Neuroendokrin daganat májmetasztázisainak teljes és tartós remissziója szomatosztatinanalóg-kezelés hatására

Somatostatin analogues represent a major treatment modality in the therapy of neuroendocrine tumors. Their efficacy is well documented in the inhibition of hormone secretion; however, novel data seem to underline their effectiveness in tumor regression, as well. In this report authors present a case of type 1 neuroendocrine tumors of the stomach associated with liver metastases. Somatostatin analogue treatment resulted in a complete regression of the primary tumor and the metastases within two years. This case draws attention on the importance of somatostatin analogue treatment not only in the control of hormonal symptoms but also in the inhibition of tumor growth. Orv. Hetil., 2011, 152, 407-410

Szomatosztatin receptor, mint lehetséges differenciál diagnosztikai, prognosztikai és terápiás faktor a gyermekkori medulloblastomák esetében = Somatostatin receptor Acts as a Potential Differential Diagnostic, Prognostic and Therapeutic Factor in Patients Treated with Medulloblastoma

A gyermekkori agytumorok terápiás eredményei nem kielégítőek. Célunk a medulloblastoma sejtjein kimutatott somatostatin receptorok (SSTR2) expressiojának vizsgálata volt; diagnosztikai-, prognosztikai és terápiás alkalmazhatóságának tanulmányozása. Az általunk vizsgált 21 medulloblastomában a SSTR2 kimutatható volt és recidivában nem változott. Az SSTR2 receptort Octreoscan vizsgálattal mutattuk ki, mely medulloblastomán kívül más agytumoros betegek egy részében is pozitiv volt (56 vizsgálat), tehát nincs differenciáldiagnosztikai jelentősége. Az Octreoscan vizsgálat az MRI nagyobb felbontóképessége ellenére hasznosnak bizonyult a medulloblastoma recidivának korai diagnosztikájában, mivel néhány MRI-vel negatív esetben is mutatott ki tumorszövetet. Szövettenyészetben az octreotid antipoliferativ, mitózisgátló hatással bír 40 ?m-nál nagyobb dózisban; apoptoticus hatása nincsen. Az octreotid vincristinnel, cisplatinnal és etoposiddal nem mutatott synergismust. Medulloblastoma xenograftban az octreotid magasabb dózisa gátolta a xenograft növekedését, de hatása a kezelés után egy héttel megszűnt. Mellékhatást nem észleltünk. Új terápiás eljárást dolgoztunk ki medulloblastomás betegek kezelésére, mellyel a 2 éves követési idő után (28 beteg) az eredmények, mind az előző, mind az átlagos nemzetközi eredményekhez képest jelentősen javultak (össztúlélés 82%); a jó prognozisú csoportban eddig egy betegnél észleltünk recidivát. | The present results of the therapy in paediatric brain tumors are unfavorable. Our aim was the study of the somatostatin receptors in medulloblastoma; the examination of its diagnostic-, prognostic- and antitumor effect. The somatostatin receptor (SSTR2) was shown by octreotid scintigraphy in 21 children with medulloblastoma, however, it was positive in some other brain tumors too. Hence it has no differencial diagnostic value. Instead of the greater sensitivity of MRI the application of Octreoscan my be useful in the early detection of a relapse in medulloblastoma, because in some MRI negativ cases it detected tumor tissue. The somatostatin in a higher dose, than 40 ?g had antiproliferativ effect in tissue culture and showed no synergetic effect with vincristin, cisplatin and etoposid. In xenograft the higher dose of octreotid showed antitumor effect, which lasted one week long after the end of treatmen. No side effect was seen. We set up a new treatment protocol for the patients with medulloblastoma. After 2 years long follow up (28 patients) the results are significantly better (OS 82%), than our previous or the international data: only one patient relapsed in the group of low risk patients

