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Clinical Oncology

MAY 20, 2016

[Mediastinal tumours and their therapy]

AGÓCS László

[Due to the tissue structure of the mediastinum a large variety of tumours and multiple systemic malignant disease may occur in the region. The tumours show a variation depending upon age and localization besides their signifi cant alterations. Based on the most accepted Shield classifi cation, the author discusses the types, characters and therapeutic discipline of the tumours in the mediastinal region. The author focuses on the surgical indications, their options and forms, highlighting on the minimal invasive methods.]

Clinical Neuroscience

JULY 30, 2016

[Meningioma and pregnancy]

BENCZE János, VARKOLY Gréta, HORTOBÁGYI Tibor

[Meningiomas are one of the most frequent primary intracranial tumours, representing one-third of all intracranialneoplasms. The vast majority of meningiomas are histologically benign, but recurrence and progression is quite frequent. They occur usually between the 6th and 7th decade, the female/male ratio is 3:2. Although rare in pregnancy, when occurring, they can cause serious, life-threatening complications due to rapid growth and unfavourable localisation. There are two dominant hypothesis explaining rapid growth in pregnancy: the role of hormonal effects and hemodynamic changes. Several studies tested these theories but none provided unequivocal answer probably because the pathomechanism is complex and multifactorial. We provide an overview of the pathomechanism of meningiomas in pregnancy with emphasis on data obtained by advanced neuropathological, molecular biological, bioinformatic, imaging and epidemiological methods. A better understanding of the processes leading to meningioma development and growth in pregnancy will help us to design personalized therapy and reduce morbidity and mortality.]

Clinical Oncology

DECEMBER 05, 2014

[Bone metastases - Current treatment strategy]

BOÉR Katalin, NÉMETH Zsuzsanna

[Bone is the most common site of metastatic disease in many solid tumours, mainly in breast, prostate and lung cancer. Patients with bone metastases are at risk for skeletal-related events such as bone pain, pathological fractures requiring surgery and/or radiation to bone lesions, hypercalcemia, and spinal cord compression. Skeletal-related events are major source of morbidity for cancer patients and may be associated with negative impact on quality of life and survival. Bisphosphonates inhibit osteoclast function and are widely used in the treatment of malignant bone disease, as preventive therapy against skeletal-related events. Recently, the NF-κappa B-ligand (RANKL)-mediated osteoclast activity and this pathway in bone metabolism became a prime target for the treatment of bone metastases. The fi rst drug targeting the RANK-RANKL pathway is denosumab, a fully monoclonal human antibody which binds to RANKL and inhibits osteoclast activity. Nowadays optimal treatment of bone metastases requires multidisciplinary management of patients including the administration of bone-modifying agents such bisphosphonates or denosumab. The use of bone-targeted agents is a valuable additional treatment in the fi ght against bone metastases and multiple, randomised trials have demonstrated the effectivity of these drugs in reducing skeletal morbidity caused by advanced cancer.]

Clinical Neuroscience

SEPTEMBER 30, 2015

[Molecular pathology of meningiomas]

MURNYÁK Balázs, CSONKA Tamás, HORTOBÁGYI Tibor

[Meningiomas represent nearly one-third of all adult primary brain tumours. According to their clinical and histologic appearance, they can be divided into WHO grades I-III. Almost 90% of meningiomas are benign, showing favourable response to conventional therapies, however, patients diagnosed with grade 2 and 3 tumours may have a poor prognosis. In addition, high frequency of tumour recurrence renders treatments more challenging even in benign meningiomas. Molecular-pathological profiling of meningiomas could lead to development of more effective therapies. Although the cytogenetic background of these tumours are already wellcharacterised, the majority of related genes and mutations is still unknown. Recently, high-throughput techniques enabled better characterisation of mechanisms involved in meningioma development, progression and recurrence. Furthermore, epigenetic dysregulation could offer new opportunities for both diagnosis and treatment of meningiomas. We provide a comprehensive overview of cytogenetic and molecular genetic defects as well as epigenetic alterations in meningiomas. Many of these may serve as biomarker or therapeutic target in the near future.]

Lege Artis Medicinae

NOVEMBER 20, 2013

[Therapeutic options for the treatment of neuroendocrine tumors]

TÓTH Miklós

[This paper provides an overview of the latest clinical advances regarding state-of-theart treatment of neuroendocrine tumours. The first-line treatment of any localized neuroendocrine tumour is surgical removal of the tumour. The only exceptions are certain small gastric carcinoids and small, hormonally inactive pancreatic tumours associated with multiple endocrine neoplasia type I. The treatment strategies of disseminated neuroendocrine tumours should be based on a pathological diagnosis that uses the 2010 WHO classification (neuroendocrine tumours G1 and G2, neuroendocrine carcinoma G3). Debulking surgery and radiofrequency ablation can be used effectively not only as an anti-tumour treatment but also in patients with severe symptoms and hormone overproduction resistant to treatment. The use of somatostatin-analogs is considered to be standard treatment in functional neuroendocrine tumours of any origin, as well as in the anti-tumour therapy of G1/G2 small intestinal neuroendocrine tumours. For progressive G1-G2 neuroendocrine pancreatic tumours, streptozocin-based combined chemotherapy is the first-line treatment. Targeted drug therapies, such as mTOR inhibitors and tyrosine kinase inhibitors are used as second- or third-line agents in patients with inoperable pancreatic neuroendocrine tumours. Peptide receptor radiotherapy is increasingly used in Europe; however, its final place amongst other therapeutic modalities remains to be investigated.]

