Lavas or ignimbrites? Permian felsic volcanic rocks of the Tisza Mega-unit (SE Hungary) revisited: A petrographic study

Permian felsic volcanic rocks were encountered in petroleum exploration boreholes in SE Hungary (eastern Pannonian Basin, Tisza Mega-unit, Békés-Codru Unit) during the second half of the 20th century. They were considered to be predominantly lavas (the so-called "Battonya quartz-porphyry") and were genetically connected to the underlying "Battonya granite." New petrographic observations, however, showed that the presumed lavas are crystal-poor (8-20 vol%) rhyolitic ignimbrites near Battonya and resedimented pyroclastic or volcanogenic sedimentary rocks in the Tótkomlós and the Biharugra areas, respectively. The studied ignimbrites are usually massive, matrix-supported, fiamme-bearing lapilli tuffs with eutaxitic texture as a result of welding processes. Some samples lack vitroclastic matrix and show low crystal breakage, but consist of oriented, devitrified fiammes as well. Textural features suggest that the latter are high-grade rheomorphic ignimbrites.Felsic volcanic rocks in SE Hungary belong to the Permian volcanic system of the Tisza Mega-unit; however, they show remarkable petrographic differences as compared to the other Permian felsic volcanic rocks of the mega-unit. In contrast to the crystal-poor rhyolitic ignimbrites of SE Hungary with rare biotite, the predominantly rhyodacitic-dacitic pyroclastic rocks of the Tisza Mega-unit are crystal-rich (40-45 vol%) and often contain biotite, pyroxene, and garnet. Additionally, some geochemical and geochronological differences between them were also observed by previous studies. Therefore, the Permian felsic volcanic rocks in SE Hungary might represent the most evolved, crystal-poor rhyolitic melt of a large-volume felsic (rhyodacitic-dacitic) volcanic system.The Permian volcanic rocks of the studied area do not show any evident correlations with either the Permian felsic ignimbrites in the Finiş Nappe (Apuseni Mts, Romania), as was supposed so far, or the similar rocks in any nappe of the Codru Nappe System. Moreover, no relevant plutonic-volcanic connection was found between the studied samples and the underlying "Battonya granite."

The Role of Surgery in the Management of Gestational Trophoblastic Neoplasia The Hungarian Experience

OBJECTIVE

To review the role of surgery in the management of gestational trophoblastic neoplasia (GTN) over the past 38 years in our national trophoblastic disease center.

STUDY DESIGN

Between January 1, 1977, and December 31, 2014, 371 patients with low-risk GTN and 190 patients with high-risk GTN were treated with chemotherapy, surgical interventions, or both. The indications for hysterectomy included excision of large uterine tumor masses, uterine hemorrhage or sepsis, or a drug-resistant uterine focus. Metastases were excised due to the presence of drug-resistant foci or complications of disease such as hemorrhage.

RESULTS

Over the period of 1977-2014 74 hysterectomies, 15 resections of vaginal metastases, 3 omentectomies, 13 adnexectomies, 9 lung resections, I nephrectomy, 1 lung resection and nephrectomy, and 2 craniotomies were performed among our patients. While hysterectomy was performed in 51 (26.8%) of 190 high-risk patients, hysterectomy was performed in only 23 (6.2%) of 371 low-risk patients (p < 0.01). From 1977-2006 metastases were resected in 18.3% (26/142) and from 2007-2014 in 16.7% (8/48) of high-risk patients.

CONCLUSION

In our center surgery, particularly in the form of hysterectomy, still plays a valuable role in the management of both low- and high-risk GTN.

