[50-year history of kidney transplantation in Hungary]. / A veseátültetés elso 50 éve Magyarországon.

The first Hungarian kidney transplantation was performed by András Németh in Szeged in 1962, approximately 50 years ago. A preliminary agreement with Eurotransplant was signed in 2011, and special patient groups gained benefit from this cooperation in 2012, wnich lead to a full membership to Eurotransplant. This event inspired the authors to review the history of Hungarian kidney transplantation of the past 50 years, from the first operation to recent via the specific cornerstones of the transplant program. The donor of the first Hungarian kidney transplantation was the brother of the recipient. The operation itself was technically successful, but the lack of immunosuppression caused graft rejection, and the patient died after 79 days. His brother, the donor, is still healthy, after 50 years, and he encourages everybody to donate organs. Organized kidney transplant program started more than 10 years later, such as 1973, in Budapest. The program was supported by the Ministry of Health. New centers joined the program later, Szeged in 1979, Debrecen in 1991 and Pécs in 1993. These four transplant centers work currently in Hungary, and 6611 kidney transplantation has been performed up to the end of year 2012.

[Progress of the liver transplantation programme in Hungary]. / A hazai májátültetési program fejlodése.

The history of organ transplantation in Hungary dates back to 50 years, and the first succesful liver transplantation was performed in the United States in that time as well. The number of patients with end stage liver disease increased worldwide, and over 7000 patients die in each year due to liver disease in Hungary. The most effective treatment of end-stage liver disease is liver transplantation. The indications of liver transplantation represent a wide spectrum including viral, alcoholic or other parenchymal liver cirrhosis, but cholestatic liver disease and acute fulminant cases are also present in the daily routine. In pediatric patients biliary atresia and different forms of metabolic liver disorders represent the main indication for liver transplantation. The results of liver transplantation in Hungary are optimal with over 80% long-term survival. For better survival individual drug therapy and monitoring are introduced in liver transplant candidates.

Tacrolimus combined with two different corticosteroid-free regimens compared with a standard triple regimen in renal transplantation: one year observational results.

Side effects of steroid use have led to efforts to minimize their use in transplantation. Two corticosteroid-free regimens were compared with a triple immunosuppressive therapy. Data from the original intent-to-treat (ITT) population (153 tacrolimus/basiliximab [Tac/Bas], 151 tacrolimus/MMF [Tac/MMF], and 147 tacrolimus/MMF/steroids [control]) were analyzed in a 12-month follow-up. Percentage of graft survival were 92.8%, 95.4%, and 95.9% (KM estimates 89.9%, 95.3%, 95.9%), percentage of surviving patients were 98.7%, 98.0%, and 100% (KM estimates 95.9%, 92.8%, and 100%). During months 7-12, graft loss occurred in 3 Tac/Bas, 2 Tac/MMF, and zero control patients, patient deaths in 1 Tac/Bas, 2 Tac/MMF, and zero control, and biopsy-proven acute rejection episodes in 4 Tac/Bas, 3 Tac/MMF, and zero control. Mean serum creatinine at month 12 was 141.9 +/- 69.6 microM, 144.0 +/- 82.1 microM, and 134.5 +/- 71.2 microM (ns). New-onset insulin use in previously non-diabetic patients at month 12 was 1/138, 6/127, and 4/126. Patient and graft survival as well as renal function at 12 months were not different between patient groups, despite considerably higher rates of acute rejection occurring within the first six months after transplantation in both steroid-free patient groups. Tac/Bas therapy might offer benefits in terms of a trend for a more favorable cardiovascular risk profile.

[Investigation of redox homeostasis in liver and renal transplant recipients]. / Redox homeostasis vizsgálata máj- és vesetranszplantáció során.

