A felső és alsó endoszkópiák indikációja, a diagnózisok megoszlása és minőségi mutatók 2010–2011-ben a Semmelweis Egyetem I. Belgyógyászati Klinikáján

Absztrakt: Bevezetés és célkitűzés: A Semmelweis Egyetem I. Belgyógyászati Klinikájának endoszkópos laboratóriumában vizsgálták a felső és alsó endoszkópiák indikációit, a diagnózisok megoszlását indikációk szerint, valamint a kolonoszkópiák minőségi mutatóit. Módszer: 2010. január 1. és 2011. december 31. között 2987 beteg felső és alsó endoszkópos vizsgálatának adatait elemezték (férfi/nő: 1361/1626, átlagéletkor: 60,7 év, SD: 16,7 év) a fekvő- és járóbeteg-megjelenések riportjaiból. Eredmények: A felső endoszkópiák során a jóindulatú fekélybetegség, nyelőcső-varicositas, gyomorpolip és gyomorrák előfordulási gyakorisága 10,8%, 4,5%, 6,1% és 2,9% volt. Az alsó endoszkópos vizsgálatok vastagbélpolipot, diverticulosist, daganatot és gyulladásos bélbetegséget 29,9%, 22,4%, 6,9% és 9,7%-ban írtak le. A betegek 26,3%-át vizsgálták okkult/manifeszt GI-vérzés indikációjával. A vérzés indikációjával vizsgált betegek idősebbek voltak (p<0,01), több volt a férfi (p<0,001, OR: 1,64), gyakrabban szedtek acenocoumarol- vagy heparinkészítményeket (p<0,001), gyakoribb volt a jóindulatú fekélybetegség (p<0,001, OR: 2,83) és nyelőcső-varicositas (p<0,001, OR: 2,79), a gasztroszkópiák, valamint a kolonoszkópiák során a colorectalis daganat (p<0,001, OR: 3,27). A kolonoszkópiák 81%-a volt komplett. Az inkomplett vizsgálat hátterében elégtelen előkészítés (38,2%), technikai nehézség (25,1%) és daganat miatti szűkület (20,5%) állt. Következtetés: A diagnózisok megoszlása és a minőségi mutatók (adenomatalálat, komplettálási arány) megfeleltek az adott populációban várhatónak. Orv. Hetil., 2016, 157(52), 2074–2081. | Abstract: Introduction and aim: The aim was to assess the incidence of endoscopic findings based on the indication of the procedures in upper/lower endoscopies, and measuring quality indicators of colonoscopies at the 1st Department of Medicine, Semmelweis University, Budapest. Method: Data of 2987 patients (male/female:1361/1626, mean age: 60.7 years(y), SD: 16.7y) between 01.01.2010 and 31.12.2011 were analyzed. Both inpatient and outpatient records were collected. Results: Incidence of peptic ulcer disease, esophageal varices, gastric polyps and gastric cancer were 10.8%, 4.5%, 6.1%, 2.9% in upper endoscopies, respectively. In colonoscopies colorectal polyps, diverticulosis, colorectal cancer and IBD were found in 29.9%, 22.4%, 6.9%, 9.7%, respectively. In patients having upper endoscopy with GI bleeding indication, older age (p<0.001), male gender (p<0.001, OR: 1.64), acenocoumarol/heparin use (p<0,001, peptic ulcers and esophageal varices were more frequent (p<0.001, OR: 2.83 and p<0.001, OR: 2.79), while in colonoscopies colorectal cancer had higher incidence (p<0.001, OR:3.27). 81% of colonoscopies were complete. Causes of incomplete procedures were ineffective bowel preparation (38.2%), technical difficulties (25.1%) and strictures (20.5%). Conclusion: The endoscopic findings and quality indicators (adenoma detection rate, coecal intubation rate) were in line with that reported in published series. Orv. Hetil., 2016, 157(52), 2074–2081

Molecular markers and potential therapeutic targets in non-WNT/non-SHH (group 3 and group 4) medulloblastomas

Childhood medulloblastomas (MB) are heterogeneous and are divided into four molecular subgroups. The provisional non-wingless-activated (WNT)/non-sonic hedgehog-activated (SHH) category combining group 3 and group 4 represents over two thirds of all MBs, coupled with the highest rates of metastases and least understood pathology. The molecular era expanded our knowledge about molecular aberrations involved in MB tumorigenesis, and here, we review processes leading to non-WNT/non-SHH MB formations.The heterogeneous group 3 and group 4 MBs frequently harbor rare individual genetic alterations, yet the emerging profiles suggest that infrequent events converge on common, potentially targetable signaling pathways. A mutual theme is the altered epigenetic regulation, and in vitro approaches targeting epigenetic machinery are promising. Growing evidence indicates the presence of an intermediate, mixed signature group along group 3 and group 4, and future clarifications are imperative for concordant classification, as misidentifying patient samples has serious implications for therapy and clinical trials.To subdue the high MB mortality, we need to discern mechanisms of disease spread and recurrence. Current preclinical models do not represent the full scale of group 3 and group 4 heterogeneity: all of existing group 3 cell lines are MYC-amplified and most mouse models resemble MYC-activated MBs. Clinical samples provide a wealth of information about the genetic divergence between primary tumors and metastatic clones, but recurrent MBs are rarely resected. Molecularly stratified treatment options are limited, and targeted therapies are still in preclinical development. Attacking these aggressive tumors at multiple frontiers will be needed to improve stagnant survival rates

Demographic shift disproportionately increases cancer burden in an aging nation: current and expected incidence and mortality in Hungary up to 2030

Ot&iacute;lia Menyh&aacute;rt,1,2 J&aacute;nos T Fekete,2 Bal&aacute;zs Győrffy1,2 1MTA TTK Lend&uuml;let Cancer Biomarker Research Group, Institute of Enzymology, Hungarian Academy of Sciences, Budapest, Hungary; 22nd Department of Pediatrics, Semmelweis University, Budapest, Hungary Background: Population aging is a common demographic pattern in developed countries, and aging increases the risk of cancer. The disproportionately high cancer burden, as a consequence, is especially pronounced in Central and Eastern European countries, including Hungary. Methods: We summarized current and projected future cancer incidences and mortalities utilizing data from the last two decades. Predictions are based on cancer incidence and mortality collected between 1996 and 2015 in Hungary. In addition to the crude rates, data were age standardized to the European standard population (ESP) of 2013, ESP of 1976, and local census of 2011.Results: The lifetime probability of developing cancer and cancer-related mortality has already reached 56.9% and 27.6% in men, respectively, and 51.9% and 21.7% in women. Between 2016 and 2030, the total population is expected to shrink by 6%, while the number of 60-year olds and above will grow by 18%. This will lead to a 35% increase in cancer incidence and 30% increase in cancer death among 65&ndash;85-year olds. Joinpoint regression identified the period 2007&ndash;2015 as starting point for this coming increase in new cases. In women, lung and breast cancer will increase yearly by 1.9% and 1.7%, respectively, between 2016 and 2030, while in men, the prostate and colorectal cancer rates will increase yearly by 3.6% and 2.1%.Conclusion: In the aging population of Hungary, cancer incidence will increase considerably over previous projections. Although a large portion of the most rapidly rising cancers are avoidable by implementing public health programs, a substantial portion remains inevitably incurable. Keywords: cancer, biostatistics, aging, lung cancer, colon cancer, breast cancer, prostate cance