Lege Artis Medicinae

[Preoperative staging of nodal status in non-small cell lung cancer]

MONOSTORI Zsuzsanna1, REPA Imre1, HEILER Zoltán2, KOSTIC Szilárd2, EGERVÁRY Márta3, BADÁR Éva4

DECEMBER 29, 1993

Lege Artis Medicinae - 1993;3(12)

[ Exact preoperative staging according to the TNM classification is a prerequisite for establishing an adequate treatment plan for patients with lung cancer. The presence of tumor in N1 nodes influences the extent of resection, while its presence in N2 nodes determines the type of surgical resection, or sometimes excludes exploration of the chest. The correlation between pre- and intraoperative nodal staging based on pathological findings was analysed in 227 patients with non-small cell lung cancer after CT examination and thoracotomy. The sensitivity of CT for mediastinal nodes (N2) was 80%, with a specificity of 87%, while the sensitivity for N1 was 55%, with a specificity of 67%. CT is the only noninvasive diagnostic tool that is relatively suitable in the mapping of all accessible metastatic lymph nodes before mediastinoscopy and thoracic surgery. In the case of a negative CT finding no further preoperative staging is necessary, while a positive finding is an indication for sampling and histological evaluation.]

AFFILIATIONS

  1. Semmelweis Orvostudományi Egyetem Központi Radiológiai Diagnosztika
  2. Országos Korányi Tbc és Pulmonológiai Intézet Orvostovábbképző Egyetem Mellkasi Sebészeti Tanszék
  3. Országos Korányi Tbc és Pulmonológiai Intézet Orvostovábbképző Egyetem Kórbonctani Osztály
  4. Országos Korányi Tbc és Pulmonológiai Intézet Orvostovábbképző Egyetem Citológiai Osztály

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[The significance of vasodilator drugs and angiotensin converting enzyme inhibitors in the treatment of congestive heart failure]

JÁNOSI András

[The significance of angiotensin converting enzyme inhibitors in the treatment of congestive heart failure is outlined. The results of multicenter, randomized trials are summarized confirming the beneficial effect on survival of vasodilator therapy and/or angiotensin converting enzyme inhibitors in the treatment of patients with congestive heart failure.]

Lege Artis Medicinae

[Medical management of inland catastrophes]

FARKAS József

[The author details the medical consequences of disasters and mass casualty situations. The concept of disaster is definied and compared with that of mass accident. It is pointed out that in principle there are no essential differences between them since both disasters and mass accidents require the application of compromise medicine princliples at the site of the catastrophe and during the course of the hospital treatment. The main point of medical support at the site is the triage based on a numeric system of classification. In hospital treatment it is of great importance to adopt uniform (doctrinarian) principles and practice in order to prevent or decrease complications occurring in almost every extreme situation. Further co-operation of our medical organizations and development of common disaster plans may improve the effectiveness of coping with a possible emergency in our country.]

Lege Artis Medicinae

[The value of colposcopical and cytological examination in the screening of cervical intraepithelial neoplasia]

PETE Imre, BŐSZE Péter, TÓTH Vera, LEHOCZKY Győző

[ From 1980 to 1991, 1379 women with abnormal colposcopic and/or cytologic findings were examined at the Department of Gynecological Oncology at the National Institute of Oncology, Budapest. The sensitivity and specificity of these screening tests were studied retrospectively. All women underwent either cervical excision or conisation. Cytological and colposcopical findings were compared with the histological findings. Sensitivity and specificity of cytology were 49% and 77%, retrospectively. The corresponding figures for colposcopy were 88% and 12%, and for cytology and colposcopy together, 96% and 14%. 1. The low sensitivity of cytology suggests that as many as 50% of CIN lesions will be missed if cytology alone is used for screening. This finding probably justifies our screening policy (i. e., colposcopy should be used as a primary tool). 2. We found 194 asymptomatic patients with carcinoma in situ, 40 with microinvasive and 8 with frank invasive carcinoma. This finding emphasizes the importance of cervical cancer screening. 3. To decrease the false positive and negative rates, the introduction of new scientific results into the every day screening practice is urgently needed. 4. Our data suggest the superiority of a colposcopical screening method to a cytological one; however histological examination must be done independently of a screening method if the suspicion of cervical dysplasia arises. ]

Lege Artis Medicinae

[Digoxin 2 days a week; Can what is wrong be safe?]

[The last 20-25 years have seen significant advances in the use of medication. Blood levels of drugs can now be measured using available laboratory methods, and many effects can now be accurately measured in addition to general clinical monitoring. This has created the basis for the everyday use of pharmacokinetics and pharmacodynamics and a separate discipline, clinical pharmacology.]