Comparison of the efficiency of Na+/Ca2+ exchanger or Na+/H+ exchanger inhibition and their combination in reducing coronary reperfusion-induced arrhythmias

During ischaemia/reperfusion, the rise in [Na(+)](i), induced by simultaneous depression of the Na(+)/K(+)-ATPase and activation of the Na(+)/H(+) exchanger (NHE), shifts the Na(+)/Ca(2+) exchanger (NCX) into reverse transport mode, resulting in Ca(2+)(i)overload, which is a critical factor in enhancing the liability to cardiac arrhythmias. The inhibition of NHE, and recently NCX has been suggested to effectively protect the heart from reperfusion-induced arrhythmias. In this study, we investigated and compared the efficacy of individual or the simultaneous inhibition of the NHE and NCX against reperfusion-induced arrhythmias in Langendorff-perfused rat hearts by applying a commonly used regional ischaemia-reperfusion protocol. The NHE and NCX were inhibited by cariporide and SEA0400 or the novel, more selective ORM-10103, respectively. Arrhythmia diagrams calculated for the reperfusion period were analysed for the incidence and duration of extrasystoles (ESs), ventricular tachycardia (VT) and ventricular fibrillation (VF). NHE inhibition by cariporide was highly efficient in reducing the recorded reperfusion-induced arrhythmias. Following the application of SEA0400 or ORM-10103, the number and duration of arrhythmic periods were efficiently or moderately decreased. While both NCX inhibitors effectively reduced ESs, the most frequently triggered arrhythmias, they exerted limited or no effect on VTs and VFs. Of the NCX inhibitors, ORM-10103 was more effective. Surprisingly, the simultaneous inhibition of the NCX and NHE failed to significantly improve the antiarrhythmic efficacy reached by NCX blockade alone. In conclusion, although principal simultaneous NHE+NCX inhibition should be highly effective against all types of the recorded reperfusion-induced arrhythmias, NCX inhibitors, alone or in combination with cariporide, seem to be moderately suitable to provide satisfactory cardioprotection - at least in the present arrhythmia model. Since ORM-10103 and SEA0400 are known to effectively inhibit after-depolarisations, it is suggested that their efficacy and that of other NCX inhibitors may be higher and more pronounced in the predominantly Ca(2+)(i)-dependent triggered arrhythmias.

Changes in the management of high-risk gestational trophoblastic neoplasia in the National Trophoblastic Disease Center of Hungary

OBJECTIVE

To compare the clinical management of patients with high-risk gestational trophoblastic neoplasia (GTN) among the periods of 1977-1990, 1991-2000, and 2001-2012 at the National Trophoblastic Disease Center of Hungary and to assess the efficacy of the FIGO 2000 staging and risk factor scoring system in comparison to the original WHO prognostic scoring system (1983).

STUDY DESIGN

We reviewed the medical records of 185 patients with high-risk GTN. From 1977-2000, patients were classified according to the original WHO prognostic scoring system (1983). From 2001-2012, high-risk patients were categorized by the FIGO 2000 system. We assessed the efficacy of MAC and EMA-CO primary combination chemotherapies. For 1977-2006 and 2007-2012 we assessed the efficacy of MAC and EMA-CO primary combination chemotherapies.

RESULTS

From 1977-1990, 63 high-risk patients (average, 4-5 patients/year), from 1991-2000, 50 high-risk patients (average, 5 patients/year), and from 2001-2012, 72 high-risk patients (average, 6 patients/year) were treated primarily with combination chemotherapy (MAC and/or EMA-CO and/or CEB). From 1977-2006, 100 high-risk patients received MAC primary combination chemotherapy and 17 cases received EMA-CO. The ratio of primary MAC primarily with and EMA-CO therapy among our high-risk patients was 5.9 (100/17) over the referred period. From 2007-2012, 21 high-risk patients were treated with primary MAC chemotherapy and 16 patients received EMA-CO. The MAC/EMA-CO ratio over this time interval was 1.3 (21/16).

CONCLUSION

We attained complete remission in 95.7% of the high-risk patients. During the last 6 years the use of EMA-CO primary combination chemotherapy increased among our high-risk patients, which has resulted in increased efficacy and fewer side effects.

