Orvosi hetilap最新文献

{"title":"[Online adaptive irradiation of a p16+ bulky head/neck cancer patient at the National Institute of Oncology].","authors":"Ádám Gáldi, Márton Poósz, Tibor Major, Péter Ágoston, Szilvia Hegyesi, Zoltán Takácsi-Nagy","doi":"10.1556/650.2025.33355","DOIUrl":"10.1556/650.2025.33355","url":null,"abstract":"<p><p>A 48-year-old male patient with a large (T3N3M0) p16 positive meso-hypopharyngeal tumor was hospitalized in our department for radiotherapy. The standard of care for this disease would have been radio-chemotherapy, but given the extent of the disease, we opted for palliative radiotherapy alone. Because of the patient’s p16 positivity, we assumed a high tumor response, so we offered the option of online adaptive radiotherapy, for the first time in our country. The patient accepted the treatment, which meant that we were able to carry it out by taking a cone-beam CT scan every day, which allowed us to redraw the target volumes and the organs to be protected, and create a new irradiation plan. The patient received a 10-fraction treatment without any significant side effects, and his existing symptoms of the disease were reduced. Due to the great improvement of the patient’s general condition and the significant regression of the target volume, we were able to complete the treatment up to the definitive dose. At the follow-up MRIs and CTs at 1, 2, 3, and 6 months, further high regression was reported in the treated region without distant metastasis. Compared to the high-fraction-dose treatment performed, we observed an excellent side effect profile based on quality of life questionnaires. We successfully completed the first online adaptive head and neck tumor treatment in Hungary. Orv Hetil. 2025; 166(32): 1265–1270.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 32","pages":"1265-1270"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Special considerations in bariatric surgery].","authors":"Gábor Barcsák, Allan Okrainec, Timothy Jackson, Todd Penner, Intekhab Hossain, Eviatar Kuhnreich, Áron Altorjay, András Botond Fecső","doi":"10.1556/650.2025.33362","DOIUrl":"10.1556/650.2025.33362","url":null,"abstract":"<p><p>Bariatric surgery is proven to be the most effective treatment for obesity and its associated metabolic diseases. In this review article, we aim to present the current developments and specific aspects of metabolic surgery, based on the scientific literature and the current trends of some high-volume bariatric centers. In North America – as well as in Europe and Hungary –, the most common bariatric procedures are the laparoscopic Roux-en-Y gastric bypass and the sleeve gastrectomy. A relatively new malabsorptive procedure, the single anastomosis duodenal-ileal bypass, is also being performed with increasing frequency. This article provides an overview of the long-term outcomes of these surgeries in terms of weight loss and their impact on comorbidities, based on relevant scientific literature from recent years. We also discuss the main factors influencing the choice of surgical technique, such as gastroesophageal reflux disease, hiatal hernia, preoperative body mass index, and the severity of associated diseases. Revision options are also addressed. Given the essential role of a multidisciplinary approach in modern bariatric surgery, we briefly touch on endobariatric procedures as well. Considering the severity of obesity in Hungary and the increasing number of bariatric procedures in the country, we believe our article may be of interest to the Hungarian medical community. Orv Hetil. 2025; 166(32): 1243–1249.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 32","pages":"1243-1249"},"PeriodicalIF":0.9,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tinnitus: associated symptoms and possible triggering factors].","authors":"András Molnár, Panayiota Mavrogeni, Gábor Dénes Répássy, Stefani Maihoub","doi":"10.1556/650.2025.33337","DOIUrl":"10.1556/650.2025.33337","url":null,"abstract":"<p><p>Introduction and objective:The background of tinnitus is complex, involving various symptoms and triggering factors observed in clinical practice. This investigation aims to analyze how these associated symptoms and triggering factors impact tinnitus severity. Method: 165 patients with primary subjective tinnitus participated. Each participant underwent comprehensive tinnitus management, which included assessing associated symptoms and identifying triggering factors. Additionally, all patients completed the Tinnitus