The time course of free radical reactions is evaluated by the authors. Within pretransplant patients as of their poorly functioning metabolism free radical overproduction may be observed, hence their antioxidant capacity decreases. When the graft is functioning well, the free radical-antioxidant balance of homeostasis is reestablished. During the early postoperative period, when symptoms (acute rejection, infection, acute tubular necrosis, cholestasis) appear, free radical reactions increase. The authors demonstrate, this is strengthened by the fact that the mediator [interleukin-6 (IL-6), C-reactive protein, serum amyloid-A], and enzyme levels that take part in the free radical processes rise. The monitoring of these parameters during the early postoperative period is a good early indicator for acute rejection and for the effect of therapy. During acute rejection just as during infection most of these parameters increased significantly compared to the healthy control. They show the activation of the immune system but they are not useful for differential diagnosis, with the exception of IL-6 which we measured in larger quantities during bacterial infection but not so in acute rejection. For the prediction of early renal graft function we used urinary enzyme levels (dipeptidyl-aminopeptidase, glutathione-S-transferase). Tissue damage is followed by enzyme increasing and antioxidant capacity depletion. With choosing of adequate tests, the perioperative redox homeostasis of the transplanted patients can be monitored and with dosing the antioxidants the uncontrolled forming of reactive oxygen metabolites can also be decreased and checked.

Malignancies after renal transplantation during 33 years at a single center.

This study provides an analysis of incidence and characteristics of malignant tumors of 2535 patients who underwent renal transplantation between 1973 and 2007 at the Transplantation Center in Budapest. One hundred ninety-three malignant diseases were found in 188 patients (7.6%). The incidence of thyroid-, renal- hepatic-, skin- and gastric cancers as well as of Kaposi sarcoma and lymphomas increased in our transplant patient cohort compared to the figures of the general population based on the data of our Cancer Registry. On the other hand, colorectal-, oralprostate and lung cancers were underrepresented in our patient cohort. The mean time of diagnosis of malignancies following kidney transplantation was 58.5+/-44.8 months. One fifth of the tumors were detected within the first year. Patients with malignancies were distributed into four groups based on the immunosuppressive regimen: group I (8.5%), azathioprine + prednisone; group II (59.0%), cyclosporine + prednisone; group III (26.6%), cyclosporine + mycophenolate mofetil + prednisone; group IV (5.9%), tacrolimus + mycophenolate mofetil + prednisone. The mean age of patients was 47.3, 53.5, 55.5 and 58.1 years in group I, II, III and IV, respectively. Oncologic and immunosuppressive therapy was decided individually. Immunosuppression was switched to rapamycin-containing regimens in 63 cases. We lost 92 patients (48.9%) with a mean survival time of 25.8+/-39.4 months. Cumulative 1- and 5-year survivals were 69.5% and 52%, respectively. The increasing number of cancers seen early after transplantation and the increased risk of developing a cancer due to the older age of recipients draw attention to the importance of regular oncologic screening in patients on the waiting list and after transplantation.

[Diagnosis and treatment outcome in primary aldosteronism based on a retrospective analysis of 187 cases]. / A primer aldosteronismus diagnosztikája és a kezelés eredményei 187 beteg adatainak retrospektív elemzése alapján.

