Correlation of Inflammatory Parameters with the Development of Cerebral Vasospasm, Takotsubo Cardiomyopathy, and Functional Outcome after Spontaneous Subarachnoid Hemorrhage.

Background: The present work aimed to determine whether a relationship exists between inflammatory parameters and the development of vasospasm (VS) and Takotsubo cardiomyopathy (TTC), as well as clinical outcome, in patients suffering from spontaneous subarachnoid hemorrhage (SAH). Methods: In this study, the authors processed the prospectively collected laboratory and clinical data of spontaneous SAH patients admitted to the neurointensive care unit between March 2015 and October 2023. The highest values of neutrophils (NEUpeak), monocytes (MONOpeak), neutrophil-to-lymphocyte ratio (NLRpeak), and CRP (CRPpeak) during the initial 7 days were correlated with the occurrence of VS and TTC, and with the outcome measures at day 30 after onset. Results: Data were collected from 175 SAH patients. Based on ROC analysis, for the development of VS, MONOpeak was the most accurate indicator (AUC: 0.619, optimal cut-off: 1.45 G/L). TTC with severe left ventricular dysfunction (ejection fraction < 40%) was indicated most sensitively by NEUpeak (ROC: 0.763, optimal cut-off: 12.34 G/L). Both for GOS and Barthel Index at day 30, CRPpeak was the best predictor for the outcome (GOS: ROC: 0.846, optimal cut-off: 78.33 mg/L and Barthel Index: ROC: 0.819, optimal cut-off: 78.33 mg/L). Conclusions: Laboratory parameters referring to inflammation during the initial 7 days after SAH correlate with the development of VS and TTC, and thus may predict functional outcome.

[Diagnosis and treatment of childhood soft tissue sarcomas]. / Gyermekkori lágyrészsarcomák diagnosztikája és kezelése.

Malignant tumors of mesenchymal origin are called sarcomas. Mesenchymal cells normally mature into skeletal muscle, smooth muscle, fat, fibrous tissue, bone and cartilage. Rhabdomyosarcoma (RMS) arises from immature mesenchymal cells that are committed to skeletal muscle lineage. However, it can also arise in tissues in which striated muscle is normally not found (such as the urinary tract). Undifferentiated sarcomas cannot be ascribed to any specific lineage. Treatment results improved significantly in the last decade by combined treatment (chemotherapy, surgery, irradiation, in some cases targeted therapy). Good treatment results can be achieved in pediatric oncology centers by early diagnosis and adequate treatment according to international treatment protocols.

MicroRNA expression might predict prognosis of epithelial hepatoblastoma.

Hepatoblastoma (HB) is the most common primary liver cancer in childhood. The fetal and mixed embryonal/fetal epithelial subtypes of HB differ not only in grade of differentiation but probably also in prognosis. We aimed to determine microRNA (miRNA) expression patterns of the main subtypes of epithelial HBs to reveal differences and relate them to survival. We studied 20 cases of epithelial HB, subtyped as pure fetal (n = 12) or embryonal/fetal (n = 8). Tissues were sampled according to subtype to arrive at 15 purely fetal and eight purely embryonal samples (n = 8) and 15 samples of non-tumorous surrounding liver (SL). Relative expression of miR-17-5p, miR-18a, miR-21, miR-34a, miR-96, miR-122, miR-181a, miR-195, miR-210, miR-214, miR-221, miR-222, miR-223, and miR-224 was determined by TaqMan MicroRNA Assays applying miR-140 as reference. A higher level of miR-18a (p < 0.01) was found in embryonal samples than in fetal samples. Lower miR-17-5p, miR-195, miR-210, miR-214, and higher miR-221 levels were detected in fetal samples (p < 0.02) in comparison with SL samples, whereas a lower miR-122 level was observed in embryonal samples (p < 0.003). Histological subtype did not correlate with survival; however, high miR-21, low miR-222, and low miR-224 levels proved to be independently prognostic for HB with significantly increased overall survival (p < 0.03). The fetal and embryonal components of epithelial HB, as well as SL, revealed different miRNA expression patterns. Furthermore, miR-21, miR-222, and miR-224 levels predict overall survival of HB patients regardless of epithelial subtype.

