with high-dose oral calcium and active vitamin D does not provide adequate or consistent control of biochemical indices and can lead to serious long-term complications. We aimed to test the efficacy, safety, and tolerability of once-daily recombinant human parathyroid hormone 1-84 (rhPTH[1-84]) in adults with hypoparathyroidism. METHODS: In this double-blind, placebo-controlled, randomised phase 3 study (REPLACE), we recruited patients with hypoparathyroidism (≥ 18 months duration) aged 18-85 years from 33 sites in eight countries. After an optimisation period, during which calcium and active vitamin D doses were adjusted to achieve consistent albumin-corrected serum calcium, patients were randomly assigned (2:1) via an interactive voice response system to 50 µg per day of rhPTH(1-84) or placebo for 24 weeks. Active vitamin D and calcium were progressively reduced, while rhPTH(1-84) could be titrated up from 50 µg to 75 µg and then 100 µg (weeks 0-5). The primary endpoint was the proportion of patients at week 24 who achieved a 50% or greater reduction from baseline in their daily dose of oral calcium and active vitamin D while maintaining a serum calcium concentration greater than or the same as baseline concentrations and less than or equal to the upper limit of normal, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00732615. FINDINGS: Between June 23, 2009, and Feb 28, 2011, 134 eligible patients were recruited and randomly assigned to rhPTH(1-84) (n=90) or placebo (n=44). Six patients in the rhPTH(1-84) group and seven in the placebo group discontinued before study end. 48 (53%) patients in the rhPTH(1-84) group achieved the primary endpoint compared with one (2%) patient in the placebo group (percentage difference 51.1%, 95% CI 39.9-62.3; p<0.0001). The proportions of patients who had at least one adverse event were similar between groups (84 [93%] patients in the rhPTH[1-84] group vs 44 [100%] patients in the placebo group), with hypocalcaemia, muscle spasm, paraesthesias, headache, and nausea being the most common adverse events. The proportions of patients with serious adverse events were also similar between the rhPTH(1-84) group (ten [11%] patients) and the placebo group (four [9%] patients). INTERPRETATION: 50 µg, 75 µg, or 100 µg per day of rhPTH(1-84), administered subcutaneously in the outpatient setting, is efficacious and well tolerated as a PTH replacement therapy for patients with hypoparathyroidism.

[Functional MRI investigation of brain activity triggered by taste stimulation]. / Ízstimulációval kiváltott agyi tevékenység funkcionális MR-vizsgálata elhízásban.

INTRODUCTION: Many factors contribute to the pathogenesis of morbid obesity, and the central nervous system - as one of those - also has an important role. Numerous studies focus on the central regulation of eating and metabolism, since associated problems like obesity, anorexia, diabetes or metabolic syndrome put an increasing burden on the health system of modern societies. Neither the pathophysiologic changes, nor the normal regulation of these systems are known adequately. Functional MR (fMRI) imaging, which has certainly gained popularity recently, aims to better understand these mechanisms. In this series we studied the brain fMRI activity changes of normal and obese persons, triggered by gustatory stimulation. METHODS: 10 obese and 10 normal weight healthy volunteers took part in the study, with comparable age and sex distribution. Gustatory stimulation was performed by 0.1 M sucrose (pleasant), 0.5 mM quinine HCl (unpleasant) and complex vanilla flavored (Nutridrink) solutions, which were administered through 0.5 mm PVC tubes, in 5-5 ml portions. For rinsing distilled water with neutral flavor was used. Imaging was performed in a 3T MRI, applying standard EPI sequences. Post processing of data was accomplished by FSL software package. RESULTS: Brain activation for gustatory stimuli was characteristically different between the two groups. There were high intensity activations in more cortical and subcortical regions of the obese volunteers compared to the normal ones. CONCLUSIONS: Our current fMRI investigations revealed different activations of numerous brain regions of normal and obese individuals, triggered by pleasant and unpleasant gustatory stimulation. Based on these results this method can help to recognize the role of the central nervous system in obesity, and may contribute to develop new therapies for weight loss.