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Clinical Oncology

FEBRUARY 28, 2020

[Neoadjuvant and palliative drug therapy for bladder cancer]

MARÁZ Anikó

[The survival of patients with muscle-invasive localized bladder cancer is more favorable if they receive neoadjuvant or adjuvant cisplatin-based chemotherapy before or after cystectomy. Based on the meta-analyses, in case of neoadjuvant cisplatin-based chemotherapy, the 5-year survival benefi t is 5-16%. The outcome is even more favorable in case of patients who respond well to neoadjuvant chemotherapy (pathological complete remission rate 12–50%). More than 3 months delay of cystectomy does not signifi cantly reduce the survival if chemotherapy is performed before the operation. Results of adjuvant phase III studies and meta-analyses are not so unambiguous as neoadjuvant data, but chemotherapy seems to infl uence favorably PD-L1 expression the survival, especially in case of pT3/4 and/or N+ (and high grade or margin positivity) cases. According to the recent publications, outcome data of patients have been effective in case of progression after platinum therapy, in or after second-line and in fi rst-line therapies for cisplatin ineligible, PD-L1 positive patients, respectively. Survival and tumor response data are very promising; in particular stages, they seem to be more effective than the previously administered chemotherapies. Current and ongoing trials are investigating the combinations of new remedies with other immunotherapeutic agents or chemotherapies as well as trying to identify biomarkers in order to further increase effectiveness.]

Clinical Oncology

DECEMBER 05, 2017

[Complex therapy of bladder cancer]

LANDHERR László

[Bladder cancer is the most common malignancy involving the urinary system. Urothelial (formerly called transitional cell) carcinoma is the predominant histologic type in the developed countries, where it accounts for approximately 90 percent of all bladder cancers. The optimal management of nonmuscle invasive urothelial cancer is highly important. For patients with muscle invasive cancer the gold standard treatment is the cystectomy. If the patient unable or unwilling to undergo radical cystectomy with urinary diversion, complete TURBT combined with radiation therapy plus chemotherapy may offer an alternative bladder-sparing approach. Patients with muscle invasive disease and regional lymph node metastasis limited to the pelvis (N1-N3), but without more distant lymph node or visceral metastasis may be treated with six cycles of cisplatin-based chemotherapy followed by cystectomy or a combined-modality approach. In metastatic cases the combination chemotherapy may prolong survival and often provides palliation of symptomatic disease. Checkpoint inhibition immunotherapy has substantial clinical activity in post-chemotherapy patients and is the preferred therapy for patients who have progressed after platinumbased therapy or is not suitable for them.]

Lege Artis Medicinae

OCTOBER 20, 2004

[LONG-TERM RESULTS OF ENDOSCOPIC SPHINCTEROTOMY - EFFECTS OF THE TRANSECTION OF BILE PAPILLA]

DÖBRÖNTE Zoltán

[The abolishment of the choledochoduodenal pressure gradient due to endoscopic sphincterotomy results in the enhancement of the enterohepatic circulation of the bile salts, in the reduction of the cholesterol saturation index and in the modification of the gallbladder function: the reduced gallbladder storage time and the increased ejection fraction facilitates gallbladder emptying. On the contrary, bacterial colonisation of the bile ducts due to duodenobiliary reflux plays a causative role in the increased risk of pigment stone formation. However, when the biliary tree is well-drained, no clinically relevant chronic inflammation develops, furthermore there is no evidence for an increased cancer risk caused by the duodenobiliary reflux. Long-term complications may occur in about 12%, as the recurrence of common bile duct stones, post-EST papillary stenosis, and biliary symptoms caused by retained gallbladder stones. Risk factors for recurrence of bile duct stones are juxtapapillary duodenum diverticulae and persistently dilated bile ducts being the main reason for papillary restenosis and sphincterotomies are mainly performed because of papillary stenosis. In cases of retained gallbladder with stones patency of the cystic duct and contractility of the gallbladder are important predictive factors of late gallbladder complications as it was confirmed by our investigations. Accordingly, small gallbladder stones may pass spontaneously after EST. The indication of a cholecystectomy following EST should be considered individually, particularly in elderly patients. As 30-year-experience confirms, EST is a safe and effective treatment of choledocholithiasis and papillary stenosis even in the long term, and also in young patients. Regular follow-up of patients with high risk for recurrent biliary symptoms is recommended to detect late complications and treat them endoscopically in time.]

Lege Artis Medicinae

MAY 20, 2004

[CURRENT STATUS OF THE DIAGNOSTICS AND THERAPY OF UROLOGICAL TUMOURS]

ROMICS Imre

[Significant amount of urological patients have malignant disease. Prostate cancer is the second most frequent cancer in males associated with high mortality and decreased quality of life. Hence the importance of early diagnosis. Furthermore, diagnostical protocols, operative and conservative therapeutic modalities are summarised. Hematuria is the most frequent sign of bladder cancer. Diagnostical, surgical and adjuvant therapeutical differencies of the superficial and muscle invasive bladder cancers are discussed. The urinary deviation after cystectomy could be associated with complications therefore regular follow up of patients is necessary. The standard therapy of renal cancer is surgical. Unfortunately its mortality has not change during past years. Testicular cancer is the disease of young males. If diagnosed early, most cases are curable. Therapy is complex, involving surgical, chemoand radiation therapy as well. Penis cancer is a rare disease, but highly malignant. In advanced stage patients are incurable.]

