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Fábián A, Bor R, Vasas B, Szűcs M, Tóth T, Bősze Z, Szántó KJ, Bacsur P, Bálint A, Farkas B, Farkas K, Milassin Á, Rutka M, Resál T, Molnár T, Szepes Z. Long-term outcomes after endoscopic removal of malignant colorectal polyps: Results from a 10-year cohort. World J Gastrointest Endosc 2024; 16:193-205. [PMID: 38680198 PMCID: PMC11045354 DOI: 10.4253/wjge.v16.i4.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/28/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging, and evidence regarding a surveillance-only strategy is limited. AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps. METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020. Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were investigated. Event rates for categorical variables and means for continuous variables with 95% confidence intervals were calculated, and Fisher's exact test and Mann-Whitney test were performed. Potential risk factors of adverse outcomes were determined with univariate and multivariate logistic regression models. RESULTS In total, 135 lesions (mean size: 22.1 mm; location: 42% rectal) from 129 patients (mean age: 67.7 years; 56% male) were enrolled. The proportion of pedunculated and non-pedunculated lesions was similar, with en bloc resection in 82% and 47% of lesions, respectively. Tumor differentiation, distance from resection margins, depth of submucosal invasion, lymphovascular invasion, and budding were reported at 89.6%, 45.2%, 58.5%, 31.9%, and 25.2%, respectively. Residual tumor was found in 10 patients, and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection. Univariate analysis identified piecemeal resection as a risk factor for residual malignancy (odds ratio: 1.74; P = 0.042). At least 1 year of follow-up was available for 117 lesions from 111 patients (mean follow-up period: 5.59 years). Overall, 54%, 30%, 30%, 11%, and 16% of patients presented at the 1-year, 3-year, 5-year, 7-year, and 9-10-year surveillance examinations. Adverse outcomes occurred in 9.0% (local recurrence and dissemination in 4 patients and 9 patients, respectively), with no difference between patients undergoing secondary surgery and surveillance only. CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement. Long-term adverse outcome rates might be higher than previously reported, irrespective of whether secondary surgery was performed.
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Affiliation(s)
- Anna Fábián
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Renáta Bor
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Medical Informatics, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6720, Hungary
| | - Tibor Tóth
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zsófia Bősze
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Kata Judit Szántó
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Péter Bacsur
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Anita Bálint
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Bernadett Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Klaudia Farkas
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
- USZ Translational Colorectal Research Group, Hungarian Centre of Excellence for Molecular Medicine, Szeged 6725, Hungary
| | - Ágnes Milassin
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Mariann Rutka
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Resál
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Tamás Molnár
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
| | - Zoltán Szepes
- Department of Internal Medicine, University of Szeged, Szent-Györgyi Albert Medical School, Szeged 6725, Hungary
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Bor R, Vasas B, Fábián A, Szűcs M, Bősze Z, Bálint A, Rutka M, Farkas K, Tóth T, Resál T, Bacsur P, Molnár T, Szepes Z. Risk Factors and Interpretation of Inconclusive Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of Solid Pancreatic Lesions. Diagnostics (Basel) 2023; 13:2841. [PMID: 37685379 PMCID: PMC10486755 DOI: 10.3390/diagnostics13172841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND The inconclusive cytological findings of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remain a major clinical challenge and often lead to treatment delays. METHODS Patients who had undergone EUS-FNA sampling for solid pancreas lesions between 2014 and 2021 were retrospectively enrolled. The "atypical" and "non-diagnostic" categories of the Papanicolaou Society of Cytopathology System were considered inconclusive and the "negative for malignancy" category of malignancy was suspected clinically. We determined the frequency and predictors of inconclusive cytological finding. RESULTS A total of 473 first EUS-FNA samples were included, of which 108 cases (22.83%) were inconclusive. Significant increases in the odds of inconclusive cytological findings were observed for lesions with a benign final diagnosis (OR 11.20; 95% CI 6.56-19.54, p < 0.001) as well as with the use of 25 G FNA needles (OR 2.12; 95% CI 1.09-4.01, p = 0.023) compared to 22 G needles. Furthermore, the use of a single EUS-FNA technique compared to the combined use of slow-pull and standard suction techniques (OR 1.70; 95% CI 1.06-2.70, p = 0.027) and less than three punctures per procedure led to an elevation in the risk of inconclusive cytology (OR 2.49; 95% CI 1.49-4.14, p < 0.001). Risk reduction in inconclusive cytology findings was observed in lesions between 2-4 cm (OR 0.40; 95% CI 0.23-0.68, p = 0.001) and >4 cm (OR 0.16; 95% CI 0.08-0.31, p < 0.001) compared to lesions ≤2 cm. CONCLUSIONS The more than two punctures per EUS-FNA sampling with larger-diameter needle (19 G or 22 G) using the slow-pull and standard suction techniques in combination may decrease the probability of inconclusive cytological findings.
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Grants
- K125377 to TM, K134863 to KF, K143549 to TM National Research, Development and Innovation Office
- UNKP-20-5-SZTE-161 to KF, UNKP-22-3-SZTE-233 to PB, UNKP-22-5-SZTE-545 to RB, UNKP-22-4-SZTE-296 to AF, UNKP-22-3-SZTE-278 to TR New National Excellence Program of the Ministry of Human Capacities, Hungary
- BO/00723/22 to RB Janos Bolyai Research Grant, Hungary
- Géza Hetényi Research Grant by Albert Szent-Györgyi Medical School, University of Szeged
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Affiliation(s)
- Renáta Bor
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Béla Vasas
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary;
| | - Anna Fábián
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, H-6720 Szeged, Hungary;
| | - Zsófia Bősze
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Anita Bálint
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Mariann Rutka
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Klaudia Farkas
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Tibor Tóth
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Tamás Resál
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Péter Bacsur
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Tamás Molnár
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
| | - Zoltán Szepes
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary; (A.F.); (Z.B.); (A.B.); (M.R.); (K.F.); (T.T.); (T.R.); (P.B.); (T.M.); (Z.S.)
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Vágvölgyi A, Ábrahám JE, Máthéné Köteles É, Korom A, Barnai M, Szűcs M, Orosz A, Kempler P, Menyhárt A, Nemes A, Várkonyi T, Baczkó I, Kósa I, Lengyel C. A three-month physical training program improves cardiovascular autonomic function in patients with metabolic syndrome with and without diabetes - a pilot study. Front Endocrinol (Lausanne) 2023; 14:1224353. [PMID: 37664832 PMCID: PMC10469893 DOI: 10.3389/fendo.2023.1224353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Vascular complications and neuropathy may develop in the presence of metabolic syndrome. The aim of our study was to measure the cardiovascular autonomic function following physical training in patients with metabolic syndrome with and without diabetes. Subjects and methods 56 patients with metabolic syndrome (32 men/24 women, 40 non-diabetic patients (NDMetS)/16 diabetic patients (DMetS) [mean ± SD]: age: 50.35 ± 8.03 vs. 56.8 ± 9.30 years, p=0.023; baseline BMI: 32.2 ± 7.03 vs. 32.8 ± 5.94 kg/m2, p=0.739) were involved in our study. All tests and measurements were carried out before and following a 3-month physical training period. Autonomic function was assessed by means of five standard cardiovascular reflex tests. ECG repolarization parameters, including short-term QT variability and stress-ECG were also measured. Results In the whole population, Valsalva-ratio (VR) and the autonomic score (AS) improved following training (VR: 1.49 ± 0.24 vs. 1.64 ± 0.34, p=0.001; AS: 2.05 ± 1.73 vs. 1.41 ± 1.36, p=0.015) accompanied by the significant decrease of the systolic (150.3 ± 16.12 vs. 134.1 ± 16.67 mmHg, p<0.001) and diastolic (90.64 ± 12.8 vs. 82.79 ± 11.1 mmHg, p<0.001) blood pressure. An improvement in VR was detected in NDMetS patients following training (1.51 ± 0.24 vs. 1.67 ± 0.31, p= 0.002). No significant changes could be detected in autonomic tests' results in the DMetS patient group following training. The applied exercise training program did not lead to significant changes in ECG repolarization. The stress-ECG test in the whole study population yielded a significant increase in the test duration (12.9 ± 3.76 vs. 15.1 ± 2.96 min, p<0.001) and in the test load (10.5 ± 2.78 vs. 11.6 ± 2.39 MET, p<0.001). The load capability improved significantly in both subgroups: 11.1 ± 2.04 vs. 12.1 ± 1.82, (p<0.001) and 9.0 ± 3.64 vs. 10.4 ± 3.05, (p=0.033) in subpopulations of NDMetS and DMetS, respectively. The DMetS patients achieved a significantly lower MET score at baseline (p=0.039) and following training (p=0.044) in comparison to the NDMetS patients. Conclusion The three-month exercise program improved the Valsalva-ratio and the AN score in the MetS patients, that is potentially protective against cardiovascular events. The training had some beneficial effect on blood pressure and the results of the stress-ECG tests in both groups. The absence of significant change in the reflex tests in DMetS group reflects an impaired adaptation compared to the NDMestS group.
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Affiliation(s)
- Anna Vágvölgyi
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Judit Erzsébet Ábrahám
- Department of Medical Prevention, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Éva Máthéné Köteles
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Andrea Korom
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Mária Barnai
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Péter Kempler
- Department of Oncology and Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Adrienn Menyhárt
- Department of Oncology and Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Várkonyi
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Kósa
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Medical Prevention, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Bor R, Fábián A, Szűcs M, Bálint A, Rutka M, Tóth T, Czakó L, Farkas K, Buzás N, Milassin Á, Molnár T, Szepes Z. Comparison of therapeutic efficacy and treatment costs of self-expandable metal stents and plastic stents for management of malignant biliary obstruction. BMC Gastroenterol 2023; 23:41. [PMID: 36797676 PMCID: PMC9933253 DOI: 10.1186/s12876-023-02668-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND According to the European Society of Gastrointestinal Endoscopy guidelines, self-expandable metal stents (SEMSs) are preferable to plastic stents (PSs) in the management of pancreatic cancer, regardless of cancer stage. The aim of this study was to compare the therapeutic efficacy and treatment costs of SEMS and PS in the management of malignant biliary obstruction. METHODS One hundred and thirty-five patients who underwent endoscopic stent placement were retrospectively enrolled and divided into PS (41 patients), primary SEMS (39 patients) and secondary SEMS (55 patients) groups. We determined the technical and functional success rate, stent patency, and cumulative treatment cost. RESULTS A total of 111 SEMSs and 153 PSs were placed with similar technical (100% vs. 98.69%) and functional success rate (90.10% vs. 86.27%) but with different stent patency (10.28 vs. 22.16 weeks; p < 0.001). Multiple PS implantations and larger stent diameter increased the length of stent patency compared to 7-Fr PSs (10.88 vs. 10.55 vs. 7.63 weeks, respectively). The cumulative treatment cost of patients with different survival times did not differ significantly between groups, however, among patients surviving 2-4 months it was higher in PS group than primary SEMS and secondary SEMS groups (2888€ vs. 2258€ vs. 2144€, respectively, p = 0.3369) due to increased number of biliary reintervention (2.08 ± 1.04 vs. 1.20 ± 0.42 vs. 1.50 ± 0.53; p < 0.0274) and longer hospital stay (15.77 ± 10.14 vs. 8.70 ± 7.70 vs. 8.50 ± 6.17 days, p = 0.0527). CONCLUSIONS In view of treatment costs, the consequences of illness, and the processes of the health care system, SEMS implantation is recommended regardless of patients' life expectancy.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725, Hungary.
