Thermoablatios lehetőségek a benignus térfoglaló képletek gyógyításában

INTRODUCTION: Depending on their size and location, some benign tumors can cause prolonged discomfort and even rupture and fatal bleeding in severe cases. Hitherto the therapeutic strategies for such lesions were observation, surgery and in selected cases transarterial embolization. AIM: Our aim was to present the possibilities of thermoablation for treating lesions. METHOD: Here we present interventions of four patients in Semmelweis University Department of Transplantation and Surgery. A thyroid adenoma and a kidney angiomyolipoma were treated with radiofrequency ablation. Two patients with a liver haemangioma were treated with microwave thermoablation technique. RESULTS: Complications were not observed in any of the cases. In most cases, the size of the treated lesions decreased. The mean decrease in volume was 32.7%. The contrast enhancement of the lesions also decreased, the mean reduction in contrast enhancing volume was 75.3%. CONCLUSIONS: Thermoablational procedures for the benign tumors presented above are safe. The therapy shows excellent cosmetic results, a shorter hospital stay and quicker recovery. Orv. Hetil., 2016, 157(51), 2040-2047

Az intervenciós radiológia szerepe a hasi szervek átültetésében = Role of interventional radiology in the transplantation of abdominal solid organs

Absztrakt: A hasi szervek transzplantációja kiemelkedő szerephez jut számos kórkép gyógyítása esetén. Az elmúlt évtizedekben robbanásszerű fejlődés ment végbe a transzplantáció kapcsán tevékenykedő szakmák mindegyikét érintően. A szervtranszplantáció sikerének kulcsa több szakma specialistáinak szoros együttműködése. A csapatmunka a teljes folyamatot végigkíséri, a megfelelő technikai és humánerőforrás-lehetőségek biztosításától a beültetett szervek és recipienseik lényegében élethosszig tartó gondozásáig. Ezen folyamat fontos részei a diagnosztikus és az intervenciós radiológia. Az utóbbi lehetőségeit, szerepét foglaljuk össze a transzplantáció előtti és utáni kóros állapotok minimálisan invazív megoldásában. Érképleteken keresztül végzett – vascularis – és folyadékgyülemeket, epevezetékeket, húgyvezetékeket érintő – nonvascularis – intervenciók mellett az intervenciós onkológia egyes lehetőségei is említésre kerülnek az összefoglalóban, a hazai tapasztalatok és a nemzetközi irodalom tükrében. Orv Hetil. 2018; 159(46): 1940–1947. | Abstract: The transplantation of the abdominal organs has a major role in the treatment of several diseases. All subspecialities affected with the transplantation showed a rapid development in the last decades. The cooperation of the specialists of different segments of medicine provides the success of organ transplantation. Teamwork is necessary throughout the whole process starting from securing the technical background and proper human workforce, followed by the lifelong management of organs and recipients as well. One of the key players of organ transplantation is radiology and interventional radiology – the role of the latter one is discussed in this review, including the minimally invasive treatment of pre- and post-transplantation situations and diseases. Besides vascular and non-vascular interventions, the options of interventional oncology will be mentioned based on international literature and Hungarian experience. Orv Hetil. 2018; 159(46): 1940–1947

Non-anastomotic biliary strictures after liver transplantation : Focus on percutaneous treatment and extent of disease

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Novel role for galectin-1 in T-cells under physiological and pathological conditions

Secreted, extracellular galectin-1 (exGal-1) but not intracellular Gal-1 (inGal-1) has been described as a strong immunosuppressive protein due to its major activity of inducing apoptosis of activated T-cells. It has previously been reported that T-cells express Gal-1 upon activation, however its participation in T-cell functions has remained largely elusive. To determine function of Gal-1 expressed by activated T-cells we have carried out a series of experiments. We have shown that Gal-1, expressed in Gal-1-transgenic Jurkat cells or in activated T-cells, remained intracellularly indicating that Gal-1-induced T-cell death was not a result of an autocrine effect of the de novo expressed Gal-1. Rather, a particular consequence of the inGal-1 expression was that T-cells became more sensitive to exGal-1 added either as a soluble protein or bound to the surface of a Gal-1-secreting effector cell. This was also verified when the susceptibility of activated T-cells from wild type or Gal-1 knockout mice to Gal-1-induced apoptosis were compared. Murine T-cells expressing Gal-1 were more sensitive to the cytotoxicity of the exGal-1 than their Gal-1 knockout counterparts. We also conducted a study with activated T-cells from patients with systemic lupus erythematosus (SLE), a disease in which dysregulated T-cell apoptosis has been well described. SLE T-cells expressed lower amounts of Gal-1 than healthy T-cells and were less sensitive to exGal-1. These results suggested a novel role of inGal-1 in T-cells as a regulator of T-cell response to exGal-1, and its likely contribution to the mechanism in T-cell apoptosis deficiency in lupus

