Hasüregi daganatáttétek stereotaxiás sugárkezelése egy ülésben. Beszámoló az első hazai, koponyán kívüli sugársebészeti beavatkozásról

Absztrakt Az elmúlt évtizedekben a daganatgyógyítás fejlődésének és eredményességének jeleként a lokális terápiás modalitások szerepe az áttétes betegségek ellátása során felértékelődött. A szerzők tudomása szerint a hazánkban első eredményes, koponyán kívüli sugársebészeti beavatkozást ismertetik. Az 58 éves férfi gyomoradenocarcinoma miatt műtéten, kemoterápián és mellékveseáttétek miatt metastatectomián esett át. Az első műtét után 4 évvel a követési komputertomográfiás vizsgálat kétgócú és inoperábilisnak véleményezett peritonealis áttétképződést mutatott, a májszél, illetve a bal vese alatt, 2 cm-es átmérőkkel. Definitív ellátásként, egy ülésben 12 Gy dózisú stereotaxiás hasi sugársebészeti beavatkozást végeztek, cone-beam komputertomográfiás ellenőrzés mellett, dinamikus ívbesugárzást, illetve 2-2 ívet alkalmazva. A kezelés 25 percig tartott, sem akut, sem késői mellékhatást nem észleltek. A kezelés után 3, illetve 7 hónappal elvégzett kontroll-komputertomográfia teljes tumorregressziót igazolt. A szerzők megállapítják, hogy megfelelő technológia és gyakorlottság birtokában, nem gyorsan növekvő oligometasztázisok esetében a koponyán kívüli stereotaxiás sugársebészeti ellátás biztonságos és hatékony alternatívája lehet a műtéti beavatkozásnak. Orv. Hetil., 2015, 156(39), 1593–1599

Additional value of microvascular flow imaging in the assessment of cystic and solid renal lesions

Contrast enhanced ultrasound (CEUS) is increasingly used in the evaluation of renal lesions, however, its availability remains limited. Thus, sensitive noncontrast ultrasound evaluation of renal lesion vascularity is an unmet need.In this single-center, retrospective study we assessed microvascular flow imaging (MV-flow) compared to CEUS in the evaluation of complex renal cysts and solid lesions. Out of 92 patients 28 were evaluated with both CEUS and MV-flow. Color Doppler, CEUS, and MV-flow was performed in 13 cases, whilst MV-flow, CEUS, and contrast-enhanced MV-flow (CE-MV-flow) was done in 16 cases. The CEUS diagnosis was considered gold standard.MV-flow showed a substantial agreement with the CEUS diagnosis (weighted Kappa = 0.806), excluding equivocal lesions (Bosniak 2F). MV-flow substantially outperformed color Doppler (weighted Kappa = 0.77 vs. 0.133). The agreement of CE-MV-flow and MV-flow was comparable (weighted Kappa = 0.79 vs. 0.69).MV-flow significantly improves evaluation of renal lesion vascularity compared to conventional techniques. However, the sensitivity is limited for equivocal lesions (e.g. Bosniak 2F cysts). Thus, MV-flow should be used as an ancillary technique, not as a substitute to CEUS. Current MV-flow presets are ill-suited for postcontrast imaging, therefore specific presets optimized for this purpose are needed to establish its potential

High versus low energy administration in the early phase of acute pancreatitis (GOULASH trial): protocol of a multicentre randomised double-blind clinical trial

INTRODUCTION: Acute pancreatitis (AP) is an inflammatory disease with no specific treatment. Mitochondrial injury followed by ATP depletion in both acinar and ductal cells is a recently discovered early event in its pathogenesis. Importantly, preclinical research has shown that intracellular ATP delivery restores the physiological function of the cells and protects from cell injury, suggesting that restoration of energy levels in the pancreas is therapeutically beneficial. Despite several high quality experimental observations in this area, no randomised trials have been conducted to date to address the requirements for energy intake in the early phase of AP. METHODS/DESIGN: This is a randomised controlled two-arm double-blind multicentre trial. Patients with AP will be randomly assigned to groups A (30 kcal/kg/day energy administration starting within 24 hours of hospital admission) or B (low energy administration during the first 72 hours of hospital admission). Energy will be delivered by nasoenteric tube feeding with additional intravenous glucose supplementation or total parenteral nutrition if necessary. A combination of multiorgan failure for more than 48 hours and mortality is defined as the primary endpoint, whereas several secondary endpoints such as length of hospitalisation or pain will be determined to elucidate more detailed differences between the groups. The general feasibility, safety and quality checks required for high quality evidence will be adhered to. ETHICS AND DISSEMINATION: The study has been approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (55961-2/2016/EKU). This study will provide evidence as to whether early high energy nutritional support is beneficial in the clinical management of AP. The results of this trial will be published in an open access way and disseminated among medical doctors. TRIAL REGISTRATION: The trial has been registered at the ISRCTN (ISRTCN 63827758)