Handicap Inventory. Results:Analyzing demographic features, there is a noted predominance of males up to 40 years of age, after which females are more prevalent. Bilateral symptoms (54.5%) and left-sided symptoms (27.8%) were the most common. A significant portion of the population (72.1%) reported experiencing constant tinnitus. Vertigo (60%) and hearing loss (45.5%) were the most frequently reported associated symptoms. Headaches (41%) and a sensation of ear fullness (35%) occurred with slightly lower frequency. Upper airway infection symptoms were observed in 21% of cases, while symptoms like tingling sensation and facial palsy were reported at low rates of 8.4% and 2.4%. A silent environment was identified as a triggering factor for tinnitus in nearly all cases (90.3%), followed by stress (66.7%). Difficulty in falling asleep was relatively uncommon, occurring in only 27.3% of the population. Issues related to the cervical spine joints and the temporomandibular joint were reported in 24% and 17% of cases, respectively. The effects of weather fronts (6%) and noise triggering (3%) were less frequently noted. Multinomial logistic regression analysis revealed that higher age (over 50 years) (p = 0.019*; OR: 0.259, 95% CI = 0.084–0.800) and issues related to the cervical spine (p = 0.013*; OR: 4.860, 95% CI = 1.405–16.812) significantly predicted more severe tinnitus. Conclusion:The most common associated symptoms and triggering factors include vertigo, hearing loss, and headache, along with a silent environment and stress. Cervical spine issues and higher age significantly predict more severe tinnitus. Orv Hetil. 2025; 166(31): 1203–1208.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 31","pages":"1203-1208"},"PeriodicalIF":0.9,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Laparoscopic sacrocolpopexy: technical overview and standardized steps].","authors":"Attila Gergely Sipos, Bence Kozma, Bálint Farkas, Zsolt Domján, Péter Takács, Zoárd Krasznai, Rudolf Lampé","doi":"10.1556/650.2025.33309","DOIUrl":"10.1556/650.2025.33309","url":null,"abstract":"<p><p>Introduction: Due to its low recurrence rate and the advantages of minimally invasive surgery, laparoscopic sacrocolpopexy has become one of the most commonly performed procedures for the treatment of apical uterovaginal prolapse. Several variations of the surgical technique exist, with the choice often reflecting the surgeon’s individual experience. However, the benefits of standardized surgical steps are indisputable in ensuring proper adaptation and safe execution of the procedure. Objective:This study aims to present the main surgical steps of laparoscopic sacrocolpopexy as applied in our clinical practice, based on the available literature and current evidence, and to analyze our clinical data. Method: Following the relevant literature, international guidelines, and our experience, the procedure was standardized into the following steps: (1) exposure of the surgical field, (2) dissection of the promontory, (3) pararectal dissection, (4) rectovaginal dissection, (5) vesicovaginal dissection, (6) supracervical hysterectomy (when indicated and the uterine corpus is present, and removal of the cervix is not justified), (7) mesh fixation to the vagina, (8) mesh fixation to the promontory, (9) peritoneal closure, (10) removal of the uterine corpus from the abdominal cavity. Results: We analyzed data from 30 laparoscopic sacrocolpopexy procedures performed at the Department of Obstetrics and Gynecology, University of Debrecen, between September 2022 and April 2023. No major intraoperative or postoperative complications occurred; deviation from the planned surgical type was required in three cases. After 6 weeks, the majority of patients reported a marked improvement in subjective prolapse symptoms. Two cases of symptomatic recurrence were identified: one managed conservatively, and one required surgical correction. No cases of de novo stress urinary incontinence were observed. Conclusion: Laparoscopic sacrocolpopexy may represent an effective surgical option for the treatment of apical uterovaginal prolapse. The application of standardized surgical steps may improve procedural safety, facilitate surgical training, and contribute to reduced operative time. Orv Hetil. 2025; 166(31): 1217–1223.