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Clinical Oncology

FEBRUARY 10, 2017

[Radiochemotherapy - questions/answers]

PIKÓ Béla, LACZÓ Ibolya

[During chemoradiotherapy the two main non-surgical anticancer methods are combined to improve the treatment outcomes. The theoretical possibilities of interactions and the most frequently used drugs will be presented here, emphasizing that although both the radiation therapy and the drugs need to be administered in full dose in practice considering the summarization of side effects we often have to make compromises. The treatments of the most frequent indications (brain, head and neck, oesophagus, lung, stomach, pancreas, rectum, bladder, cervix, soft tissue sarcoma) will be demonstrated. Since there are several drugs and drug combinations that are not included in the Hungarian registered anticancer therapies, for their off-label use the permission of the National Institute of Pharmacy and Nutrition is required. To choose the optimal treatment (during planning the optimal place of chemoradiotherapy, agents and doses) the opinion of a multidisciplinary team is necessary]

Clinical Oncology

MAY 10, 2015

[Invasive endoscopy in oncology]

MADÁCSY László

[Recent advances in interventional gastrointestinal endoscopy have led to a large variety of new diagnostic and minimally invasive endoscopic surgical procedures in oncological patients. Endoscopic ultrasound with the possibility of fi ne needle aspiration is currently one of the most accurate imaging technology for adequate staging of gastrointestinal cancers including oesophageal, gastric, rectal and pancreatic cancer. Endoscopic mucosal resection and endoscopic submucosal dissection offers a minimal invasive endoscopic treatment modality as an alternative for laparoscopic surgery for patients with early intramucosal neoplasias, fl at adenomas and laterally spreading tumors of the oesophagus, stomach, duodenum and colorectum. Self-expandable metal stents are now readily available for endoscopic palliation of different type of malignant gastrointestinal obstructions including oesophageal, duodenal, colonic and biliary stenosis. These recent developments of interventional gastrointestinal endoscopy lead to more precise and accurate tumor staging and more effective oncological therapy for patients with gastrointestinal cancers.]

Lege Artis Medicinae

JANUARY 21, 2006

[THE ROLE OF THE CONSUMPTION OF HOT FOOD AND DRINK IN THE DEVELOPMENT OF OESOPHAGEAL SQUAMOUS CELL CARCINOMA]

SZÁNTÓ Imre, ENDER Ferenc, BANAI János, ALTORJAY Áron, SELI Artúr, FARSANG Zoltán, VÖRÖS Attila

[INTRODUCTION - Potential risk factors leading to the development of squamous cell carcinoma in the oesophagus have been analyzed and summarized in a number of epidemiological studies. Authors disagree as to the pathogenic significance of the individual risk factors in various populations. However, it is commonly accepted that alcohol abuse and smoking play a significant role in the development of this disease. Several reports have suggested a positive relationship between oesophageal squamous cell carcinoma and the consumption of hot food and drink. A recent publication, however, claims that the consumption of hot drink is not a pathogenic factor in itself. In our study we wished either to confirm or to rule out a positive relationship between the development of oesophageal squamous cell carcinoma and the history of consuming hot food or drink. PATIENTS AND METHODS - During the study period (1 January, 1993 - 31 September, 2004) 449 patients with oesophageal squamous cell carcinoma were examined in our endoscopy laboratory. Histories were taken according to a predefined scheme. The aim was to identify patients with a history of consuming hot food or drink and to determine their percentage within the study population. A group of 738 patients examined endoscopically for indications other than oesophageal cancer served as controls. RESULTS - In the control group a significantly higher proportion of patients tended to consume hot food or drink compared to patients with cancer. Among the patients with oesophageal tumour who consumed hot food or drink a higher proportion was addicted to smoking and alcohol compared to the control group. CONCLUSIONS - In our study population we failed to identify a positive relationship between the development of squamous cell carcinoma in the oesophagus and the habit of consuming hot food or drink. We suggest that consumption of hot food or drink may play some role in the development of oesophageal cancer if it is associated with simultaneous smoking and alcohol consumption.]