| | - Anna Fábián
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Mónika Szűcs
- grid.9008.10000 0001 1016 9625Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Mariann Rutka
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Tibor Tóth
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - László Czakó
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Klaudia Farkas
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Norbert Buzás
- grid.9008.10000 0001 1016 9625Department of Health Economics, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Tamás Molnár
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
| | - Zoltán Szepes
- grid.9008.10000 0001 1016 9625First Department of Medicine, University of Szeged, Kálvária Sgt 57, Szeged, 6725 Hungary
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Máthéné Köteles É, Rafael B, Korom A, Vágvölgyi A, Ábrahám JE, Domján A, Szűcs M, Nemes A, Barnai M, Lengyel C, Kósa I. Physiological and psychological effects of a 12-week home-based telemonitored training in metabolic syndrome. Front Cardiovasc Med 2023; 9:1075361. [PMID: 36704473 PMCID: PMC9871627 DOI: 10.3389/fcvm.2022.1075361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023] Open
Abstract
Background Metabolic Syndrome (MetS) increases the risk of cardiovascular diseases (CVD) and affects around one fourth of the population worldwide. In the prevention and treatment regular exercise trainings are inevitable. Providing personal supervision in out/inpatient care settings for such a large target population challenges the healthcare systems, but using telemonitoring of the home-performed trainings could be a promising and widely available option. Objectives The aim of this study was to evaluate the physiological and psychological effects of a 12-week home-based physical training program, telemonitored by widely available fitness devices on parameters of MetS patients. Methods A total of 55 MetS patients (mean age 49.19 ± 7.93 years) were involved in the study. They were asked to perform 3-5 sessions of exercise activity (min. 150 min) each week for 12 weeks. Trainings were monitored off-line by heart rate sensors, a fitness application and a cloud-based data transfer system. Physiotherapists supervised, coached, and feedback the trainings through an online coach system. We investigated different anthropometric parameters, maximum exercise and functional capacity levels, laboratory parameters, the level of depression, insomnia, vital exhaustion, and wellbeing as well. Results The average weekly training time was 152.0 ± 116.2 min. Out of the 55 participants who completed the program, 22 patients (40%) performed the recommended 150 min or more weekly. Patients showed statistically significant changes in: all the measured waist and hip circumferences; 6-min walk distance (6MWD; from 539.69 ± 78.62 to 569.72 ± 79.96 m, p < 0.001); maximal exercise capacity (11.02 ± 2.6 to 12.14 ± 2 MET, p < 0.001), stress-electrocardiogram duration time (13.74 ± 3.29 to 15.66 ± 2.64 min, p < 0.001); body weight (98.72 ± 21.7 to 97.45 ± 21.76 kg, p = 0.004); high-density lipoprotein cholesterol (n = 45, 1.28 ± 0.31 to 1.68 ± 0.36 mmol/L, p < 0.001); fasting plasma glucose (FPG; n = 47, 6.16 ± 1.26 to 5.44 ± 1.31 mmol/L, p = 0.001); glycated hemoglobin A1c (HbA1c; n = 41, 6.22 ± 0.68 to 5.87 ± 0.78%, p = 0.01). Out of the 55 patients who finished the program 38 patients (70%) completed all the psychological questionnaires. We found statistically significant decrease of the overall scores of the Maastricht Vital Exhaustion Questionnaire, from 3.37 ± 2.97 points to 2.63 ± 2.70 points (p < 0.05) and a significant increase of the overall scores of the WHO Wellbeing Scale from 9.92 ± 2.59 points to 10.61 ± 2.76 points (p < 0.05). We have not found any statistically significant changes in the scores of the Beck Depression Inventory and the Athens Insomnia Scale. Conclusion A 12-week home-based telemonitored training supported by an affordable, commonly available device system produces positive, statistically significant changes in many core components in MetS patients. Telemonitoring is a cheap method for coaching and feeding back the home-based interventions.
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Affiliation(s)
- Éva Máthéné Köteles
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Beatrix Rafael
- Department of Medical Prevention, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Andrea Korom
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Anna Vágvölgyi
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Judit Erzsébet Ábrahám
- Department of Medical Prevention, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Andrea Domján
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary,*Correspondence: Attila Nemes,
| | - Mária Barnai
- Department of Physiotherapy, Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Kósa
- Department of Medical Prevention, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary,Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Spekker E, Bohár Z, Fejes-Szabó A, Szűcs M, Vécsei L, Párdutz Á. Estradiol Treatment Enhances Behavioral and Molecular Changes Induced by Repetitive Trigeminal Activation in a Rat Model of Migraine. Biomedicines 2022; 10:biomedicines10123175. [PMID: 36551931 PMCID: PMC9776064 DOI: 10.3390/biomedicines10123175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
A migraine is a neurological condition that can cause multiple symptoms. It is up to three times more common in women than men, thus, estrogen may play an important role in the appearance attacks. Its exact pathomechanism is still unknown; however, the activation and sensitization of the trigeminal system play an essential role. We aimed to use an animal model, which would better illustrate the process of repeated episodic migraine attacks to reveal possible new mechanisms of trigeminal pain chronification. Twenty male (M) and forty ovariectomized (OVX) female adult rats were used for our experiment. Male rats were divided into two groups (M + SIF, M + IS), while female rats were divided into four groups (OVX + SIF, OVX + IS, OVX + E2 + SIF, OVX + E2 + IS); half of the female rats received capsules filled with cholesterol (OVX + SIF, OVX + IS), while the other half received a 1:1 mixture of cholesterol and 17β-estradiol (OVX + E2 + SIF, OVX + E2 + IS). The animals received synthetic interstitial fluid (SIF) (M + SIF, OVX + SIF, OVX + E2 + SIF) or inflammatory soup (IS) (M + IS, OVX + IS, OVX + E2 + IS) treatment on the dural surface through a cannula for three consecutive days each week (12 times in total). Behavior tests and immunostainings were performed. After IS application, a significant decrease was observed in the pain threshold in the M + IS (0.001 < p < 0.5), OVX + IS (0.01 < p < 0.05), and OVX + E2 + IS (0.001 < p < 0.05) groups compared to the control groups (M + SIF; OVX + SIF, OVX + E2 + SIF). The locomotor activity of the rats was lower in the IS treated groups (M + IS, 0.01 < p < 0.05; OVX + IS, p < 0.05; OVX + E2 + IS, 0.001 < p < 0.05), and these animals spent more time in the dark room (M + IS, p < 0.05; OVX + IS, 0.01 < p < 0.05; OVX + E2 + IS, 0.001 < p < 0.01). We found a significant difference between M + IS and OVX + E2 + IS groups (p < 0.05) in the behavior tests. Furthermore, IS increased the area covered by calcitonin gene-related peptide (CGRP) immunoreactive (IR) fibers (M + IS, p < 0.01; OVX + IS, p < 0.01; OVX + E2 + IS, p < 0.001) and the number of neuronal nitric oxide synthase (nNOS) IR cells (M + IS, 0.001< p < 0.05; OVX + IS, 0.01 < p < 0.05; OVX + E2 + IS, 0.001 < p < 0.05) in the caudal trigeminal nucleus (TNC). There was no difference between M + IS and OVX + IS groups; however, the area was covered by CGRP IR fibers (0.01 < p < 0.05) and the number of nNOS IR cells was significantly higher in the OVX + E2 + IS (p < 0.05) group than the other two IS- (M + IS, OVX + IS) treated animals. Overall, repeated administration of IS triggers activation and sensitization processes and develops nociceptive behavior changes. CGRP and nNOS levels increased significantly in the TNC after IS treatments, and moreover, pain thresholds and locomotor activity decreased with the development of photophobia. In our model, stable high estradiol levels proved to be pronociceptive. Thus, repeated trigeminal activation causes marked behavioral changes, which is more prominent in rats treated with estradiol, also reflected by the expression of the sensitization markers of the trigeminal system.
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Affiliation(s)
- Eleonóra Spekker
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Zsuzsanna Bohár
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Annamária Fejes-Szabó
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Korányi Fasor 9, H-6720 Szeged, Hungary
| | - László Vécsei
- ELKH-SZTE Neuroscience Research Group, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Department of Neurology, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-351; Fax: +36-62-545-597
| | - Árpád Párdutz
- Department of Neurology, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, H-6725 Szeged, Hungary
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Molnár T, Domján A, Szűcs M, Surányi A, Bódis J. Utilizing Synergism between the Transverse Abdominal and Pelvic Floor Muscles at Different Postures in Nulliparous Women: A Randomized Case-Control Study. Urol Int 2021; 106:274-281. [PMID: 34814156 DOI: 10.1159/000519590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to determine the effects of the pelvic floor muscle (PFM) training (PFM-T) in combination with transverse abdominal (TRA) muscle activation (cPFM-T) in female urinary incontinence. METHODS We enrolled nulliparous women in supine (SUG) (n = 22), sitting (SIG) (n = 19), and control (COG) (n = 14) groups. We conducted an 8-week cPFM-T programme. We examined the effect of training on the parameters with the Kruskal-Wallis test, the pairwise comparisons with the Mann-Whitney U test, and the Wilcoxon rank test with the Bonferroni correction. RESULTS Before training, 15 participants reported occasional urinary leakage. After cPFM-T, 7 participants reported that urinary leakage had disappeared. Maximal isometric contraction of the PFMs until fatigue improved significantly in the SUG (p < 0.001) and SIG (p = 0.015) groups but not significantly in the COG group (p = 0.499). Holding time increased in the SUG (p = 0.972) and the SIG (p = 0.717) groups and decreased in the COG group (p = 0.132). The dynamic endurance of the PFM improved significantly in the SUG group (p < 0.001) but not in the SIG (p = 0.798) and the COG (p = 0.153) groups. The number of maximal fast contractions within 1 min increased in both the SUG (p < 0.001) and SIG (p = 0.813) groups and decreased in the COG group (p = 0.257). Relaxation improved significantly in the SIG group (p = 0.011). TRA mucle thickness increased in both training groups. CONCLUSION Slow-twitch fibres of the PFM can be trained effectively with PFM-T in both the body positions.
