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Farkas A, Andrási K, Szűcs E, Rárosi F, Kecskés L, Furák J. [Comparison of non-intubated, spontaneously breathing and intubated, mechanically ventilated videothoracoscopic lobectomy]. Orv Hetil 2024; 165:393-399. [PMID: 38461441 DOI: 10.1556/650.2024.33008] [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] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/20/2024] [Indexed: 03/12/2024]
Abstract
Bevezetés: A minimálinvazív műtéti technika a
mellkassebészetben, a tüdődaganatok ellátása kapcsán előtérbe került az elmúlt
évtizedekben, melynek egyik kiemelkedő részét alkotják a spontán légzés mellett
elvégzett mellkassebészeti műtétek. Célkitűzés: Jelen
közleményünkben a nem intubált és nem relaxált videoasszisztált torakoszkópos
(I. csoport) és az intubált és relaxált videoasszisztált torakoszkópos (II.
csoport) tüdőlebeny-eltávolítások eredményeit hasonlítottuk össze.
Módszer: Az I. csoportban 118, míg a II. csoportban 211,
uniportalis tüdőlebeny-eltávolításon átesett beteg adatait hasonlítottuk össze,
majd propensit score elemzéssel kiválasztott 70-70 betegnél végeztük el
hasonlóan a statisztikai elemzést. Eredmények: A teljes
betegcsoportot tekintve a műtéti idő 91,6 és 91,1 perc (p = 0,857), az átlagos
dréneltávolítás 3,43 és 4,62 nap (p<0,001), az elhúzódó légáteresztés 12,8%
és 20,8% (p = 0,07), a redrenázs 7,7% és 6,16% (p = 0,624), a reoperáció 2,5% és
5,2% (p = 0,393), a morbiditás 18,8% és 27,9% (p = 0,065) volt az I. és a II.
csoportban külön-külön. 30 napos mortalitás csak a II. csoportban fordult elő.
’Propensity score’ értékelés után az átlagos műtéti idő 92,08 és 95,25 perc (p =
0,442), az átlagos dréneltávolítás 3,01 és 4,57 nap (p <0,01), az elhúzódó
légáteresztés 11,4% és 20% (p = 0,164), a redrenázs 5,7% és 7,14% (p = 0,730), a
reoperáció 2,8% és 5,6% (p = 0,681), a morbiditás 15,7% és 27,1% (p = 0,099)
volt az I. és a II. csoportban külön-külön. 30 napos mortalitás egyik csoportban
sem fordult elő. Következtetés: A nem intubált, nem relaxált
uniportalis videoasszisztált torakoszkópos tüdőlebeny-eltávolítás
általánosságban kedvezőbb eredményeket mutatott az intubált, relaxált
uniportalis videoasszisztált torakoszkópos tüdőlebeny-eltávolítással szemben. A
műtét után hamarabb került sor a mellkasi drén eltávolítására, és a szövődmények
aránya is kisebb volt. Orv Hetil. 2024; 165(10): 393–399.
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Affiliation(s)
- Attila Farkas
- 1 Vas Vármegyei Markusovszky Egyetemi Oktatókórház, Mellkassebészeti Osztály Szombathely, Markusovszky u. 5., 9700 Magyarország
| | - Katinka Andrási
- 1 Vas Vármegyei Markusovszky Egyetemi Oktatókórház, Mellkassebészeti Osztály Szombathely, Markusovszky u. 5., 9700 Magyarország
| | - Evelin Szűcs
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Klinika Szeged Magyarország
| | - Ferenc Rárosi
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Orvosi Fizikai és Orvosi Informatikai Intézet Szeged Magyarország
| | - László Kecskés
- 1 Vas Vármegyei Markusovszky Egyetemi Oktatókórház, Mellkassebészeti Osztály Szombathely, Markusovszky u. 5., 9700 Magyarország
| | - József Furák
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Klinika Szeged Magyarország
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2
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Farkas A, Csókási T, Fabó C, Szabó Z, Lantos J, Pécsy B, Lázár G, Rárosi F, Kecskés L, Furák J. Chronic postoperative pain after non-intubated uniportal VATS lobectomy. Front Surg 2023; 10:1282937. [PMID: 38026483 PMCID: PMC10679439 DOI: 10.3389/fsurg.2023.1282937] [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: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Patients undergoing thoracic surgery are at increased risk of developing, long-lasting pain. Beyond the non-surgical factors, the type of operation, including the number of incisions, and the anesthetic assessment seemed to be important factors, although some studies are controversial. The aim of our study was to examine the presence of chronic postoperative pain after non-intubated uniportal VATS lobectomy. We examined the difference between the intubated, relaxed and non-intubated spontaneous ventilation surgical approaches in patients who underwent video-assisted thoracoscopic (VATS) uniportal lobectomy. Methods Demographic and postoperative data were retrospectively collected and analyzed, focusing on the use of pain medications, in 67 patients of the 140 patients selected by propensity score matching who underwent intubated (iVATS) or non-intubated (NITS) uniportal VATS lobectomy. This study focused on the use of analgesic medications 3, 6, and 12 months after surgery. Results Thirty-five intubated and 32 non-intubated patients were compared. Although the analgesic consumption was nearly 2% higher among the iVATS patients during the follow-up period, there were no statistically significant differences at 3 months (15.6 vs. 17.1%) (p = 0.868), at 6 months (9.4 vs. 12.4%) (p = 0.785), and at 12 months (3.3 vs. 5.9%) (p = 0.633) between the NITS and iVATS groups, respectively. More female than male patients reported chronic pain, but the difference was not statistically significant (p = 0.616). Diabetes mellitus was a statistically significant cofactor associated with chronic pain (p = 0.03), while cardiac disease (p = 0.6), perioperative morbidity (p = 0.228), prolonged air leak (p = 0.057), and repeat drainage (p = 0.626) were not. Conclusion Our study suggests that after non-intubation VATS lobectomies, the postoperative pain was less at 3, 6, and 12 months in NITS patients compared to iVATS patients. The 2% difference was not significant, so it may not be appropriate to claim the advantages of NITS in terms of postoperative pain.
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Affiliation(s)
- Attila Farkas
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Tímea Csókási
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Csongor Fabó
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Pécsy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ferenc Rárosi
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - László Kecskés
- Department of Thoracic Surgery, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
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Neuperger P, Szalontai K, Gémes N, Balog JÁ, Tiszlavicz L, Furák J, Lázár G, Puskás LG, Szebeni GJ. Single-cell mass cytometric analysis of peripheral immunity and multiplex plasma marker profiling of non-small cell lung cancer patients receiving PD-1 targeting immune checkpoint inhibitors in comparison with platinum-based chemotherapy. Front Immunol 2023; 14:1243233. [PMID: 37901220 PMCID: PMC10611454 DOI: 10.3389/fimmu.2023.1243233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction The effect of platinum-based chemotherapy (Chem.) and second- or multiple- line immune checkpoint PD-1 blocking therapy by Nivolumab or Pembrolizumab (ICI) was assayed in the peripheral blood of non-small cell lung cancer (NSCLC) patients. Methods Flow cytometry was used to detect NSCLC-related antigen binding IgG antibodies. The Luminex MagPix multiplex bead-based cytokine/chemokine detecting system was used to quantitatively measure 17 soluble markers in the plasma samples. Single-cell mass cytometry was applied for the immunophenotyping of peripheral leukocytes. Results The incubation of patient derived plasma with human NSCLC tumor cell lines, such as A549, H1975, and H1650, detected NSCLC-specific antibodies reaching a maximum of up to 32% reactive IgG-positive NSCLC cells. The following markers were detected in significantly higher concentration in the plasma of Chem. group versus healthy non-smoker and smoker controls: BTLA, CD27, CD28, CD40, CD80, CD86, GITRL, ICOS, LAG-3, PD-1, PD-L1, and TLR-2. The following markers were detected in significantly higher concentration in the plasma of ICI group versus healthy non-smoker and smoker controls: CD27, CD28, CD40, GITRL, LAG-3, PD-1, PD-L1, and TLR-2. We showed the induction of CD69 and IL-2R on CD4+ CD25+ T-cells upon chemotherapy; the exhaustion of one CD8+ T-cell population was detected by the loss of CD127 and a decrease in CD27. CD19+CD20+, CD79B+, or activated B-cell subtypes showed CD69 increase and downregulation of BTLA, CD27, and IL-2R in NSCLC patients following chemotherapy or ICI. Discussion Peripheral immunophenotype caused by chemotherapy or PD-1 blocking was shown in the context of advanced NSCLC.
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Affiliation(s)
- Patrícia Neuperger
- Laboratory of Functional Genomics, HUN-REN Biological Research Centre, Szeged, Hungary
- PhD School in Biology, University of Szeged, Szeged, Hungary
| | | | - Nikolett Gémes
- Laboratory of Functional Genomics, HUN-REN Biological Research Centre, Szeged, Hungary
- PhD School in Biology, University of Szeged, Szeged, Hungary
| | - József Á. Balog
- Laboratory of Functional Genomics, HUN-REN Biological Research Centre, Szeged, Hungary
| | | | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László G. Puskás
- Laboratory of Functional Genomics, HUN-REN Biological Research Centre, Szeged, Hungary
- Avicor Ltd., Szeged, Hungary
| | - Gábor J. Szebeni
- Laboratory of Functional Genomics, HUN-REN Biological Research Centre, Szeged, Hungary
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
- CS-Smartlab Devices Ltd., Kozármisleny, Hungary
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Farkas A, Tolvaj B, Andrási K, Kecskés L, Furák J. [Left pneumonectomy for intrapulmonary unicentric Castleman disease]. Orv Hetil 2023; 164:1476-1483. [PMID: 37717235 DOI: 10.1556/650.2023.32860] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 09/19/2023]
Abstract
Castleman disease is an uncommon lymphoproliferative disorder, located most commonly in the mediastinal lymph nodes. The intrapulmonary presentation is extremely rare, with 14 published cases in the English literature. The clinical presentation of the disorder is not specific and the diagnosis is often challenging. The main goal is to achieve an R0 surgical resection which gives the potential chance for a recurrence-free survival. We present the case of a symptomless, 15-year-old female patient with left-sided tumor mass. Transthoracal invasive tissue biopsy confirmed Castleman disease. The central mass involved the main structures in the left hilus and therefore left pulmonectomy was necessary to reach the complete, tumor-free resection margins. The patient had no local or distant relapse during the 7-year follow-up. Although Castleman disease treated by complete surgical resection provides excellent results, radical and extended lung resection is sometimes inevitable to reach tumor-free margins. Orv Hetil. 2023; 164(37): 1476-1483.