[Malignant insulinoma]. / Malignus insulinoma.

Authors present the history of a 56-year-old man who was evaluated for recurrent epigastric pain. Clinical investigation revealed a 4-cm tumor in the head of the pancreas and a solitary liver metastasis. Pathological examination of the surgically excised pancreatic tumor indicated a moderately differentiated neuroendocrine carcinoma and Ki-67 labeling index revealed moderate proliferative activity. Despite short-term chemotherapy combined with interferon and somatostatin analogue administration, the metastatic disease rapidly progressed. Octreotide scintigraphy disclosed abundant expression of somatostatin receptors both on primary tumor and hepatic metastases. 9°Yttrium-DOTATOC treatment was performed in three sessions within 9 months (3 x 200 mCi) with a mixed therapeutic response. Endocrine symptoms were not observed during the first 33 months of the disease. 34 months after the initial diagnosis of the neoplastic disease, imaging studies and chromogranin A measurement revealed rapidly progressing disease and the patient developed frequent episodes of hypoglycemic attacks. Serum insulin and C-peptide measurements confirmed insulin oversecretion. Continuous administration of somatostatin analogue was supplemented with diazoxide, but the latter therapy was not tolerated because of severe water retention. The high dose oral carbohydrate intake was supplemented with continuous glucose infusion. As a rescue procedure, repeated liver chemoembolization was performed, which resulted only in a short-term effect. The autopsy and the immunohistochemical investigations confirmed the diagnosis of insulin-producing, metastatic neuroendocrine carcinoma.

Gastrointestinal stromal tumor presenting as a hormonally inactive adrenal mass.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rarely, tumors with the same histological and immunohistochemical features arise in organs having no connection to the tubular gastrointestinal tract designated as extra-gastrointestinal stromal tumors (EGISTs). In this article, we report the first case of an EGIST presenting as a hormonally inactive adrenal mass. A 68-year-old woman with a 3-month history of right abdominal pain was clinically diagnosed as having a hormonally inactive right adrenal tumor sizing 15 cm in diameter. This mass and the tightly fixed right adrenal gland were resected en bloc.Histologically, the tumor was composed primarily of monomorphic spindle cells. Mitotic figure was 2­3 per 50 high power fields. Immunohistochemical analysis revealed strong positivity for CD117 (c-KIT) and smooth muscle actin (a-SMA), but negativity for beta-catenin, CD34, pan-keratin,S-100, desmin, and H-caldesmon. Genetic analysis showed no mutations in KIT gene exons 9, 11, 13, and 17,and in exon 18 of the platelet-derived growth factor-2 receptor gene (PDGFR). The patient proved to be tumor-free at the 18-month follow-up. This case under study demonstrates that EGIST should be included in the differential diagnosis of hormonally inactive adrenal tumors.CD117 (c-KIT) immunohistochemistry should be applied in the pathological workup of soft tissue adrenal tumors.This case is an additional example suggesting that the prognosis of even a very large EGIST is not definitely grave.

[Bilateral testicular tumor in a young man with congenital 11ß-hydroxylase deficiency]. / 11-ß-hidroxiláz enzim defektusában szenvedo fiatal férfi kétoldali heredaganata.

Adrenal rest tumor presenting as palpable testicular mass has been well described in boys and adult males with congenital adrenal hyperplasia. It develops most commonly in patients with 21- hydroxylase deficiency, but the entity may also occur in rare forms of congenital adrenal hyperplasia, including 11ß-hydroxylase deficiency. Because the management of testicular adrenal rest tumors is substantially different from that applied in benign and malignant testicular tumors, an accurate differentiation between these entities is particularly important. Authors present the history of a young adult male with 11ß-hydroxylase deficiency who developed adrenal rest tumors presenting as palpable bilateral testicular masses during treatment with glucocorticoids, then testicular masses showed a rapid regression after an adequate glucocorticoid treatment. Considering lessons obtained from this case, authors review the pathomechanism, symptoms, as well as current diagnostic and treatment modalities of testicular adrenal rest tumors.

