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Clinical Oncology

FEBRUARY 20, 2019

[Practical use of meta-analyses in predicting disease risk, outcome, and therapy response in breast cancer]

KAHÁN Zsuzsanna, TARI Gergely, ENYEDI Márton, HARACSKA Lajos

[Germinal BRCA status infl uences patient care both in early and advanced/metastatic breast cancer. Ideally, the patient should make the decision on the type of surgery or the avoidance of radiotherapy being aware of the BRCA status; based on the most recent clinical studies, this knowledge may infl uence the type of chemotherapy in the neoadjuvant, adjuvant, or metastatic setting or may raise the use of emerging targeted therapies. DNA-targeting cytostatic agents, mostly platinum agents and PARP inhibitors that act by inducing synthetic lethality, provide specifi c therapies in BRCA-mutant cases. The optimum place and sequence of these specifi c agents in treatment, however, are not known yet. International guidelines promote BRCA testing for the specifi cation of treatment strategy in all HER2-negative advanced/metastatic breast cancer cases (NCCN) or at least in all cases when, based on certain predictors, the presence of mutations is likely (ESMO). Recently, the methods employed for BRCA testing have improved immensely and are widely available through the services of various providers. For the identifi cation of the mutation, sequencing of the whole genes is needed, which can be achieved faster and more cost-effi ciently using next-generation sequencing (NGS) platforms compared to previous methods. It is the responsibility of the physician to consider the possibility of BRCA mutations and to raise the issue of BRCA testing to the patient if the family history, the age, previous malignant disease(s) of the patient, or the cancer features are suggestive of genetic risk.]

Clinical Oncology

FEBRUARY 20, 2019

[Liquid biopsy in clinical oncology – fine-tuning precision medicine]

PRISKIN Katalin, PINTÉR Lajos, JAKSA Gábor, PÓLYA Sára, KAHÁN Zsuzsa, SÜKÖSD Farkas, HARACSKA Lajos

[The classical method of genetically characterising a tumour requires tissue biopsy with which a small sample is removed from the affected organ. This sample represents the tumour in the further analyses. However, the localised nature of sample collection limits representative characterisation. The so-called circulating tumour DNA, isolated from blood plasma after a simple sample collection, potentially enables the oncological analysis of all tumour tissues carrying genetic alterations that can be identifi ed as markers. In order to maximally exploit the potentials of circulating tumour DNA, we must adjust the analytical tools to its specifi c features. The preanalytical handling and storage of the sample signifi cantly infl uences its further usability. In order to be able to detect a potential mutation in a mostly wild-type background, the development of new, specifi c methods is needed, most of which are based on next-generation sequencing techniques. In the past decades, the pronounced decrease in the costs of such techniques led to an accumulation of an immense amount of genetic information on tumorigenesis. Due to the development of sequencing technologies, the turnaround times of tests also decreased enabling their employment in routine care besides research. Starting from our research, this can be realised via three approaches: technological development, the implementation of our already existing diagnostic methods in liquid biopsy, and the construction of well-planned disease-specifi c gene panels. Based on international trends and our experience in serum diagnostics, we are certain that liquid biopsy will become a central pillar of oncological screening and precision oncology in the near future.]

Clinical Oncology

DECEMBER 10, 2018

[The use of NGS in oncology in diagnostic setting]

BECSÁGH Péter

[Today the information could be the basis of further development by collecting, saving, structuring and analyzing them. Inside the living organism and inside viruses the biochemical storage system was evolved. The linear coding inside macromolecular structures could create and store a series of building block combinations along the chain structure. Those chemical structures are the so called information coding macromolecules, for example, the polypeptides and nucleic acids. Analysis of the genetically coded functionalities of tumor cells has a great impact in the oncological setting. The connected functions of inherited or acquired alterations inside the tumor cell clones are the main contributors of tumor evolution and surviving, although provide a way to target possible mechanism and touch points. Today the oncodiagnostic use of next generation sequencing technology focus on tumor evolution and tumor surviving connected gene set analysis. This kind of gene panel analysis connected to NGS technology is enough enforced - enforced enough - to reach the diagnostic level, but one still need to take care about the quality and standardization to meet the IVD conditions.]