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Affiliation(s)
- Attila Farkas
- 1 Markusovszky Egyetemi Oktatókórház, Mellkassebészeti Osztály Szombathely, Markusovszky u. 5.; 9700 Magyarország
| | - Balázs Tolvaj
- 2 Markusovszky Egyetemi Oktatókórház, Patológiai Osztály Szombathely Magyarország
| | - Katinka Andrási
- 1 Markusovszky Egyetemi Oktatókórház, Mellkassebészeti Osztály Szombathely, Markusovszky u. 5.; 9700 Magyarország
| | - László Kecskés
- 1 Markusovszky Egyetemi Oktatókórház, Mellkassebészeti Osztály Szombathely, Markusovszky u. 5.; 9700 Magyarország
| | - József Furák
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Klinika Szeged Magyarország
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5
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Zombori-Tóth N, Hegedűs F, Almási S, Sejben A, Tiszlavicz L, Furák J, Cserni G, Zombori T. Proposal of a grading system for squamous cell carcinoma of the lung - the prognostic importance of tumour budding, single cell invasion, and nuclear diameter. Virchows Arch 2023; 483:393-404. [PMID: 37555982 PMCID: PMC10542270 DOI: 10.1007/s00428-023-03612-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/16/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
The prognostic markers of lung squamous cell carcinoma (LSCC) are less investigated. The aim of our study was to evaluate tumour budding (TB), minimal cell nest size, nuclear diameter (ND), and spread through air spaces (STAS) among patients with resected LSCC, semi-quantitatively. Furthermore, we aimed to identify a grading system for the best prognostic stratification of LSCC. Patients who underwent surgical resection at the Department of Surgery, University of Szeged between 2010 and 2016 were included. Follow-up data were collected from medical charts. Morphological characteristics were recorded from histologic revision of slides. Kaplan-Meier analysis, log rank test and Cox proportional-hazards model, ROC curve analysis, and intraclass correlation were utilised. Altogether 220 patients were included. In univariate analysis, higher degree of TB, infiltrative tumour border, larger ND, the presence of single cell invasion (SCI) and STAS were associated with adverse prognosis. Based on our results, we proposed an easily applicable grading scheme focusing on TB, ND, and SCI. In multivariate analysis, the proposed grading system (pOS < 0.001, pRFS < 0.001) and STAS (pOS = 0.008, pRFS < 0.001) were independent prognosticators. Compared to the previously introduced grading systems, ROC curve analysis revealed that the proposed grade had the highest AUC values (AUCOS: 0.83, AUCRFS: 0.78). Each category of the proposed grading system has good (ICC: 0.79-0.88) reproducibility. We validated the prognostic impact of TB, SCI, ND, and STAS in LSCC. We recommend a reproducible grading system combining TB, SCI, and ND for proper prognostic stratification of LSCC patients. Further research is required for validation of this grading scheme.
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Affiliation(s)
| | - Fanni Hegedűs
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Szintia Almási
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - József Furák
- Department of Surgery, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tamás Zombori
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary.
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Hegedűs F, Sükösd F, Tiszlavicz L, Furák J, Pálföldi R, Fejes Z, Zombori T. [Alectinib and mixed large cell neuroendocrine carcinoma of the lung.]. Orv Hetil 2023; 164:548-554. [PMID: 37031440 DOI: 10.1556/650.2023.32738] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/23/2023] [Indexed: 04/10/2023]
Abstract
The treatment of mixed large cell neuroendocrine carcinoma is less studied due to its low incidence. However, the presence of anaplastic lymphoma kinase (ALK) fusion gene is rare in such tumours, ALK inhibitors may represent a promising therapeutic option instead of cytostatic therapy. Routine chest X-ray and then computed tomography (CT) examination revealed a pulmonary tumour in a 52-year-old asymptomatic woman. The neoplasm was removed by lobectomy. Histological examination confirmed papillary predominant lung adenocarcinoma. The patient was treated with postoperative chemotherapy and irradiation. 3 years later, neurologic symptoms were observed, therefore, brain CT was performed. The evaluation confirmed brain metastases which were removed. Histological examination identified metastasis of large cell neuroendocrine carcinoma. Revision and molecular examination of the metastasis and lung specimen revealed pulmonary mixed large cell neuroendocrine carcinoma with ALK-rearrangement. Alectinib (Alecensa) treatment was initiated resulting in regression of the previously observed liver metastases. Progression has not occurred in the last 3 years since the start of treatment. Detection of ALK fusion genes and research of ALK inhibitor therapy focus primarily on lung adenocarcinomas. Our case report would like to draw attention to the evaluation of driver mutations in pulmonary mixed neuroendocrine carcinoma with adenocarcinoma component because targeted treatment may be an effective alternative. Orv Hetil. 2023; 164(14): 548-554.
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Affiliation(s)
- Fanni Hegedűs
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged, Állomás utca 2., 6725 Magyarország
| | - Farkas Sükösd
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged, Állomás utca 2., 6725 Magyarország
| | - László Tiszlavicz
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged, Állomás utca 2., 6725 Magyarország
| | - József Furák
- 2 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika Szeged Magyarország
| | - Regina Pálföldi
- 3 Csongrád-Csanád Megyei Mellkasi Betegségek Szakkórháza Deszk Magyarország
| | - Zsuzsanna Fejes
- 4 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Radiológiai Klinika Szeged Magyarország
| | - Tamás Zombori
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Pathologiai Intézet Szeged, Állomás utca 2., 6725 Magyarország
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7
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Sejben A, Pancsa T, Tiszlavicz L, Furák J, Paróczai D, Zombori T. Highlighting the immunohistochemical differences of malignant mesothelioma subtypes via case presentations. Thorac Cancer 2023; 14:857-863. [PMID: 36808895 PMCID: PMC10067356 DOI: 10.1111/1759-7714.14827] [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: 12/06/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/22/2023] Open
Abstract
Malignant mesothelioma (MM) is a rare tumor of mesothelial cells, with an increasing incidence both in developed and developing countries. MM has three major histological subtypes, in order of frequency, according to the World Health Organization (WHO) Classification of 2021: epithelioid, biphasic, and sarcomatoid MM. Distinction may be a challenging task for the pathologist, due to the unspecific morphology. Here, we present two cases of diffuse MM subtypes to emphasize the immunohistochemical (IHC) differences, and to facilitate diagnostic difficulties. In our first case of epithelioid mesothelioma, the neoplastic cells showed cytokeratin 5/6 (CK5/6), calretinin, and Wilms-tumor-1 (WT1) expression, while remaining negative with thyroid transcription factor-1 (TTF-1). BRCA1 associated protein-1 (BAP1) negativity was seen in the neoplastic cells' nucleus, reflecting loss of the tumor suppressor gene. In the second case of biphasic mesothelioma, expression of epithelial membrane antigen (EMA), CKAE1/AE3, and mesothelin was observed, while WT1, BerEP4, CD141, TTF1, p63, CD31, calretinin, and BAP1 expressions were not detected. Due to the absence of specific histological features, the differentiation between MM subtypes could be a challenging task. In routine diagnostic work, IHC may be the proper method in distinction. According to our results and literature data, CK5/6, mesothelin, calretinin, and Ki-67 should be applied in subclassification.
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Affiliation(s)
- Anita Sejben
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Tamás Pancsa
- Department of Pathology, University of Szeged, Szeged, Hungary
| | | | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Pulmonology, University of Szeged, Deszk, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
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8
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Lantos J, Furák J, Zombori-Tóth N, Zombori T, Bihari K, Varga E, Hartmann P. [Changes of the T cell composition in the thymus during the COVID-19 pandemic]. Orv Hetil 2022; 163:2062-2066. [PMID: 36566438 DOI: 10.1556/650.2022.32664] [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: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION In our study, we aimed to investigate whether the COVID-19 infection itself or the vaccination against it affect the differentiation of T cells in the thymus, and whether the reduction in T cell counts observed in the blood of COVID-19-infected individuals is also observed at the tissue level in the thymus. METHOD Data from a total of 55 thymectomy patients were processed to create three groups: 1) the pre-COVID-19 (PC) group included 22 patients, 12 women and 10 men, who underwent thymectomy between 2008 and 2013; 2) in the no-COVID-19 (NC) group (patients without verified infection or vaccination), 20 patients, 11 women and 9 men, underwent thymectomy in 2020-2021; 3) the vaccinated or infected COVID-19 (VIC) group included 13 patients, 4 women and 9 men, who underwent thymectomy also in 2020-2021. The pathological samples were immunohistochemically tested for CD4, CD8, CD25 and FOXP3 to verify the helper, cytotoxic and regulatory T cells. RESULTS The VIC group had significantly lower values for CD4, compared to the PC and NC groups. The FOXP3 value was significantly lower in the VIC and NC groups compared to the PC group. No significant differences were found for CD8 and CD25 between the groups studied. DISCUSSION The COVID-19 infection or vaccination affects the T cell composition of the thymus. Decreased expression of CD4 has been demonstrated in the VIC group, which confirms a decrease in the T cell counts that also occurs in the thymus. The low FOXP3 levels observed in the NC group during the COVID-19 era, compared to the PC group, may be indicative of a high rate of asymptomatic coronavirus infections and a worsening of immunetolerance. CONCLUSION First in the world, we have verified that the helper T cell composition of the thymus in COVID-19 infection era is reduced, and in the asymptomatic patients the immune function is decreased as well. Orv Hetil. 2022; 163(52): 2062-2066.