Clinical epidemiology and management of gestational trophoblastic neoplasia in Hungary in the past 34 years

OBJECTIVE

To review our clinical experience in the treatment of patients with gestational trophoblastic neoplasia (GTN) over the past 34 years in our national trophoblastic disease center.

STUDY DESIGN

Between January 1, 1977, and December 31, 2010, 331 patients with low-risk GTN and 174 patients with high-risk GTN (altogether 505) were treated. The patients were directed to the national trophoblastic disease center from all parts of Hungary. The patients were between 14 and 54 years of age, with an average age of 28.7 years. Primary chemotherapy was selected based upon the patient's stage and prognostic score of GTN.

RESULTS

Among 237 low-risk patients, 228 (96.2%) achieved remission as a result of primary methotrexate (MTX) therapy. Out of 94 low-risk patients 90 (95.7%) achieved remission as a result of primary actinomycin-D (Act-D) therapy. MTX, Act-D and cyclophosphamide (MAC) as a primary therapy was used in 118 high-risk cases, and 110 (93.2%) patients achieved complete remission. A total of 32 high-risk patients were treated with the etoposide, high-dose MTX/folinic acid, Act-D, cyclophosphamide and vincristine (EMA-CO) regimen, and of 26 primary therapies complete remission was achieved in 21 (80.8%) cases. Primary cisplatin, etoposide and bleomycin (CEB) therapy was successful in 16 of 17 high-risk cases (94.1%). Metastases were found in 47.3% (239/505) of the patients. Hysterectomy was performed in 68 of 505 (13.5%) cases. Chemotherapy, surgical intervention or other supplementary treatments resulted in 100% remission in cases of nonmetastatic and metastatic low-risk disease. Comparison of mean prognostic scores resulted in significant differences between CEB and MAC, CEB and EMA-CO, and MAC and EMA-CO.

CONCLUSION

Our data indicate that MTX/folinic acid or Act-D should be the primary treatment in patients with nonmetastatic or metastatic low-risk GTN. Patients with high-risk metastatic GTN should be treated primarily with combination chemotherapy. Our data support the effectiveness of MAC, EMA-CO and CEB regimens. Results also show that patient care under the direction of experienced clinicians serves to optimize the opportunity for cure and minimize morbidity.

30 years' experience in the treatment of low-risk gestational trophoblastic neoplasia in Hungary

OBJECTIVE

To review the clinical experience in the treatment of patients with low-risk gestational trophoblastic neoplasia (GTN) over the past 30 years in a national trophoblastic disease center.

STUDY DESIGN

Between January 1, 1977, and December 31, 2007, 302 patients with low-risk GTN were treated. The patients were directed to our institution from all parts of Hungary. The patients were 14 to 53 years of age with an average age of 28.3 years. Methotrexate (MTX)/folinic acid or actinomycin-D (Act-D) primary chemotherapy was selected based upon the patient's stage and prognostic score of GTN.

RESULTS

Among 218 low-risk patients, 210 (96.3%) achieved remission as a result of MTX therapy. In 8 patients (3.7%), MTX-Act-D-cyclophosphamide (MAC) combination chemotherapy was needed to achieve complete remission, in some cases assisted by operation. Among 84 patients, 81 (96.4%) achieved remission as a result of Act-D therapy. In 3 cases (3.6%) complete remission was achieved by MAC combination chemotherapy. We detected metastases in 22.8% (69/302) of our low-risk patients. Chemotherapy, surgical intervention or other supplementary treatments resulted in 100% remission in cases of low-risk nonmetastatic and metastatic disease.

CONCLUSION

Our data indicate that MTX/folinic acid or Act-D should be the primary treatment in patients with nonmetastatic or metastatic low-risk GTN. Importantly, patients with resistance to single-agent chemotherapy regularly achieve complete remission with MAC combination chemotherapy. Results show that patient care under the direction of experienced clinicians serves to optimize the opportunity for cure and minimize morbidity.