Clinical Oncology

MAY 10, 2018

[Fusions in solid tumors]

KOPPER László

[Genetic fusions are the cosequence of genomic rearrangement including chromosomal inversion, interstitial deletion, duplication, amplifi cation, translocation. Fusions can influence tumor development and progression. Fusions fi rst discovered in hematological malignances (e.g. BCR-ABL), butlater more and more were identified dueto the higly sensitive NGS. It has been found that the oncogenic fusions are in minority in a given tumor. Today, some fusions were apprevedas targets (ALK, ROS1, PDGFB) by FDA. Asino ther targeted therapy resistance is in evitable, which is a very important challenge for newly designed drugs.]

Lege Artis Medicinae

JUNE 20, 2016

[Neurological symptoms in a patient with treated multiple myeloma]

ZOMBORI Tamás, PIUKOVICS Klára

[INTRODUCTION - Meningeal infiltration by multiple myeloma is rare. Its incidence among cases of multiple myeloma is 1%. CASE REPORT - Multiple myeloma was diagnosed in a 53-year-old woman in December 2014. After chemotherapy, the disease was treated with autologous bone marrow transplantation in June 2015. Remission was observed through two months, but in August the patient was hospitalized due to severe headache with neck stiffness. Meningitis or viral encephalitis were suspected following her investigation. She was taken to the Intensive Care Unit because of a progression to status epilepticus. The EEG-examination revealed generalized slow wave activity and a right temporal epileptiform focus manifesting rarely. Clinical brain death developed on the 17th day in hospital. DISCUSSION - Although meningeal infiltration is infrequent in multiple myeloma, the present case report draws attention to this possibility. ]

Clinical Neuroscience

MARCH 20, 2007

[HUMAN TRYPSIN(OGEN) 4-LIKE IMMUNOREACTIVITY IN THE WHITE MATTER OF THE CEREBRAL CORTEX AND THE SPINAL CORD]

GALLATZ Katalin, MEDVECZKY Péter, NÉMETH Péter, SZILÁGYI László, GRÁF László, PALKOVITS Miklós

[Human brain trypsin(ogen) 4-like (HT-4) immunoreactivity was localized in glial cells of human cerebral cortex and spinal cord. After a short post mortem delay (two hours), cortical and spinal cord regions were dissected, frozen or immersed into a fixative solution. Sections of 10 and 50 µm thickness were cut and immunostained by antibodies raised against recombinant human trypsin 4. HT-4-like immunoreactive glial cells and fibers were stained in the white matter, low to moderate levels of immunostaining were also observed in the matrix of the cerebral cortex and the spinal cord. To characterize HT-4-like immunopositive glial cells, alternate sections were immunostained for astrocytes and oligodendrocytes. HT-4 is present predominantly in astrocytes, but some of the oligodendrocytes and microglial cells may also contain this enzyme.]

Hungarian Radiology

DECEMBER 10, 2005

[X-ray examination of paintings]

SZABÓ Éva, SZENTKIRÁLYI Miklós

[INTRODUCTION - After the discovery of X-ray it was not only used for medical purposes, but also to study the internal structure of various objects. The X-ray examination can be applied not only to examine paintings, but other works of art. METHODS AND RESULTS - The rontgenograms are made by industrial film without any screen in the museum. In case of paintings soft-beam examination technique was used. The basic principle of the X-ray examination of different paintings is based on the presence of different atomic number in different paints. Authors after the examination of four paintings achieved a significant finding. In these paintings the stylistic and structural features of the pictures, injuries, originality, changes in the composition during the work of the artist can be studied. CONCLUSIONS - Recordings made by an industrial radiological equipment in the Museum of Fine Arts (Budapest) are helpful in the restorer work.]

Lege Artis Medicinae

FEBRUARY 21, 2004

[LARGE VESSEL MANIFESTATION OF GIANTCELL ARTERITIS]

KOLOSSVÁRY Endre, PINTÉR Hajnalka, ERÉNYI Éva, KOLLÁR Attila, FARKAS Katalin, KISS István, HARCOS Péter, SIMON Károly

[The diagnosis of giant-cell arteritis is a real challenge for clinicians. There are several reasons for the difficulties in establishing the diagnosis. This disease is associated to rare conditions, therefore most physicians lack clinical experience. This condition shows very heterogeneous manifestation, the intensity of the symptoms vary in time. Early diagnosis is of great importance in order to prevent ischemic complications. Among these complications one should emphasise the role of anterior ischemic optic neuropathy that may result in abrupt blindness. In this case report, we show a rare socalled large vessel manifestation of giant-cell arteritis. This form of the disease needs different approach in diagnosis where color duplex ultrasonography may have distinguished importance. The final verification of the diagnosis is based on histology. However the lack of all histological criteria do not exclude the presence of giant-cell arteritis.]