Search results

Hypertension and nephrology

JUNE 20, 2019

[Overview of a 10 years kidney biopsies data from the Nephrological and Blood Pressure Center Szeged]

[The authors retrospectively analyzed the data of kidney biopsies performed between 01/01/2007 and 31/12/2016 performed in the Center. During this period 452 biosies were performed. Mean age of patients was 48.7±15.0 years, of them, 43.5% were man and 56.5% women. The nephrotic syndrome was the most common (38.8%) clinical indications for a biopsy. The mos common histological diagnoses were the membranous nephropathy (16.7%), the IgA nephropathy (11.6%) and the FSGS (10.9%). The most common suggestions by nephrologists were the FSGS (17.4%), the membranous nephropathy (16.1%) and the IgA nephropathy (10.3%). These percentages of diabetic nephropathy were 7.5% and 12.2%. Minor complications not requiring any interventions occured in 98 cases (21.7%), major ones in 13 cases (2.9%). By the results FSGS seems to be overrated by nephrologists, but it is among the 3 most common histological findings. Diabetic nephropathy is a similarly excessive clinical diagnosis, sithence the histologically confirmed diagnoses are only a little more than half of it. Regular meetings of pathologists and nephrologists about clinical suggestions and real histological diagnoses may help to improve the ratio of more accurate suggestions.]

Clinical Oncology

MAY 10, 2018

[Immunotherapy of lungcancer – an update]


[Ten years ago the median survival of small cell lung cancer (SCLC) and non small cell lung cancer (NSCLC) was less than one year. In the case of SCLC the situation did not change. There are revolutionary new possibilities in the treatment of NSCLC (histology based cytotoxic chemotherapy, molecular targeted therapy etc.). Unfortunately there is no signifi cant development in treatment strategy of SCLC in the last 30 years. Nowadays in NSCLC immune check point inhibitor therapy is a novel treatment method in the clinical praxis as well. The integration of the PD axis and the CTLA4 inhibitors in the complex therapy of the management of NSCLC is a new challenge. The pembrolizumab monotherapy in fi rst line setting is a new standard of care with high PDL1 expression. In second line setting the pembrolizumab, nivolumab and atezolizumab widely used in clinical praxis as well. In locally advanced disease of NSCLC after radiochemotherapy the durvalumab maintenance monotherapy showed a signifi cant progression free survival benefi t, comparing to placebo. We have got new treatment possibilities in the treatment of SCLC as well. The results of clinical trials with antibody conjugate therapy are promising. The nivolumab monotherapy and the combination treatment of nivolumab + ipilimumab gave promising results as well. In the treatment of SCLC and NSCLC there is a need for biomarker selected therapy (tumor mutational burden [TMB], DLL3, cMyc etc.). Based on the new positive results of the clinical trials there is a possibility to transform lung cancer from a subacute disease to a chronic illness.]

Clinical Neuroscience

MARCH 30, 2019

[Prognostic factors of surgically treated spinal meningeomas and long-term surgical outcomes ]


[Introduction, the aim of article - The spinal meningeomas are one of the most common types of spinal tumors. In the treatment of spinal meningeomas, the surgical removal is the gold standard method. There are many factors that have impacts on surgical outcomes such as age, preoperative neurological condition, the extent of resection and histological grade. The aim of our article is to analyze surgical experiences, prognostic features and long-term surgical outcomes of spinal meningeomas. Patients and methods - Retrospective database of surgically treated patients with spinal meningeomas between 2008 and 2016 was made in the National Institute of Clinical Neuroscience, Budapest, Hungary. Demographic data, preoperative neurological symptoms, radiological discrepancies, pathological results (histology, grade), types of treatments and postoperative results were examined. All of our patients were followed clinically and radiologically in the postoperative courses. Results - All of the 153 patients were surgically treated. We have examined 112 women and 41 men. The average age of the patients was 65.5 years. In 98.7% of the cases, the postoperative control examinations (postoperative 6th week) showed a significant improvement in sensorial and motorial functions. The neurological improvements were evident right after the surgeries. In 2 cases (1.30%), no changes were observed in the preoperative symptoms. Recurrence was noticed in 4 cases (2.61%). Conclusion - According to our results, the spinal meningeomas can be sufficiently treated with early diagnosis and total surgical removal. Most of the patients become asymptomatic and the rate of recurrence is quite low.]