INTRODUCTION: Primary aldosteronism is the most common form of mineralocorticoid hypertension. The disease has been described by Jerome W. Conn in 1955; since that time there has been a great progress in the knowledge concerning the prevalence, diagnostics and treatment of the disease. AIMS: The authors retrospectively analyzed the efficacy of diagnostic procedures and the outcome of treatment by the analysis of data of 187 patients with primary aldosteronism examined between 1958 and 2004 at the 2nd Department of Medicine of Semmelweis University. METHODS: The efficacy of different methods used for the diagnosis, the frequency of the different subtypes of primary aldosteronism, as well as the surgical outcomes in patients with surgically treated subtypes of primary aldosteronism were studied. RESULTS: Aldosterone-producing adenoma was detected in more than two thirds of patients (n = 135), whereas idiopathic hyperaldosteronism was found in 46 patients. Other subtypes of primary hyperaldosteronism occurred less frequently (unilateral primary adrenocortical hyperplasia in 5 patients and adrenocortical carcinoma in one patient). For the diagnosis of familial hyperaldosteronism type I, molecular biological studies of the aldosterone-synthase/11beta-hydroxylase gene chimera were carried out in 30 patients but none of them showed the presence of the chimeric gene. When comparing the clinical parameters of patients with aldosterone-producing adenoma and idiopathic hyperaldosteronism, no significant differences were found in the time period between the diagnosis of hypertension and the diagnosis of primary aldosteronism, or in the systolic and diastolic blood pressure values. The mean of the lowest documented serum potassium concentration was slightly lower in patients with aldosterone-producing adenoma (2.8 +/- 0.1 mmol/l) compared to those with idiopathic hyperaldosteronism (3.1 +/- 0.2 mmol/l), but the difference was not significant. Normokalemic primary hyperaldosteronism was found in 7 cases. The ratio of plasma aldosterone concentration (ng/dl) to plasma renin activity (ng/ml/h) was above 20 in all patients with aldosterone-producing adenoma and in all but 5 cases with idiopathic hyperaldosteronism. To confirm the diagnosis and to differentiate the subtypes of primary aldosteronism, the postural test combined with furosemide administration was performed in the majority of patients. When cases showing an elevation of plasma cortisol level during the test were excluded, this test differentiated patients with aldosterone-producing adenoma from those with idiopathic hyperaldosteronism with a sensitivity of 69% and a specificity of 92%. In cases of adrenocortical adenomas not or not clearly detectable by radiological imaging techniques, as well as in cases with bilateral adrenocortical adenomas, selective adrenal vein sampling was performed (n = 55). All but 4 patients with aldosterone-producing adenoma underwent adrenalectomy. Histology and postoperative hormone results confirmed the preoperative diagnosis in all operated patients. After surgery serum potassium concentration returned to normal in all patients showing low serum potassium levels before surgery. Also, the moderate to severe preoperative hypertension disappeared or improved after surgery. CONCLUSIONS: These observations are in contrast with the results of international studies which showed a high frequency of normokalemic primary aldosteronism and a more frequent occurrence of idiopathic hyperaldosteronism well treatable with aldosterone-antagonists. Therefore, it can be presumed that a significant number of primary aldosteronism cases that are not accompanied with severe hypokalemia remain undetected in Hungary.

[Changes in gene expression in the course of proliferative processes in the parathyroid gland]. / Génexpresszió-változások a mellékpajzsmirigy proliferatív folyamata során.

The aim of this study was to investigate the changes in expression pattern of the most important genes connected with apoptosis in proliferative apoptotic lesions (hyperplasia, adenoma), applying cDNA microarray technique, in order to promote the possible diagnostic or therapeutic utilisation of any difference in gene expression compared to the healthy (normal) parathyroid gland. Samples were taken from surgically removed 2 hyperplasias, 2 adenomas and 2 normal parathyroid glands. The Apoptosis Gene Array (Superarray) was used. This contains 112 genes, in tetraspot arrangement. The probes measured 250-600 base pairs. Streptavidin was bound to the array. CDP Star TM chemiluminescent substrate was used for detection. The samples deriving from hyperplasia or adenoma were compared to samples from normal parathyroid glands. The following genes were overexpressed in both hyperplasia and adenoma: CHEK1, ATM, BCL-XL, FAS, TNF, cIAP1, TRAIL, FADD, CASP 4,5,6,8, CD120b, CD137, LTA, TANK, TARF2, CAD, LIGHTR, DR3LG. CASP1,10, BFAR, BOD, BCL2L2, TRANCE were underexpressed in both hyperplasia and adenoma. Genes overexpressed only in hyperplasia were: MDM2, MCL1, BCL2A1, BLK, RIPK2, CD40LG, TRAF5, HUS1, BNIP3. Underexpressed only in hyperplasia: BOK, CIDEA, TRAF1, TRIP. Overexpressed only in adenoma: APOLLON, RIPK1, LTB, LTBR, CASP2,13, cIAP2, CIDEB. Underexpressed only in adenoma: TRAF4 and FASLG. Overexpresion or underexpression meant 1.5-fold difference from normal average values. As a result of this study, both pro-apoptotic and antiapoptotic genes were identified in hyperplasia and adenoma of the parathyroid gland. It seems that increased proliferation is connected also with increased apoptotic activity, but tumor cell candidates are able to survive, by activation of signal pathways resulting in overexpresion of anti-apoptotic genes.