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Affiliation(s)
- Judit Lantos
- 1 Bács-Kiskun Megyei Kórház, Neurológiai és Stroke Osztály Kecskemét Magyarország
| | - József Furák
- 2 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar, Sebészeti Klinika Szeged Magyarország
| | - Noémi Zombori-Tóth
- 3 Csongrád-Csanád Megyei Mellkasi Betegségek Szakkórháza Deszk Magyarország
| | - Tamás Zombori
- 4 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar, Pathologiai Intézet Szeged Magyarország
| | - Katalin Bihari
- 1 Bács-Kiskun Megyei Kórház, Neurológiai és Stroke Osztály Kecskemét Magyarország
| | - Endre Varga
- 5 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar, Traumatológiai Klinika Szeged Magyarország
| | - Petra Hartmann
- 5 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar, Traumatológiai Klinika Szeged Magyarország
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9
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Gonzalez M, Chriqui LE, Décaluwé H, Aigner C, Rényi-Vámos F, Opitz I, Furák J, Szanto Z, Brunelli A, Falcoz PE. Sleeve lobectomy in non-small cell lung cancer patients: A report from the European Society of Thoracic Surgery database 2021. Eur J Cardiothorac Surg 2022; 62:6809125. [DOI: 10.1093/ejcts/ezac502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/10/2022] [Revised: 09/24/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
OBJECTIVES
For centrally located lung tumours, sleeve lobectomy is preferred over pneumectomy. We report on surgical practices and peri-operative outcomes of sleeve resections based on the European Society of Thoracic Surgeons database.
METHODS
We retrieved data of patients undergoing sleeve lobectomy or bilobectomy from 2007 to 2021. We evaluated baseline characteristics, surgical approach, neo-adjuvant treatments, morbidity and post-operative outcomes of open and video-assisted thoracic surgery (VATS) procedures.
RESULTS
In total, 1652 patients (median age: 63; f/m: 446/1206) underwent sleeve lobectomy (n = 1536) or bilobectomy (n = 116) by open thoracotomy (n = 1491; 90.2%) or VATS (n = 161; 9.8%) with thoracotomy conversion rate of 21.1% (n = 34). 398 (24.1%) received neo-adjuvant treatment. Overall morbidity and 30-day mortality were 40.6% and 2.2% respectively. Bronchial anastomotic complications occurred in 29 patients (1.8%) with conservative treatment in 6 cases (20.7%) and operative management in 23 (79.3%). On multivariable analysis, factors of elevated risk of cardiopulmonary complications were BMI < 20 (OR: 2.26; P < 0.001) and bilobectomy (OR : 2.28, p < 0.001). Age <60 (OR. 0.71, p = 0.013), female sex (OR: 0.54, p < 0.001) and VATS (0.64, p < 0.001) were associated with decreased risk. Neo-adjuvant treatment was not associated with increased risks of cardiopulmonary complications (OR: 1.05; p = 0.664). Compared to open thoracotomy, VATS was associated with significantly decreased overall morbidity (30.4% vs 41.7%, p = 0.006) and length of stay (median: 5 days vs 8 days; p < 0.001).
CONCLUSION
Sleeve lobectomies can be safely performed after neo-adjuvant treatment. VATS approach fosters shorter length of stay and decreased morbidity.
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Affiliation(s)
- Michel Gonzalez
- Lausanne University Hospital Department of Thoracic Surgery. , Lausanne, Switzerland
| | | | - Herbert Décaluwé
- University Hospitals Leuven Department of Thoracic Surgery, , Leuven, Belgium
| | - Clemens Aigner
- University Medicine Essen-Ruhrlandklinik Department of Thoracic Surgery, , Essen, Germany
| | - Ferenc Rényi-Vámos
- National Institute of Oncology Department of Thoracic Surgery, , Budapest, Hungary
| | - Isabelle Opitz
- University Hospital Zurich Department of Thoracic Surgery, , Zurich, Switzerland
| | - József Furák
- University of Szeged Department of Surgery, , Szeged, Hungary
| | - Zalan Szanto
- University of Pécs Department of Surgery Medical School, , Hungary
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10
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Zombori-Tóth N, Paróczai D, Lantos J, Almási S, Sejben A, Tiszlavicz L, Cserni G, Furák J, Zombori T. The More Extensive the Spread through Air Spaces, the Worse the Prognosis Is: Semi-Quantitative Evaluation of Spread through Air Spaces in Pulmonary Adenocarcinomas. Pathobiology 2022; 90:104-113. [PMID: 35947971 PMCID: PMC10129026 DOI: 10.1159/000525456] [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: 01/14/2022] [Accepted: 05/09/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The extent of spread through air spaces (STAS) is less investigated among patients with lung adenocarcinoma who underwent sublobar resection. Therefore, we aimed to evaluate the extent of STAS semi-quantitatively, to assess its prognostic impact on overall survival (OS) and recurrence-free survival (RFS), and to investigate the reproducibility of this assessment. METHODS The number of tumour cell clusters and single tumour cells within air spaces was recorded in three different most prominent areas (200x field of view). The extent of STAS was categorized into three groups, and the presence of free tumour cluster (FTC) was recorded. RESULTS Sixty-one patients were included. Recurrence was more frequent with higher grade (p = 0.003), presence of lymphovascular invasion (p = 0.027), and presence of STAS of any extent (p = 0.007). In multivariate analysis, presence of FTC (HR: 5.89; 95% CI: 1.63-21.26; p = 0.005) and more pronounced STAS (HR: 7.46; 95% CI: 1.60-34.6; p = 0.01) had adverse impact on OS and RFS, respectively. Concerning reproducibility, excellent agreement was found among STAS parameters (ICC range: 0.92-0.94). DISCUSSION More extensive STAS is an unfavourable prognostic factor in adenocarcinomas treated with sublobar resection. As the evaluation of extent of STAS is reproducible, further investigation is required to gather more evidence.
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Affiliation(s)
| | - Dóra Paróczai
- Csongrád-Csanád County Hospital of Chest Diseases, Deszk, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Szintia Almási
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary.,Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - József Furák
- Department of Surgery, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
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11
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Furák J, Tosi D. Editorial: Non-intubated thoracic surgery: From concepts to clinical reality. Front Surg 2022; 9:948373. [PMID: 35983559 PMCID: PMC9379319 DOI: 10.3389/fsurg.2022.948373] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- József Furák
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Correspondence József Furák
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
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12
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Géczi T, Simonka Z, Lantos J, Wetzel M, Szabó Z, Lázár G, Furák J. Near-infrared fluorescence guided surgery: State of the evidence from a health technology assessment perspective. Front Surg 2022; 9:919739. [PMID: 35959120 PMCID: PMC9360526 DOI: 10.3389/fsurg.2022.919739] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/13/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Different applications of near-infrared fluorescence-guided surgery are very promising, and techniques that help surgeons in intraoperative guidance have been developed, thereby bridging the gap between preoperative imaging and intraoperative visualization and palpation. Thus, these techniques are advantageous in terms of being faster, safer, less invasive, and cheaper. There are a few fluorescent dyes available, but the most commonly used dye is indocyanine green. It can be used in its natural form, but different nanocapsulated and targeted modifications are possible, making this dye more stable and specific. A new active tumor-targeting strategy is the conjugation of indocyanine green nanoparticles with antibodies, making this dye targeted and highly selective to various tumor proteins. In this mini-review, we discuss the application of near-infrared fluorescence-guided techniques in thoracic surgery. During lung surgery, it can help find small, non-palpable, or additional tumor nodules, it is also useful for finding the sentinel lymph node and identifying the proper intersegmental plane for segmentectomies. Furthermore, it can help visualize the thoracic duct, smaller bullae of the lung, phrenic nerve, or pleural nodules. We summarize current applications and provide a framework for future applications and development.
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Affiliation(s)
- Tibor Géczi
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Correspondence: Tibor Géczi
| | - Zsolt Simonka
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Melinda Wetzel
- Department of Anesthesiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Institute of Surgical Research, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - József Furák
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
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13
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Furák J, Barta Z, Lantos J, Németh T, Pécsy B, Buzás A, Vas M, Fabó C, Szabó Z, Rieth A, Lázár G. [Early postoperative results of sublobal lung resections performed with spontaneous ventilation combined with double lumen tube intubation. A new surgical method]. Magy Seb 2022; 75:117-120. [PMID: 35895541 DOI: 10.1556/1046.2022.20005] [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] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Introduction. Non-intubated spontaneous ventilated (NITS) minimally invasive surgery (video-assisted thoracic surgery VATS) is a widespread procedure, but there are some doubts regarding its safety. We developed a safe method, spontaneous ventilation with intubation (SVI) to resolve these concerns. In this study, the early postoperative results of the SVI sublobar resections are presented. Methods. Between 2020 May 25 and 2021 March 26, 20 SVI VATS sublobar resection was performed with a double lumen intratracheal tube. Results. Surgeries were performed for 9 females and 11 males with a mean age of 66.1. The mean BMI was 27.8, FEV1 was 89.1%, and Carlson Comorbidity score was 6.1. The mean surgical time was 61.5 min, drainage time was 1.85 days and hospital stay was 3.35 days. Morbidity was found to be 5%. Primer lung cancer was removed in 9 cases, we performed 6 metastasectomies and in 5 cases benign lesion was removed. Conclusion. According to the early postoperative results spontaneous ventilated VATS sublobar resections with double lumen intratracheal tube can be considered a safe thoracic surgical method.