Clinical Neuroscience

OCTOBER 05, 2013

[Occurence and molecular pathology of low grade gliomas]

MURNYÁK Balázs, CSONKA Tamás, KLEKNER Álmos, HORTOBÁGYI Tibor

[Background - The WHO grade I. and II. low-grade gliomas represent nearly the 15% of all primary brain tumors. These tumours contain clinically, hisologically and molecularly distinct tumor types. According to their histologic characteristic, grade II glial tumours are the diffuse astrocytoma, oligodendroglioma and oligoastrocytoma subgroups; the ependymal tumors are not included in this study. Methods - In our publication, we analysed the histological diagnosed glioma cases between 2007 and 2011 at our institution. Results - Low-grade gliomas were diagnosed in 127 cases (62 male / 65 female), and the mean ages were 39 years (±20.3). More than half of the cancers were localizated in the frontal lobe, and the second most frequent area was the temporal lobe. Finally, we comlete our report with an overview of major molecular pathways in low-grade gliomas.]

Clinical Neuroscience

OCTOBER 05, 2013

[Occurence and molecular pathology of high grade gliomas]

MURNYÁK Balázs, CSONKA Tamás, HEGYI Katalin, MÉHES Gábor, KLEKNER Álmos, HORTOBÁGYI Tibor

[Background - Glial tumours represent the most frequent type of primary brain cancers. Gliomas are characterized by heterogeneity that makes the diagnosis, histological classification and the choosing of correct therapy more difficult. Despite the advances in developing therapeutic strategies patients with malignant gliomas have a poor prognosis; therefore glial tumours represent one of the most important areas of cancer research. There are no detailed data on the epidemiology of gliomas in Hungary. Methods - In the first section of our publication, we analysed the histological diagnosed cases between 2007 and 2011 at the Institute of Pathology, University of Debrecen Medical and Health Science Centre. We analyzed the incidence of 214 high-grade gliomas by tumor grades, gender, age, and the anatomical localization. Results - The majority of cases were glioblastoma (182 cases), and the remaining 32 cases were anaplastic gliomas. The mean age of patients was 57 years (±16.4), and the male:female ratio was 1.1:1. The most frequent area of tumors was the frontal lobe followed by the temporal, parietal and occipital lobe. We include new findings published recently about glioma patogenesis, molecular pathways, mutant genes and chromosomal regions. We explain briefly the role of selected important genes in glioma genesis and give an update on knowledge provided by modern molecular methods, which could beneficially influence future therapy and the diagnosis of gliomas.]

LAM KID

OCTOBER 04, 2013

[Infective sacroiliitis]

BARTHA Attila

[INTRODUCTION - Pyogen infection of the sacroiliac joint occurs rarely in rheumatological practice. Its clinical symptoms are diverse, so the diagnosis is often made late. CASE REPORT - The author presents a case of a 67-year-old woman. The patient did not have any major diseases nor any predisposing factors for infection. Five days after doing hard physical work she felt strong pain irradiating from her lower back to the right lower limb. She was referred to the Department of Neurology with the diagnosis of right lumbar radiculopathy. She was primarily examined for tumours because of her high red blood cell sedimentation rate and CRP level and her inability to walk. The correct diagnosis was set up on the basis of MRI examination: infective sacroiliitis on the right side, which has spreaded to the adjacent tissues. USguided biopsy was unsuccesful, so empiric antibioitic treatment was started. The patient was discharged from hopsital after 35 days and continued clindamycin therapy at home. At control examination 6 month later she did not have any symptoms or complaints and laboratory examinations did not indicate inflammatory activity. MRI examination still showed an extensive oedema. CONCLUSION - Pyogen arthritis should be considered even in the absence of fever, leukocytosis and predisposing factors. By making the correct diagnosis and starting long-term antibiotic therapy in time, joint destruction is preventable and the patient is curable.]

Journal of Nursing Theory and Practice

FEBRUARY 28, 2013

[Non-healing (chronic) wounds on lower limbs]

DARÓCZY Judit

[The incidence of chronic wounds is high (5-7% of the population); these include ulcers developing due to venal and arterial circulation failure, diabetes, tumours and pathological pressure. Chronic wounds represent serious economic and communal/individual social problems. Their treatment takes place at every level of healthcare: primary care, home nursing, specialist clinics, acute inpatient care and rehabilitation wards. Treating the wounds requires specialist expertise. Continuous training is essential, not only for doctors but also for nurses. Doctors and nurses have to work together in order to treat the wounds. The author sets out to describe the physiological basics of the healing of the wounds, the clinical properties of the wounds, and the principles of their professional treatment. ]