BackgroundIn periarrest situations and during resuscitation it is essential to rule out reversible causes. Hyperkalemia is one of the most common, reversible causes of periarrest situations. Typical electrocardiogram (ECG) alterations may indicate hyperkalemia. The aim of our study was to compare the prevalence of ECG alterations suggestive of hyperkalemia in normokalemic and hyperkalemic patients.Methods170 patients with normal potassium (K+) levels and 135 patients with moderate (serum K+ = 6.0–7.0 mmol/l) or severe (K+ > 7.0 mmol/l) hyperkalemia, admitted to the Department of Emergency Medicine at the Somogy County Kaposi Mór General Hospital, were selected for this retrospective, cross-sectional study. ECG obtained upon admission were analyzed by two emergency physicians, independently, blinded to the objectives of the study. Statistical analysis was performed using SPSS22 software. χ2 test and Fischer exact tests were applied.Results24% of normokalemic patients and 46% of patients with elevated potassium levels had some kind of ECG alteration suggestive of hyperkalemia. Wide QRS (31.6%), peaked T-waves (18.4%), Ist degree AV-block (18.4%) and bradycardia (18.4%) were the most common and significantly more frequent ECG alterations suggestive of hyperkalemia in severely hyperkalemic patients compared with normokalemic patients (8.2, 4.7, 7.1 and 6.5%, respectively). There was no significant difference between the frequency of ECG alterations suggestive of hyperkalemia in normokalemic and moderately hyperkalemic patients. Upon examining ECG alterations not typically associated with hyperkalemia, we found that prolonged QTc was the only ECG alteration which was significantly more prevalent in both patients with moderate (17.5%) and severe hyperkalemia (21.1%) compared to patients with normokalemia (5.3%).ConclusionsA minority of patients with normal potassium levels may also exhibit ECG alterations considered to be suggestive of hyperkalemia, while more than half of the patients with hyperkalemia do not have ECG alterations suggesting hyperkalemia. These results imply that treatment of hyperkalemia in the prehospital setting should be initiated with caution. Multiple ECG alterations, however, should draw attention to potentially life threatening conditions.

Variation in FTO is the most important common genetic determinant of body weight. Altered energy metabolism could underlie this association. We hypothesized that higher circulating glucose or triglycerides can amplify the FTO impact on BMI. In 2671 subjects of the TUEF study, we investigated the interaction effect of fasting glucose and triglyceride levels with rs9939609 in FTO on BMI. We analysed the same interaction effect by longitudinally utilizing mixed effect models in the prospective Whitehall II study. In TUEF, we detected an interaction effect between fasting glucose and fasting triglycerides with rs9939609 on BMI (p = 0.0005 and p = 5 × 10−7, respectively). The effect size of one risk allele was 1.4 ± 0.3 vs. 2.2 ± 0.44 kg/m² in persons with fasting glucose levels below and above the median, respectively. Fasting triglycerides above the median increased the per-allele effect from 1.4 ± 0.3 to 1.7 ± 0.4 kg/m2. In the Whitehall II study, body weight increased by 2.96 ± 6.5 kg during a follow-up of 13.5 ± 4.6 yrs. Baseline fasting glucose and rs9939609 interacted on weight change (p = 0.009). Higher fasting glucose levels may amplify obesity-risk in FTO carriers and lead to an exaggerated weight gain over time. Since weight gain perpetuates metabolic alterations, this interplay may trigger a vicious circle that leads to obesity and diabetes.

Nowadays the lack of exercise and improper eating habits are main characteristics of modern life style. This favors not only formation of type 2 diabetes or cardiovascular diseases, but also increaseas the incidence and prevalence of malignant tumors. Today there are many epidemiologic trials that demonstrate the connection between type 2 diabetes and formation of several malignomas. Its cause should be searched in common paths of pathologic processes. One of this is the birth of hyperinsulinsulinemia, which accompanies insulin resistance. Hyperinsulinemia of the host leads to increased glucose uptake in the highly insuline sensitive tumor cells which supports tumor growth. This makes type 2 diabetes a metabolic state favoring tumor formation, suggesting a potential application of oral insulin sensitizers in cancer therapy. Currently several international trials are testing the anti-tumor activity of metformin and thiazolidinedions (TZD). Besides this, encouraging results were obtained with the use of anti-IGFR antibodies in the treatment of tumors. A common therapy of diabetes and tumor may lead to new possibilities in the treatment of malignant tumor diseases. By doing this we could be able to weaken the tumor and strengthen the body, enabling it to fight against cancer. Bánhegyi RJ, Rus-Gal PO, Nagy AK, Martyin T, Varga R, Pikó B. Correlation between type 2 diabetes and malignant tumors - new possibilities in the complex therapy of cancers?