Diagnosis and treatment of high-risk metastatic gestational trophoblastic neoplasia in Hungary

OBJECTIVE

To review results in treatment of high-risk metastatic gestational trophoblastic neoplasia (GTN) in Hungary.

STUDY DESIGN

Between January 1, 1977, and December 31, 2006, 142 patients with high-risk metastatic GTN were treated. Patients were 14-51 years of age (average 27.9). We selected primary chemotherapy based on patient GTN stage and prognostic score.

RESULTS

Methotrexate, actinomycin-D and cyclophosphamide (MAC) as a primary therapy was used in 100 cases and as second-line chemotherapy in 6 cases. Of the 100 cases, 95 achieved complete remission. Twenty-one high-risk patients were treated with etoposide, high-dose methotrexate with folinic acid rescue, actinomycin-D, cyclophosphamide and vincristine (EMA-CO). Of 17 primary therapies, 13 patients achieved complete remission. Primary cisplatin, etoposide and bleomycin (CEB) was successful in 12 of 14 high-risk cases. Hysterectomy was performed in 42 of 142 high-risk patients; metastases were resected in 26 of 142 of high-risk patients. Comparison of mean prognostic scores resulted in significant differences between CEB and MAC, CEB and EMA-CO and MAC and EMA-CO.

CONCLUSION

Results support that patients with high-risk metastatic GTN should primarily be treated with combination chemotherapy. Our data support the effectiveness of MAC, EMA-CO and CEB regimens.

25 years' experience in the treatment of gestational trophoblastic neoplasia in Hungary

OBJECTIVE

To review our clinical experience in the treatment of gestational trophoblastic neoplasia (GTN) over the past 25 years in our national trophoblastic disease center.

STUDY DESIGN

Between January 1, 1977, and December 31, 2001, we treated 355 patients with GTN. The patients were between 14 and 53 years of age, with an average of 28.3. Primary chemotherapy was selected based on the patient's stage of gestational trophoblastic tumor (GTT) and prognostic score.

RESULTS

We found metastases in 49.3% (175 of 355) of our patients. Of 173 patients, 162 (93.2%) achieved remission as a result of methotrexate therapy. In 11 patients (6.8%) complete remission was achieved by combination chemotherapy, in some cases assisted by operation. Of 68 patients, 63 (92.6%) achieved remission as a result of actinomycin D therapy, and 5 (7.4%) achieved complete remission by combination chemotherapy. Chemotherapy, surgical intervention or other supplementary treatments resulted in 100% successful therapy in cases of nonmetastatic and low-risk metastatic disease.

CONCLUSION

According to our experience, methotrexate/folinic acid or actinomycin D should be the primary treatment in patients with nonmetastatic or low-risk metastatic GTN. Patients with resistance to single-agent chemotherapy regularly achieve remission with combination chemotherapy.

DOC-2/hDab2, a candidate tumor suppressor gene involved in the development of gestational trophoblastic diseases

Gestational trophoblastic diseases comprise a spectrum of interrelated diseases including partial mole, complete mole and gestational choriocarcinoma. Using reverse transcriptase PCR (RT-PCR) analysis, we identified higher levels of DOC-2/hDab2 expression in the normal trophoblast cells in culture than in choriocarcinoma cell lines. Subsequent study using immunohistochemistry showed high levels of DOC-2/hDab2 protein expression in normal trophoblast tissues but significantly lower levels of expression in gestational trophoblastic disease tissues, particularly in complete mole and choriocarcinoma. When DOC-2/hDab2 was transfected into the choriocarcinoma cell lines, Jar, JEG and BeWo, the stable transfectants showed significantly reduced growth rate in culture. These data suggest that down regulation of DOC-2/hDab2 may play an important role in the development of gestational trophoblastic diseases.

