Lege Artis Medicinae

[The multidisciplinary pathological examination of colorectal carcinomas - From the biopsy sample to the K-RAS mutation analysis]


SEPTEMBER 20, 2010

Lege Artis Medicinae - 2010;20(09)

[BACKGROUND - The role of pathologist in the reporting of colorectal carcinomas (CRC) has dramatically changed in the past 20 years. This change has been generated by the enormous progress in the surgical, radiological, oncological and pathological techniques and their interactions. AIM - To interpret the role of pathologist in the colorectal multidisciplinary team. METHODS - The most important histopathological prognostic and predictive factors, the surgical planes, the involvement of circumferencial margin, the regression grade after neoadjuvant chemoradiotherapy were assessed in 964 patients treated with operable colorectal cancer during 2001-2007 in the County Hospital of Baranya and the four nearby city hospitals. RESULTS - Most of our patients (>75%) were treated with advanced stage tumors. The lymph nodes were harvested through careful slicing, visual inspection and palpation - accordingly the average lymph node count increased from 7.45 to 19.0. After using elastic fibre stain we detected twice as much vascular invasion then before. The results of the surgical quality after TME and APER were somewhat dissapointing. Although the ratio of the specimens resected in the mesoretal fascial plane was comparable to the international results (39.8%), the ratio of resections in the muscularis propria plane was unacceptably high (47.8%) and it was more pronounced (50-100%) between the low volume surgeons of the small city hospitals. The involvement of the circumferencial resection margin was affected by the advanced pT and pN stage, the vascular invasion, the surgical plane, the type and number of resection performed by the surgeons, the regression grade after preoperative chemoradiotherapy and the gender. CONCLUSIONS - In addition to the traditional histopathological features the pathologist has to investigate the quality features of the preopreative assessment, the surgical planes of excision and the grade of regression after neoadjuvant chemoradiation and feed back these results to the members of the CRC multidisciplinary team. The optimal treatment of the CRC can be achived only in this setting.]



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[Dabigatran treatment prevents stroke in non-valvular atrial fibrillation]

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[New era of anticoagulation]


[Two types of anticogulants have been introduced into the clinical practice and used succesfully for more than 60 years: the heparins and the cumarins. Blood coagulation is targeted by the two drugs on many sites, their inhibitory action is not specific. The hirudins as specific trombin inhibitors have been introduced later for specific indications. After the discovery of the exact structure of the clotting factors, the drug development could have been directed against its active center which made possible the development of more specific anticoagulants. Some attributes of an ideal anticoagulants: sufficient efficacy with safe administration, predictable therapeutic effect with fixed dosing, no need for monitoring, oral administration, to have a specific antidote, no food or drug interactions. New anticoagulants are inhibitors of the initiation of blood coagulation. Tissue factor pathway inhibitors; inhibitors of the propagation of clotting process: activated protein C; indirect factor Xa inhibitors (requiering antithrombin to its actions: pentasaccharide, idrabiotaparinux and ultra-low-molecular weight heparins); direct FXa inhibitors, acting without antithrombin: rivaroxaban and apixaban; and out of the direct oral thrombin inhibitors acting against fibrin-formation, dabigatran-etexilate are discussed.]

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Clinical Neuroscience

Association of anterior thoracic meningocele and azygos lobe of the lung

DENIZ Ersay Fatih, SENAYLI Atilla, BICAKCI Ünal

Here we report an anterior thoracic meningocele case. Twoyears- old female patient was presented with kyphosis. Azygos lobe of the lung was also demonstrated during radiological studies. Posterolateral thoracotomy incision and extralpeural approach was performed for excision of the anterior meningocele to untether the cord. Although both anomalies are related to faulty embryogenesis and it is well known that faulty embryogenesis may also reveal coexisting abnormalities, we could not speculate a common mechanism for anterior thoracic meningocele and azygos lobe of the lung association.