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Affiliation(s)
- József Furák
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Zsanett Barta
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Judit Lantos
- 2 Bács-Kiskun Megyei Kórház, Neurológiai és Stroke Osztály, Kecskemét, Magyarország (osztályvezető: Prof. Dr. Bihari Katalin)
| | - Tibor Németh
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Balázs Pécsy
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - András Buzás
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Márton Vas
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Csongor Fabó
- 3 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Aneszteziológiai és Intenzív terápiás Intézet, Szeged, Magyarország (tanszékvezető: Prof. Dr Babik Barna)
| | - Zsolt Szabó
- 4 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Műtéttani Intézet, Szeged, Magyarország (tanszékvezető: Prof. Dr. Boros Mihály)
| | - Anna Rieth
- 5 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Gyermekgyógyászati Klinika, Gyermeksebészeti Osztály, Szeged, Magyarország (osztályvezető: Dr. Kovács Tamás)
| | - György Lázár
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
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14
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Furák J, Németh T, Lantos J, Fabó C, Géczi T, Zombori-Tóth N, Paróczai D, Szántó Z, Szabó Z. Perioperative Systemic Inflammation in Lung Cancer Surgery. Front Surg 2022; 9:883322. [PMID: 35669251 PMCID: PMC9163434 DOI: 10.3389/fsurg.2022.883322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/02/2022] [Indexed: 12/05/2022] Open
Abstract
Systemic inflammation (SI) is a response of the immune system to infectious or non-infectious injuries that defends the body homeostasis. Every surgical intervention triggers SI, the level of which depends on the extent of damage caused by the surgery. During the first few hours after the damage, the innate or natural immunity, involving neutrophils, macrophages, and natural killer cells, plays a main role in the defense mechanism, but thereafter the adaptive immune response ensues. The number of leukocytes is elevated, the levels of lymphocytes and natural killer cells are reduced, and the cytokines released after surgery correlate with surgical damage. Minimally invasive thoracic surgery procedures induce less inflammatory response and reduce the immune defense in patients to a more moderate level compared with the open surgery procedures; this immunosuppression can be further diminished in spontaneous ventilation cases. The normal functioning of the immune defense is important in controlling the perioperative circulatory tumor cells. Moreover, elevated levels of inflammatory cytokines before immune therapy have a negative impact on the response, and significantly shorten the progression-free survival. Clinically, the lower are the levels of cytokines released during lung surgery, the lesser is the postoperative morbidity, especially pneumonia and wound infection. The return to normal levels of lymphocytes and cytokines occurs faster after spontaneous ventilation surgery. The use of locoregional anesthesia can also reduce SI. Herein, we review the current knowledge on the effects of different operative factors on postoperative SI and defense mechanism in lung cancer surgery.
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Affiliation(s)
- József Furák
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
- Correspondence: József Furák
| | - Tibor Németh
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Judit Lantos
- Department of Neurology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Csongor Fabó
- Department of Anesthesiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Géczi
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Noémi Zombori-Tóth
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Medical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zalán Szántó
- Department of Thoracic Surgery. Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szabó
- Institute of Surgical Research, Faculty of Medicine, University of Szeged, Szeged, Hungary
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15
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Zombori-Tóth N, Ugocsai K, Vincze Á, Furák J, Tiszlavicz L, Iványi B, Zombori T. Pulmonary necrotizing sarcoid granulomatosis. Orv Hetil 2021; 162:1541-1547. [PMID: 34537719 DOI: 10.1556/650.2021.32236] [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: 03/03/2021] [Accepted: 03/20/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A nekrotizáló sarcoid granulomatosis a granulomatosus pulmonalis angitisek közé tartozó, ritka kórkép. Egyesek a sarcoidosis variánsának, mások primer pulmonalis vasculitisnek tartják. A kórkép klinikai és patológiai jellegzetességeit két eset bemutatásával ismertetjük. A 20 éves nőbeteg sürgősséggel került pulmonológiai osztályra száraz köhögés, jobb oldali, mély belégzéssel összefüggő mellkasi fájdalom és láz miatt, a 63 éves férfi beteget pedig pneumoniát követő kontroll-mellkasröntgenfelvételen látott elváltozás kivizsgálása során észlelték. Az autoimmun panel vizsgálata, a mikrobiológiai tesztek mindkét betegnél negatívnak bizonyultak, a légzésfunkciós vizsgálat és a bronchoszkópos vizsgálat nem talált eltérést. A mellkas-CT-felvételen lágyrész-denzitású nodulusok látszottak egyoldali dominanciával, a folyamatot nem kísérte a hilusi nyirokcsomók szimmetrikus megnagyobbodása. A nodulusok szövettani vizsgálata vált indokolttá, melyet videoasszisztált torakoszkópos tüdőreszekciós mintavétellel biztosítottak. Mikroszkóposan a tüdőparenchymában gócos nekrózisokat, a környezetükben el nem sajtosodó epitheloid sejtes granulomatosus gócokat, az átfutó artériákban pedig granulomatosus arteritist láttak; a klinikai adatok figyelembevételével a tüdő nekrotizáló sarcoid granulomatosisa diagnózisát állították fel. A tüdőbetegség mindkét betegnél egy év alatt spontán regrediált. Az irodalom adatait és az eseteket összegezve, a tüdő nekrotizáló sarcoid granulomatosisában mikrobiológiai vizsgálatokkal nem igazolható tüdőfertőzés, és az immunológiai kivizsgálás sem tár fel szisztémás autoimmun betegséget; a diagnózis a klinikai kép és a képalkotó vizsgálatok alapján indikált szövettani vizsgálattal állítható fel. A betegség szteroidkezelésre jól reagál, de előfordul spontán regresszió is, az utóbbira láttunk példát. Bár az entitás átmenetet képez a nekrotizáló vasculitisek és a sarcoidosis között, egyre több érv szól amellett, hogy a sarcoidosis spektrumába tartozik. Orv Hetil. 2021; 162(38): 1541-1547. Summary. Necrotizing sarcoid granulomatosis is a rare entity currently classified as a subtype of granulomatous pulmonary angiitis. It is considered to be either a variant of sarcoidosis or a primary pulmonary angiitis. Two cases are demonstrated to present its clinical and pathological features. A 20-year-old female patient was admitted to the department of pulmonology with dry cough, right-sided chest pain during hyperventilation and fever. A 63-year-old male patient was observed with a right-sided lesion on chest X-ray after pneumonia. In both cases, autoimmune panel examination, microbiology tests, spirometry function test and bronchoscopy were unremarkable. Chest CT scans have revealed nodules with soft-tissue density without bilateral hilar lymphadenopathy. In order to clarify the diagnosis, video-assisted thoracoscopic resection (biopsy) was performed. Microscopically, parenchymal focal necrosis with adjacent to non-caseating granulomas and granulomatous angiitis were detected. In both cases, spontaneous remission occurred within a year. Histological examination - integrated with clinical data and radiological tests' results - is the gold standard form of evaluation to confirm necrotizing sarcoid granulomatosis; furthermore, exclusion of pneumonia and autoimmune diseases are also required. The disease responds well to corticosteroids; moreover, spontaneous remission is often reported, as it happened in both cases. Necrotizing sarcoid granulomatosis is a transition between necrotizing vasculitides and sarcoidosis; although more and more evidence appears supporting the fact that necrotizing sarcoid granulomatosis may belong to the spectrum of sarcoidosis. Orv Hetil. 2021; 162(38): 1541-1547.
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Affiliation(s)
| | - Katalin Ugocsai
- 1 Csongrád-Csanád Megyei Mellkasi Betegségek Szakkórháza, Deszk
| | | | - József Furák
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Klinika, Szeged
| | - László Tiszlavicz
- 4 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 2., 6701
| | - Béla Iványi
- 4 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 2., 6701
| | - Tamás Zombori
- 4 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 2., 6701
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16
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Szalontai K, Gémes N, Furák J, Varga T, Neuperger P, Balog JÁ, Puskás LG, Szebeni GJ. Chronic Obstructive Pulmonary Disease: Epidemiology, Biomarkers, and Paving the Way to Lung Cancer. J Clin Med 2021; 10:jcm10132889. [PMID: 34209651 PMCID: PMC8268950 DOI: 10.3390/jcm10132889] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD), the frequently fatal pathology of the respiratory tract, accounts for half a billion cases globally. COPD manifests via chronic inflammatory response to irritants, frequently to tobacco smoke. The progression of COPD from early onset to advanced disease leads to the loss of the alveolar wall, pulmonary hypertension, and fibrosis of the respiratory epithelium. Here, we focus on the epidemiology, progression, and biomarkers of COPD with a particular connection to lung cancer. Dissecting the cellular and molecular players in the progression of the disease, we aim to shed light on the role of smoking, which is responsible for the disease, or at least for the more severe symptoms and worse patient outcomes. We summarize the inflammatory conditions, as well as the role of EMT and fibroblasts in establishing a cancer-prone microenvironment, i.e., the soil for ‘COPD-derived’ lung cancer. We highlight that the major health problem of COPD can be alleviated via smoking cessation, early diagnosis, and abandonment of the usage of biomass fuels on a global basis.
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Affiliation(s)
- Klára Szalontai
- Csongrád County Hospital of Chest Diseases, Alkotmány u. 36., H6772 Deszk, Hungary;
| | - Nikolett Gémes
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- PhD School in Biology, University of Szeged, H6726 Szeged, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Semmelweis u. 8., H6725 Szeged, Hungary;
| | - Tünde Varga
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
| | - Patrícia Neuperger
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- PhD School in Biology, University of Szeged, H6726 Szeged, Hungary
| | - József Á. Balog
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- PhD School in Biology, University of Szeged, H6726 Szeged, Hungary
| | - László G. Puskás
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- Avicor Ltd. Alsó Kikötő sor 11/D, H6726 Szeged, Hungary
| | - Gábor J. Szebeni
- Laboratory of Functional Genomics, Biological Research Centre, Temesvári krt. 62., H6726 Szeged, Hungary; (N.G.); (T.V.); (P.N.); (J.Á.B.); (L.G.P.)
