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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]

Lege Artis Medicinae

APRIL 20, 2016

[Extensive retroperitoneal extramedullary hematopoiesis mimicking disseminated abdominal cancer]

KŐVÁRI Bence, DONKÓ Veronika, PIUKOVICS Klára

[INTRODUCTION - Myelofibrosis is a type of chronic myeloproliferative neoplasia frequently associated with extramedullary hematopoiesis. This latter process usually affects the spleen and the liver, and should be designated as nonhepatosplenic extramedullary hematopoiesis if it involves other organs. Nonhepatosplenic extramedullary hematopoiesis is reported to be more common in patients who had splenectomy. CASE REPORT - A 66-year-old woman with 5-year history of myelofibrosis was hospitalized eight month prior to death due to increasing abdominal effusion, abdominal discomfort and dyspnea. Three years before death, splenectomy was performed. The abdominal imaging studies disclosed a circumscribed tumorous mass in the pancreas, with enlargement of the peripancreatic lymph nodes. The lesion interpreted as pancreatic cancer progressed and the patient died. Post mortem histological evaluation confirmed the abdominal mass to represent myeloid metaplasia of the retroperitoneal fat tissue. CONCLUSIONS - Besides the possibility of a secondary primary tumor, the discovery of a novel mass lesion in patients with myelofibrosis should raise the suspicion of extramedullary hematopoiesis, especially when the patient had splenectomy.]

Clinical Oncology

FEBRUARY 10, 2015

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

HARSÁNYI László, BARANYAI Zsolt

[The cornerstone of the therapy of most tumors is still the resecability of the primary tumor: if the cancer can be removed, the chance for recovery will signifi cantly increase. The development of the complex oncologic therapy lead also to the headway of metastasis surgery that used to be a rarity few decades ago. Based on the fi ndings of recent molecular genetic research and multimodular oncologic treatment it was found in more and more tumors that the removal of their metastasis shows benefi t for patients with advanced disease. In order to operate metastatic disease successfully extensive surgical experience and the knowledge of the tumors biologic behavior are required. Thus, the continuous interdisciplinary cooperation and the role of the oncoteam are essential to correct therapeutic decisions. In this review we discuss the possible surgical interventions of abdominal hematogenous metastases of different tumors.]

Clinical Oncology

FEBRUARY 20, 2014

[Management of pancreatic cancer today]

BODOKY György, LAKATOS Gábor

[Pancreatic cancer (PC) is a major health problem with a poor prognosis. The number of patients with PC is increasing globally. There are no screening tests for early detection of PC, but even when diagnosed early, surgery is possible in only a minority of cases. Managing PC remains a big challenge. For selected patients with borderline or unresectable disease, neoadjuvant therapy offers the potential for tumor downstaging. In patients with resectable disease, adjuvant chemotherapy improves the fi ve year survival rate, whereas the use of adjuvant radiochemotherapy is still controversial. In metastatic cancer, monotherapy with gemcitabine remained the main therapeutic option during more than 10 years. Many different combinations with other drugs and new targeted therapies have been tested with gemcitabine. Only a combination of erlotinib and gemcitabine has shown a modest survival benefi t until now. Many gene alterations that directly contribute to pancreas tumorigenesis have been identifi ed or are under active investigation. Recently, the FOLFIRINOX regimen has been reported to be more active than gemcitabine in selected metastatic patients. Quality of life is an extremly important factor, when treating a patient with PC. CA 19-9 serum level can provide important information with regards to prognosis, overall survival, and response to chemotherapy as well as predict post-operative recurrence. There is a strong need for other predictive biomarkers to select patients, who might benefi t from available and new therapeutic options.]

LAM Extra for General Practicioners

DECEMBER 15, 2012

[THE SENSOR-AUGMENTED INSULIN PUMP AND ITS USE IN CLINICAL PRACTICE]

KÁNTOR Irén

[Diabetes is one of the most common chronic diseases. Technological advances provide increasingly refined tools for clinicians to manage type 1 and type 2 diabetes. Continuous subcutaneous insulin infusion (CSII), also known as insulin pump, allows for a sophisticated delivery of basal as well as bolus insulin. Continuous glucose monitoring helps patients and clinicians understand and manage changes in blood glucose trends and minute-to-minute blood glucose variablitiy. The sensor-augmented insulin pump was created by the merging of these devices, which has been a revolutionary step towards self-regulatory, closed-loop insulin delivery or the creation of an artificial pancreas.]

Lege Artis Medicinae

NOVEMBER 22, 2012

[The sensor-augmented insulin pump and its use in clinical practice]

KÁNTOR Irén

[Diabetes is one of the most common chronic diseases. Technological advances provide increasingly refined tools for clinicians to manage type 1 and type 2 diabetes. Continuous subcutaneous insulin infusion (CSII), also known as insulin pump, allows for a sophisticated delivery of basal as well as bolus insulin. Continuous glucose monitoring helps patients and clinicians understand and manage changes in blood glucose trends and minute-to-minute blood glucose variablitiy. The sensor-augmented insulin pump was created by the merging of these devices, which has been a revolutionary step towards self-regulatory, closed-loop insulin delivery or the creation of an artificial pancreas.]