[Diagnostic imaging for the screening of hepatocellular carcinoma]. / Képalkotó vizsgálatok a hepatocellularis carcinoma szurésére.

The application of diagnostic imaging is of fundamental importance in the screening, diagnosis and therapy of hepatocellular carcinoma. Among the diagnostic imaging options, ultrasonography has leading role, as it is simple, non-invasive and enables real-time imaging. Screening and active follow up of patients at high risk of primary liver tumors is essential in their early detection. Screening/active follow up of patients at high risk of primary liver tumors means six monthly ultrasound examination. The diagnosis of hepatocellular carcinoma is based on the detection of its characteristic contrast enhancing dynamics, which is possible through dynamic diagnostic imaging procedures (contrast agent enhanced ultrasonography, triphasic CT, MRI). The diagnostic imaging procedure applied depends on the size of the lesions. Examination of the cirrhotic liver remains particularly difficult even with the modern diagnostic imaging procedures, especially concerning the recognition of small early stage hepatocellular carcinoma, and premalignant lesions.

Improper supplementation habits of folic acid intake by Hungarian pregnant women: improper recommendations.

BACKGROUND: Neural tube defects (NTDs) are some of the most common congenital anomalies. Proper folic acid supplementation is a dominant risk factor, which has been shown to decrease the incidence of NTDs. In Canada, the incidence of neuroblastoma has presented a considerable decrease of 60% as a result of enrichment cereal grain flours with synthetic folic acid. The aim of this study was to investigate the effect of folic acid intake by pregnant women on the incidence of NTDs and neuroblastoma. METHODS: Regular folic acid intake has been recommended to pregnant women in Hungary since the eighties of the last century by health visitors eventually raking effect as an official protocol which had been released in 1997. During 2001, 2002 and 2003, folic acid intake habits of pregnant women were evaluated by health visitors, proving to be successful in collecting data from 95.06% of the pregnant women. The incidence of NTDs has been registered by the Hungarian National Centre of Epidemiology, Department of Human Genetics and Teratology. The Pediatric Cancer Registry provided the incidence of neuroblastoma in children. RESULTS: Consistent findings revealed a regular intake of supplementary folic acid products by 68.71% of the pregnant women. Out of these, 93.13% of pregnant women who were taking folic acid, started the supplementation after their 7 weeks of pregnancies, a time designated as the completion period of the development of the neural tube. The dose of folic acid supplementation was evaluated as less than 5 mg/day in 84.75% of the pregnant women. In Hungary, the incidence of NTDs has remained constant, while the incidence of neuroblastoma has shown constant slight increase in spite of the introduction of folic acid supplementation in 1997. CONCLUSIONS: Based on our experience, folic acid supplementation was initiated after the recognition of pregnancy and its application in a dose of lower than 5 mg/day neither decreased the incidence of NTDs nor did it have an effect on the neuroblastoma incidence. It is implicated that proper folic acid supplementation, which is started from the conception, can be achieved only with the enrichment of cereal grain flours.

[Alternative therapy in childhood cancer]. / Alternatív terápia a gyermekonkológiában.