Lege Artis Medicinae

JULY 20, 2017

[Eosinophil granulomatous polyangiitis]


[Due to the high prevalence of kidney involvement, patients with systemic autoimmune disorders, also including small vessel vasculitides are frequently seen in neph-rology centers. Activated neutrophils attacking the wall of various blood vessel are key features in these diseases, leading to bleeding, occlusion, ischaemia and tissue necrosis. This latter finding is reflected in the term necrotising vasculitis. In this paper, we present a case of eosinophil ganulomatous polyangiitis (EGPA, formerly called Churg-Strauss syndrome), the least common form of ANCA associated small vessel vasculitides. We found it very interesting but not uncommon that our patient was admitted to the nephrology ward with vague symptoms that became more and more suggestive and typical for vasculitis during our observation, guiding us to the right diagnosis. Timely and appropriate immunosuppressive therapy based on immunology lab report and histology findings resulted in good response and remission of the disease in our patient. ]

Clinical Oncology

DECEMBER 10, 2016

[Individualized treatment of advanced/metastatic adult soft tissue sarcomas]

SZŰCS Zoltan, JONES L. Robin

[Considering the extreme histological heterogeneity of soft tissue sarcomas (STS), their management is an art of its own. Over the last decade the treatment of STSs has been slowly shifting towards a more individualized, histology driven tailored approach. With the availability of novel antineoplastic agents and the differential sensitivity of different subtypes of sarcomas to these drugs, we aim to provide some guidance in terms of optimal sequencing of therapies. Furthermore, we discuss some of the emerging targeted therapies currently evaluated for the palliative treatment of the more common and some of the very rare STS subtypes.]

Clinical Oncology

FEBRUARY 10, 2015

[Molecular diagnostics of brain tumors - an up-date]


[In recent years there have been major advancements in the understanding of molecular events driving brain tumor genesis and progression. Although state-of-the-art techniques are not widely available, many of the molecular discoveries lead to novel antibodies that can assist in identifying the major molecular subgroups by immunohistochemistry. Molecular informations will likely be incorporated into the next World Health Organization (WHO) classifi cation of central nervous system tumors, but clinical practice in many centres have already taken on the available informations and therapeutic decisions are made based on genetic/epigenetic information. In the adult population IDH, ATRX and 1p/19q codeletion studies help to defi ne molecular subgroups that correlate better with prognosis and therapeutic response than traditional histology based diagnosis. The KIAA1549-BRAF fusion gene is a hallmark for pilocytic astrocytomas, while diffuse pediatric gliomas lack the IDH mutations and 1p/19q codeletions that are common in adult astrocytomas and oligodendrogliomas. Uncommon in adults, Histone H3.3 mutations are pathognomic in pediatric brainstem malignant gliomas. Molecular subgroups of medulloblastomas have also been identifi ed, and a corresponding set of antibodies are ready to guide treatment decisions in those centres where molecular techniques are not available. These genetic and epigenetic events determine a tumor’s behaviour, and integrating this level of informations into neuropathology practice is essential to provide the best possible care to both pediatric and adult patients.]

Lege Artis Medicinae

FEBRUARY 15, 2015

[Inflammatory myofibroblastic tumor of abdominal wall arising from uterine myoma]