Two corticosteroid-free regimens-tacrolimus monotherapy after basiliximab administration and tacrolimus/mycophenolate mofetil-in comparison with a standard triple regimen in renal transplantation: results of the Atlas study.

BACKGROUND: The side effects associated with corticosteroids have led to efforts to minimize their use in renal transplant patients. In this study we compared two corticosteroid-free tacrolimus-based regimens with a standard triple therapy. METHODS: This was a 6-month, phase III, open-label, parallel-group, multicenter study. The total analysis set comprised 451 patients, randomized (1:1:1) to receive tacrolimus (Tac) monotherapy following basiliximab (Bas) administration (n=153), Tac/mycophenolate mofetil (MMF) (n=151), or, Tac/MMF/corticosteroids triple therapy as a control (n=147). RESULTS: The study was completed by 91.2% (triple therapy), 94.7% (Tac/MMF), and 82.4% (Bas/Tac) of patients. Patient baseline characteristics were similar in all groups. The incidences of biopsy-proven acute rejection were 8.2% (triple therapy), 30.5% (Tac/MMF), and 26.1% (Bas/Tac), p<0.001 (multiple test for comparison with triple therapy); Bas/Tac vs. Tac/MMF, p=ns. The incidences of corticosteroid-resistant acute rejection were 2.0%, 4.0%, and 5.2%, p=ns. Graft survival (95.9%, 96.7%, and 94.7%, p=ns) and patient survival (100%, 99.3%, and 99.3%, p=ns) were similar in all groups. Median serum creatinine at month 6 was 123.0 micromol/L (triple therapy), 134.7 micromol/L (Tac/MMF) and 135.8 micromol/L (Bas/Tac). The overall safety profiles were similar; differences (p<0.05) were reported for anaemia (24.5% vs. 12.6% vs. 14.5%), diarrhoea (12.9% vs. 17.9% vs. 5.9%), and leukopenia (7.5% vs. 18.5% vs. 5.9%) for the triple therapy, Tac/MMF, and Bas/Tac group, respectively. The incidences of new-onset diabetes mellitus were 4.6%, 7.1%, and 1.4%, respectively. CONCLUSION: Corticosteroid-free immunosuppression was feasible with the Bas/Tac and the Tac/MMF regimens. Both corticosteroid-free regimens were equally effective in preventing acute rejection, with the Bas/Tac therapy offering some safety benefits.

[Clinical factors influencing the complications and survival of liver transplantation in Hungary]. / A májátültetés szövodményeit és túlési eredményeit befolyásoló tényezok Magyarországon.

UNLABELLED: Clinical factors in association with the complications and the outcome of liver transplantation. The Hungarian experience. Demography, morbidity, perioperative characteristics and mortality. INTRODUCTION: The authors summarize the demographic, morbidity and mortality characteristics of the Hungarian Liver Transplant Program. They evaluate the changes and development, that has taken place with regard to indications, recipient population and characteristics, operation technique, and peroperative patient management. METHOD: In order to present the development, data are compared between two time periods (before and after 1999). Categorical variables are evaluated by chi-square test, continuous ones are with Levene Test (for homogeneity of means), Student T test and Mann-Whitney U-test. Cumulative survivals are computed with Kaplan-Meyer log rank analysis. Variables showed statistical significance on survival bz univariate analysis were then put into multivariate Cox-regression analysis. ROC analysis was performed to set the cut off point of certain continuous parameters in relation to survival. RESULTS: The results are summarized on Tables and statistical Figures. Regarding patients mortality in the beginning the main factors with impact were respectively technical ones like arterial thrombosis, while in the last 4 years perioperative fluid management and transfusion policy became important. Both sepsis and postoperative renal insufficiency remained key factors for mortality, however their incidence diminished dramatically. DISCUSSION: The overall outcome of the retrospective analysis is, that the program has been developed to European standards with respect to its volume, technical capabilities and results.