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Affiliation(s)
- Tímea Molnár
- Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Andrea Domján
- Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Andrea Surányi
- Department of Obstetrics and Gynaecology, University of Szeged, Szeged, Hungary
| | - József Bódis
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
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Spekker E, Laborc KF, Bohár Z, Nagy-Grócz G, Fejes-Szabó A, Szűcs M, Vécsei L, Párdutz Á. Effect of dural inflammatory soup application on activation and sensitization markers in the caudal trigeminal nucleus of the rat and the modulatory effects of sumatriptan and kynurenic acid. J Headache Pain 2021; 22:17. [PMID: 33789568 PMCID: PMC8011387 DOI: 10.1186/s10194-021-01229-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/15/2021] [Indexed: 01/12/2023] Open
Abstract
Background The topical inflammatory soup can model the inflammation of the dura mater causing hypersensitivity and activation of the trigeminal system, a phenomenon present in migraineurs. Calcitonin gene-related peptide, transient receptor potential vanilloid-1 receptor, and neuronal nitric oxide synthase are important in the sensitization process there. 5-HT1B/1D receptor agonists, triptans are used as a treatment of migraine. Kynurenic acid an NMDA antagonist can act on structures involved in trigeminal activation. Aim We investigated the effect of inflammatory soup induced dural inflammation on the calcitonin gene-related peptide, transient receptor potential vanilloid-1 receptor, and neuronal nitric oxide synthase levels in the caudal trigeminal nucleus. We also tested whether pretreatment with a well-known antimigraine drug, such as sumatriptan and kynurenic acid, a compound with a different mechanism of action, can affect these changes and if their modulatory effects are comparable. Material and methods After subcutaneous sumatriptan or intraperitoneal kynurenic acid the dura mater of adult male Sprague-Dawley rats (n = 72) was treated with inflammatory soup or its vehicle (synthetic interstitial fluid). Two and a half or four hours later perfusion was performed and the caudal trigeminal nucleus was removed for immunohistochemistry. Results and conclusion Inflammatory soup increased calcitonin gene-related peptide, transient receptor potential vanilloid-1 receptor, and neuronal nitric oxide synthase in the caudal trigeminal nucleus compared to placebo, which was attenuated by sumatriptan and kynurenic acid. This suggests the involvement of 5-HT1B/1D and NMDA receptors in neurogenic inflammation development of the dura and thus in migraine attacks.
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Affiliation(s)
- Eleonóra Spekker
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary
| | - Klaudia Flóra Laborc
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary
| | - Zsuzsanna Bohár
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary.,MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Gábor Nagy-Grócz
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary.,Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | | | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary. .,MTA-SZTE Neuroscience Research Group, Szeged, Hungary.
| | - Árpád Párdutz
- Department of Neurology, Interdisciplinary Excellence Center, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis utca 6, Szeged, H-6725, Hungary
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Bor R, Szántó KJ, Fábián A, Farkas K, Szűcs M, Rutka M, Tóth T, Bálint A, Milassin Á, Dubravcsik Z, Szepes Z, Molnár T. Effect of COVID-19 pandemic on workflows and infection prevention strategies of endoscopy units in Hungary: a cross-sectional survey. BMC Gastroenterol 2021; 21:98. [PMID: 33657994 PMCID: PMC7927759 DOI: 10.1186/s12876-021-01670-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/16/2021] [Indexed: 02/08/2023] Open
Abstract
Background Health care professionals in endoscopic labs have an elevated risk for COVID-19 infection, therefore, we aimed to determine the effect of current pandemic on the workflow and infection prevention and control strategies of endoscopy units in real-life setting. Methods All members of Hungarian Society of Gastroenterology were invited between 7 and 17 April 2020 to participate in this cross-section survey study and to complete an online, anonymous questionnaire. Results Total of 120 endoscopists from 83 institutes were enrolled of which 35.83% worked in regions with high cumulative incidence of COVID-19. Only 33.33% of them had undergone training about infection prevention in their workplace. 95.83% of endoscopists regularly used risk stratification of patients for infection prior endoscopy. While indications of examinations in low risk patients varied widely, in high-risk or positive patients endoscopy was limited to gastrointestinal bleeding (95.00%), removal of foreign body from esophagus (87.50%), management of obstructive jaundice (72.50%) and biliary pancreatitis (67.50%). Appropriate amount of personal protective equipment was available in 60.85% of endoscopy units. In high-risk or positive patients, surgical mask, filtering facepiece mask, protective eyewear and two pairs of gloves were applied in 30.83%, 76.67%, 90.00% and 87.50% of cases, respectively. Personal protective equipment fully complied with European guideline only in 67.50% of cases. Conclusions Survey found large variability in indications of endoscopy and relative weak compliance to national and international practical recommendations in terms of protective equipment. This could be improved by adequate training about infection prevention.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary.
| | - Kata Judit Szántó
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tibor Tóth
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Zsolt Dubravcsik
- Department of Gastroenterology and Endoscopy, Bács-Kiskun County Hospital, Kecskemet, Hungary
| | | | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
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Vágvölgyi A, Maróti Á, Szűcs M, Póczik C, Urbán-Pap D, Baczkó I, Nemes A, Csajbók É, Sepp K, Kempler P, Orosz A, Várkonyi T, Lengyel C. Peripheral and Autonomic Neuropathy Status of Young Patients With Type 1 Diabetes Mellitus at the Time of Transition From Pediatric Care to Adult-Oriented Diabetes Care. Front Endocrinol (Lausanne) 2021; 12:719953. [PMID: 34512550 PMCID: PMC8430208 DOI: 10.3389/fendo.2021.719953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The prevalence of neuropathic lesions in young patients with type 1 diabetes mellitus (T1DM) at the time of transition from pediatric care to adult-oriented diabetes care is poorly studied. A comparative study with healthy volunteers to assess the possible neuropathic condition of this special population and to identify the potential early screening needs has not been performed yet. The results may provide important feedback to pediatric diabetes care and a remarkable baseline reference point for further follow up in adult diabetes care. PATIENTS AND METHODS Twenty-nine young patients with T1DM [age: 22.4 ± 2.9 years; HbA1c: 8.5 ± 2.1%, diabetes duration: 12.2 ± 5.8 years; (mean ± SD)] and 30 healthy volunteers (age: 21.5 ± 1.6 years; HbA1c: 5.3 ± 0.3%) were involved in the study. Autonomic function was assessed by standard cardiovascular reflex tests. Complex peripheral neuropathic testing was performed by Neurometer®, Neuropad®-test, Tiptherm®, Monofilament®, and Rydel-Seiffer tuning fork tests. RESULTS T1DM patients had significantly higher diastolic blood pressure than controls (80 ± 9 vs. 74 ± 8 mmHg, p < 0.01), but there was no significant difference in systolic blood pressure (127 ± 26 vs. 121 ± 13 mmHg). Cardiovascular reflex tests had not revealed any significant differences between the T1DM patients and controls. No significant differences with Neurometer®, Neuropad®-test, and Monofilament® were detected between the two groups. The vibrational sensing on the radius on both sides was significantly impaired in the T1DM group compared to the controls with Rydel-Seiffer tuning fork test (right: 7.5 ± 1.0 vs. 7.9 ± 0.3; left: 7.5 ± 0.9 vs. 7.9 ± 0.3, p < 0.05). The Tiptherm®-test also identified a significant impairment in T1DM patients (11 sensing failures vs. 1, p < 0.001). In addition, the neuropathic complaints were significantly more frequently present in the T1DM patient group than in the controls (9 vs. 0, p < 0.01). CONCLUSION In this young T1DM population, cardiovascular autonomic neuropathy and cardiac morphological alterations could not be found. However, Rydel-Seiffer tuning fork and Tiptherm®-tests revealed peripheral sensory neurological impairments in young T1DM patients at the time of their transition to adult diabetes care.
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Affiliation(s)
- Anna Vágvölgyi
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Maróti
- Department of Pediatrics and Pediatric Health Center, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Csongor Póczik
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Urbán-Pap
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Éva Csajbók
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Krisztián Sepp
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Kempler
- Department of Oncology and Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
- *Correspondence: Andrea Orosz,
| | - Tamás Várkonyi
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, University of Szeged, Szeged, Hungary
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Fábián A, Bor R, Szabó E, Kardos V, Bálint A, Farkas K, Milassin Á, Rutka M, Szántó K, Molnár T, Szűcs M, Lőrinczy K, Orbán-Szilágyi Á, Gyökeres T, Gyimesi G, Szepes A, Kovács V, Rácz I, Szepes Z. Endoscopic treatment of gastric antral vascular ectasia in real-life settings: Argon plasma coagulation or endoscopic band ligation? J Dig Dis 2021; 22:23-30. [PMID: 33128340 DOI: 10.1111/1751-2980.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/15/2020] [Accepted: 10/27/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The efficacy of argon plasma coagulation (APC) on gastric antral vascular ectasia (GAVE) may be impaired over time and depends greatly on the application settings. Endoscopic band ligation (EBL) may be an alternative, but study on its efficacy is limited. This study aimed to evaluate and compare the clinical efficacy of APC and EBL in treating GAVE. METHODS Changes in the need for blood transfusion, number of treatment sessions and hospitalizations were retrospectively assessed in 63 transfusion-dependent patients with GAVE (mean age: 67.1 y, 54.0% female) treated with either APC or EBL (45 and 18 patients, respectively) in four tertiary endoscopic centers. RESULTS Both methods substantially increased hemoglobin levels and decreased patients' need for a transfusion (22.0 ± 4.0 g/L and -5.62 ± 2.30 units of packed red blood cells [RBC] with APC, and 27.4 ± 6.1 g/L and -4.79 ± 2.46 units of packed RBC with EBL), without a significant statistical difference between the methods. However, fewer EBL sessions were required both for the cessation of need for a transfusion compared with those for the resolution of GAVE lesions (0.90 ± 0.10 vs 1.69 ± 0.31, P = 0.028). CONCLUSIONS Both APC and EBL are effective in GAVE treatment. EBL may be superior in terms of number of treatment sessions, but not in its influence on hemoglobin level and need for transfusion. Further prospective studies with large, homogeneous sample size and standardized APC settings are needed.