[INTRODUCTION - The inflammatory pseudotumor appears in various organs. It is well circumscribed, unencapsulated proliferation which simulates malignant tumor clinically as well as radiologically and morphologically. It’s etiology is unknown. The histology prooves inflammatory origin of this process: the nodular structure of the tumor-like mass is composed of fibroblasts, myofibroblasts, plasma cells and lympho­cytes. Recurrence may happen. CASE REPORT - Because of the rapidly expanding uterine myoma of a 40 years old woman laparotomy has been performed. In the lower two-thirds of abdominal wound the myoma penetrated into the abdominal wall. Here the abdominal wall lost it's normal structure, became bacon-like, homogenous in consistency and white-grey in colour. The myoma and the attached part of the abdominal wall was excised together. The part of myoma those in contact with abdominal wall contained proliferating myofibroblasts, fibroblasts and was infiltrated by plasma cells and lymphocytes. These findings could be seen in the abdominal wall too. The rapid proliferation which simulated malignant tumor has been diagnosed as inflammatory myofibroblastic tumor. The patient does well two years after the operation. CONCLUSION - It is important to know about the entity of inflammartory pseudotumor in differential diagnostic point of view, as it mimics malignant tumor. The structure is nodular, the histology is characteristic and the therapy is surgical. The follow up is very important because of possibility of probable recurrence. ]

Clinical Neuroscience

MAY 30, 2012

[Prognostic factors of primary spinal tumors]

LAZÁRY Áron, BORS István Béla, SZÖVÉRFI Zsolt, RÓNAI Márton, VARGA Péter Pál

[Aims - Primary spinal tumors are rare diseases and there are less objective data in the international literature. We analyzed the epidemiology and clinical consequences of primary spinal tumors based on the clinical experience of the National Center for Spinal Disorders. Methods - Demographic and clinical data of 300 patients treated in our institute between 1995 and 2007 was collected retrospectively and analysed. Results - Beyond the relatively more frequent pathologies (chordoma, myeloma multiplex) we treated in our hospital some of the very rare types of tumors (spinal leiomyosarcoma, synovial sarcoma). Primary spinal tumors are most often located in the lumbosacral region causing most frequently (73%) local or radiating pain. Modern therapy of these patologies is based on the surgical intervention. Mean operation time was 130 minutes, mean blood loss was 650 ml in our pratice during these often technically challenging surgeries. We found a significant association among the operation time, the blood loss and the extension of the tumor (p<0.01). Histology (p<0.0001), severity of symptomes (p<0.05) and blood loss (p<0.05) were significantly related to mortality. Local recurrence was more than 5-fold in case of patients previously operated in another institute (p<0.0001). Conclusions - We successfully determined some significant prognostic factor on clinical behavior of primary spinal tumors performing a large scale retrospective study. Long time follow up of the patients and completion of our database with prospective data are planned for the future.]

Hypertension and nephrology

JUNE 10, 2011

[Postconditioning in major vascular operations for the prevention of postoperative renal complications]


[Objectives: During vascular surgeries on the abdominal aorta, lower extremities suffer ischaemia-reperfusion (IR) injury which can lead to rhabdomyolysis. A severe complication is the myonephropathic metabolic syndrome with acute renal failure. The aim of the study was to investigate whether postconditioning (rapid repetitive cycles of ischaemia and reperfusion on the onset of the organ reperfusion, a novel technique to reduce ischaemia-reperfusion injuries) could prevent renal failure in major vascular surgery. Subjects and methods: Male Wistar-rats underwent 180 minutes of bilateral lower limb ischaemia and four hours of reperfusion. Postconditioning consisted of 6 cycles of 10-second aortic occlusion/10-second declamping. Microcirculation of the kidney was detected with laser Doppler flowmeter. After 4, 24, 72 hours of reperfusion serum, urine, and histological samples were collected. Acid-base state was evaluated immediately after reperfusion. Results: After four hours of reperfusion there were no significant histological alterations in the muscle in contrast to the 24 hour rhabdomyolysis with inflammation. CK, LDH, AST levels increased in the acute phase but improved in the 24th and 72nd postoperative hours. Kidney histology and laboratory tests showed definite signs of acute tubular injury in control animals. In the early stage serum creatinine; seBUN/creatinin; FENa showed significantly (p<0.05) lower kidney injury in the postconditioned group. Postconditioning improved the kidney cortex microcirculation. Conclusion: Postconditioning can reduce the prevalence and consequences of renal failure after experimental major vascular surgery in rats.]