Óriás mellkasi paraganglioma diagnosztikai nehézségei és terápiás lehetőségei

A paragangliomák a szimpatikus vagy paraszimpatikus ganglionokból kiinduló, többségükben jóindulatú daganatok, de rosszindulatú formájuk is ismert. A fej-nyak régióban, a glomus caroticumban, illetve a vegetatív idegrendszer dúcláncának megfelelően a hasüregben, illetve a mellüregben is előfordulhatnak. A 39 éves férfi beteg kivizsgálása extrém magas vérnyomásértékek, éjszakai izzadás és 10 kg-os fogyás miatt kezdődött. A mellkas-CT-vizsgálat a jobb oldali tüdőkapuban óriási térfoglalást írt le, a bronchoszkópos mintavétel sikertelen volt. Jobb oldali thoracotomiából mintavétel történt, reszekcióra a kifejezett adhéziók, illetve a szívérintettség miatt nem volt lehetőség. A szövettani vizsgálat eredménye paraganglioma lett, ezt a laborvizsgálatok is támogatták. Ennek megfelelőn szomatosztatinanalóg-terápiát kezdtünk, majd 131I-MIBG-kezelést alkalmaztunk, jó klinikai eredménnyel. A koronarográfia során észleltük, hogy a jobb coronaria két marginális ággal hozzájárul a mellkasi terime vérellátásához. Megfelelő előkészítést követően, szív- és mellkassebészeti beavatkozással a tumor eltávolíthatónak bizonyult, ennek eredményeként a posztoperatív szakban a beteg vérnyomáscsökkentőit elhagytuk. A kontrollok során tumormaradványra utaló jel nem volt. A vérnyomáskiugrások okának keresésekor merüljön fel bennünk a paraganglioma lehetősége is. Ezen esetekben az invazív beavatkozások, amennyiben nem előzi meg őket gyógyszeres előkészítés, akár fatális kimenetellel járhatnak. Az egyre szélesedő terápiás lehetőségek kihasználásával és az intézetek közötti kooperációval az óriás-paragangliomában szenvedő betegek is tumormentessé tehetők. Orv Hetil. 2022; 163(31): 1243–1249.

[Nurse style of central vein! Our experience in the peripherally inserted central venous catheter]

What is PICC line insertion? The PICC is a soft, flexible catheter which is made of polyurethane or silicone, and is inserted via an upper or lower extremity peripheral vein into superior or inferior vena cava. The origin of PICC line dates back to the early 1950s. Since the introduction of the PICC catheter, this method of venous catheterization has gone through many changes as regards the technique of insertion or the type of catheter used. Despite the routine use of PICC line worldwide, little progress has been made in its use in Hungary. In this short review we will briefly summarise the use of PICC line, its indications, advantages, disadvantages, and on complementary devices which are necessary during the procedure. We discuss our experience in insertion of PICC line at Pécs University, where the procedure is solely done by a certified registered nurse. We hope that with continuous progression of nurse competency, this procedure will be implemented at a higher scale in Hungary. Orv Hetil. 2017; 158(22): 856-863.

Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study

OBJECTIVE

The role of cortisol in the prediction of mortality risk in critical illness is controversial in the literature. The aim of this study was to evaluate the prognostic value of cortisol concentrations in a mixed population of critically ill patients in medical emergencies.

DESIGN

In this prospective, observational study, measurement of total (TC) and free cortisol (FC) levels was made in the serum samples of 69 critically ill patients (39 males and 30 females, median age of 74 years) at admission (0 h) and 6, 24, 48, and 96 h after admission.

METHODS

Cortisol levels were determined using HPLC coupled high-resolution ESI-TOF mass spectrometry. The severity of disease was calculated by prognostic scores. Statistical analyses were performed using the SPSS 22.0 software.

RESULTS

The range of TC varied between 49.9 and 8797.8 nmol/l, FC between 0.4 and 759.9 nmol/l. The levels of FC at 0, 6, 24, and 48 h and TC at 0, 6 h were significantly elevated in non-survivors and correlated with the predicted mortality. The prognostic value of these cortisol levels was comparable with the routinely used mortality scores. In predictive models, FC at 6, 24, and 48 h proved to be an independent determinant of mortality.

CONCLUSIONS

The predictive values of FC in the first 2 days after admission and TC within 6 h are comparable with the complex, routinely used mortality scores in evaluating the prognosis of critically ill patients. The cortisol response probably reflects the severity of disease.

A specifically radiolabeled somatostatin analog with strong antitumor activity induces apoptosis and accumulates in the cytosol and the nucleus of HT29 human colon carcinoma cells

The new heptapeptide somatostatin analog TT-232 decreases proliferation of HT-29 human colon carcinoma cells in vitro by reducing mitotic and increasing apoptotic activity. We have synthesized and characterized a specifically tritium labeled 3H-Tyr3-TT-232 (30 Ci/mmol) to investigate the effect and the fate of this antitumor peptide on human colon tumor cells. 3H-labeled TT-232 could be detected on the cell surface, on cytoplasmic membranes and also in the nucleus of HT-29 cells, 1-6 h after the administration of 0.5 and 50 microg/mL [3H]TT-232. Binding and internalization of TT-232 to human colon tumor cells at a relatively high dose provide further evidence for the existence of low-affinity somatostatin receptors in such cells, which might mediate the apoptosis-inducing effect. Our data suggest the possible use of TT-232 in the treatment of human colon tumors.

Synthesis of gonadotropin-releasing hormone III analogs. Structure-antitumor activity relationships

Following the observation that the activity of gonadotropin-releasing hormone III (GnRH-III) in the suppression of growth of MDA-MB-231 and MCF-7 breast cancer cells surpasses that of GnRH and other analogs thereof, analogs of GnRH-III were synthesized to investigate the structural basis for the improved antitumor activity. Compounds synthesized include analogs with changes in the central sequence in which GnRH-III differs from GnRH and in the C- and N-terminal regions. The results indicate that a salt bridge between Asp6 and Lys8 stabilizes the active conformation of GnRH-III and show the importance of the Trp7. Replacement of the C-terminal Gly-NH2 with D-Ala-NH2 was not well tolerated, but replacement with ethylamide was. Replacement of pGlu1 with Ac-D-Trp appears to have a significantly deleterious effect on a unique conformation of GnRH-III which is responsible for its binding to the receptors on cancer cell lines and the resultant antitumor activity.