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Affiliation(s)
- Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ella Szabó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Viktor Kardos
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Katalin Lőrinczy
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Ákos Orbán-Szilágyi
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Tibor Gyökeres
- Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - György Gyimesi
- Department of Gastroenterology, Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary
| | - Attila Szepes
- Department of Gastroenterology, Bács-Kiskun County University Teaching Hospital, Kecskemét, Hungary
| | - Valéria Kovács
- Internal Medicine Department and Gastroenterology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - István Rácz
- Internal Medicine Department and Gastroenterology, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
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12
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Bor R, Vasas B, Fábián A, Szűcs M, Füredi Á, Czakó L, Rutka M, Farkas K, Molnár T, Milassin Á, Bálint A, Szántó K, Hamar S, Kaizer L, Tiszlavicz L, Szepes Z. Slow-pull technique yields better quality smears: prospective comparison of slow-pull and standard suction techniques of endoscopic ultrasound-guided fine-needle aspiration. Scand J Gastroenterol 2020; 55:1369-1376. [PMID: 33016159 DOI: 10.1080/00365521.2020.1825792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diagnostic accuracy and quality of smears obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are influenced by characteristics of suction and examined organ. AIMS AND METHODS Efficiency of EUS-FNA and quality of smears obtained by slow-pull (SP) and standard suction (SS) techniques was prospectively compared in the sampling of pancreatic (N = 56) and extrapancreatic (N = 145) tumors. RESULTS SS technique resulted in a higher number of smear pairs both in pancreatic (1.74 vs. 3.19; p < 0.001) and extrapancreatic tumors (1.62 vs. 3.28; p < 0.001); however, it decreased the proportion of diagnostic smears (46.69% vs. 36.52%; p = 0.002 and 49.17% vs. 30.67%; p < 0.001) and increased the bloodiness (1.51 vs. 2.07; p < 0.001 and 1.48 vs. 2.05; p < 0.001). In pancreatic cancers, no difference was observed in terms of diagnostic accuracy (81.38% vs. 83.45%) and cellularity (1.44 vs. 1.27; p = 0.067); however, they were substantially higher in extrapancreatic tumors using SP technique (71.41% vs. 60.71% and 1.34 vs. 0.77; p < 0.001). Only SP technique resulted in a significant difference between examiners in terms of technical success rate and quality of smears without any decrease of diagnostic accuracy. CONCLUSIONS SP technique yields better quality smears independently from tumors characteristics; however, it shows significant examiner-dependency. SS technique reduces the diagnostic accuracy of sampling in extrapancreatic tumors.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Árpád Füredi
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Sándor Hamar
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - László Kaizer
- Department of Pathology, University of Szeged, Szeged, Hungary
| | | | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Laborc KF, Spekker E, Bohár Z, Szűcs M, Nagy-Grócz G, Fejes-Szabó A, Vécsei L, Párdutz Á. Trigeminal activation patterns evoked by chemical stimulation of the dura mater in rats. J Headache Pain 2020; 21:101. [PMID: 32799798 PMCID: PMC7429748 DOI: 10.1186/s10194-020-01169-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/07/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although migraine is one of the most common primary headaches, its therapy is still limited in many cases. The use of animal models is crucial in the development of novel therapeutic strategies, but unfortunately, none of them show all aspects of the disease, therefore, there is a constant need for further improvement in this field. The application of inflammatory agents on the dura mater is a widely accepted method to mimic neurogenic inflammation in rodents, which plays a key role in the pathomechanism of migraine. Complete Freund's Adjuvant (CFA), and a mixture of inflammatory mediators, called inflammatory soup (IS) are often used for this purpose. METHODS To examine the activation pattern that is caused by chemical stimulation of dura mater, we applied CFA or IS over the right parietal lobe. After 2 h and 4 h (CFA groups), or 2.5 h and 4 h (IS groups), animals were perfused, and c-Fos immunoreactive cells were counted in the caudal trigeminal nucleus. To explore every pitfall, we examined whether our surgical procedure (anesthetic drug, stereotaxic apparatus, local lidocaine) can alter the results under the same experimental settings. c-Fos labeled cells were counted in the second-order neuron area based on the somatotopic organization of the trigeminal nerve branches. RESULTS We could not find any difference between the CFA and physiological saline group neither 2 h, nor 4 h after dural stimulation. IS caused significant difference after both time points between IS treated and control group, and between treated (right) and control (left) side. Stereotaxic frame usage had a substantial effect on the obtained results. CONCLUSIONS Counting c-Fos immunoreactive cells based on somatotopic organization of the trigeminal nerve helped to examine the effect of chemical stimulation of dura in a more specific way. As a result, the use of IS over the parietal lobe caused activation in the area of the ophthalmic nerve. To see this effect, the use of lidocaine anesthesia is indispensable. In conclusion, application of IS on the dura mater induces short-term, more robust c-Fos activation than CFA, therefore it might offer a better approach to model acute migraine headache in rodents.
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Affiliation(s)
- Klaudia Flóra Laborc
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Eleonóra Spekker
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
| | - Zsuzsanna Bohár
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Gábor Nagy-Grócz
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
- Faculty of Health Sciences and Social Studies, University of Szeged, Szeged, Hungary
| | - Annamária Fejes-Szabó
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary.
- MTA-SZTE Neuroscience Research Group, Szeged, Hungary.
- Interdisciplinary Excellence Center, Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Árpád Párdutz
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Semmelweis u. 6, Szeged, H-6725, Hungary
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Csányi I, Houshmand N, Szűcs M, Ócsai H, Kemény L, Oláh J, Baltás E. Acral lentiginous melanoma: a single-centre retrospective review of four decades in East-Central Europe. J Eur Acad Dermatol Venereol 2020; 34:2004-2010. [PMID: 31989672 DOI: 10.1111/jdv.16227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) occurs on the palms, soles and subungual surface and has poor prognosis. It is uncommon in the Caucasian population and has remained unreported in East-Central Europe. OBJECTIVES Our aim was to collect data from East-Central Europe by analysing the demographic and clinicopathologic features of patients with ALM and comparing data with the reports in literature. METHODS We conducted a single-centre, retrospective review between 1976 and 2016 at one of the largest melanoma referral centres in Hungary. RESULTS We identified 176 patients with ALM (3.83%) from 4593 patients with melanoma (mean age: 66.2 years). The tumours were mainly located on the lower extremities (88.63%). The mean Breslow tumour thickness was 3.861 mm, 37.50% of the tumours were thicker than 4.00 mm, and 71.6% exhibited microscopic ulceration. Nearly one-third of the patients underwent sentinel lymph node (SLN) biopsy, and 60.3% of the biopsies were positive for metastasis. The positive SLN status was associated with significantly thick tumours and reduced survival. Patients with ALM had 5- and 10-year overall survival rates of 60.5% and 41.6%, respectively. The mean delay in diagnosis was 18 months after the discovery of skin tumours. In multivariate analyses, age, tumour thickness and distant metastasis were independent risk factors for poor survival (P < 0.001). CONCLUSIONS Our study, which is the first single-centre report in East-Central Europe focusing on ALM, confirms that patient and tumour characteristics and prognostic factors are similar with previous literature data involving Caucasians; however, tumour thickness and survival suggest even worse prognosis.
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Affiliation(s)
- I Csányi
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - N Houshmand
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - M Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - H Ócsai
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,Outpatient Department of Dermato-Oncology, Békés County Central Hospital, Kálmán Pándy Subdivision, Gyula, Hungary
| | - L Kemény
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,Dermatological Research Group, Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - J Oláh
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.,Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - E Baltás
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
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Bor R, Vasas B, Fábián A, Bálint A, Farkas K, Milassin Á, Czakó L, Rutka M, Molnár T, Szűcs M, Tiszlavicz L, Kaizer L, Hamar S, Szepes Z. Prospective comparison of slow-pull and standard suction techniques of endoscopic ultrasound-guided fine needle aspiration in the diagnosis of solid pancreatic cancer. BMC Gastroenterol 2019; 19:6. [PMID: 30626331 PMCID: PMC6327397 DOI: 10.1186/s12876-018-0921-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
Abstract
Background The usage of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis of solid pancreatic cancer is increasing, however mainly retrospective studies are available about the detailed methods of sampling. Methods To compare prospectively the diagnostic yield of EUS-FNA samples obtained with slow-pull (SP) and with standard suction technique (SS). Results EUS-FNA sampling was diagnostic in 72 of 92 cases (78.3%). Diagnostic yield was 67.4% in the SS and 65.2% in the SP group. The number of smear pairs (1.84 vs. 3.56; p < 0.001) and blood contamination (1.50 vs. 2.19; p < 0.001) were significantly higher in the SS group, which resulted in lower rate of diagnostic samples (41.8% vs. 30.0%; p = 0.003). There was no difference in the cellularity (1.58 vs. 1.37; p = 0.2554), or in the sensitivity and specificity in the identification of malignancy between SP and SS subgroups (69.9, 100% vs. 73.5, 100%). Histological samples were obtained in 60 cases (with SP: 49 cases; with SS: 46 cases). There was no difference in the diagnostic yield of histological samples between the groups (63 and 58.7%). Conclusion The diagnostic yield, the cellularity of smears and the rate of acquiring sufficient histological material are similar in the SP and SS group, but due to lower bloodiness and decreased number of slides, the pathological diagnosis is faster and more cost-effective.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Béla Vasas
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - László Kaizer
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Sándor Hamar
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged, 6720, Hungary.
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Bálint A, Farkas K, Szepes Z, Nagy F, Szűcs M, Tiszlavicz L, Bor R, Milassin Á, Rutka M, Fábián A, Molnár T. How disease extent can be included in the endoscopic activity index of ulcerative colitis: the panMayo score, a promising scoring system. BMC Gastroenterol 2018; 18:7. [PMID: 29310593 PMCID: PMC5759871 DOI: 10.1186/s12876-017-0725-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/12/2017] [Indexed: 12/31/2022] Open
Abstract
Background Colonoscopy plays crucial role in the establishment of the diagnosis, management and follow-up of ulcerative colitis (UC). None of the currently widely used endoscopic scores consider disease extent, and therefore do not correlate with the real severity of UC. Our aim was to assess the accuracy of a new score, the Pancolonic Modified Mayo Score that can reflect not only the severity, but the extent of active UC. Methods One hundred and four UC patients were enrolled in this prospective study. The Endoscopic Mayo Scores of the involved area of the five colorectal segments were added; furthermore, the sum was multiplied by 3 in case of eMayo ≥2 (range 0 [normal] to 45 [most severe]) to obtain the Pancolonic Modified Mayo Score (panMayo) in order to clearly distinguish the active and inactive disease. We analysed the correlation of panMayo Score with eMayo and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and complicated disease outcome. We compared the endoscopic indices with serum and faecal inflammatory parameters and Riley Score. Results The panMayo Score correlated with eMayo and UCEIS. Every endoscopic score showed correlation with Riley Score, CRP, haemoglobin, haematocrit, serum iron, faecal MMP-9 and calprotectin and also predicted a complicated disease outcome. Only panMayo score correlated exclusively with the extent of UC. Conclusions We suggest that this new score gives additional information about disease extent besides disease activity with a strong correlation with laboratory parameters of inflammation and with the other widely used endoscopic indices.