Hungarian Radiology

DECEMBER 21, 2009

[Diagnosis of ovarian torsion through the ultrasound and in the operating theatre - An audit and review of the current diagnostic modalities]

SHOAIB Shaikh, NYÁRI Edit, KONCZ Júlia, LAKATOS Andrea, LOMBAY Béla

[INTRODUCTION - This audit was carried out to assess the usefulness of ultrasound in the diagnosis of adnexal torsion in pediatric and adolescent patients, and to demonstrate any ultrasound characteristics which are predictive of ovarian torsion in this population. PATIENTS AND METHODS - Retrospective review of ultrasound reports, operative reports, and medical records for 17 pediatric patients treated at BAZ-County University Hospital, Miskolc, was performed. The patients had presented to the pediatric surgery with complaints of abdominal pain between August 2000 and August 2008, and underwent an abdominal/pelvic ultrasound prior to going to the operating room for surgical management. All ultrasounds were categorized regarding the presence or absence of adnexal torsion. Other sonographic parameters included were: the mass size, description, and the presence of signs associated with adnexal torsion (presence and arrangement of ovarian follicles, presence of free fluid in the pelvis, and the presence or absence of arterial or venous flow by color Doppler to the ovaries). Surgical and pathological findings were also studied. RESULTS - All 17 patients in this review were surgically confirmed cases of torsion. 14 (82%) of the torsions occurred on the right side, 3 (18%) on the left side. Ultrasound described 8 adnexal masses with torsion as cystic (n=8, 47%). Pelvic fluid was present in nine patients (53%). Of 10 patients in which follicles were noted, follicles were observed to be peripherally displaced in seven (41%). Only two patients (12%) underwent laparoscopic surgery, remaining received open surgery. On evidence of torsion in the operating room, detorsion was performed in all cases. Finally, tubal cystectomy was performed in 2 (12%), ovarian cystectomy in four (24%), oophorectomy in two (29%), salpingooophorectomy in 6 cases (35%), and oophoropexy was performed in three cases (2%). The majority of pathology in those with confirmed torsion were hemorrhagic cysts in 10 cases (59%), paratubal cysts in three cases (18%), and teratomas in one cases (6%). No histologies were sent for three patients who received oopheropexy. 13 patients (76%) with torsion had adnexal masses greater 5 cm. The duration of complaints prior to treatment was also an important factor: Generally patients with more than one day long complaints underwent oophorectomy, exception to this was a case with intrauterine torsion. CONCLUSIONS - In our audit, patients with adnexal masses greater than 5 cms were more likely to have torsion than those patients with masses less than 5 cms.]

Lege Artis Medicinae

JANUARY 20, 2005

[POST-CHOLECYSTECTOMY SYNDROME AND SPHINCTER OF ODDI DYSFUNCTION]

MADÁCSY László

[After cholecystectomy, recurrent biliary-like pain, alone or in association with a transient increase in liver enzymes may be the clinical manifestation of the sphincter of Oddi dysfunction (SOD). Most of the clinical information concerning SOD refers to postcholecystectomy patients who have been classified according to clinical presentation, laboratory results and endoscopic retrograde cholangio-pancreatography (ERCP) findings as: biliary type I, biliary type II, and biliary type III. The prevalence of SOD has been reported to vary from 9 to 11% in unselected patients having postcholecystectomy syndrome up to 68% in a selected group of patients without organic disorder and complaining of postcholecystectomy pain. Diagnostic work-up of postcholecystectomy patients for suspected SOD includes liver biochemistry and pancreatic enzyme levels plus negative findings of structural abnormalities. Usually this would include transabdominal ultrasound, gastroscopy and ERCP. Depending on the available resources, endoscopic ultrasound and magnetic resonance cholangiography may precede endoscopic retrograde cholangiopancreatography in specific clinical conditions. In SOD patients, the endoscopic sphincter of Oddi manometry is the gold-standard diagnostic method to evaluate the abnormal motor function of the sphincter of Oddi. Quantitative evaluation of bile transit with cholescintigraphy is valuable in the decision whether to perform sphincter of Oddi manometry or to treat. The standard treatment for SOD is sphincterotomy. In biliary type I patients, the indication for endoscopic sphincterotomy is straightforward without the need of additional investigations. Slow bile transit on cholescintigraphy in biliary type II patients is an indication to perform endoscopic sphincterotomy without sphincter of Oddi manometry. Positive Nardi or Debray evocative test in biliary type III patients is an indication to perform sphincter of Oddi manometry. Medical therapy with nitrosovasodilatators, Ca-channel blockers, theophyllin compounds, β2 receptor agonists and anticholinerg drugs can be useful in biliary type II and type III patients preceding endoscopic sphincterotomy. If medical therapy fails, one might proceed to perform ERCP and endoscopic sphincterotomy but only in patients with abnormal SO manometry results.]