Lege Artis Medicinae

NOVEMBER 20, 2005

[MANAGEMENT OF LIFE-THREATENING ENDOSCOPIC THERAPY-RESISTENT OESOPHAGUS VARICEAL BLEEDING]

ERŐSS Bálint Mihály, SZÉKELY György, SIKET Ferenc, LÁZÁR István

[INTRODUCTION - Liver cirrhosis has two serious consequences: hepatic failure and portal hypertension. Portal hypertension has two important clinical appearances: variceal bleeding and therapy resistant ascites. Variceal bleeding can be recurrent and resistant to endoscopic treatment. These complications can be prevented by implantation of Transjugular Intrahepatic Portosystemic Shunt (TIPS). CLINICAL CASE - A 59 year old male with cirrhosis due to hepatitis C, was hospitalized in our department in April 2004 with variceal bleeding. We tried to control the bleeding twice by band ligation, once by sclerotherapy and with the use of Sengstaken-Blakemore tube, but bleeding continued for three weeks despite the endoscopic treatment. The patient needed intensive care therapy and was treated with more than forty units of packed red cells and plasma. At that point we decided to implant a TIPS, which was carried out succesfully. After TIPS implantation no rebleeding occured and the shunt had good patency. Moderate hepatic encephalopathy was observed, which is a well known phenomenon, but it could be treated with pharmacologic therapy. CONCLUSIONS - In case of portal hypertension TIPS implantation can prevent from variceal rebleedings and may caus significant improvement in the quality of life.]

Hungarian Radiology

FEBRUARY 15, 2005

[Esophageal diverticula in mixed connective tissue disease]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - The functional and morphological changes of oesophagus occur in two third of mixed connective tissue disease patients according to the literature. CASE REPORT - We report three cases of 27, 39 and 48 year old women suffering of lateral pharyngoesophageal, epibronchial and epiphrenic diverticula associated with connective tissue disease. Diverticula had an average diameter of 3.8 cm (maximal diameters: 7.2-8 cm). The esophageal pouches produced dysphagia, dystonia, motility disorders, food stagnation and vomiting, retrosternal burning sensation and tachyarrythmia after 5-16 month's latency period. In one patient pneumoesophagus also evolved. The high serum enzyme levels and proximal electromyogram proved the presence of polymyositis. CONCLUSION - The localization, number and the size of esophageal diverticula are determined by the interstitial myopathy.]

Lege Artis Medicinae

AUGUST 20, 2003

[The connection between gastroesophageal reflux disease and obstructive sleep apnoea]

DEMETER Pál, VÁRDI Visy Katalin

[Clinical knowledge on the gastroesophageal reflux disease has been increased with the subject of extragastrointestinal complications in the last decade. Because of cardiological, pulmonological, laryngeal and dental complications, an interdisciplinary approach is required. The non-cardiac chest pain, bronchial asthma, chronic bronchitis, chronic caugh, posterior laryngitis and acidic damage of dental enamel are the most important complications. Authors study a less common connection between the gastroesophageal reflux disease and obstructive sleep apnoea. Sleeping can be considered as a risk factor of the reflux event by itself, because of the decrease of primary peristalsis, producing of saliva, and acidic and volume clearance of oesophagus as well. During obstructive sleep apnoea negative intrathoracic pressure increases extremely, resulting in increased transdiaphragmatic gradient of pressure as well. In addition, the powerful movement of diaphragm twitches the lower oesophageal sphincter through the phrenoesophageal ligament. These two mechanism practically promotes the reflux event in patients with obstructive sleep apnea. The new challenge for the gastroenterologists is to further research this new connection, to play more active role in the complex therapy, and to have a new diagnostic approach of serious gastroesophageal reflux disease.]