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Affiliation(s)
- Anita Bálint
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Korányi fasor 9, Szeged, 6720, Hungary
| | - László Tiszlavicz
- Department of Pathology, University of Szeged, Állomás u. 2, Szeged, 6725, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, H6720, Korányi fasor 8-10, Szeged, 6720, Hungary.
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Rutka M, Molnár T, Bor R, Farkas K, Fábián A, Győrfi M, Bálint A, Milassin Á, Szűcs M, Tiszlavicz L, Nagy F, Szepes Z. [Efficacy of the population-based pilot colorectal screening program. Hungary, Csongrád county, 2015]. Orv Hetil 2017; 158:1658-1667. [PMID: 29037058 DOI: 10.1556/650.2017.30822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Hungary, a nationwide colorectal screening program is about to be introduced in order to improve the extremely high mortality rate of colorectal cancer (CRC). AIM The aim of our study was to summarize experiences and assess short-term efficacy of the population-based pilot colorectal screening program in 2015 in Csongrád County, Hungary. PATIENTS AND METHOD Asymptomatic individuals between the ages of 50 and 70 with average risk of colorectal cancer participated in the program that was based on the two-step screening method (i.e. immune fecal blood test and colonoscopy). The short-term efficacy of the screening program was assessed as the change in total CRC incidence and initial tumor stage in the screening year (2015) compared to a control year (2013) in Szeged and its surroundings. Participation rate, positive predictive value of the screening methods and tumor detection rate was assessed. RESULTS 22,130 individuals were invited, the participation rate was 46.4%. Immune fecal blood test proved to be non-negative in 1,343 cases (13%), screening colonoscopy was performed in 766 of them (7.5%). Total colonoscopy was performed in 711 individuals. Based on the reports, adenoma was detected in 358 (50.3%) and malignancy in 42 (5.9%) individuals. In the background population, the incidence of colon cancer was significantly higher (183 vs. 228; p = 0.026) and was diagnosed at significantly earlier stage (p = 0.002). Lymph node involvement was significantly lower in 2015 (48.3% vs. 37.1%; p = 0.049). CONCLUSION The Csongrád county population-based colorectal cancer screening was evidently successful on the short term considering participation rate, and the changes in CRC incidence and stage, thus its national extension is necessary. Orv Hetil. 2017; 158(42): 1658-1667.
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Affiliation(s)
- Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Anna Fábián
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Márk Győrfi
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Mónika Szűcs
- Orvosi Fizikai és Orvosi Informatikai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Tiszlavicz
- I. Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ferenc Nagy
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8., 6720
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Bor R, Fábián A, Bálint A, Farkas K, Szűcs M, Milassin Á, Czakó L, Rutka M, Molnár T, Szepes Z. Endoscopic management of complications of self-expandable metal stents for treatment of malignant esophageal stenosis and tracheoesophageal fistulas. Therap Adv Gastroenterol 2017; 10:599-607. [PMID: 28835774 PMCID: PMC5557190 DOI: 10.1177/1756283x17718408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 05/03/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. METHODS We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. RESULTS A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24-48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1-6; median 2), 13.58 weeks (range 1.5-48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions. CONCLUSIONS In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Milassin Á, Sejben A, Tiszlavicz L, Reisz Z, Lázár G, Szűcs M, Bor R, Bálint A, Rutka M, Szepes Z, Nagy F, Farkas K, Molnár T. Analysis of risk factors - especially different types of plexitis - for postoperative relapse in Crohn’s disease. World J Gastrointest Surg 2017; 9:167-173. [PMID: 28824749 PMCID: PMC5545135 DOI: 10.4240/wjgs.v9.i7.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 04/25/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the presence of submucosal and myenteric plexitis and its role in predicting postoperative recurrence.
METHODS Data from all patients who underwent Crohn’s disease (CD)-related resection at the University of Szeged, Hungary between 2004 and 2014 were analyzed retrospectively. Demographic data, smoking habits, previous resection, treatment before and after surgery, resection margins, neural fiber hyperplasia, submucosal and myenteric plexitis were evaluated as possible predictors of postoperative recurrence. Histological samples were analyzed blinded to the postoperative outcome and the clinical history of the patient. Plexitis was evaluated based on the appearance of the most severely inflamed ganglion or nerve bundle. Patients underwent regular follow-up with colonoscopy after surgery. Postoperative recurrence was defined on the basis of endoscopic and clinical findings, and/or the need for additional surgical resection.
RESULTS One hundred and four patients were enrolled in the study. Ileocecal, colonic, and small bowel resection were performed in 73.1%, 22.1% and 4.8% of the cases, respectively. Mean disease duration at the time of surgery was 6.25 years. Twenty-six patients underwent previous CD-related surgery. Forty-three point two percent of the patients were on 5-aminosalicylate, 20% on corticosteroid, 68.3% on immunomodulant, and 4% on anti-tumor necrosis factor-alpha postoperative treatment. Postoperative recurrence occurred in 61.5% of the patients; of them 39.1% had surgical recurrence. 92.2% of the recurrences developed within the first five years after the index surgery. Mean disease duration for endoscopic relapse was 2.19 years. The severity of submucosal plexitis was a predictor of the need for second surgery (OR = 1.267, 95%CI: 1.000-1.606, P = 0.050). Female gender (OR = 2.21, 95%CI: 0.98-5.00, P = 0.056), stricturing disease behavior (OR = 3.584, 95%CI: 1.344-9.559, P = 0.011), and isolated ileal localization (OR = 2.671, 95%CI: 1.033-6.910, P = 0.043) were also predictors of postoperative recurrence. No association was revealed between postoperative recurrence and smoking status, postoperative prophylactic treatment and the presence of myenteric plexitis and relapse.
CONCLUSION The presence of severe submucosal plexitis with lymphocytes in the proximal resection margin is more likely to result in postoperative relapse in CD.
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Petrovszki I, Csányi I, Szűcs M, Ócsai H, Houshmand N, Kemény L, Oláh J, Baltás E. [Factors influencing early detection of malignant melanoma]. Orv Hetil 2017; 157:2028-2033. [PMID: 27989229 DOI: 10.1556/650.2016.30610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIM Melanoma is a highly aggressive tumour with often unpredictable outcome. Our aim with this study was to determine factors influencing early detection of melanoma. METHOD We analyzed 139 questionnaires completed by patients diagnosed with melanoma. RESULTS We found that our patients are health-conscious regarding cardiovascular diseases and attend cancer screenings on recall. However, their knowledge about melanoma is insufficient. Most of them perform skin self-examination, but they do not know what to check. Melanoma is detected mostly by the patients themselves, but it takes more than one year to consult a doctor. Our study confirmed that patients' attitude toward melanoma is an important factor influencing early detection. We found that physical examination and communication about skin cancer prevention is not part of the routine medical care. CONCLUSIONS It is important to improve knowledge about melanoma among the general population and health care providers and to emphasize that early detection can save lives. Orv. Hetil., 2016, 157(51), 2028-2033.
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Affiliation(s)
- Irén Petrovszki
- Bőrgyógyászati és Allergológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ildikó Csányi
- Bőrgyógyászati és Allergológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Mónika Szűcs
- Orvosi Fizikai és Orvosi Informatikai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Henriette Ócsai
- Bőrgyógyászati és Allergológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged.,Békés Megyei Központi Kórház Gyula
| | - Nazanin Houshmand
- Bőrgyógyászati és Allergológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Lajos Kemény
- Bőrgyógyászati és Allergológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged.,Dermatológiai Kutatócsoport, Magyar Tudományos Akadémia-Szegedi Tudományegyetem Szeged
| | - Judit Oláh
- Bőrgyógyászati és Allergológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Eszter Baltás
- Bőrgyógyászati és Allergológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
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21
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Bálint A, Berényi A, Farkas K, Pallagi Kunstár É, Altorjay Á, Csonka A, Krizsán M, Szűcs M, Pál A, Fábián A, Bor R, Milassin Á, Szulcsán Á, Mariann R, Szepes Z, Molnár T. Pregnancy does not affect fecal calprotectin concentration in healthy women. Turk J Gastroenterol 2017; 28:171-175. [PMID: 28336498 DOI: 10.5152/tjg.2017.16711] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIMS Noninvasive activity markers are extremely important in conditions, such as pregnancy, when endoscopy is not recommended. The aim of this prospective study was to determine fecal calprotectin (FC) concentrations in healthy non-pregnant and pregnant women and in patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS Healthy pregnant and non-pregnant women and patients with active and inactive IBD were prospectively enrolled in this study. Demographic and clinical parameters and clinical disease activity scores in patients with IBD were recorded. Blood and stool samples of every patient were obtained to determine C-reactive protein and FC levels. FC levels were measured with a quantitative lateral flow assay. RESULTS One hundred and thirty-five subjects were enrolled in the study (24 non-pregnant and 48 pregnant healthy women, 40 non-pregnant patients with active IBD and 23 non-pregnant patients with inactive IBD). FC was significantly higher in active IBD patients than in pregnant (p<0.001) and non-pregnant healthy women (p<0.001). No difference could be detected in FC concentrations between pregnant and non-pregnant healthy women. CONCLUSION Since FC levels remained unchanged during pregnancy, it may be a useful noninvasive diagnostic tool in pregnancy for monitoring mucosal inflammation.
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Affiliation(s)
- Anita Bálint
- Department of Medicine, University of Szeged, Szeged, Hungary.
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Milassin Á, Rutka M, Csontos ÁA, Miheller P, Palatka K, Szűcs M, Szepes Z, Bálint A, Bor R, Fábián A, Farkas K, Nagy F, Molnár T. What Is the Personal Experience of IBD Patients about Their Anti-TNF-Alpha Therapy? Health (London) 2017. [DOI: 10.4236/health.2017.97073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Bálint A, Törőcsik D, Palatka K, Szepes Z, Szűcs M, Tamás F, Nagy F, Farkas K, Fábián A, Bor R, Milassin Á, Rutka M, Molnár T. Prognostic factors, effectiveness and safety of endoscopic balloon dilatation for de novo and anastomotic strictures in Crohn’s disease—A multicenter “real life” study. Cogent Medicine 2016. [DOI: 10.1080/2331205x.2016.1233687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Anita Bálint
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Dalma Törőcsik
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Károly Palatka
- 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szepes
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Ferenci Tamás
- Physiological Controls Group, John von Neumann Faculty of Informatics, Óbuda University, Budapest, Hungary
| | - Ferenc Nagy
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Klaudia Farkas
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Anna Fábián
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Renáta Bor
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Ágnes Milassin
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Mariann Rutka
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Tamás Molnár
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
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24
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Bor R, Farkas K, Bálint A, Szűcs M, Ábrahám S, Milassin Á, Rutka M, Nagy F, Milassin P, Szepes Z, Molnár T. Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease. J Ultrasound Med 2016; 35:2367-2372. [PMID: 27629757 DOI: 10.7863/ultra.15.09043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) and transrectal sonography are the two accepted imaging modalities for evaluation of perianal fistulas and abscesses. Transperineal sonography is a new technique that is easy to learn and can be performed at any time. The purpose of this study was to prospectively compare the diagnostic accuracy of MRI, transrectal sonography, and transperineal sonography with surgical findings in patients with perianal Crohn disease. METHODS All patients with perianal Crohn disease underwent MRI, transrectal sonography, and transperineal sonography within a few days before surgery. Fistulas were classified as simple (43.8%) or complex (52.2%) based on surgical findings. RESULTS Twenty-three patients with active perianal Crohn disease (12 women and 11 men; mean age, 29.9 years; current therapy: antibiotics, 69.6%; azathioprine, 56.5%; and biologics, 73.9%; previous surgery, 26.1%; and proportion of smokers, 39.1%) were included. Sensitivity values for MRI, transrectal sonography, and transperineal sonography for diagnosis of fistulas were 84.6%, 84.6%, and 100%, respectively. Transperineal sonography was more sensitive for diagnosis of perianal abscesses than MRI and transrectal sonography (100%, 58.8%, and 92.8%). CONCLUSIONS Transperineal sonography is a very accurate diagnostic method with outstanding sensitivity compared with MRI and transrectal sonography for evaluation of complicated perianal Crohn disease. Due to its simplicity and low cost, it is recommended that transperineal sonography be the first diagnostic modality in these cases.