[Detection of gamma-interferon mRNA in JEG-3 choriocarcinoma cell line by means of polymerase chain reaction]

To investigate the pathogenesis of choriocarcinoma the authors employed a newly developed gene amplification method by reverse polymerase chain reaction for the detection of gamma-interferon messenger RNA in JEG-3 choriocarcinoma cell line. Polymerase chain reaction products were analysed by agarose gel electrophoresis. Using 1 Kb DNA ladder as a marker, 84 base-pair fragment was selectively amplified correlating with published gamma-interferon gene fragment length. Because cDNA contains a virtually complete copy of the mRNA this method provides an evidence for the expression of gamma-interferon gene in JEG-3 choriocarcinoma cell line. Based on these results a potential autocrine mechanism may be present in JEG-3 choriocarcinoma cell line.

[The effect of breach presentation on the development of the hips]

Authors examined, using sonographic methods in 100 children with breech-presentation, which of the intrauterine postures means a major danger in the development of hip dysplasia. It was found that acetabular alterations, requiring therapy or not, develop more frequently in groups in which the hips were in total flexion, the knees in semiflexion and the lower extremities in major external rotation. Based on their results they state that not the simple breech position is the greatest danger in the development of dysplasia and dislocation in babies born with breech presentation.

[Results of sonographic hip examination of infants in a risk group]

During sonographic examination of 770 newborns and infants the diagnostic value and the possibility of valuation of singular risk factors were investigated. According our data an acetabular dysplasia, requiring treatment can be found most frequently in the background of a limitation of abduction motion. Pathologic alterations may be found less frequently in groups with familiar anamnesis and with breech presentation. It could be stated that the aspecific click is a clinical symptom of significance and cannot be neglected whereas we could not prove connections between asymmetry of the folds and the sonographic data. Our results prove that the anamnesis and the clinical symptoms alone do not make a perfect recognition of the dysplasia possible; in consequence it is suggested that sonography should be used as a screening.

Effect of choriocarcinoma supernatant on natural killer and lymphokine-activated killer cell activity

The effect of JEG-3 choriocarcinoma supernatant on human natural killer cell and lymphokine-activated killer cell activity was investigated. Choriocarcinoma supernatants from JEG-3 cell lines were obtained at the time of their optimal growth. K562 erythroblastoid cells were used as target cells for natural killer and lymphokine-activated killer cell mediated lysis in a 51Cr release assay. The choriocarcinoma supernatants had a significant dose-dependent suppressive effect on natural killer and lymphokine-activated killer cell activity. This suppression was more expressed at high effector: target cell ratios. Therefore, choriocarcinoma supernatants appear to have potent inhibitory effects on many aspects of cellular immunity, although, additional studies should be performed to further characterize and identify immunoregulatory molecule(s) in choriocarcinoma supernatants.

Tetraploidy in human placenta. A dilemma in molar and non-molar pregnancies

17 cases of partial molar pregnancy were analysed cytogenetically by the direct-preparation method. Eight partial moles were triploid, 7 diploid/tetraploid mosaic, and 2 tetraploid. In the course of prenatal cytogenetic screening, out of 1,263 chorionic villus samplings, 2 tetraploid and 1 diploid/tetraploid cases were found. These cases of partial moles do not fit into the usual patterns of triploid partial moles. The findings presented here suggest that different causative factors may be involved in the origin of molar degenerations. These results also call to attention that tetraploidy is an existent and relatively common abnormality.

Direct chromosomal preparation for studying hydatidiform moles

This report describes a simple direct method to obtain chromosomes from hydatidiform moles. Of 24 moles, 20 have been successfully karyotyped by this method. Of the 20 cases, 14 were complete and six were partial. The karyotype of complete moles was invariably diploid. Three of the partial moles were triploid (69,XXX), but three showed diploid/tetraploid mosaicism.

Synovial chondromatosis of the metacarpophalangeal joint

The authors present a case of synovial chondromatosis localized on the left hand of a woman and discuss the pathogenesis, history and treatment of the synovial chondromatosis. The patient has been free of complaints for the 2 years since the operation.