INTRODUCTION: In Hungary there are as many as 300 children diagnosed with malignant tumor each year. Along with the traditional treatments, alternative remedies have been increasingly applied in the past two decades despite the availability of the more complex and more effective malignant tumor treatments. AIMS: The authors attempted to find out about the applied alternative remedies for childhood cancer outside the traditional treatments, to determine how frequently they were applied and to examine what psychological factors had lead to their application. PATIENTS: Children's parents, getting active treatment and also the ones that have been rehabilitated at the II. Department of Pediatrics, Semmelweis University. RESULTS: 60 percent of the 34 children being examined were getting several kinds of therapy. The most frequently applied alternative remedies were the following: nature products, diet supplements, herbs, diet changes. The parents' choice was mainly influenced by other parents' opinions (42%), frequently appearing commercials in media (26%) and their current financial background (23%). The authors have found on the base of their research that the general aim of parents was: to help their own incapability to help (31%), to make sure about the efficiency of the treatment (45%). CONSEQUENCES: Independently of demographic or clinical facts the use of alternative remedies are excessively widespread and popular with children having tumor. Thus it is not advisable or reasonable to absolutely refuse them since they are quite widespread and people tend to strongly believe in them. As for doctors, they are to give professional advice and help with choosing the alternative remedies that are not harmful or even more, the ones that can make traditional treatments more effective.

[Folic acid supplementation for pregnant women in Hungary]. / A magyarországi várandósok folsavszedési szokásai.

INTRODUCTION: Neural tube defects are common major congenital anomalies. Folic acid supplementation has been shown to reduce the incidence of neural tube defects. In 2003, incidence of neuroblastoma has decreased with 60% in Canada as a result of enriched cereal grain flours with synthetic folic acid. The aim of this study was to investigate the effect of the practice of the folic acid intake by pregnant women (based on the Hungarian recommendation) to the incidence of neural tube defects and neuroblastoma. METHODS: The practice of folic acid supplementation was examined by questionnaires filled according to the documentation of health visitors. The data were worked up by computer. The incidence of neural tube defect was obtained from the data of the Hungarian Congenital Anomalies Registry, however, the data of National Health Insurance Company are also given. The incidence of neuroblastoma was the data of the Hungarian Pediatric Tumor Registry. Regular folic acid intake has been recommended to pregnant women in Hungary, since the eighties of the last century. An official protocol had been released by the Obstetric and Gynecologic Professional Board in 1997. In this paper, the authors report the Hungarian pregnant women's folic acid intake in years of 2001, 2002 and 2003. These years were chosen, because according to the data of the Hungarian Pediatric Cancer Registry 45% of the neuroblastoma cases are less than 1 year old, and 45% of them are 1-5 years old at the time of diagnosis. The authors succeeded to collect the data from 95% of the pregnant women during these years (271,748 women). RESULTS: Based on the statistical analysis of the collected data, 69% of the pregnant women were regularly taking folic acid products in Hungary, however, the dose of the daily intake was below 5 mg. 93% of the pregnant women started the folic acid intake after their 7th weeks of pregnancy The incidence of neural tube defects was constant, and the incidence of neuroblastoma slightly increased during the above mentioned period. CONCLUSIONS: This work highlighted that, the folic acid intake to prevent neural tube defects was started too late, because the formation of neural tube is finished on 28. day of pregnancy. 85% of the pregnant women used less amount of folic acid than 5 mg/day. The increasing number of planned pregnancies would allow to start folic acid intake earlier. However, based on international experience, the enrichment of cereal grain flours with synthetic folic acid could provide optimal results.

[Investigation of the blood supply of liver tumors--ultrasonography with contrast agents]. / Májdaganatok keringésvizsgálata. I. Kontrasztanyagos ultrahangvizsgálatok.

Despite the significant advances in technology the sensitivity and specificity of ultrasound examination still doesn't reach that of modern CT and MR scans. A new modality to improve the potential of traditional ultrasound, in patients with nodular hepatic disease, is the use of ultrasonographic contrast agents. The ultrasound examinations using contrast agents enable the analysis of the vascularisation, and flow characteristics of foci, including that of the portal circulation, consequently the more accurate characterisation of the focal masses. Ultrasonographic contrast agents can be used in assessing the effectiveness of tumor therapy, as well as in directing therapeutic interventions. The author discusses the basics of ultrasound contrast imaging, the different types of contrast agents, and their mechanism of action. She presents the significance of the method in focal hepatic disease in light of the available literature.