HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program.

OBJECTIVES: The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases. METHODS: A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients. RESULTS: The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology's archive or the Hungarian Cancer Registry (p < 0.001). CONCLUSIONS: HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary. CLINICAL RELEVANCE STATEMENT: HUNCHEST-II is the so-far largest population-based low-dose CT screening program in Hungary. A positive test's overall positive predictive value was 58%, and most screen-detected malignancies were early-stage lesions. These results pave the way for expansive systematic screening in the region. KEY POINTS: • Conducted in 18 medical facilities, HUNCHEST-II is the so far largest population-based low-dose CT screening program in Hungary. • The vast majority of screen-detected malignancies were early-stage lung cancers, and the overall positive predictive value of a positive test was 58%. • HUNCHEST-II facilitates early diagnosis, thus arguing in favor of introducing systematic lung cancer screening in Hungary.

Thromboembolic complications in COVID-19 patients / Thromboemboliás szövodmények COVID-19-betegekben.

Összefoglaló. Bevezetés: A koronavírus-2 által okozott fertozések igen gyakran súlyos, akut légzoszervi károsodás kialakulásához vezetnek, melynek következtében légzési elégtelenség manifesztálódik. A pneumoniák kialakulásának kezdete (2019. december) óta igen sok beteg szorult kórházi kezelésre. A súlyos tüdogyulladások ellátása során igazolódott, hogy a légzoszervi gyulladásos folyamatok során a betegek jelentos részében vénás, ritkábban artériás thrombosisok alakulnak ki, tovább súlyosbítva a klinikai állapotot. Célkituzés: A 2020. szeptember és 2021. március közötti idoszakban 1590, koronavírus-2 által megfertozött, tüdogyulladással szövodött beteget láttunk el osztályunkon. Betegeinkben azt vizsgáltuk, hogy milyen jellegu és arányú a thromboemboliás szövodmények elofordulása. Módszer: Az 1590, koronavírus-2 által fertozött beteg mindegyikében meghatároztuk a pneumonia súlyosságát; klinikai gyanú eseteiben alsó végtagi Doppler-ultrahangvizsgálatot, valamint komputertomográfiával végzett tüdoangiográfiát végeztünk. Eredmények: A képalkotó vizsgálatok eredményei azt igazolták, hogy a koronavírus-2 által okozott tüdogyulladással kezeltekben 13%-os gyakorisággal fordult elo mélyvénás thrombosis; akut tüdoemboliát a betegek 17%-ában kórisméztünk. Következtetés: A koronavírus-2 által okozott fertozésekben elsosorban a tüdoben, de egyéb szervekben is (szív, vese, máj) súlyos gyulladással járó kórfolyamatok alakulhatnak ki, amelyek hatására fokozott thrombosiskészség jelentkezik a gyulladásos és koagulációs rendszer interakciója következtében. A fokozott thrombosishajlam végeredményeként vénás és ritkábban artériás thrombosisok kialakulása súlyosbítja a betegek klinikai állapotát, s kedvezotlen hatást gyakorol az életkilátásra. Orv Hetil. 2021; 162(43): 1710-1716. INTRODUCTION: The infections caused by coronavirus-2 very often lead to severe, acute respiratory damages, because of which respiratory insufficiency is manifested. As a result, since the development of pneumonias (December, 2019), many patients have required hospitalization. When treating the severe pneumonia cases, it was proved that in a significant number of patients with respiratory inflammatory processes, venous, less often arterial thrombosis occured, making the clinical state even more severe. OBJECTIVE: We treated 1590 coronavirus-2 infected, pneumonia-connected patients between September, 2020 and March, 2021 at our department. We examined the nature and the proportion of the thromboembolic complications. METHOD: We determined the severity of pneumonia in the 1950 coronavirus-2 infected patients; when clinically suspected, they had lower limb Doppler ultrasound examination and angiography carried out with computer tomograph. RESULTS: The result of imaging examinations proved that in 13% of cases deep vein thrombosis occured; in 17% of cases acute pulmonary embolia occured with pneumonia caused by coronavirus-2. CONCLUSION: In coronavirus-2 infected cases, mainly in the lung, but also in other organs (heart, kidney, liver), severe inflammatory disease-processes may occur, as a result of which increased thrombosis tendency shows because of the ineraction of the inflammatory and coagulatory system. As a result of the increased thrombosis tendency, venous and less often arterial thrombosis worsen the clinical state of patients, and have unfavourable effect on life expectancy. Orv Hetil. 2021; 162(43): 1710-1716.

[Carcinomatous meningitis]. / Meningitis carcinomatosa.

INTRODUCTION: Carcinomatous meningitis is a serious complication of advanced stage solid tumours, which may become more common with improved survival. CASE REPORTS: A 53-year-old woman with a recent history of breast cancer (pT2pN2M0) had been treated by mastectomy and adjuvant chemotherapy and radiotherapy. She presented with weakness, diplopia and vertigo raising the possibility of vertebrobasilar ischaemia or an intracranial mass. In another patient, a 62-year-old man with hypertension, a stenotic common bile duct had been diagnosed when examined for abdominal complaints. When he presented with a high blood pressure value accompanied by intensive headache, vomiting and bilateral hearing loss, he was thought to have a hypertensive crisis. The rapidly progressive neurological symptoms and the history of breast cancer and findings suggesting pancreatic head tumour, respectively, led to the clinical diagnosis of carcinomatous meningitis in both cases, despite any evidence on CT scans or a negative MR scan, though of limited value, in the first case. This diagnosis was confirmed by the laboratory and cytological findings of the cerebrospinal fluid, and also by the post mortem examination, since both patients died within a month after the onset of the symptoms. The primary tumour in the second patient proved to be a widely metastasizing diffuse type gastric cancer. CONCLUSION: Carcinomatous meningitis has a varying but characteristic presentation which generally makes it easy to diagnose, but it can sometimes present differential diagnostic problems. What we can learn from these two cases may help in recognizing this complication.