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, Közép fasor 52, H6726 Szeged, Hungary
- CS-Smartlab Devices Ltd., Ady E. u. 14., H7761 Kozármisleny, Hungary
- Correspondence:
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Rieth A, Varga E, Kovács T, Ottlakán A, Németh T, Furák J. Contemporary management strategies of blunt tracheobronchial injuries. Injury 2021; 52 Suppl 1:S7-S14. [PMID: 32674886 DOI: 10.1016/j.injury.2020.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/25/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tracheobronchial injuries are rare but feasibly life-threatening conditions. A prompt diagnosis and early management can be lifesaving. Due to the unspecific symptoms and indirect radiological signs the diagnosis often delays. OBJECTIVES We present a short series of patients suffering from tracheobronchial airway laceration. All the three patients had blunt thoracic or neck trauma and showed early signs of tracheobronchial injury. In the first case a 44-year-old woman was crushed by a bus. Subcutaneous emphysema, pneumothorax on chest computed tomography and hypoxaemia despite of chest tube suggested the presence of an airway injury. During operation a 4-cm-long tear of the trachea and a complete transection of the right main bronchus were found. In the second case a 12-year-old girl was crossed by a truck trailer. Early signs were respiratory failure, extended subcutaneous emphysema, blood clot in the larynx, pneumothorax on both sides. Chest CT showed pneumomediastinum. During the operation a longitudinal laceration was found separating the two main bronchi at the bifurcation. In the third case a 9-year-old boy was injured in a car accident, when the seat-belt crossed his neck. Spreading subcutaneous emphysema, pneumomediastinum and an overinflated endotracheal tube's cuff were found on CT. A completely transected trachea between the first and second tracheal rings was found. All three patients required fast intubation and bronchoscopic examination to confirm the diagnosis, and to identify the site of lacerations. All the patients underwent primary reconstruction and recovered successfully. CONCLUSIONS In case of suspected tracheobronchial injury, a high index of suspicion is required for early diagnosis. Most commonly respiratory distress, subcutaneous emphysema and pneumothorax are found on physical examination. Prompt intubation below the site of the injury and early laryngo- or bronchoscopic examination have priority, as we did in our cases. A primary anastomosis is required with minimal resection during urgent operation. A better outcome is to be expected when extubation is done early after surgery. We offer ordinal steps that should be taken to lead to a prompt management and good long-term outcome based on the literature and our experiences.
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Affiliation(s)
- Anna Rieth
- Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, Szeged, Hungary.
| | - Endre Varga
- Department of Traumatology, University of Szeged, Szeged, Hungary.
| | - Tamás Kovács
- Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, Szeged, Hungary.
| | - Aurél Ottlakán
- Division of Thoracic Surgery, Department of Surgery, University of Szeged, Szeged, Hungary.
| | - Tibor Németh
- Division of Thoracic Surgery, Department of Surgery, University of Szeged, Szeged, Hungary.
| | - József Furák
- Division of Thoracic Surgery, Department of Surgery, University of Szeged, Szeged, Hungary.
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Zombori T, Turkevi-Nagy S, Sejben A, Juhász-Nagy G, Cserni G, Furák J, Tiszlavicz L, Krenács L, Kővári B. The panel of syntaxin 1 and insulinoma-associated protein 1 outperforms classic neuroendocrine markers in pulmonary neuroendocrine neoplasms. APMIS 2021; 129:186-194. [PMID: 33417719 DOI: 10.1111/apm.13113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/28/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
Syntaxin-1 (STX1) is a recently described highly sensitive and specific neuroendocrine marker. We evaluated the applicability of STX1 as an immunohistochemical marker in pulmonary neuroendocrine neoplasms (NENs). We compared STX1 with established neuroendocrine markers, including insulinoma-associated protein 1 (INSM1). Typical carcinoids (n = 33), atypical carcinoids (n = 7), small cell lung carcinomas ([SCLCs] n = 30), and large cell neuroendocrine lung carcinomas (n = 17) were immunostained using tissue microarray for STX1, chromogranin A, synaptophysin, CD56, and INSM1. Eighty-four of eighty-seven (96.5%) NENs showed STX1 positivity. Carcinoids and LCNECs typically presented a combined strong membranous and weak cytoplasmic staining pattern; cytoplasmic expression was predominately observed in SCLCs. The sensitivity of STX1 was 90% in SCLCs and 100% in typical carcinoids, atypical carcinoids, and large cell neuroendocrine lung carcinomas. The overall sensitivity of STX1 in pulmonary NENs was 96.6%, and the sensitivity of the other markers was as follows: chromogranin A (85.2%), synaptophysin (85.2%), CD56 (92.9%), and INSM1 (97.7%). STX1 was found to be an excellent neuroendocrine marker of pulmonary NENs, with sensitivity and specificity surpassing that of classic markers. We propose a panel of STX1 and INSM1 for the routine immunohistochemical workup of pulmonary NENs.
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Affiliation(s)
- Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
| | | | - Anita Sejben
- Department of Pathology, University of Szeged, Szeged, Hungary
| | | | - Gábor Cserni
- Department of Pathology, University of Szeged, Szeged, Hungary.,Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - László Krenács
- Laboratory of Tumor Pathology and Molecular Diagnostics, Szeged, Hungary
| | - Bence Kővári
- Department of Pathology, University of Szeged, Szeged, Hungary.,Department of Pathology, Henry Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Furák J, Paróczai D, Burián K, Szabó Z, Zombori T. Oncological advantage of nonintubated thoracic surgery: Better compliance of adjuvant treatment after lung lobectomy. Thorac Cancer 2020; 11:3309-3316. [PMID: 32985138 PMCID: PMC7606006 DOI: 10.1111/1759-7714.13672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Video-assisted thoracoscopic (VATS) surgery contributes to improved survival, adjuvant chemotherapy delivery and less postoperative complications. Nonintubated thoracic surgery (NITS) VATS procedures improves immunological responses in lung cancer patients; however, there is no data regarding adjuvant chemotherapy delivery effectiveness following NITS lobectomies. In this study, we aimed to compare protocol compliance and toxic complications during adjuvant chemotherapy after intubated and nonintubated VATS lobectomies in non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed the medical records of 66, stage IB-IIIB NSCLC patients who underwent intubated or nonintubated VATS lobectomy and received adjuvant chemotherapy. RESULTS A total of 38 patients (17 males, mean age 64 years) underwent conventional VATS and 28 (7 males; mean age 63 years) uniportal VATS NITS. Both groups had comparable demographic data, preoperative pulmonary function, and Eastern Cooperative Oncology Group (ECOG) status. Among the intubated and nonintubated patients, 82% and 75% were diagnosed with adenocarcinoma, respectively. The incidence of adenocarcinoma and squamous cell carcinoma cases were similar in both groups; however, the pathological staging showed significant differences, as 5 (18%) nonintubated patients had stage IB lung cancer, compared with the intubated group (P = 0.01). Further distribution of stages was similar between the groups. We observed significant differences in chest tube duration and operation time in the nonintubated group (P < 0.01). Among nonintubated patients, 92% completed the planned chemotherapy protocol, compared to 71% of the intubated group (P = 0.035). Grade 1/2 toxicity occurred significantly more often in the intubated group (16% vs. 0%, P = 0.03) and there was a lower incidence of grade 4 neutropenia in the nonintubated group (0% vs. 16%, P = 0.03). CONCLUSIONS Our results showed that the nonintubated procedure resulted in improved adjuvant chemotherapy compliance and lower toxicity rates after lobectomy. KEY POINTS SIGNIFICANT FINDINGS OF THE STUDY: Oncological advantage of the non-intubated thoracic surgery: better compliance with therapy protocol. What this study adds NITS lobectomies contribute to better administration of adjuvant chemotherapy with the planned cycle number and dosage.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Dóra Paróczai
- Department of Pulmonology, University of Szeged, Deszk, Hungary.,Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
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20
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Németh T, Szabó Z, Pécsy B, Barta ZV, Lázár G, Torday L, Maráz A, Zombori T, Furák J. Changes in the surgical treatment of pulmonary metastases during the last 12 years. Orv Hetil 2020; 161:1215-1220. [PMID: 32628621 DOI: 10.1556/650.2020.31770] [Citation(s) in RCA: 1] [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] [Received: 02/29/2020] [Accepted: 03/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In our retrospective study, we examined changes in the histological results and types of metastatectomies of pulmonary metastases during the last 12 years, in two 5-year periods. AIM AND METHOD There were 55 patients in the first group (2006-2010), 54.5% of the patients were male (n = 30), 45.5% were female (n = 25), the mean age was 57.9 years (24-80). The second group (2014-2018) consisted of 115 patients, with 60% male (n = 69) and 40% female (n = 46), the mean age was 62.2 years (26-82). RESULTS During the first period, the primary tumor was found in the rectum 19.3% (n = 11), colon 17.5% (n = 10), or kidney 14% (n = 8), while during the second period, the primary tumor was in the colon in 23.1% (n = 31), in the rectum in 15.7% (n = 21), or in the kidney in 9% (n = 12). The following types of surgeries were performed: atypical resection: 38.6% (n = 22) and 46.3% (n = 62); lobectomy in 31.6% (n = 18) and 26.9% (n = 36); pulmonectomy in 10.5% (n = 6) and 1.5% (n = 2); segmentectomy in 7% (n = 4) and 9.7% (n = 13); and bilobectomy in 1.8% (n = 1) and 0.7% (n = 1) in the first and second group, respectively. The ratio of video-assisted thoracic surgery (VATS) was 5.3% (n = 3) during the first period, and this ratio increased to 64.9% (n = 87) during the second period. The mean disease-free survival between the surgery of the primary tumor and the removal of the pulmonary metastasis was 45.2 months (0-144) during the first period and 33.8 months (0-180) during the second period. The median survival was 39 months in the first period, and it increased to 59 months in the second group. The mean 5-year survival was 41% in both groups. CONCLUSION During the last 12 years, there was a more than two-fold increase in the number of patients requiring surgery due to pulmonary metastases, and the ratio of VATS metastasectomy increased significantly as well (5.3% vs. 64.9%). No significant difference was found in the ratio of the types of the primary tumors. The median survival was slightly better in the second group. Orv Hetil; 161(29): 1215-1220.