Hungarian Radiology

APRIL 10, 2005

[Radiological diagnostics of the pancreas neoplasms - Onco Update 2005]

FORRAI Gábor, BODOKY György

[Authors reviewed the recent results of pancreas tumour radiological diagnostics and the place of the imaging and interventional methods. Systematical review of the most recent articles were summarized (July 2003-December 2004) in the following subjects: the etiology and clinico-pathology, general diagnostic and therapeutical questions of early pancreatic neoplasms, abdominal ultrasound, computed tomography, multidetector computed tomography, magnetic resonance imaging, MR-cholangiopancreatography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, intraductal ultrasound, endoscopic ultrasound-guided cytology, percutaneous biopsy, positron emission tomography, positron emission tomography - computed tomography, special pancreatic tumours. Experiences about the pancreas diagnostic methods are accumulating year-to-year rapidly. Therefore the current examination algorithm is changing continuously. New diagnostic and therapeutic modalities are entering in the daily practice. These are the reasons why the up-to-date knowledge of the literature is mandatory.]

Lege Artis Medicinae

SEPTEMBER 19, 2007

[THE USE OF ACID SUPPRESSANTS IN PANCREATIC DISEASES]

GERVAIN Judit

[The histamine-2 receptor antagonists and the proton pump inhibitors are part of current therapeutic protocols for most diseases of the pancreas. Acid suppression is definitely recommended to improve the effect of enzyme supplements in chronic pancreatitis and in maldigestion that develop after certain gastric and pancreatic surgeries. For this purpose proton pump inhibitors should be used since they are effective and provide lasting inhibition. In cystic fibrosis, their use is indicated already in the sub-clinical stage and they are also part of the basic protocol for the treatment of Zollinger-Ellison syndrome. Acid suppressants are not routinely used in the therapeutic protocols of acute pancreatitis. Their use is well-grounded in necrotizing pancreatitis in the stage of multiple organ failure to prevent the development of stress ulcer. During enteral tube feeding, their use is indicated to protect the permanently empty stomach and because of the frequent reflux symptoms. The risk of bacterial overgrowth, which is often considered a contraindication, is insignificant if jejunal tube feeding is applied and antibiotic treatment is frequently administered.]

Hungarian Radiology

APRIL 07, 2009

[A rare pancreatic mass in childhood]

TORDAS Adél, PALOTAI Andrea, KISS Imre, KIS Éva

[INTRODUCTION - Malignant pediatric pancreas tumors are rare in the pediatric age group. Among these tumors the malignant hemangiopericytoma is an even more rare condition. CASE REPORT - We have diagnosed this soft tissue sarcoma in a three month old infant during a screening abdominal ultrasound examination. The examination showed a space-occupying lesion in the region of the pancreas and the adrenals. Following further diagnostic imaging, a complete surgical resection was performed. Histology showed malignant hemangiopericytoma. The child received a 5 month long, successful adjuvant chemotheraphy. CONCLUSIONS - Malignant hemangiopericytoma belongs to the non-rhabdomyosarcoma group of diseases. Two subtypes have been described: infantile-type ( hemangiopericytoma) in infants under 1 year, and the adult-type disease in children over 1 year of age. About one third of the infantile subtype are considered congenital. Most common anatomic locations are the retroperitoneum, the pelvis, the extremities, the head and neck region. Prognosis is favorable, the 10-year-survival rate is 80%. Differential diagnosis includes other tumors of the region, such as lesions of the adrenal gland, kidney, stomach and pancreas.]

Hungarian Radiology

AUGUST 20, 2004

[Diagnostic difficulties of pancreatic rupture caused by blunt abdominal trauma]

WENINGER Csaba, ROSTÁS Tamás, MORÓ Zsuzsanna, GERSEI Emma

[INTRODUCTION - The aim of this study was to analyze the radiological observations of four cases of pancreatic fracture caused by blunt abdominal trauma. PATIENTS AND METHOD - The authors diagnosed pancreatic transection in four patient during a 4-year period. The patients were examined with spiral CT. Two children suffered pancreatic injury caused by blunt abdominal trauma (7,5 and 13 years old) and two adult men (40 and 35 years old). RESULTS - The abdominal ultrasound examination was not diagnostic regarding to pancreatic injury, but depicted free abdominal fluid and associated injuries of other organs. The pancreatic fracture was diagnosed only in one case at the first abdominal CT. The examiner failed to recognize the pancreatic transection in two cases at the initial CT. A pseudocyst was diagnosed by the examiner correctly in the 4th case, depicted earlier with US some weeks after the blunt abdominal trauma, but the pancreatic rupture was seen during reviewing of the CT scans, only. CONCLUSION - The recognition of pancreatic injury is difficult but very important, because it requires surgical intervention. In the literature, spiral CT considered as the best imaging technique in the evaluation of pancreatic injury. The radiologist has to think about the traumatic injury of pancreas also and know the signs of pancreatic fracture.]