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 31","pages":"1217-1223"},"PeriodicalIF":0.9,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kedvezőtlen tendencia a prosztatarák hazai incidenciájában – a Nemzeti Rákregiszter előzetes eredményei.","authors":"István Kenessey, András Wéber, Péter Nagy, Magdolna Dank","doi":"10.1556/650.2025.31M","DOIUrl":"10.1556/650.2025.31M","url":null,"abstract":"","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 31","pages":"1238-1239"},"PeriodicalIF":0.9,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hyperplastic polyp-like change at the diagnosis of inflammatory bowel disease].","authors":"Ádám Ferenczi, Anita Sejben","doi":"10.1556/650.2025.33363","DOIUrl":"10.1556/650.2025.33363","url":null,"abstract":"<p><p>In inflammatory bowel disease (IBD), serrated lesions are of particular importance. The diagnosis of hyperplastic polyp-like change is used for IBD-associated lesions with morphology identical to hyperplastic polyps and with a clearly polypoid lesion on endoscopic examination. Hyperplastic polyp-like change is often detected in association with synchronous or metachronous neoplasia, and may also harbor p53, KRAS and BRAF mutations. We present the case of a 20-year-old female patient who was previously diagnosed and treated for acute abdominal catastrophe and abdominal abscesses. The current colonoscopic examination reflected inflammation of the caecum and the ascending colon, with a 6 mm polypoid lesion in the caecum, from which a specimen was taken. Histopathological examination showed right colon predominant ulcerative colitis with hyperplastic polyp-like change. IBDs significantly increase the risk of colorectal carcinoma by 1.5–2, with colitis-associated dysplasia being the main risk factor. The current professional guidelines recommend surveillance colonoscopy for ≥8 years of disease and for extensive IBD involving ≥1/3 of the colon. In any case, hyperplastic polyp-like change should be distinguished from serrated epithelial change and sessile serrated lesion. The potentially worse prognosis underlying these entities highlights the importance of complete resection and close follow-up in this patient group. Orv Hetil. 2025; 166(31): 1230–1233.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 31","pages":"1230-1233"},"PeriodicalIF":0.9,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Perinephric myxoid pseudotumor of fat].","authors":"Boglárka Pósfai, Alex Jenei, Tamás Pancsa, Levente Kuthi","doi":"10.1556/650.2025.33342","DOIUrl":"10.1556/650.2025.33342","url":null,"abstract":"<p><p>Myxoid pseudotumors rarely develop in the perirenal adipose tissue, they are incidental findings most commonly. Myxoid pseudotumors may mimic other benign and malignant tumors of this region; therefore, being aware of these lesions is particularly important for the pathologist. In our report, we present the case of a 38-year-old man who developed end-stage renal disease due to bilateral vesicoureteral reflux and left-sided hydronephrosis, for which renal allograft transplantation was performed. 19 years after the transplantation, graftectomy became necessary. During histological processing, in addition to the histological features of end-stage renal disease, we observed a circumscribed spindle cell proliferation with myxoid areas in the renal hilum. Based on the absence of cytological atypia and the immunohistochemical findings, the lesion was diagnosed as a perinephric myxoid pseudotumor of fat tissue. This disease of unknown pathogenesis develops in association with both tumorous and non-tumorous kidney disorders. According to the current data, it is considered a benign tumor-like lesion, and no recurrences have been reported so far following excision. This rare entity most commonly resembles well-differentiated liposarcoma, and its distinction relies on morphology, immunoprofile, and MDM2 FISH analysis. FISH reaction did not show MDM2 gene amplification in the tumor cells in the current case of perinephric myxoid pseudotumor. Orv Hetil. 2025; 166(31): 1224–1229.