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Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Departments of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Milassin
- Department of Radiology, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
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25
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Rutka M, Bálint A, Farkas K, Palatka K, Lakner L, Miheller P, Rácz I, Hegede G, Vincze Á, Horváth G, Szabó A, Nagy F, Szepes Z, Gábor Z, Zsigmond F, Zsóri Á, Juhász M, Csontos Á, Szűcs M, Bor R, Milassin Á, Molnár T. [Long-term adalimumab therapy in ulcerative colitis in clinical practice: result of the Hungarian multicenter prospective study]. Orv Hetil 2016; 157:706-711. [PMID: 27106726 DOI: 10.1556/650.2016.30429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Adalimumab was approved for the treatment of ulcerative colitis refractory to conventional therapy several years later than infliximab in Europe. Due to the relatively low remission rate observed in Ultra trials, data on the efficacy of adalimumab in ulcerative colitis are really helpful in the daily practice. AIM The aim of this study was to prospectively collect data on induction and maintenance adalimumab therapy in patients with ulcerative colitis treated in Hungarian centres. METHOD This prospective study collected data of all patients with ulcerative colitis treated with adalimumab in 10 Hungarian centres. The primary endpoints of the study were rates of remission, response and primary failure at week 12, and the rate of continuous clinical response, remission and loss of response at weeks 30, and 52. Secondary endpoints were endoscopic outcome at week 52 and comparison of the efficacy of adalimumab between treatment naive and infliximab-experienced patients. RESULTS 73 patients with active ulcerative colitis were enrolled in the study. 75.3% of the patients exhibited clinical response after the induction at week 12. The probability of maintaining adalimumab treatment was 48.6% at week 52 with a continuous clinical response in 92% of these patients. Mucosal healing was achieved in 48.1% of the patients at week 52. Dose intensification was performed in 17.6% of the patients. Minor side effects developed in 4% of the patients and 5.4% of the patients underwent colectomy during the 1-year treatment period. CONCLUSIONS These results coming from the real clinical setting demonstrate a favourable efficacy of adalimumab induction and maintenance therapy in patients with ulcerative colitis.
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Affiliation(s)
- Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Károly Palatka
- II. Belgyógyászati Klinika, Debreceni Tudományegyetem, Általános Orvostudományi Kar Debrecen
| | | | - Pál Miheller
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | | | - Gábor Hegede
- Péterfy Sándor Utcai Kórház-Rendelőintézet és Sürgősségi Központ Budapest
| | - Áron Vincze
- I. Belgyógyászati Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | | | | | - Ferenc Nagy
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Gábor
- Semmelweis Kórház és Egyetemi Oktatókórház Miskolc
| | | | | | - Márk Juhász
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Ágnes Csontos
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Mónika Szűcs
- Orvosi Fizika és Orvosi Informatika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
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26
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Annaházi A, Ábrahám S, Farkas K, Rosztóczy A, Inczefi O, Földesi I, Szűcs M, Rutka M, Theodorou V, Eutamene H, Bueno L, Lázár G, Wittmann T, Molnár T, Róka R. A pilot study on faecal MMP-9: a new noninvasive diagnostic marker of colorectal cancer. Br J Cancer 2016; 114:787-92. [PMID: 26908323 PMCID: PMC4984857 DOI: 10.1038/bjc.2016.31] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 01/06/2016] [Accepted: 01/20/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Colorectal cancer (CRC) is one of the leading malignancies worldwide, therefore cheap noninvasive screening methods are of great importance. Matrix-metalloproteinase-9 (MMP-9) has a role in the progression of CRC, and its level is elevated in tumour biopsies. Faecal MMP-9 levels are increased in active ulcerative colitis patients, but in CRC patients, they have never been measured. We aimed to assess the faecal MMP-9 levels in patients undergoing total colonoscopy according to endoscopic and histological diagnosis. Methods: One hundred and nine patients provided faecal samples for MMP-9 analysis. A total colonoscopy was performed; suspicious lesions were evaluated by histology. Faecal MMP-9 levels were measured by ELISA. Results: The number of patients allocated to different groups were: negative/diverticulosis: 34 (referred to as controls); hyperplastic polyps: 15; adenomas: 32 (22 at high risk); and CRC: 28. Faecal MMP-9 was significantly increased in CRC compared with all other groups (P<0.001). Faecal MMP-9 was suitable to distinguish CRC patients from controls (sensitivity: 89.3% specificity: 91.2%). By means of a lower cutoff level, faecal MMP-9 identified high-risk adenomas besides CRC (sensitivity: 76% specificity: 85.3%). This lower cutoff level screened 59% of high-risk adenomas. Conclusions: Faecal MMP-9 may be a promising new noninvasive marker in CRC.
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Affiliation(s)
- Anita Annaházi
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Pf. 427, Szeged 6701, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - András Rosztóczy
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Orsolya Inczefi
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Imre Földesi
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Korányi Fasor 9, Szeged 6720, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Vassilia Theodorou
- Toxalim UMR 1331 INRA/INP/UPS, Neuro-Gastroenterology and Nutrition Unit, 180, Chemin de Tournefeuille, BP.93173, Toulouse Cedex 3, 31027, France
| | - Helene Eutamene
- Toxalim UMR 1331 INRA/INP/UPS, Neuro-Gastroenterology and Nutrition Unit, 180, Chemin de Tournefeuille, BP.93173, Toulouse Cedex 3, 31027, France
| | - Lionel Bueno
- Toxalim UMR 1331 INRA/INP/UPS, Neuro-Gastroenterology and Nutrition Unit, 180, Chemin de Tournefeuille, BP.93173, Toulouse Cedex 3, 31027, France
| | - György Lázár
- Department of Surgery, University of Szeged, Pf. 427, Szeged 6701, Hungary
| | - Tibor Wittmann
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
| | - Richárd Róka
- First Department of Medicine, University of Szeged, Korányi Fasor 8-10, Szeged 6720, Hungary
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Daróczi T, Bor R, Fábián A, Szabó E, Farkas K, Bálint A, Czakó L, Rutka M, Szűcs M, Milassin Á, Molnár T, Szepes Z. [Cost-effectiveness trial of self-expandable metal stents and plastic biliary stents in malignant biliary obstruction]. Orv Hetil 2016; 157:268-74. [PMID: 26853728 DOI: 10.1556/650.2016.30365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Self-expandable metal and plastic stents can be applied in the palliative endoscopic treatment of patients with unresectable malignant biliary obstruction. The use of metal stentsis recommended if the patient's life expectancy is more than four months. AIM To compare the therapeutic efficacy and cost-effectiveness of metal and plastic stents in the treatment of malignant biliary obstruction. METHOD The authors retrospectively enrolled patients who received metal (37 patients) or plastic stent (37 patients). The complication rate, stent patency and cumulative cost of treatment were assessed in the two groups. RESULTS The complication rate of metal stents was lower (37.84% vs. 56.76%), but the stent patency was higher compared with plastic stents (19.11 vs. 8.29 weeks; p = 0.0041). In the plastic stent group the frequency of hospitalization of patients in context with stent complications (1.18 vs. 2.32; p = 0.05) and the necessity of reintervention for stent dysfunction (17 vs. 27; p = 0.033) were substantially higher. In this group multiple stent implantation raised the stent patency from 7.68 to 10.75 weeks. There was no difference in the total cost of treatment of malignant biliary obstruction between the two groups (p = 0.848). CONCLUSIONS Considering the cost of treatment and the burden of patients the authors recommend self-expandable metal sten timplantation if the life expectancy of patients is more than two months. In short survival cases multiple plastic stent implantation is recommended.
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Affiliation(s)
- Tímea Daróczi
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anna Fábián
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Ella Szabó
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - László Czakó
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Mónika Szűcs
- Orvosi Fizika és Orvosi Informatika Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
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28
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Bálint A, Farkas K, Palatka K, Lakner L, Miheller P, Rácz I, Hegede G, Vincze Á, Horváth G, Szabó A, Nagy F, Szepes Z, Gábor Z, Zsigmond F, Zsóri Á, Juhász M, Csontos Á, Szűcs M, Bor R, Milassin Á, Rutka M, Molnár T. Efficacy and Safety of Adalimumab in Ulcerative Colitis Refractory to Conventional Therapy in Routine Clinical Practice. J Crohns Colitis 2016; 10:26-30. [PMID: 26392413 DOI: 10.1093/ecco-jcc/jjv169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/15/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Adalimumab [ADA] was approved for the treatment of ulcerative colitis [UC] refractory to conventional therapy in 2012 in Europe. Due to the observed discrepancies between clinical trials and practice, data on the outcome of ADA therapy are really needed from the real life. The aim of this study was to estimate the short- and long-term efficacy and safety of ADA in UC patients from each Hungarian biological centre. PATIENTS AND METHODS This prospective study consisted of UC patients treated with ADA in 10 Hungarian inflammatory bowel disease centres. The primary endpoints of the study were rates of continuous clinical response, remission, non-response and loss of response at Weeks 12, 30, and 52.The secondary endpoints included mucosal healing at Week 52 and the comparison of the efficacy of ADA between biological naive and infliximab [IFX]-treated groups. Colonoscopy was performed before starting the therapy and at Week 52. RESULTS In all, 73 active UC patients were enrolled in the study: 67.1% of the patients received previous IFX therapy; 75.3% of the patients showed short-term clinical response at Week 12. The probability of maintaining ADA was 48.6% at Week 52 with a continuous clinical response in 92% of these remaining patients. Mucosal healing was achieved in 48.1% of the patients at Week 52. Escalation of ADA was performed in 17.6%, and minor side effects developed in 4% of the patients; 5.4% of the patients underwent colectomy during the 1-year treatment period. CONCLUSION UC is a progressive disease that may need early aggressive therapy to prevent structural and functional complications. The results of our study demonstrated the favourable efficacy of short- and long-term ADA treatment for patients with UC.