Primary gastrointestinal melanomas, part of the mucosal melanoma group, are uncommon. They constitute about five percent of all melanomas and most of them are located in the rectum (3 percent of all melanomas). The prognosis is poor, overall 5-year survival in rectal melanoma is 10-20 percent. We present three of our cases. The first case - a 68-year-old male patient - was operated on for histologically proved rectal melanoma. Three years after radical excision and oncological treatment a metastasis of the primary tumor was diagnosed in the stomach. Total gastrectomy was performed, followed by oncological treatment. In the second case of a 59-year-old male patient an appendectomy was performed for symptoms of appendicitis. The histopathological examination revealed melanoma of the appendix. Further investigations revealed the primary tumor in the stomach and metastases in the lungs as well. The third case - an 82-year-old female patient - was investigated for frequent defecations, mucus in stool and fecal incontinence. Primary melanoma was proved in the lower third of the rectum with multiple hepatic metastases. These three cases in our practice are remarkable for the rarity of the disease, and in two cases the presence of both the primary tumor and the metastasis were located in the gastrointestinal tract.

Az utóbbi évtizedek orvosi kutatásainak egyik tartósan kiemelt területe a szénhidrátháztartás zavarai és a rosszindulatú daganatok közti metabolikus és molekuláris kapcsolatok részletes elemzése, amely folyamatosan újabb és újabb daganatellenes terápiák kifejlesztésének és bevezetésének lehetőségét vetíti előre. Epidemiológiai, preklinikai és klinikai vizsgálatok alapján ma már biztosan tudjuk, hogy az előrehaladott cukorbetegség számos daganat képződésében önálló rizikótényezőként szerepelhet, sőt a tumorkockázat növekedése akár már praediabeteses kórállapotokban jelentkezhet. Napjainkban ugyanakkor azt is teljes bizonyossággal kimondhatjuk, hogy a kétfajta kórkép közti kapcsolat fordított irányban is fennáll. Közismert tény, hogy a malignus daganatok a gazdaszervezetben olyan metabolikus és molekuláris változásokat idéznek elő, amelyek egy idő után a korai diabetesre jellemző inzulinrezisztens állapotot okoznak. Ez a tumor által generált inzulinrezisztencia a betegek egy részénél akár másodlagos cukorbetegség kialakulásához is elvezethet, amelyet a jelenleg alkalmazott antineoplasztikus terápiák esetleges diabetogén effektusa csak tovább súlyosbíthat. Az utóbbi években a rosszindulatú daganatos megbetegedések és a 2-es típusú diabetes mellitus szoros kapcsolatának molekuláris okait feltárni kívánó kutatások a figyelmet a RAS és a PI3K jelátviteli utak központi szerepére irányították. Ezek megváltozott működése ugyanis a teljes sejtciklust, a komplett celluláris metabolizmust, a sejtek növekedését és proliferációját, vagyis a sejtek túlélését jelentősen befolyásolja, részben a tumorképződés és tumorprogresszió, részben pedig az inzulinrezisztencia létrejötte felé tolja. Ma már tudjuk, hogy a molekuláris ok-okozati viszonyok aligha érthetők meg az IGF-receptorok, valamint a RAS és a PI3K jelátviteli utak működésének és kapcsolódási pontjainak megismerése nélkül. Éppen ezért munkánkban a legfontosabb metabolikus összefüggések felvázolását követően a közös molekuláris háttér részleteire fókuszálunk. Orv Hetil. 2022; 163(39): 1535–1543.