Lu-177-labeled zirconia particles for radiation synovectomy

The present article describes the preparation of beta emitter lutetium-177-lebeled zirconia colloid and its preliminary physico-chemical and biological evaluation of suitability for local radionuclide therapy. The new 177Lu-labeled therapeutic radiopharmaceutical candidate was based on the synthesis mode of a previously described zirconia nanoparticle system. Morphology and size of developed radiopharmaceutical compound were evaluated through scanning electron microscope and dynamic light scattering methods. The radiocolloid had a 1.7 micrometer mean diameter and showed suitable radiolabeling and colloid size in vitro stability at RT and during blood sera stability test. After the in vitro characterizations, the product was investigated in the course of the treatment of a spontaneously diseased dog veterinary patient’s hock joint completed with SPECT imaging follow-up measurements and a dual-isotope SPECT imaging tests with conventional 99mTc-MDP bone scintigraphy. In the treated dog any clinical side effects or signs of histopatological alterations of the joints could not be observed during the treatment. SPECT follow-up studies unequivocally showed appropriately high localization of the 177Lu-labeled colloid in hock joint and detectable but negligible radiocolloid leakages in the nearest lymph node, respectively

Veseérintettség májátültetés során

Introduction: In liver cirrhosis renal function decreases as well. Hepatorenal syndrome is the most frequent cause of the decrease, but primary kidney failure, diabetes mellitus and some diseases underlying endstage liver failure (such as hepatitis C virus infection) can also play an important role. In liver transplantation several further factors (total cross-clamping of vena cava inferior, polytransfusion, immunosuppression) impair the renal function, too. Aim: The aim of this study was to analyse the changes in kidney function during the first postoperative year after liver transplantation. Method: Retrospective data analysis was performed after primary liver transplantations (n = 319). Results: impaired preoperative renal function increased the devepolment of postoperative complications and the first year cumulative patient survival was significantly worse (91,7% vs 69,9%; p<0,001) in this group. If renal function of the patients increased above 60 ml/min/1,73 m2 after the first year, patient survival was better. Independently of the preoperative kidney function, 76% of the patients had impaired kidney function at the first postoperative year. In this group, de novo diabetes mellitus was more frequently diagnosed (22,5% vs 9,5%; p = 0,023). Conclusions: Selection of personalized immunosuppressive medication has a positive effect on renal function. Orv. Hetil., 2013, 154, 1018-1025

Inherently fluorescent and porous zirconia colloids : preparation, characterization and drug adsorption studies

Porous, fluorescent zirconia particles of nearly 380 nm diameter were prepared without template molecules or labeling dyes. The porous structure is the result of aggregation-induced particle formation. The inherent fluorescence is assigned to coordinatively unsaturated Zr4+ ions at the sol–gel derived ZrO2 surface. After physico-chemical characterization of the native zirconia particles carboxyl and/or amine bearing drug molecules (D,L-a-difluoromethylornithine – DFMO, ursolic acid – UA and doxorubicin – DOX) were adsorbed onto their surface, and the products were analyzed with Fourier-transform infrared spectroscopy (FTIR), thermogravimetry (TG), small-angle X-ray scattering (SAXS), fluorimetry and zeta potential vs. pH measurements. We have found that DOX complexes coordinatively unsaturated Zr4+ ions without dislocating them, while carboxyl-bearing drugs interact with basic surface Zr–OH sites eliminating some of the carbonate species. The adsorption of UA at the zirconia surface shifts considerably the isoelectric point of the surface and thus provides kinetic stability to the particles at physiological pH. An in vivo biodistribution study in two healthy dogs performed by SPECT/CT detection after 99mTc labeling of the nanocarriers has shown the possibility of drug delivery application