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Affiliation(s)
- Tibor Németh
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - Zsolt Szabó
- Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Intézet,Szegedi Tudományegyetem, Szeged
| | - Balázs Pécsy
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - Zsanett Virág Barta
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - György Lázár
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
| | - László Torday
- Általános Orvostudományi Kar, Onkoterápiás Klinika,Szegedi Tudományegyetem, Szeged
| | - Anikó Maráz
- Általános Orvostudományi Kar, Onkoterápiás Klinika,Szegedi Tudományegyetem, Szeged
| | - Tamás Zombori
- Általános Orvostudományi Kar, Patológiai Intézet,Szegedi Tudományegyetem, Szeged
| | - József Furák
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem, Szeged, Semmelweis u. 8., 6720
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21
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Zombori T, Sejben A, Tiszlavicz L, Cserni G, Pálföldi R, Csada E, Furák J. Architectural Grade Combined With Spread Through Air Spaces (STAS) Predicts Recurrence and is Suitable for Stratifying Patients Who Might Be Eligible for Lung Sparing Surgery for Stage I Adenocarcinomas. Pathol Oncol Res 2020; 26:2451-2458. [PMID: 32564261 PMCID: PMC7471099 DOI: 10.1007/s12253-020-00855-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/11/2020] [Indexed: 12/25/2022]
Abstract
The spread through air spaces (STAS) has a main role in local recurrence of stage I lung adenocarcinomas (LAs), therefore its presence might question sublobar resection as a therapeutic option. The aim of our study was to evaluate the distribution of STAS in stage I LAs, to stratify patients according to local recurrence and to identify a group of patients who might be suitable for sublobar surgery. Patients resected with LA were included. The presence of STAS was recorded on hematoxylin eosin stained slides and clinicopathological data were obtained from medical charts. Overall survival (OS) and disease-free survival (DFS) were registered. Statistical methods included Kruskal-Wallis tests, Kaplan-Meier analyses, log-rank tests and Cox-regressions. 292 patients were included. STAS was identified in 38.7% and 95.7% of micropapillary carcinomas showed STAS. Significant correlation was found between STAS and high-grade patterns. Significant differences were found between OS and DFS estimates of STAS0 and STAS1 cases (5-y-OS: 80.0% vs. 68.4%; 5-y-DFS: 71.1% vs. 57.1%). The presence of STAS was associated with unfavorable prognosis in low and intermediate architectural grades, but not in high-grade. Multivariate analysis revealed that architectural grade (HR(OS):2.09; HR(DFS):1.52) and STAS (HR(OS):1.51; HR(DFS):1.48) were independent prognostic markers in stage I LA. Architectural grade combined with STAS was superior to other prognostic grades. The combination of architectural grade and STAS proved to be a prognostic factor that is superior to previously introduced grading systems. Patients having low and intermediate grade LAs without STAS might be eligible for sublobar resection.
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Affiliation(s)
- Tamás Zombori
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., H6725, Szeged, Hungary.
| | - Anita Sejben
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., H6725, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., H6725, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Faculty of Medicine, University of Szeged, Állomás u. 1., H6725, Szeged, Hungary.,Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, Kecskemét, H6000, Hungary
| | - Regina Pálföldi
- Csongrád County Hospital of Chest Diseases, Alkotmány u. 36. , Deszk, H6772, Hungary
| | - Edit Csada
- Csongrád County Hospital of Chest Diseases, Alkotmány u. 36. , Deszk, H6772, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Semmelweis u. 8., Szeged, H6720, Hungary
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Rieth A, Ottlakán A, Kovács T, Balogh B, Furák J. The role of an overinflated endotracheal tube in the diagnosis of tracheal injuries. Orv Hetil 2020; 161:1063-1068. [PMID: 32516125 DOI: 10.1556/650.2020.31743] [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: 01/30/2020] [Accepted: 02/29/2020] [Indexed: 11/19/2022]
Abstract
Tracheobronchial injury is an uncommon, but often life-threatening condition. It is mostly caused by blunt thoracic or neck trauma, difficult or prolonged intubation associated with nasogastric tube insertion. An early diagnosis and treatment can be lifesaver. The diagnosis is often late because of atypical symptoms and unspecific radiological signs, and due to the presence of severe coexistent injuries. Generally, the classic hallmark during physical examination is a progressive, extensive surgical emphysema. Radiological signs are often atypical, which makes the diagnosis more difficult. The most frequent signs found on computed tomography are also unspecific, mostly surgical emphysema, pneumomediastinum or pneumothorax may be noted. We present three patients suffering from airway laceration caused by car accident, difficult intubation, and prolonged utilization of nasogastric and endotracheal tube. All the patients had an overdistended endotracheal balloon herniated outside the extratracheal space along the rupture of the tracheal wall. These external balloons were all detected on radiography. This is a direct and pathognomic sign of airway injury, suggesting complete rupture in the tracheal wall. In our report, we would like to highlight the diagnostic role of an overinflated cuff. Orv Hetil. 2020; 161(25): 1063-1068.
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Affiliation(s)
- Anna Rieth
- Általános Orvostudományi Kar, Gyermekklinika, Gyermeksebészet,Szegedi Tudományegyetem Szeged, Korányi fasor 14-15., 6725
| | - Aurél Ottlakán
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi Tudományegyetem Szeged
| | - Tamás Kovács
- Általános Orvostudományi Kar, Gyermekklinika, Gyermeksebészet,Szegedi Tudományegyetem Szeged, Korányi fasor 14-15., 6725
| | - Brigitta Balogh
- Általános Orvostudományi Kar, Gyermekklinika, Gyermeksebészet,Szegedi Tudományegyetem Szeged, Korányi fasor 14-15., 6725
| | - József Furák
- Általános Orvostudományi Kar, Sebészeti Klinika, Mellkassebészet,Szegedi Tudományegyetem Szeged
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Furák J, Szabó Z, Tánczos T, Paszt A, Rieth A, Németh T, Pécsy B, Ottlakán A, Rárosi F, Lázár G, Molnár Z. Conversion method to manage surgical difficulties in non-intubated uniportal video-assisted thoracic surgery for major lung resection: simple thoracotomy without intubation. J Thorac Dis 2020; 12:2061-2069. [PMID: 32642108 PMCID: PMC7330381 DOI: 10.21037/jtd-19-3830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The major limitations of widespread use of non-intubated thoracic surgery (NITS) is the fear of managing complications. Here we present our practice of converting from uniportal video-assisted thoracic surgery (VATS) NITS to open NITS in cases of surgical complications. Methods The study period was from January 26, 2017, to November 30, 2018. Total intravenous anesthesia was provided with propofol guided by bispectral index, and the airway was maintained with a laryngeal mask with spontaneous breathing. Local anesthesia with 2% lidocaine at the skin incision, and intercostal and vagus nerve blockades were induced using 0.5% bupivacaine. For conversion with surgical indications, a thoracotomy was performed at the incision without additional local or general anesthetics. Results In 160 complete NITS procedures, there were 145 VATS NITS and 15 open NITS (9 conversions to open NITS and 6 intended NITS thoracotomies). In the 15 open NITS cases (2 pneumonectomies, 1 bilobectomy, 1 sleeve lobectomy, 7 lobectomies, 3 sublobar resections, 1 exploration), the mean operative time was 146.7 (105–225) and 110 (75–190) minutes in the converted and intended open NITS groups, respectively. There were no significant differences between systolic blood pressure (P=0.316; 95% CI, −10.469 to 3.742), sat O2% (P=0.27; 95% CI, −1.902 to 0.593), or propofol concentration in the effect site (P=0.053; 95% CI, −0.307 to 0.002) but significant differences in pulse (P=0.007; 95% CI, −10.001 to −2.72), diastolic blood pressure (P=0.013; 95% CI, −9.489 to −1.420) and in end-tidal CO2 (P=0.016; 95% CI, −7.484 to −0.952) before versus after thoracotomy, but there was no clinical relevance of the differences. Conclusions For conversion with surgical indications during the VATS-NITS procedure, NITS thoracotomy can be performed safely at the site of the utility incision without the need for additional drugs, and the major lung resections can be performed through this approach.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Zsolt Szabó
- Department of Anesthesiology, University of Szeged, Szeged, Hungary
| | - Tamás Tánczos
- Department of Anesthesiology, University of Szeged, Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Anna Rieth
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Tibor Németh
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Balázs Pécsy
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Ferenc Rárosi
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
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Zombori T, Juhász-Nagy G, Tiszlavicz L, Cserni G, Furák J, Szalontai K, Pálföldi R. [Large-cell neuroendocrine carcinoma of the lung - challenges of diagnosis and treatment]. Orv Hetil 2020; 161:313-319. [PMID: 32073294 DOI: 10.1556/650.2020.31581] [Citation(s) in RCA: 4] [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] [Indexed: 11/19/2022]
Abstract
Small-cell lung carcinoma (SCLC) and the rare large-cell neuroendocrine carcinoma belong to the high grade pulmonary neuroendocrine carcinomas. Making the correct diagnosis and selection of treatment modalities require multidisciplinary meetings due to the morphological overlaps, aggressive behaviour and debated therapeutic guidelines of these entities. A 52-year-old woman was admitted to the hospital because of headache, nausea and tenebrous vision. The CT revealed metastatic tumour mass in the occipital lobe and in the cerebellum. Both tumours were removed and resulted in histological diagnosis of metastatic neuroendocrine carcinoma. Chest X-ray established contrast-enhancing lesion in the left lung. Bronchoscopy was performed and histological examination revealed large-cell neuroendocrine carcinoma. Postoperative skull irradiation and small-cell lung cancer chemotherapy protocol were utilized. Due to atelectasis and progression, chest irradiation was initiated, which was interrupted because of novel brain metastases. Further chemotherapy followed the non-small-cell lung cancer protocol. After 3 months, thoracic progression, brain and disseminated bone metastases were diagnosed. After a 14-month-long therapy, the patient deceased. Large-cell neuroendocrine carcinoma has a poor prognosis, the incidence of brain metastasis is 25-50%. In early stage large-cell neuroendocrine carcinoma, lobectomy is the standard treatment and adjuvant chemotherapy should also be considered. Although the non-small-cell lung cancer chemotherapy protocol is approved widely in the treatment of large-cell neuroendocrine carcinoma, the utility of SCLC scheme has also been suggested. Orv Hetil. 2020; 161(8): 313-319.