Lege Artis Medicinae

JULY 10, 2001

[Endoscopic diagnosis of oesophageal intramural metastasis from an adenocarcinoma of the gastrooesophageal junction]

SZÁNTÓ Imre, VÖRÖS Attila, NAGY Pál, GONDA Gábor, ALTORJAY Áron, BANAI János, GAMAL E. Mohamed, KISS János

[INTRODUCTION - Authors present six cases of intramural oesophageal metastases of adenocarcinomas located in the gastro-oesophageal junction. The tumours and metastases were diagnosed by endoscopic examinations. PATIENTS AND METHODS - Between 01. 01. 1994. and 31. 12. 2000. a total number of 143 patients were examined with the diagnosis of adenocarcinoma of the gastro-oesophageal junction. In six patients (4,19 %), intramural oesophageal metastases were verified. In each case the diagnosis was confirmed by histological examination. TNM stage of the tumours was assessed considering the results of endoscopic ultrasound examination, the findings at initial operation and the pathological data in all cases, where resection was performed. The tumours were localized according to Siewert- Stein’s classification. RESULTS - In six patients who had adenocarcinoma of the gastro-oesophageal junction, the diagnosis of intramural oesophageal metastases was confirmed. The histological structure of the primaer tumours and metastases were the same. Metastases were detected by endoscopic ultrasound examination in three cases of the four examined patients as submucosal masses. All of the cardiac tumours proved to be well advanced: four of them classified as T4N1 by endoscopic ultrasound. Intramural metastases were diagnosed in each Siewert-Stein subgroups. CONCLUSION - Endoscopic examination is of crucial importance in the diagnosis of adenocarcinomas of the gastro-oesophageal junction and in their intramural metastases as well. Beside the endoscopic identification the primary tumour, the thorough examination of the proximal part of the oesophagus seems to be of great importance. These metastatic cancers appeared in the advanced stage of the disease. Endoscopic ultrasound examination is of great help in these cases to identify whether the mass causing oesophageal impression is outside of the wall of the organ, or in which layer it is localized. Endoscopic ultrasound examination also gives the possibility for preoperative assessment of the TNM stage of the disease.]

Lege Artis Medicinae

DECEMBER 16, 2006

[CLINICAL ASPECTS OF NOCTURNAL GASTRO-OESOPHAGEAL REFLUX]

DEMETER Pál

[Gastro-oesophageal reflux that occur at night has special clinical features and thus require extra attention. During sleep most anti-reflux mechanisms diminish, which results in prolonged contact between gastric acid and oesophageal mucosa compared to reflux during the day. Nighttime reflux symptoms adversely affect quality of life, vitality, physical and mental health. A further important consequence is the potential exacerbation of respiratory disorders such as asthma and sleep apnea. There is increasing interest in the association between nocturnal reflux and certain extra-oesophageal symptoms, including reflux laryngitis and chronic cough. An increased risk of erosive damage and adenocarcinoma of the oesophagus are also observed among patients who report nocturnal reflux symptoms. The primary goal of treatment is to improve quality of life and reduce the risk of complications by decreasing the time of acid contact with oesophageal mucosa. Nighttime reflux symptoms are much more difficult to control than daytime symptoms. Treatment guidelines generally recommend lifestyle changes as the initial approach in managing nocturnal symptoms, however, this is successful in only a small proportion of patients. Evidence-based reviews and meta-analyses favour the use of proton pump inhibitors in the treatment of gastro-oesophageal reflux disease and reflux-oesophagitis. Proton pump inhibitors are the most efficient acid-suppressing agents and thus diminish the harmful effect of acidic gastric reflux on the oesophageal mucosa. In addition, by decreasing the volume of gastric acid, they reduce the tendency to reflux.]

Lege Artis Medicinae

NOVEMBER 19, 2006

[TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE]

PAPP János

[In the acidic type of gastroesophageal reflux disease treatment is based on the use of proton pump inhibitors. Efficiency of the treatment is primarily assessed by the changes in symptoms. A long-term, continuous drug use is invariably necessary. In typical cases an increased dose or combination therapy is rarely required, however, in the presence of extraesophageal symptoms, the use of higher doses has been found to be beneficial. The minimum efficient drug amount is usually determined by gradually decreasing the dose. Surgery is mainly recommended for young patients, but it is indispensable in the management of complications or in volume reflux. Endoscopic antireflux therapy is still considered a clinical trial. Treatment of Barrett’s oesophagus by drugs or antireflux surgery does not decrease the incidence of Barrett’s cancer - the mostly recommended approach is endoscopic ablation.]