A neuroendokrin daganatok molekuláris vizsgálata a nukleáris medicinában

A neuroendokrin daganatok somatostatin receptort expresszálnak és katecholamin tároló vesiculumokat tartalmazhatnak. Radioizotóppal jelzett molekulákkal mindkét molekuláris mechanizmus felhasználható diagnosztikára és terápiára is. A diagnózisban, stagingben, a beteg követésében a somatostatin receptorhoz kötődő radiopharmakonok: az 111In-DTPA-octreotide (OctreoScan) és a 99mTc-EDDA/HYNIC-TOC (Tektrotyd) SPECT vizsgálat lényeges szerepet játszik. Segítsé gével kiválaszthatók azok a betegek, akiknél a Peptide-ReceptorRadionuclide-Terápiától eredmény várható. Az adrenerg receptorokban dúsuló "fals transzmitter" MIBG molekula un. theranosztikum, mert a I23-I-MIBG specifikus diagnosztikára (SPECT), a 131-I-MIBG célzott (molekuláris alapú) sugárterápiára használható. A neuroendokrin tumorok somatostatin expressziója, ill. MIBG dúsító képessége kezelés hatására, de a lefolyás során spontán is változhat. Mindkét típusú radiofarmakonnal ez követhető, a fenotípus képileg ábrázolható és ennek alapján lehetőségünk van az optimális, személyre szabott kezelés megválasztására

Inoperábilis, gyermekkori thymus carcinoma (thymoma C): esetbemutatás egy új terápiás lehetőség kapcsán

A thymus carcinoma gyermekkorban ritkán előforduló rosszindulatú daganat. Különösen az inoperábilis esetek prognózisa rossz a kombinált sugár- és kemoterápia ellenére. Közleményünkben az octreotid nevű somatostatin analóg és a prednisolon alkotta új kombinációs terápia hatásáról számolunk be, amelyet egy előrehaladott thymus carcinoma miatt gondozott beteg esetében alkalmaztunk először

Advanced Pediatric Inoperable Thymus Carcinoma (Type C Thymoma): Case Report on a Novel Therapeutic Approach

Although there has been considerable advancement in treatment techniques but still there are some illnesses that continue to exhibit a rather poor curability, such as thymoma. This report highlights the benefit of octreotide and prednisolone therapy in a 15-year-old girl, who was diagnosed with inoperable thymus carcinoma, with chemotherapy and radiotherapy being the last resort. The detection of type 2 somatostatin receptors on the surface of the tumor justified the introduction of treatment with somatostatin analog and prednisolone. Fortunately, after 6 months of this treatment, the tumor showed partial regression. However, 2 months later, somatostatin receptor negative metastases appeared; therefore, a switch over to imatinib became essential, because the tumor was CD-117 positive. Despite the therapy change, the patient's condition deteriorated owing to tumor progression

Neuroendokrin daganatok szomatosztatinreceptorendoradioterápiája: hazai betegeken szerzett tapasztalatok [Somatostatin receptor endoradiotherapy of neuroendocrine tumors: experience in Hungarian patients]

Beside conventional therapies for the treatment of neuroendocrine tumors, a new therapeutical approach, peptide receptor radionuclide therapy has been developed recently. There are two important features which make this therapy feasible: somatostatin receptors are strongly over-expressed in most neuroendocrine tumors resulting in a high tumor-to-background ratio and internalization of the somatostatin-receptor complex in neuroendocrine cells. Due to these features, neuroendocrine tumors can be treated with radiolabelled somatostatin analogues. For peptide receptor radionuclide therapy, somatostatin analogues are conjugated to a chelator that can bind a radionuclide. The most frequently used radionuclides for neuroendocrine tumor treatment are the beta-emitter Yttrium-90 (90Y) and the beta+gamma emitter Lutetium-177 (177Lu). Candidates for somatostatin receptor endoradiotherapy are patients with progressive, metastatic, somatostatin-receptor positive neuroendocrine tumors. Many patients have been successively treated with this approach: according to international results major remission can be achieved in 25% of the cases. Although this therapy is still unavailable in Hungary, Hungarian patients can be treated with somatostatin receptor endoradiotherapy with financial support from the National Health Fund in a co-operation with the University of Basel since 2005. During the past 5 years, 51 Hungarian patients have been treated with this therapy. This review briefly summarizes the theoretical background, indications, effectiveness and side effects of somatostatin receptor endoradiotherapy and the authors present the first data obtained from Hungarian patients. Orv. Hetil., 2011, 152, 392-397