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Affiliation(s)
- Anita Bálint
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Károly Palatka
- 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lilla Lakner
- Markusovszky University Hospital, Szombathely, Hungary
| | - Pál Miheller
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Gábor Hegede
- Péterfy Sándor Street Hospital-Clinic and Emergency Center, Budapest, Hungary
| | - Áron Vincze
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | - Gábor Horváth
- Semmelweis Hospital and University Hospital [MISEK], Miskolc, Hungary
| | | | - Ferenc Nagy
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Gábor
- Semmelweis Hospital and University Hospital [MISEK], Miskolc, Hungary
| | | | - Ágnes Zsóri
- Kazincbarcika Hospital, Kazincbarcika, Hungary
| | - Márk Juhász
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Csontos
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
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Bor R, Balanyi Z, Farkas K, Bálint A, Rutka M, Szűcs M, Milassin Á, Szepes Z, Nagy F, Molnár T. [Comparison of symptoms, laboratory parameters and illness perception in patients with irritable bowel syndrome and inflammatory bowel disease]. Orv Hetil 2015; 156:933-8. [PMID: 26027601 DOI: 10.1556/650.2015.30168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Symptoms-based differential diagnosis of irritable bowel syndrome and inflammatory bowel disease is often difficult. AIMS To determine the differential diagnostic ability of clinical activity indexes and psychological questionnaires in these conditions, which have never been simultaneously analyzed. METHOD 37 irritable bowel syndrome, 54 Crohn's disease and 41 ulcerative colitis patients were enrolled in the study. The patients completed the Crohn's Disease Activity Index test, Illness Perception Questionnaire and Inflammatory Bowel Disease Questionnaire. Hematocrit and C-reactive protein level of patients were also analyzed. RESULTS Patients with irritable bowel syndrome felt their abdominal pain more severe than the other two groups (p = 0.005), while the quality of life was the worst in Crohn's disease (p = 0.0000001). Significantly more patients with inflammatory bowel disease considered that their condition is lifelong (p = 0.000781). The knowledge about disease was more appropriate in patients with inflammatory bowel disease (p = 0.00629). No significant difference was found in hematocrit levels, but the C-reactive protein level was significantly lower in patients with irritable bowel syndrome (p = 0.001). CONCLUSIONS Illness perception questionnaires and C-reactive protein can help in the differentiation of inflammatory bowel disease from irritable bowel syndrome.
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Affiliation(s)
- Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
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Farkas K, Bálint A, Bor R, Földesi I, Szűcs M, Nagy F, Szepes Z, Annaházi A, Róka R, Molnár T. Faecal matrix metalloprotease-9 is a more sensitive marker for diagnosing pouchitis than faecal calprotectin: results from a pilot study. Expert Rev Gastroenterol Hepatol 2015; 9:387-92. [PMID: 25264031 DOI: 10.1586/17474124.2015.965144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Potential non-invasive markers of pouchitis would have a great deal of significance within clinical practice. AIM This study is aimed at assessing the diagnostic accuracy of fecal calprotectin and matrix metalloprotease-9 as potential markers in patients both with and without pouchitis. PATIENTS AND METHODS Stool and blood samples were collected from 33 ileal pouch-anal anastomosis patients before a follow-up pouchoscopy. Biopsy samples were taken for histological purposes. The presence of cuffitis and stenosis was evaluated with an endoscopy. Calprotectin and matrix metalloprotease-9 were quantified with an enzyme-linked immunosorbent assay. RESULTS Pouchitis was detected in 30.3% of the patients. The levels of fecal calprotectin and matrix metalloprotease-9 increased significantly in patients with pouchitis. The sensitivity and specificity of matrix metalloprotease-9 was higher than that of fecal calprotectin. Only matrix metalloprotease-9 correlated significantly with the severity of pouchitis. DISCUSSION Fecal matrix metalloprotease-9 has a high specificity in the diagnosis of pouchitis.
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Affiliation(s)
- Klaudia Farkas
- First Department of Medicine, University of Szeged H-6720, Korányi fasor 8, Szeged, Hungary
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Farkas K, Saródi Z, Bálint A, Földesi I, Tiszlavicz L, Szűcs M, Nyári T, Tajti J, Nagy F, Szepes Z, Bor R, Annaházi A, Róka R, Molnár T. The diagnostic value of a new fecal marker, matrix metalloprotease-9, in different types of inflammatory bowel diseases. J Crohns Colitis 2015; 9:231-7. [PMID: 25585596 DOI: 10.1093/ecco-jcc/jjv005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Only limited data are available regarding the diagnostic accuracy of fecal matrix metalloprotease-9 [MMP-9] for inflammatory bowel disease [IBD]. The aims of our study were to assess the diagnostic accuracy of fecal MMP-9 in patients with active Crohn's disease [CD], ulcerative colitis [UC], and pouchitis, and to compare the diagnostic accuracy of fecal MMP-9 and fecal calprotectin [CP] in IBD. METHODS Stool and blood samples were collected in 50 CD, 54 UC, and 34 ileal pouch-anal anastomosis patients before control endoscopies were performed. Biopsies were taken for histologic purposes. The activities of CD, UC, and pouchitis were defined with the use of clinical, endoscopic, and histologic activity scores. Fecal CP and MMP-9 levels were quantified by enzyme-linked immunosorbent assay. RESULTS Active CD, UC, and pouchitis were detected in 38%, 54%, and 29% of the patients, respectively. A significant correlation was revealed between fecal CP and the clinical activities of CD and UC, and between fecal CP and the endoscopic activity of UC and pouchitis. Fecal MMP-9 did not correlate with any of the activity indices of CD; however, strong associations were shown between fecal MMP-9 and clinical, endoscopic, and histologic activities of both UC and pouchitis. CONCLUSIONS This is the first study assessing the diagnostic accuracy of MMP-9 in different types of IBD. Our results showed that fecal MMP-9 has high sensitivity in the detection of endoscopically active UC and pouchitis. These non-invasive methods help assess intestinal inflammation.
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Affiliation(s)
- Klaudia Farkas
- First Department of Medicine, University of Szeged, Hungary
| | - Zoltán Saródi
- First Department of Medicine, University of Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Hungary
| | - Imre Földesi
- First Department of Medicine, University of Szeged, Hungary
| | | | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Hungary
| | - János Tajti
- Department of Surgery, University of Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Hungary
| | - Anita Annaházi
- First Department of Medicine, University of Szeged, Hungary
| | - Richárd Róka
- First Department of Medicine, University of Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Hungary
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Sarusi A, Rárosi F, Szűcs M, Csík N, Farkas AS, Papp JG, Varró A, Forster T, Curtis MJ, Farkas A. Absolute beat-to-beat variability and instability parameters of ECG intervals: biomarkers for predicting ischaemia-induced ventricular fibrillation. Br J Pharmacol 2014; 171:1772-82. [PMID: 24417376 DOI: 10.1111/bph.12579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/15/2013] [Accepted: 01/03/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Predicting lethal arrhythmia liability from beat-to-beat variability and instability (BVI) of the ECG intervals is a useful technique in drug assessment. Most investigators use only arrhythmia-free ECGs for this. Recently, it was shown that drug-induced torsades de pointes (TdP) liability can be predicted more accurately from BVI measured irrespective of rhythm, even during arrhythmias (absolute BVI). The present study tested the broader applicability of this assessment by examining whether absolute BVI parameters predict another potential lethal arrhythmia, ischaemia-induced ventricular fibrillation (VF). EXPERIMENTAL APPROACH Langendorff-perfused rat hearts were subjected to regional ischaemia for 15 min. Absolute BVI parameters were derived from ECG intervals measured in 40 consecutive ventricular complexes (irrespective of rhythm) immediately preceding VF onset and compared with time-matched values in hearts not expressing VF. KEY RESULTS Increased frequency of non-sinus beats and 'R on T' arrhythmic beats, shortened mean RR and electrical diastolic intervals, and increased BVI of cycle length and repolarization predicted VF occurrence. Absolute BVI parameters that quantify variability of repolarization (e.g. 'short-term variability' of QT interval) had the best predictive power with high sensitivity and specificity. In contrast, VF was not predicted by any BVI parameter derived from the last arrhythmia-free interlude before VF. CONCLUSIONS AND IMPLICATIONS The novel absolute BVI parameters that predicted TdP in rabbit also predict ischaemia-induced VF in rat, indicating a diagnostic and mechanistic congruence. Repolarization inhomogeneity represents a pivotal biomarker of ischaemia-induced VF. The newly validated biomarkers could serve as surrogates for VF in pre-clinical drug investigations.
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Affiliation(s)
- Annamária Sarusi
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
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Farkas K, Bálint A, Valkusz Z, Szepes Z, Nagy F, Szűcs M, Bor R, Wittmann T, Molnár T. Bolus administration of steroid therapy is more favorable than the conventional use in preventing decrease of bone density and the increase of body fat percentage in patients with inflammatory bowel disease. J Crohns Colitis 2014; 8:992-7. [PMID: 24530134 DOI: 10.1016/j.crohns.2014.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 12/22/2013] [Accepted: 01/29/2014] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The effects of short course of corticosteroids on the metabolic processes and bone formation has not been well studied. Our aim was to compare the efficacy, the side effects and the bone and lipid metabolisms in IBD patients using bolus or conventional tapering of methylprednisolone for 12 weeks. PATIENTS AND METHODS Nineteen IBD patients received intravenous methylprednisolone of 1mg/kg for 5 days tapered by 4 mg per week. Patients were prospectively randomized in two groups. In "conventional" group (I) steroids were given daily. In "pulse" group (II) weekly doses of steroids were given on special days of the week. The body mass index (BMI) was measured before and after the corticosteroid therapy. Blood samples were collected to assess glucose level, electrolytes, cholesterol and triglyceride levels, inflammatory parameters, cortisol, osteocalcin and crosslaps values. Total body composition analysis was performed at the beginning and at the end of the steroid therapy. RESULTS In Group I, BMI increased, total body bone density decreased significantly at the end of the steroid therapy. Body fat percent showed a tendency to be higher at the end of steroid therapy in Group I. Cholesterol level increased significantly in Group I patients. The decrease in serum cortisol level was more remarkable in Group I vs. Group II after steroid therapy. Less side-effect occurred in Group II vs. Group I. DISCUSSION Our results suggest that bolus tapering of corticosteroids may have more favorable short term outcome than conventional tapering that may revolutionize steroid therapy in IBD.