[The demographic, perioperative and mortality characteristics of the Hungarian Liver Transplant Program]. / A hazai májátültetés demográfiája, perioperatív jellemzoi es mortalitása.

INTRODUCTIONS: The authors summarize the demographic, morbidity and mortality characteristics of the Hungarian Liver Transplant Program. AIMS: They evaluate the changes and development, that has taken place with regard to indications, recipient population and characteristics, operation technique, and peroperative patient management. METHOD: In order to present the development, data are compared between two time periods (before and after 1999). The results are summarized on Tables and statistical Figures. Categorical variables are evaluated by chi2-test, continuous ones are with Levene Test (for homogeneity of means), Student T test and Mann-Whitney U-test. Cumulative survivals are computed with Kaplan-Meier log rank analysis. RESULTS: 194 primary liver transplantation have been performed. The hepatitis C was the leading indication from the beginning. Ten (10) liver transplantation have been performed in 1995, while 44 in 2004. The mortality within the first 2 months decreased from 24% to 5%. The 1, 3 and 5 year cumulative patient survival increased from 55%, 45% es 39% (1995-1997), to 72%, 64% es 61% (1998-2000). Recently this is 78%, 77% es 77%. CONCLUSIONS: Between 1995-1997 conventional liver transplantation became standard, while piggy back turned to be popular from 1998. From 1999 the HCV-PCR monitoring, the combined antiviral treatment, the UW perfusion of the donors took place. From 2003 we introduced the tailored immunosuppression, the steroid-free protocol for viral diseases. Total infused volume was decreased together with the amount of transfusion. The retrograde graft reperfusion (from the caval side) was introduced in 2004 together with the split technique in the liver transplantation and the rebirth of the pediatric program. The overall outcome of the retrospective analysis is, that the program has been developed to European standards with respect to its volume, technical capabilities and results.

[Comparison of the results of conventional, crossclamp and piggyback technique in liver transplantation]. / Hagyományos, "crossclamp" és "piggyback" technikával végzett máj- átültetések eredményeinek összehasonlítása.

The authors evaluate the results of the technical variants of liver transplantion in the first 10 years. They present the technique of conventional and piggyback liver transplantation. Their aim is to compare the outcome of the two surgical implantation techniques. Using the piggyback technique, the need for intraoperative blood transfusion was less (10U) compared to conventional transplantion (15U). Vascular complication rate was lower with conventional, compared to piggy back technique. Hepatic artery thrombosis rate was higher (14% vs. 5%) while venous outflow occlusion rate was lower (0% vs. 8%) in conventional technique compared to piggyback. Postoperative kidney failure was more frequent after conventional and crossclamp technique (45%). The 1, 3, and 5 year cumulative patient survival rates were 62%, 55% and 52% in the conventional group, and 79%, 71% is 63% after piggyback. The 1, 3 and 5 years graft survival were 60%, 53% and 50% after conventional and 74%, 66% and 60% after piggyback implantation. The piggyback technique became routine standard procedure in Hungary, with lower transfusion need, less kidney failure and very good results.

Influence of obesity on lymph node recovery from rectal resection specimens.

Careful lymph node dissection from colorectal resection specimens is important procedure for cancer staging. Present study intended to assess the impact of surgical technique and patient's obesity on this process. Number of lymph nodes harvested by manual dissection from resection specimens of 141 patients with rectal cancer and the rate of nodal metastases were analyzed and compared in different groups of patients selected by length of resection specimen and body mass index. The median and mean number of lymph nodes found per patient were 6 and 6.7. The shorter resection specimens (<16 cm after formalin fixation) yielded significantly lower number of nodes than those with length > 16 cm (5.7 versus 7.9). Most significant reduction in mean number of lymph nodes was observed in obese patients with short specimens (4.8). This subset of patients presented the lowest rate of nodal metastases (38%). The surgical technique seems to be an important factor for lymph node recovery from rectal resections specimens. The patient's obesity had an unfavourable impact on this procedure. Standardized surgery and histopathological examination are needed even in non-specialized centers to harvest adequate number of lymph nodes.