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Affiliation(s)
- Tamás Zombori
- Általános Orvostudományi Kar, Pathologiai Intézet,Szegedi TudományegyetemSzeged, Állomás u. 1., 6725
| | - Gréta Juhász-Nagy
- Általános Orvostudományi Kar, Pathologiai Intézet,Szegedi TudományegyetemSzeged, Állomás u. 1., 6725
| | - László Tiszlavicz
- Általános Orvostudományi Kar, Pathologiai Intézet,Szegedi TudományegyetemSzeged, Állomás u. 1., 6725
| | - Gábor Cserni
- Általános Orvostudományi Kar, Pathologiai Intézet,Szegedi TudományegyetemSzeged, Állomás u. 1., 6725
| | - József Furák
- Általános Orvostudományi Kar, Sebészeti Klinika,Szegedi TudományegyetemSzeged
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25
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Abstract
Pulmonary arterial intimal sarcoma is a rare tumour with high mortality. Due to its localisation, the symptoms can mimic pulmonary thromboembolism and pneumonia, therefore assessing the diagnosis and choosing the adequate therapy is never easy. Its therapy mainly consists of surgery combined with radiochemotherapy. A 46-year-old male patient with testicular seminoma, pulmonary embolism, bronchial asthma and pollen allergy in his history had a follow-up thoracic CT. On the left side of the lung, a pleura-infiltrating 7-8 cm lesion, which occluded the pulmonary artery, was described. The first biopsy specimen showed fragments of spindle cell tumour. The primary diagnosis was leiomyoma, leiomyomatous hyperplasia, yet the presence of leiomyosarcoma could not have been ruled out. Due to the arterial obstruction, the patient underwent left sided pulmonectomy. Histological examination showed a tumour mostly composed of spindle cells that were diffusely positive with SMA, focally diffuse with MDM2 immunohistochemistry together with high proliferation activity. h-Caldesmon, S-100, ERG and pancytokeratin expressions were not detected. With fluorescent in situ hybridization 10% of tumour cells showed polysomy and MDM2 amplification. According to the results, high-grade pulmonary arterial intimal sarcoma diagnosis has been made. The precise incidence of pulmonary arterial intimal sarcoma is unknown. Some literature data suggest it can be the cause of chronic pulmonary hypertension in 1-4% of the cases. Weight loss can draw attention to the malignant nature of the disease. Imaging techniques and histology are the gold standard in setting the diagnosis. The prognosis is poor. Early recognition and surgery combined with chemotherapy can prolong survival. Orv Hetil. 2020; 161(6): 232-236.
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Affiliation(s)
- Anita Sejben
- Pathologiai Intézet,Szegedi Tudományegyetem, Általános Orvostudományi KarSzeged, Állomás u. 1., 6725
| | - László Tiszlavicz
- Pathologiai Intézet,Szegedi Tudományegyetem, Általános Orvostudományi KarSzeged, Állomás u. 1., 6725
| | - József Furák
- Sebészeti Klinika,Szegedi Tudományegyetem, Általános Orvostudományi KarSzeged
| | | | - Zoltán Sápi
- I. Patológiai és Kísérleti Rákkutató Intézet,Semmelweis Egyetem, Általános Orvostudományi KarBudapest
| | - Tamás Zombori
- Pathologiai Intézet,Szegedi Tudományegyetem, Általános Orvostudományi KarSzeged, Állomás u. 1., 6725
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Németh T, Pécsy B, Géczi T, Sas K, Szpisjak L, Rieth A, Kiss V, Szőnyegi F, Tiszlavicz L, Zombori T, Lázár G, Furák J. [Successful multidisciplinary management of tetraplegia with a thoracic operation. Unicentric, mediastinal Castleman disease]. Orv Hetil 2019; 161:33-38. [PMID: 31884815 DOI: 10.1556/650.2020.31560] [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
Castleman disease is a rare lymphoproliferative disease the exact cause of which is not known. The diagnosis is based on the adequate histological examination. While in the unifocal form, the disease most commonly affects the chest, and symptoms may resolve as a result of intact excision of the tumour; other treatment methods may be performed in addition to or instead of surgical incision in the case of the multifocal form. We present the case of a patient with Castleman disease who received multidisciplinary treatment. Speech difficulty, dysphagia, and progressive paresis occurred in the upper and lower extremities of the 56-year-old male patient 18 weeks before his check-up examinations. Although the complaints temporarily resolved with plasmapheresis, surgical sampling could not confirm the origin of the mediastinal lymphadenomegaly detected with thoracic CT. The patient was admitted to our department to remove the 5 cm large subcarinal lymph node or to gain a tissue sample from it. On admission, significant atrophy, hypotonia and tetraplegia were seen in the four extremities, and areflexia was detected all over the body. The 5.5 × 3.5 cm large subcarinal lymph node conglomerate was removed from posterolateral thoracotomy. Histology was performed, Castleman disease was confirmed. 3 days after the surgery, the patient was able to move the extremities, and then on the 9th postoperative day, the patient could walk using a walking frame, and he was transferred back to the Department of Neurorehabilitation. At transfer, the muscle strength of the upper extremities was almost intact, and 4/5 muscle strength was detected in the lower extremities. After this, methylprednisolone, vitamin B1, calcium citrate, famotidine therapy was administered, and 2 weeks after his transfer, he was discharged home; at that time, the patient was able to walk safely without a walking frame. The symptoms resolved almost completely 3 months after the surgery. Diagnosis and treatment of Castleman disease are multidisciplinary tasks. If the patient is suitable for surgery, surgical removal has to play a key role in the treatment of unifocal Castleman disease. Orv Hetil. 2020; 161(1): 33-38.
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Affiliation(s)
- Tibor Németh
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Balázs Pécsy
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Tibor Géczi
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - Katalin Sas
- Neurológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Szpisjak
- Neurológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Anna Rieth
- Gyermekgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Valéria Kiss
- Neurológiai Osztály, Jász-Nagykun Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet Szolnok
| | - Ferenc Szőnyegi
- Neurológiai Osztály, Jász-Nagykun Szolnok Megyei Hetényi Géza Kórház-Rendelőintézet Szolnok
| | - László Tiszlavicz
- Pathologiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Tamás Zombori
- Pathologiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - György Lázár
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6725
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Rieth A, Kovács T, Novák Z, Kapus K, Ottlakán A, Németh T, Furák J. Surgical treatment of awn aspiration causing bronchopleural fistula and bronchiectasis: case reports. BMC Pediatr 2019; 19:368. [PMID: 31640618 PMCID: PMC6805588 DOI: 10.1186/s12887-019-1783-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/20/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aspiration of grass inflorescences is an extremely rare phenomenon with potential diagnostic difficulties. Due to its special shape, each coughing and respiratory action helps its migration towards the periphery of lung, resulting late-onset, life-threatening complications. The diagnosis has some difficulties for the reason that soon after the aspiration initial symptoms, such as coughing, wheezing or vomiting disappear and bronchoscopy is mostly negative. At least serious complications such as tension pneumothorax, bronchopleurocutaneous fistula or even spontaneous percutan elimination may develope. CASE PRESENTATION We present two cases of pleuropneumonia resulting from aspiration of the head of barley grass. Soon after the accidents initial symptoms diminished, inflammatory markers improved and bronchoscopy was unable to confirm the presence of awn. Despite of conservative treatment (antibiotics, physiotherapy, bronchodilators, expectorants, and inhalation) localized pulmonary inflammation developed after 1 and 9 months showed up on chest computed tomography. After ineffective conservative treatment, surgical resections became inevitable in order to remove chronically inflamed parts (lobectomy, segmentectomy) and foreign bodies. Both patients recovered and were discharged home after successful interventions. CONCLUSIONS Due to its peculiar shape and behaviour, awn inhalation is a special and atypical form of aspiration, thus great care and awareness is needed in its treatment. Negative bronchoscopic result does not exclude the presence of bronchial grass head. Symptomless child with negative bronchoscopy and improved inflammatory markers should be followed up thoroughly to recognize late complications in time. Regular diagnostic steps (chest ultrasound/X-ray) should be performed to localize potential chronic lung inflammation. Chest computed tomography is a valuable diagnostic tool for identifying and localising the foreign body. In cases with localized inflammation and peripheric localisation, segmentectomy can be a successful and safe alternative of lobectomy.
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Affiliation(s)
- Anna Rieth
- Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, 14-15. Korányi Avenue, Szeged, 6725, Hungary.
| | - Tamás Kovács
- Division of Pediatric Surgery, Department of Pediatrics, University of Szeged, 14-15. Korányi Avenue, Szeged, 6725, Hungary
| | - Zoltán Novák
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Katalin Kapus
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Aurél Ottlakán
- Division of Thoracic Surgery, Department of Surgery, University of Szeged, Szeged, Hungary
| | - Tibor Németh
- Division of Thoracic Surgery, Department of Surgery, University of Szeged, Szeged, Hungary
| | - József Furák
- Division of Thoracic Surgery, Department of Surgery, University of Szeged, Szeged, Hungary
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Abstract
Li-Fraumeni syndrome is a rare genetic disorder predisposing the individual to multiple different cancer types, caused by a germline mutation of the TP53 or CHEK2 genes inherited in an autosomal dominant manner. We hereby describe the case of a family with Li-Fraumeni syndrome. An asymptomatic 40-year-old female was diagnosed with primary lung leiomyosarcoma (T3N0), adenocarcinoma (T1aN0), and inflammatory myofibroblastic tumor, which were surgically removed without further treatment. Twenty months later she underwent surgery for retroperitoneal liposarcoma and even though she received adjuvant chemotherapy, deceased shortly after. Due to family history, the patient underwent TP53 mutation testing, using peripheral blood genomic DNA, which identified a heterozygous, likely pathogenic missense mutation (c.722C>G p.Ser241Cys) in case of the mother and her son. Three years after the patient's death, her 17-year-old son was diagnosed with a 3.5 cm osteosarcoma of the right second rib, which was surgically removed, followed by adjuvant chemotherapy. However, despite treatment, he deceased after two years. Throughout four generations of the patient's family, 10 malignant tumors (stomach-, breast-, 2 lung-, and colon cancer, leukemia, leiomyosarcoma, liposarcoma and 2 osteosarcoma) were diagnosed with a mean age of 43.2 (13-70 years) years. The simultaneous appearance of primary lung leiomyosarcoma, inflammatory myofibroblastic tumor and adenocarcinoma in the same organ is extremely rare. When possible, surgical resection should be carried out. Genetic testing for TP53 is recommended when family history is suggestive of Li-Fraumeni syndrome. Prognosis remains poor. Orv Hetil. 2019; 160(6): 228-234.