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Affiliation(s)
- Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary.
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Wittmann
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Molnár T, Farkas K, Szepes Z, Nagy F, Szűcs M, Nyári T, Bálint A, Wittmann T. Long-term outcome of cyclosporin rescue therapy in acute, steroid-refractory severe ulcerative colitis. United European Gastroenterol J 2014; 2:108-12. [PMID: 24918015 DOI: 10.1177/2050640614520865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/26/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Although cyclosporin is effective in severe ulcerative colitis (UC), long-term colectomy rate varies between 60 and 88% among patients in whom cyclosporin initially induced remission. The aim of our study was to evaluate the long-term outcome and the optimal duration of cyclosporin therapy in acute, severe UC. METHODS A total of 73 patients underwent i.v. cyclosporin therapy for a steroid refractory flare up of UC between 1998 and 2009. All patients were treated with 1 mg/kg i.v. methylprednisolone for 3-7 days before the administration of cyclosporin. Patients received i.v. cyclosporin of 4-5 mg/kg for 5 days following oral treatment. RESULTS The mean follow up after the initiation of cyclosporin was 4.2 years. There were 20 patients who underwent early colectomy. Cyclosporin had to be discontinued due to side effects in 22 patients. Cyclosporin failed and late colectomy was performed in 14 of the 53 responders. Duration of cyclosporin treatment was significantly longer in those who avoided colectomy. The probability of avoiding colectomy proved to be 66% in case of 1-year treatment period with cyclosporin. The longer treatment period resulted in longer colectomy-free disease course. CONCLUSIONS Cyclosporin is effective in acute, severe UC during long-term follow up. Our data suggest that the longer cyclosporin is used, the more it is possible to avoid colectomy in the future.
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Bálint A, Farkas K, Szűcs M, Szepes Z, Nagy F, Wittmann T, Molnár T. Long-term increase in serum cholesterol levels in ulcerative colitis patients treated with cyclosporine: an underdiagnosed side effect frequently associated with other drug-related complications. Scand J Gastroenterol 2014; 49:59-65. [PMID: 24138131 DOI: 10.3109/00365521.2013.848231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Several serious side effects may limit the use of cyclosporine. Cyclosporine has been reported to increase the total cholesterol level; however, the change in serum cholesterol levels before and after cyclosporine therapy has not been examined in ulcerative colitis (UC) patients. The purpose of this article was to compare serum cholesterol levels before and after cyclosporine therapy in patients with refractory UC and to examine the relationship between serum cholesterol levels and other common side effects. PATIENTS AND METHODS We prospectively assessed serum cholesterol levels in UC patients who had been treated with cyclosporine. Data of 72 patients were analyzed and compared to a control group treated with Infliximab. RESULTS The average duration of cyclosporine therapy was 9.6 months, and side effects developed in 52 patients. Elevated cholesterol levels were detected in 47.2% of the patients. Serum cholesterol levels were significantly increased during and after discontinuation of cyclosporine therapy compared to the time before use of the drug. However, cholesterol levels measured during cyclosporine therapy were significantly higher compared to the time after its discontinuation (p < 0.001). Patients with drug-related side effects showed higher cholesterol levels after discontinuation of the therapy compared to those who did not experience any adverse events. CONCLUSIONS Our findings suggest that cyclosporine therapy may result in increased serum cholesterol levels even in the long-term, after discontinuation of the therapy. Considering that significantly higher post-therapy cholesterol levels were more common in patients who developed drug-related complications, routine measurement of serum cholesterol may increase the safety of the drug.
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Affiliation(s)
- Anita Bálint
- Department I of Medicine, University of Szeged , Szeged , Hungary
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Bor R, Farkas K, Bálint A, Szűcs M, Ábrahám S, Baradnay G, Wittmann T, Szepes Z, Nagy F, Molnár T. Efficacy of tumor necrosis factor-alpha inhibitors in fistulising perianal Crohn’s disease. Orv Hetil 2013; 154:1943-8. [DOI: 10.1556/oh.2013.29770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction: Tumor necrosis factor-alpha inhibitors are increasingly used in the treatment of severe Crohn’s disease. Aim: The aim of the authors was to assess retrospectively the short and long term efficacy of tumor necrosis factor-alpha inhibitors in fistulising Crohn’s disease. Method: Responses to therapy was determined using Crohn’s Disease Activity Index, Perianal Disease Activity Index, the rate of complete fistula closure and the additional surgical procedures during biological therapy. Results: After 12 weeks the perianal activity was decreased in more than 80% of the cases, and the complete remission rate was about 60%. After one year of therapy about one third of the patients had fistula closure, but after cessation of the biological therapy recurrence of fistulas was detected in every second patient. In most cases additional immunosuppressive therapy was necessary during biological treatment. During the one-year therapy period additional surgical treatments were performed in 45% of patients; seton insertion and abscess drainage were the most frequent procedures. Conclusions: Tumor necrosis factor-alpha inhibitor therapy is effective in the treatment of perianal Crohn’s disease, however, additional immunosuppressive drugs and rectum sparing surgical procedures were necessary during the one-year treatment period. Because of the high rate of fistula recurrence, long term tumor necrosis factor-alpha treatment may be useful. Orv. Hetil., 154(49), 1943–1948.
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Affiliation(s)
- Renáta Bor
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Klaudia Farkas
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Anita Bálint
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Mónika Szűcs
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Orvosi Fizika és Orvosi Informatika Intézet Szeged
| | - Szabolcs Ábrahám
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika Szeged
| | - Gellért Baradnay
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika Szeged
| | - Tibor Wittmann
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Zoltán Szepes
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Ferenc Nagy
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
| | - Tamás Molnár
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Szeged Korányi fasor 8–10. 6720
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Molnár T, Földesi I, Farkas K, Lázár G, Tiszlavicz L, Szűcs M, Nagy F, Szepes Z, Bálint A, Bor R, Wittmann T. The diagnostic accuracy of fecal calprotectin in pouchitis. Z Gastroenterol 2013. [DOI: 10.1055/s-0033-1347533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Farkas K, Bálint A, Nagy F, Szepes Z, Szűcs M, Wittmann T, Molnár T. Letter: factors that may predict response to ciclosporin in ulcerative colitis. Aliment Pharmacol Ther 2013; 37:654. [PMID: 23406407 DOI: 10.1111/apt.12190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/04/2012] [Indexed: 12/08/2022]
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Annaházi A, Molnár T, Farkas K, Rosztóczy A, Izbéki F, Gecse K, Inczefi O, Nagy F, Földesi I, Szűcs M, Dabek M, Ferrier L, Theodorou V, Bueno L, Wittmann T, Róka R. Fecal MMP-9: a new noninvasive differential diagnostic and activity marker in ulcerative colitis. Inflamm Bowel Dis 2013; 19:316-20. [PMID: 22550024 DOI: 10.1002/ibd.22996] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) is characterized by frequent relapses, with the presence of colorectal inflammation and mucosal lesions. Matrix-metalloprotease 9 (MMP-9) is elevated in colonic biopsies, urine, and blood plasma of UC patients. MMP-9 has been suggested as a predictor of UC in the urine of children; however, 20% of the controls tested positive. So far, fecal MMP-9 levels have never been measured. Our aims were: 1) to compare fecal MMP-9 levels in UC patients to control subjects and a functional gastrointestinal disorder characterized by diarrhea (IBS-D); 2) to test the correlation between UC disease activity and fecal levels of MMP-9; and 3) to correlate fecal MMP-9 levels with a known fecal marker of UC activity, calprotectin. METHODS UC (n = 47), IBS-D (n = 23) patients, and control subjects (n = 24) provided fecal samples for MMP-9 analysis. In UC patients, disease severity was evaluated by the Mayo score. Fecal MMP-9 and calprotectin levels were measured by enzyme-linked immunosorbent assay and lateral flow assay, respectively. RESULTS MMP-9 was undetectable or ≤0.22 ng/mL in the feces of all controls and IBS-D patients. In UC patients, fecal MMP-9 levels significantly correlated with the overall Mayo score (P < 0.001), the endoscopic score (P < 0.001), and the serum C-reactive protein levels (P = 0.002). Additionally, in UC patients fecal MMP-9 levels showed a significant correlation with a known disease activity marker, fecal calprotectin (P = 0.014). CONCLUSIONS These results highlight fecal MMP-9 as a useful tool in the differential diagnosis of diarrheic disorders and in the noninvasive evaluation of disease activity and mucosal healing in UC.
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Affiliation(s)
- Anita Annaházi
- First Department of Medicine, University of Szeged, Szeged, Hungary. annanita3@yahoocom
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Szűcs M, Keszthelyi A, Szendrői A, Dombóvári P, Majoros A, Mavrogenis S, Riesz P, Keszthelyi L, Asztalos I, Romics I. Investigation of anal sphincter function following Mainz pouch type II urinary diversion after radical cystectomy. Int Urol Nephrol 2012; 44:1013-20. [PMID: 22367172 DOI: 10.1007/s11255-012-0142-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 02/07/2012] [Indexed: 11/28/2022]
Abstract
PURPOSES Our aim was to evaluate the anal sphincter function following cystectomy with urinary diversion of Mainz pouch II. METHODS Seventy-six patients were involved in our survey, and the cohort was for two groups divided. The first group was a retrospective review of 40 patients with examination of the state of continence. Comparative examinations on anal sphincter function and the quality of life survey were carried out. The second group consisting of 15 patients underwent a prospective investigation including rectal manometry in both the pre- and postoperative periods. Measurements of resting anal sphincter pressure (RASP), maximal anal closing pressure (MACP) and the function of the recto anal inhibitions reflex were taken. RESULTS In the first part of our investigation, 80% of the patients were considered as continent. There were no significant differences observed between RASP values in the cases of continent as well as of incontinent patients (79.2 ± 2 vs. 73.6 ± 68.4 mmHg, p = 0-53); however, the MACP values of the continent patients were significantly higher (204.3 ± 22.8 vs. 117.3 ± 14 mmHg, p = 0.001). In the course of the second experiment, both the RASP (86.3 ± 18.7 vs. 76.1 ± 13.9 mmHg p = 0.0049) and the MACP (232.2 ± 53.8 vs. 194.1 ± 74.5 mmHg, p = 0.0054) were detected as decreasing in the case of the incontinent group. CONCLUSIONS A decrease in rectal sphincter function is responsible for incontinence following Mainz pouch type II diversion, and this dysfunction can be correlated with the surgery. Ureterosigmoideostomy is therefore considered as a useful method of urinary diversion only in selected cases with proven good sphincter function.
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Affiliation(s)
- M Szűcs
- Department of Urology and Urooncological Center, Semmelweis University, H1082 Üllői út 78/b, Budapest, Hungary
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