Apoptosis and P53, Bcl-2 and Bax gene expression in parathyroid glands of patients with hyperparathyroidism.

Altogether 107 patients were operated on at the Department of Transplantation and Surgery of Semmelweis University in the past four years, for clinical symptoms of hyperparathyroidism. Clinical and laboratory data of the patients supported the diagnosis of primary or secondary hyperparathyroidism. Chronically impaired renal function was found in 52 cases. The removed parathyroid glands showed hyperplasia in 54, adenoma in 50 and carcinoma in 3 cases. The majority of parathyroid lesions in primary hyperparathyroidism were adenomas (41 cases) and in secondary hyperparathyroidism were hyperplasias (43 cases). The ratio of oxyphil to chief cells as well as occasional mitotic and apoptotic figures were determined. The oxyphil component was present in both hyperplastic and tumorous lesions. Apoptosis and mitosis were rarely seen in hyperplasias and adenomas (under 2%), whereas in carcinomas 3% of the tumor cells were apoptotic and 4% showed mitosis. Cytoplasmic p53 positivity could be observed in 3 of the adenomas and in 2 of the hyperplasias. The carcinomas, four adenomas and 3 hyperplasias showed nuclear p53 positivity. Bcl-2 and Bax were detected in the cytoplasm of the tumor cells in the majority of adenomas and in the cells of hyperplasias. Oxyphil cells were more frequently positive than chief cells or clear cells. Colocalization of Bcl-2 and Bax was found randomly in all types of lesions. The very low incidence of carcinoma, the low mitotic and apoptotic ratio in adenomas and hyperplasias suggest a potent antiproliferative defense mechanism in the parathyroid cell population. This may also be reflected in the cytoplasmic colocalization of various gene products which regulate cell death and cell proliferation. No significant differences in the p53, Bcl-2 and Bax spectrum were found between the primary and secondary (i.e. renal failure) parathyroid alterations.

Is obesity a favorable factor for resectability of rectal cancer?

BACKGROUND/AIMS: It is well established that unresectable rectal tumors have a detrimental effect on long-term survival. Predictive factors for resectability focused on the body mass index and surgeon case volume were assessed in the present study. METHODOLOGY: Data of 387 patients with rectal cancer and 284 patients with colon tumor who underwent elective surgical exploration during two periods (1986-1992 and 1994-2001) were evaluated. Univariate and multivariate analysis was performed to estimate the predictive factors for resectability of rectal cancer. The ratio of unresectable rectal and colon tumors was compared in subgroups of patients selected by body mass index. RESULTS: The observed rate of resectability of rectal cancer was 78%. Coexisted distant metastases, low caseload of surgeons, body mass index < 25 kg/m2, tumor location < or = 12 cm and the first treatment period were associated with low rate of resectability. The ratio of unresectable tumors treated by surgeons with low case volume varied significantly with body mass index in rectal cancers (< 20 = 52%, 20-24.9 = 29%, 25-29.9 = 16%, > or = 30 = 19%) but not in colon tumors. CONCLUSIONS: In respect to resectability of rectal cancer there was significant difference between surgeons with medium and low case volume. Patient's obesity seemed to be a favorable factor for resectability of tumors located in the rectum but not in the colon when operations were performed by surgeons with low case volume.

[Autotransplantation of the kidney 100 years after Imre Ullmann's pioneering operation]. / A vese autotranszplantációja 100 évvel Ullmann Imre úttöró mútétjét követóen.

The authors give an overview on renal autotransplantation on occasion of Emerich (Imre) Ullmann's pioneer operation 100 years ago. Ullmann was born in 1861 in Pécs, Hungary. After finishing the Vienna Medical School, he worked on the I. Surgical Clinic of the University of Vienna. In 1902, already as the chief of surgery of a Vienna hospital he successfully performed canine kidney autotransplantation, later also technically successful allo- and xenotransplantation. Human renal autotransplantations have been performed since the early 1960's mainly because of renovascular hypertension/aneurysm or ureter injuries or tumor. Rare indications are the loin pain-hematuria syndrome, echinococcosis of the kidney, the nutcracker syndrome, ureteroarterial fistula and there are reports about allograft autotransplantations also. Lately, laparoscopy gained place and nephrectomies are done more often minimally invasive. In Hungary twenty-four cases of kidney autotransplantation were performed.