Clinical Neuroscience

[Tension-type headache in ulcerative colitis]

TAJTI Jr. János, LÁTOS Melinda, ÁBRAHÁM Szabolcs, SIMONKA Zsolt, PASZT Attila, LÁZÁR György

[Background and purpose - Tension-type headache is a very common disease with a high socio-economic impact as its lifetime prevalence is 30-78% in the general population. The incidence of inflammatory bowel diseases is continuously rising. Limited data are accessible on quality of life in patients with surgically treated ulcerative colitis. The aim of our study is to examine quality of life, concerning headache, among patients who had undergone surgery due to ulcerative colitis. Methods - Between 1 January 2005 and 1 March 2016, surgery was performed due to ulcerative colitis in 75 patients. During this retrospective analysis the average duration of the follow-up was 46 (1-124) months. The pre-sence of headache was evaluated by the use of Brief Illness Perception and Headache Questionnaires. Results - Among the primary headache disorders (n=27), tension-type headache occurred in 19 (70.4%) cases, and 8 (29.6%) patients had migraine (without aura). Among tension-type headache cases 17 (89.5%) patients experienced episodic form and 2 (10.5%) suffered from chronic form. Patients with headache had obtained a significantly higher score on Brief Illness Perception Questionnaire. Conclusions - According to our study tension-type headache is common among patients with ulcerative colitis. This observation raises the question whether stress plays role in the pathogenesis of both diseases, which influences and worsens considerably quality of life. Neurological examination, psychological and psychiatric guidance are worth considering in patients with ulcerative colitis.]

Clinical Oncology

[Current strategy in the surgical treatment of abdominal hematogenous metastases]


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Clinical Neuroscience



[The most effective type of epilepsy surgery in adults is temporal lobe epilepsy (TLE) surgery. Three quarter of the patients become seizure free, however the remaining patients experience seizures after resection. In our study we analyzed retrospectively the possible electro-clinical, neuroimaging and surgery-related outcome predictors in 94 adult patients who had anterior temporal lobectomy (ATL) from the material of Epilepsy Centre of the National Institute of Psychiatry and Neurology, Budapest since the beginning of the surgery program in 1989 until 2001. Three outcome endpoints were chosen: the seizure status at the last visit, the longest seizure free period and the time to the first non-acute postoperative seizure. The predictors were assessed by multivariate and Cox regression methods. After one year of surgery 72% of the patients were seizure free, after two years 67% and after five years 59%. Factors predicting favorable outcome in TLE surgery were: typical temporomesial aura, strictly unilateral interictal anterotemporal spikes, unilateral ictal onset, slow contralateral propagation, hippocampal sclerosis (HS) as etiology. Factors predicting poor outcome in TLE surgery were: increase in seizure frequency in the last two preoperative years, presence of preoperative psychiatric disturbances, ictal contralateral propagation, MRI lesion distant from the surgery site, incongruency of data of preoperative investigations, postoperative sequels and non-HS type MR residuum.]

Clinical Neuroscience

Attitude of spine surgeons towards the application of 3D technologies - a survey of AOSpine members

ÉLTES Endre Péter, KISS László, BARTOS Márton, EÖSZE Zsolt, SZÖVÉRFI Zsolt, VARGA Pál Péter, LAZÁRI Áron

Background - 3D technologies (3D virtual and physical model, 3D printing, computer aided engineering, finite element analysis based simulations) play an important role in personalized spine surgery. Objective - In collaboration with AOSpine a global, online survey-based study was performed in order to determine the acceptance rate and the factors which stand against the wider spread of 3D technologies. Methods - A survey containing 21 questions was developed and divided into five pages, every page corresponding to one chapter. Our analysis is based on the responses of 282 spine surgeons from 57 countries. To interpret our results in a global context, we used the Human Development Index of the respondent's countries in comparisons. Results - Significant difference between the AOSpine regions (p ≤ 0.05) was found, with the highest acceptance in Asia-Pacific region. There was no significant difference in acceptance score according to the field of spine surgery, or the surgical experience in years (p=0.77, and p=0.19). In the case of public practice, we found significantly higher acceptance compared to private and mixed (public and private) surgical practice (p ≤ 0.05). The acceptance of the technology varied based on the respondent’s resident country’s Human Development Index and was significantly different between „Medium” vs “Very high” (p = 0.0005) and „High” vs „Very high” (p=0.019) category. Significant positive correlation was found between the acceptance score and the HDI score (Spearman test, ρ = 0.37, p = 0.007). The main limitation factor was identified as the lack of information. Conclusion - There is high interest among spine surgeons towards the incorporation of 3D technologies into the clinical practice. Education, the healthcare system, and the economic environment plays a major role in acceptance. Our results provide the basis of a strategy to promote the application of 3D technologies.