Lege Artis Medicinae

[Coronary Angioplasty Versus Excisional Atherectomy Trial]

MATOS Lajos

[Atherectomy reduced coronary stenosis 50% or more often (89%) than angioplasty (80%, p<0.001), and the acute increase in vessel diameter was more pronounced (p<0.001). Atherectomy was associated with more early complications (11%) than angioplasty (5%, p<0.001) and hospital costs were also higher ($11 904 vs $10 637, p<0.006). After six months, the restenosis rate was 50% for atherectomy and 57% for angioplasty (p<0.06). However, the probability of infarction or death at six months was higher in the group treated with atherectomy (86%) than after angioplasty (4,6%, p<0,007).]

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Introduction - Glioblastoma multiforme (GBM) is the most common malignant primary anomaly of central nervous system. The GBM infiltrates the nearly sturctures from the initial tumor and its metastatic attribution is well known. The aim of our single-centered retrospective study was to introduce the importance of postoperative medical imaging confirmation of total tumor resection for patient with GBM combined concomitant and adjuvant chemoradiotherapy on a 10 year long patient follow up. Methods - From January 2006 to April 2015 we registered 59 patients with newly diagnosed GBM at the University of Kaposvár Health Center Institute of Diagnostic Imaging and Radiation Oncology. The histological diagnosis was confirmed by a proficient neuropathologist (World Health Organisation WHO; grade IV astrocytoma). According to histological status if the ECOG performance status of patients allowed it the mutidisciplinary oncoteam recommended adjuvant chemoradiotherapy all features strictly by Stupp protocol. (60 Gy dose on the gross tumor volume and 2-3 cm margin for the clinical target volume with parallel 75 mg/m2 TMZ. Four weeks after monotherapial phase patients had to recieve 6 cycles of TMZ first cycle with 150 mg/m2 up to 200 mg/m2). The irradiation was carried out by a conformal three dimensional planning system. Results - 59 patients with the median age of 63 (range 17-84) year. Our sample counted 34 male patients and 25 woman patients. 14 patients underwent gross total tumor resection while, 39 patients underwent partial resection and the rest from our sample 6 patients passed through biopsy. Statistical analysis showed a lengthier survival among males than females, with a median survival of 13 months for males and females, the OS of 26.209 for males, meanwhile 15.625 for females. However, the difference is not considerable (log-rank p=0.203). Our study found that the estimated survival of patients at least 50 years old is significantly shorter at a median survival of 12 months (log rank p=0.027) than that of patients below 50 years of age at a median survival of 23 months. The longest estimated median survival was calculated with patients of ECOG '0' condition (16 months). However, no significant difference was found in the estimated survival of patients of different ECOG conditions (log-rank p=0.146). Based on the extent of surgery, complete resection resulted in the longest average survival of 36.4 months, followed by 21.5 months among patients with biopsy, and 15.8 months among patients with partial resection. Different surgical procedures, however, did not result in significant differences in survival (log-rank p=0.059). The overal survival of patients who had complete resection confirmed by MRI compared with the overal survival of patients with residual tumor confirmed by MRI as well we can estimate that there is significant difference between these two groups (p=0,004). Conclusion - Despite complex and intense treatment, recurrence is inevitable and causes relatively rapid death. In our analysis complete resection, as defined from the neurosurgeon’s report and postoperative MRI, resulted in an independently significant improvement in OS. Our results are the evidences that the treatment of patients with glioblastoma multiforme in Hungary is at least on the same level as any other developed European countries.

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Cerebral cavernous malformations (CCMs) represent a relatively rare and heterogeneous clinical entity with mutations identified in three genes. Both sporadic and familial forms have been reported. We present a young female patient with episodic paresthesia and headaches, but without acute neurological deficits. Her mother had a hemorrhaged cavernoma surgically removed 21 years ago. Cranial magnetic resonance imaging revealed multiple cavernous malformations in the size of a few millimeters and the ophthalmologic exam detected retinal blood vessel tortuosity in the proband. Targeted exome sequencing analysis identified a nonsense mutation in exon 16 of the KRIT1 gene, which resulted in a premature stop codon and a truncated protein underlying the abnormal development of cerebral and retinal blood vessels. This mutation with pathogenic significance has been reported before. Our case points to the importance of a thorough clinical and molecular work up despite the uncertain neurological complaints, since life style recommendations, imaging monitoring and genetic counseling may have major significance in the long term health of the patient.

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