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 31","pages":"1224-1229"},"PeriodicalIF":0.9,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Power versus science].","authors":"Csaba Varga","doi":"10.1556/650.2025.HO2840","DOIUrl":"10.1556/650.2025.HO2840","url":null,"abstract":"","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 31","pages":"1234-1237"},"PeriodicalIF":0.9,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Methodological monitoring of the effects of endocrine disruptors in complex health maintenance].","authors":"Krisztián Sepp, Péter Sándor Kiss, Anna László, Zsuzsanna Valkusz, Marianna Radács, Márta Gálfi, Zsolt Molnár","doi":"10.1556/650.2025.33353","DOIUrl":"10.1556/650.2025.33353","url":null,"abstract":"<p><p>Introduction: By the 3rd millennium, the Earth as a living environment had been altered by environmental stresses. For 25 years, our research group has been thematically engaged in model studies of homeostatic disruptor effects. These have enabled thematic studies to follow the effects of chemical agents, e.g., the combined effects of chlorobenzenes (hexachlorobenzene : 1,2,4-trichlorobenzene 1 : 1), which have endocrine disrupting properties. Objective: We aimed to develop a test model system to investigate the effects of endocrine disruptors in a validated test system. Method: In the test system, male and female Wistar rats were used as model animals for in vivo studies. Subtoxicity was controlled by liver enzymes and body weight and physiological characterization. The exposure pathway was standardized. Then, the organism-level sub-toxic dose range and the time windows for acute and chronic monitoring of subtoxicity were defined. Plasma arginine vasopressin, and oxytocin levels were measured by RIA and LIA. Data were evaluated using SAS and ANOVA. Results: A stable in vivo control system had to be established to monitor the biological effects. The chlorobenzene exposures were standardized via gastrointestinal probe, in a final volume of 1.0 ml per day, at doses of 0.1 and 1.0 µg/kg body weight. The chlorobenzene potency model compounds were optimized during in vivo gastrointestinal exposure. Exposures were standardized: via gastrointestinal probe, 1 ml final volume per day, at doses of 0.1 and 1.0 µg/kg body weight. Experimental time intervals were 0–90 days. Discussion: In our work, we have succeeded in developing a test system to establish a validated method for monitoring chemical environmental exposures. We have also developed a standardised procedure for the determination of human toxicity potentials. Conclusion: A validated test system has been developed to test for persistent organic pollutants, which are nowadays a major health concern, making their testing of real relevance in clinical practice. Orv Hetil. 2025; 166(31): 1209–1216.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 31","pages":"1209-1216"},"PeriodicalIF":0.9,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The current state of the background, incidence, and treatment strategies of hip fractures].","authors":"Máté Burkus, Andreas Bruch","doi":"10.1556/650.2025.33349","DOIUrl":"10.1556/650.2025.33349","url":null,"abstract":"<p><p>Hip fractures are typical injuries among old and very old patients. Their incidence is particularly high and strongly correlates with increasing age. While a significant rise in fracture rates was projected for the late 20th century and subsequent decades, available literature data since then have presented mixed findings. Although an absolute increase in fracture numbers was observed, in many developed regions a decline in incidence has also been noted. The epidemiology of hip injuries is relatively complex. Beyond factors such as smoking, alcohol consumption, hereditary and acquired diseases, and certain drug therapies, geographical and social factors – including urbanization – also play a clearly demonstrable role. The most fundamental principle in the therapeutic algorithm for hip fractures is striving for the earliest and most complete restoration of patient mobility, thereby reducing the high complication rates associated with immobilization. However, treating old and very old patients cannot be based only on trauma principles. For these individuals, concurrent interdisciplinary geriatric therapy as well as proper rehabilitation and nursing care are of great importance. Given the frequency of periarticular hip injuries – as their role is significant in the daily emergency practice as well as in every other subspecialty that includes the care of the elderly – it is essential to understand their epidemiological background and the fundamentals of treatment options. This knowledge can facilitate early and adequate recognition of injuries as well as prompt and appropriate therapy. The aim of this review is to provide a general and comprehensive overview, thereby expanding current knowledge on hip fractures based on the latest available literature. Orv Hetil. 2025; 166(30): 1163–1171.</p>","PeriodicalId":19911,"journal":{"name":"Orvosi hetilap","volume":"166 30","pages":"1163-1171"},"PeriodicalIF":0.9,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}