Jóindulatú pajzsmirigygöbök rádiófrekvenciás hőablatiós kezelése

Introduction: Benign thyroid nodules are frequent findings in imaging studies, most of the time not requiring any intervention. Treatment is usually started when nodules increase in size, the patient becomes symptomatic or clinically relevant hyperthyroidism develops. Thermoablation is an effective alternative modality. In Hungary, our team has pioneered these interventions using radiofrequency ablation for decreasing the size of the nodules. Aim: We are presenting our results showing the effectiveness of this treatment after introducing the role, importance and technique of thermoablation in benign thyroid nodules. Method: Between June of 2016 and September of 2019, 186 nodules of 140 patients were treated with radiofrequency ablation and had at least 6 months of follow up. The volume and diameter of all the ablated nodules were measured and calculated, then the decreases of these parameters were followed using ultrasonography. The mean follow-up time was 12.5 +/- 5.9 months. Results: The size measurements at the follow-up ultrasonography examinations showed a decrease in size and vascularity. The mean volume reduction was 44.7 +/- 17.6% at one-month post-treatment and 72.9 +/- 17.9% at 6 months. There were 3 minor complications. Conclusions: Radiofrequency ablation represents a feasible, effective, well tolerated method for outpatient treatment of benign thyroid nodules. This method is a valuable alternative to surgical treatments in selected cases

Treatment of early hepatic artery complications after adult liver transplantation: a single center experience

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Downstaging of hepatocellular carcinoma with radiofrequency ablation on the Hungarian liver transplantation waiting list: Early results and learned lessons

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Invalidity of Tokyo guidelines in acute biliary pancreatitis : A multicenter cohort analysis of 944 pancreatitis cases

There is a noteworthy overlap between the clinical picture of biliary acute pancreatitis (AP) and the 2018 Tokyo guidelines currently used for the diagnosis of cholangitis (AC) and cholecystitis (CC). This can lead to significant antibiotic and endoscopic retrograde cholangiopancreatography (ERCP) overuse.We aimed to assess the on-admission prevalence of AC/CC according to the 2018 Tokyo guidelines (TG18) in a cohort of biliary AP patients, and its association with antibiotic use, ERCP and clinically relevant endpoints.We conducted a secondary analysis of the Hungarian Pancreatic Study Group's prospective multicenter registry of 2195 AP cases. We grouped and compared biliary cases (n = 944) based on the on-admission fulfillment of definite AC/CC according to TG18. Aside from antibiotic use, we evaluated mortality, AC/CC/AP severity, ERCP performance and length of hospitalization. We also conducted a literature review discussing each criteria of the TG18 in the context of AP.27.8% of biliary AP cases fulfilled TG18 for both AC and CC, 22.5% for CC only and 20.8% for AC only. Antibiotic use was high (77.4%). About 2/3 of the AC/CC cases were mild, around 10% severe. Mortality was below 1% in mild and moderate AC/CC patients, but considerably higher in severe cases (12.8% and 21.2% in AC and CC). ERCP was performed in 89.3% of AC cases, common bile duct stones were found in 41.1%.Around 70% of biliary AP patients fulfilled the TG18 for AC/CC, associated with a high rate of antibiotic use. Mortality in presumed mild or moderate AC/CC is low. Each of the laboratory and clinical criteria are commonly fulfilled in biliary AP, single imaging findings are also unspecific-AP specific diagnostic criteria are needed, as the prevalence of AC/CC are likely greatly overestimated. Randomized trials testing antibiotic use are also warranted