[New results in allotransplantation of pancreatic islet cells]. / A pancreas szigetsejt-allotranszplantáció új eredményei.

An up-to-date synthesis of pancreatic islet allotransplantation is included in this summary, with emphasis on new developments and clinical results of the field. Rationale for islet transplantation in type 1 diabetes mellitus, current patient selection criteria, clinical data, technical aspects of organ procurement, islet isolation and transplantation are highlighted. The current challenges are also presented and analysed. Significant advances in clinical islet transplantation have been achieved recently. New immunosuppressive strategies were introduced, there were considerable changes in the patient selection criteria. International collaborations were established in order to standardize islet isolation and transplantation procedures. The spectacular results, recently reported by the Edmonton-group, represent a major breakthrough of the field and the outcomes are comparable with the results of whole pancreas transplantation. Islet transplantation became one of the most promising fields of tolerance induction research. Although still considered experimental, within the frameworks of expanding international collaborations, pancreatic islet allotransplantation gains more and more recognition in the clinical practice. These elements give hope that diabetes might be in the near future treated by islet cell transplantation.

[Combined interferon-alfa-2b and ribavirin therapy in patients with recurrent chronic hepatitis c after liver transplantation]. / Kombinált interferon-alfa-2b és ribavirin terápia májtranszplantációt követó krónikus C-hepatitisben.

UNLABELLED: Interferon with ribavirin therapy has been proposed for the treatment of hepatitis C recurring in liver transplants. AIM OF THE STUDY: Was to assess the efficacy of standard combination therapy (interferon plus ribavirin) of chronic hepatitis C in transplanted patients with recurrent severe HCV induced chronic hepatitis. METHODS: 12 patients with HCV-PCR positive reaction (genotype 1b) were treated with the therapy of interferon-alpha-2b (3 MU three times a week) and 800-1000 mg ribavirin daily. Liver biopsy had been done in every patients before and after the treatment. Study endpoints were the end of treatment and the 6 month post-therapy sustained virologic response. RESULTS: At the end of treatment 3 patients were negative for HCV-PCR and all of them had negative reaction after 6 month follow-up period. CONCLUSION: The results are in a good accordance with treatment of patients with chronic hepatitis C without liver transplantation.

[Our experiences with surgical treatment of gastrointestinal stromal tumors]. / A GastroIntestinalis Stroma Tumorok sebészi kezelésében szerzett tapasztalataink néhány eset kapcsán.

INTRODUCTION: Stromal tumors of the gastrointestinal tract are rare neoplasms, but they are the most common ones of mesenchymal origin. In a large proportion of patients clinical onset is represented by surgical emergencies. Incidence of GIST is calculated to be 10-20 cases per million per year. GISTs account for 0.1-3% of all gastrointestinal tumors, up to 20% of small bowel malignancies. At least 30-70% of the cases are malignant. PATIENTS: We summary our experiences of surgical treatment of GIST, apropos of five patients handled at our department in 2003. There were 3 male, 2 female, 55.8 years. The 5 patients had altogether 21 operations. Diagnosis was recognized before op. in three cases. RESULTS: In one case the tumor was inoperable, in one other technical operable, but oncologically not complete. In another case recurrence is known, and in one dissemination was observed during operation. There is only one case of fives, where we can hope, that a tumor-free situation had been left. Diagnosis was confirmed in every case with CD117 strain. SUMMARY: Surgery remains the standard treatment for GISTs. Disease recurrence is quite common, the rate is 65-75%, even when surgery is performed with intent to cure. In a surgical emergency or in the absence of a perioperative diagnosis, the surgeon is responsible for recognizing and treating these tumors. The benefit of surgical exercises for recurrent disease is unclear. In our opinion it is worth operating these cases, because in some cases amazing survival can be available.