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Affiliation(s)
- Anita Sejben
- Pathologiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Tiszlavicz
- Pathologiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Kornélia Polyák
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School Boston, MA, Amerikai Egyesült Államok
| | - László Kovács
- Reumatológiai és Immunológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Anikó Maráz
- Onkoterápiás Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Dóra Török
- Orvosi Genetikai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Ádám Leprán
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - Aurél Ottlakán
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
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Abstract
The incidence of traumatic diaphragmatic rupture (TDR) is around 0.5% of all trauma patients, located more frequently on the left side (80%), with penetrating trauma being more predominantly the cause (63%) than blunt injuries (37%). TDR typically develops during thoracoabdominal injuries and outcome depends on the severity of the associated organ lesion. Diagnosis is sometimes very difficult: chest X-ray can verify TDR in only 25-70% of cases, although the specificity of a multidetector computed tomography (MDCT) is 100% and 83% for left and right-sided ruptures, respectively. When TDR is a part of a polytrauma, the management of the patient must follow the ATLS (Advanced Trauma Life Support) protocol and surgery is rarely based on the primary survey. The usual scenario involves cases detected during the secondary survey. In acute cases approach is determined by the site of the life-threatening injuries. In the daily surgical routine, in cases of acute TDR, laparotomy provides the best approach to manage the associated abdominal injuries and diaphragmatic rupture. Alternatively a transthoracic approach offer access to reconstruction in cases of delayed. A transdiaphragmatic procedure is offered when during an exploration (laparotomy or thoracotomy), any sign of an injury (bleeding, perforation) is verified through the rupture of the diaphragm in the other cavity (abdomen or chest and vice versa): the injury via a transdiaphragmatic way can be managed. Usually, a simple and small rupture up to 5-6 cm can be reconstructed with No. 0 or 1 monofilament non-absorbable or absorbable interrupted sutures, while for larger defects, interrupted figure-of-eight or horizontal mattress sutures are required. Mesh prosthesis is rarely needed.
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Affiliation(s)
- József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Kalliopi Athanassiadi
- Department of Thoracic & Vascular Surgery, "EVANGELISMOS" General Hospital, Athens, Greece
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Ottlakán A, Pécsy B, Csada E, Ádám G, Maráz A, Borda B, Lázár G, Furák J. Tüdőlebeny-eltávolítást követő kemoterápia tolerabilitását befolyásoló perioperatív tényezők. Orv Hetil 2018; 159:748-755. [DOI: 10.1556/650.2018.31016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract: Introduction: Lung cancer is the leading cause of malignancy-related deaths in Hungary, involving complex surgical and oncological treatment. Aim: Factors influencing the tolerability of complete/planned and incomplete postoperative chemotherapy after surgery were analyzed. Method: During a 6-year period (January 1, 2011–December 31, 2016), data of 72 patients operated with lung cancer (adenocarcinoma and squamous cell carcinoma), receiving complete (4 cycles) and incomplete (<4 cycles) postoperative chemotherapy were analyzed. The following factors among the two groups [complete: n = 53; incomplete: n = 19] were analyzed: gender, mean age, body mass index, Malnutrition Universal Screening Tool, Charlson Comorbidity Index, second malignant tumor, atrial fibrillation, Forced Expiratory Volume 1 sec, Performance Status, open/Video-Assisted Thoracic Surgery (VATS) lobectomy, duration of surgery, postoperative fever, need for transfusion, prolonged air leak, redo surgery, histology, tumor stage. Results: The rate of complete postoperative cycles obtained from logistic regression analysis, were substantially higher after VATS lobectomies [n = 26 (83.87%)] compared to open procedures [n = 27 (65.85%)]; (p = 0.092; OR = 0.356), without significance. Multivariate analysis (open/VATS lobectomy, upper/middle-lower lobe resection, diabetes, prolonged air leak, postoperative fever) showed significantly increased successful uptake of complete cycles after VATS (p = 0.0495), while upper/middle lobe resections (p = 0.0678) and the lack of diabetes (p = 0.0971) notably increased the number of complete cycles, without significance. Conclusion: Twenty-six percent of patients were unable to receive complete planned postoperative chemotherapy. VATS lobectomy patients received significantly higher number of complete cycles of postoperative chemotherapy. Diabetes and lower lobe lobectomies had a negative effect on the tolerability of postoperative chemotherapy. Orv Hetil. 2018; 159(19): 748–755.
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Affiliation(s)
- Aurél Ottlakán
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - Balázs Pécsy
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - Edit Csada
- Csongrád Megyei Mellkasi Betegségek Szakkórháza Deszk
| | - Gábor Ádám
- Csongrád Megyei Mellkasi Betegségek Szakkórháza Deszk
| | - Anikó Maráz
- Onkológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Bernadett Borda
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - György Lázár
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
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Szabó Z, Tanczos T, Lebak G, Molnár Z, Furák J. Non-intubated anaesthetic technique in open bilobectomy in a patient with severely impaired lung function. J Thorac Dis 2018; 10:E275-E280. [PMID: 29850168 DOI: 10.21037/jtd.2018.04.80] [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: 12/25/2022]
Abstract
General anaesthesia has been the most commonly used method for almost all types of thoracic surgery. Recently, there has been a growing interest in non-intubated anaesthetic techniques. The rationale being, to prevent complications related to general anaesthesia and positive pressure ventilation such as barotrauma or ventilation-perfusion mismatch. We present a case with severely impaired forced expiration volume (26%), carbon monoxide diffusing capacity (26%) and VO2max (13.9 mL/kg/min). According to current guidelines, this patient was suitable to undergo one-lung ventilation only with high risk of morbidity and mortality. Therefore, we chose the non-intubated technique for thoracotomy. Oxygenation was satisfactory throughout, the patient remained hemodynamically stable and the operation was uneventful. Oxygen supplementation was stopped from day 2 and he was discharged on day 7. To our knowledge, this is the first case report where a planned non-intubated method was applied for thoracotomy, and our results suggest that it might be a feasible and safe approach for open thoracotomy in difficult cases where severely impaired lung function indicates that one lung ventilation may carry significant risks.
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Affiliation(s)
- Zsolt Szabó
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Tanczos
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Lebak
- Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - József Furák
- Department of Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Géczi T, Csada E, Tiszlavicz L, Lázár G, Furák J. [Changes in the clinicopathological features of surgically treated lung cancer around the millennium]. Orv Hetil 2018; 159:391-396. [PMID: 29504418 DOI: 10.1556/650.2018.30964] [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 Lung cancer is the most common malignant tumor in Europe and Hungary. In 2010, 10 557 new cases were registered in Hungary; 80-85% of these cases were associated with smoking. AIM In our work we analyzed the data of lung cancer patients of the last 15 years retrospectively. METHOD We examined the demographic characteristics, the histological type, the stage of the lung cancer, the type of the surgical procedure used, other supplemental treatment and survival retrospectively. RESULTS Lung cancer has occurred 50 per cent more often among females in the last decade. This growth is due to the increase of adenocarcinoma cases. Thanks to the improving diagnostic modalities and the routine follow-up of oncological patients, the number of I/A cases has been doubled recently and the preoperative staging and physical condition check-up have become more accurate. Neoadjuvant treatment has been introduced, the proportion of sublobar resections has risen, the ratio of pneumonectomy and sleeve lobectomy has become equal, so many previously unresectable cases turned to be resectable and the tolerance of adjuvant therapy has also improved. Videothoracoscopic lobectomy has become an everyday practice, leading to a decrease in the operative stress on patients. CONCLUSION In spite of this development, the five-year survival has not changed significantly, staying around 50%. Orv Hetil. 2018; 159(10): 391-396.
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Affiliation(s)
- Tibor Géczi
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - Edit Csada
- Csongrád Megyei Mellkasi Betegségek Szakkórháza Deszk
| | - László Tiszlavicz
- Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - György Lázár
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Semmelweis u. 8., 6720
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Zombori T, Furák J, Nyári T, Cserni G, Tiszlavicz L. Evaluation of grading systems in stage I lung adenocarcinomas: a retrospective cohort study. J Clin Pathol 2017; 71:135-140. [PMID: 28747392 DOI: 10.1136/jclinpath-2016-204302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Received: 12/22/2016] [Revised: 05/23/2017] [Accepted: 06/12/2017] [Indexed: 01/03/2023]
Abstract
AIMS There is no internationally accepted grading system for lung adenocarcinoma despite the new WHO classification. The architectural grade, the Kadota grade and the Sica score were evaluated and compared with overall (OS) and disease-free survival (DFS). METHODS Comprehensive histological subtyping was used in a series of resected stage I lung adenocarcinoma to identify subtypes of adenocarcinomas, the architectural grade, the Kadota grade, the Sica grade, the mitotic count, nuclear atypia, the presence of lymphovascular, vascular and airway propagation, necrosis, and micropapillary or solid growth pattern in any percentage. Statistical models fitted included Kaplan-Meier estimates and Cox proportional hazard regression models. RESULTS 261 stage I adenocarcinomas were included. The 5-year survivals of different subtypes were as follows: lepidic (n=40, OS: 92.5%; DFS 91.6%), acinar (n=54, OS: 81.8%; DFS: 68.6%), papillary (n=49, OS: 73.6%; DFS: 61.0%), solid (n=95, OS: 64.7%; DFS: 57.8%) and micropapillary (n=23, OS: 34.8%; DFS: 33.5%). Concerning the architectural grade, there were significant differences between OS and DFS of low and intermediate (pOS=0.005, pDFS<0.001), low and high (pOS<0.001, pDFS<0.001) and intermediate and high grades (pOS=0.002, pDFS<0.001). Low-grade and intermediate grade tumours did not differ in survival according to Kadota grade and Sica grade. In the multivariable model, architectural grade was found to be an independent prognostic marker. In another model, architectural pattern proved to be superior to architectural grade. CONCLUSIONS Of the three grading systems compared, the architectural grade makes the best distinction between the outcome of low-grade, intermediate-grade and high-grade stage I adenocarcinomas.
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Affiliation(s)
- Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, University of Szeged, Szeged, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Szeged, Hungary
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Zombori T, Tóth N, Furák J, Berényi Z, Tiszlavicz L. [Tumor of posterior mediastinum - rare case of extramedullar myelolipoma]. Magy Seb 2017; 70:74-77. [PMID: 28294675 DOI: 10.1556/1046.70.2017.1.11] [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
CASE REPORT A 71-year-old male with acute exacerbation of chronic bronchitis was treated in summer of 2015. The CT scan has revealed a mass on the right side of 11th thoracic vertebra in the adipose tissue with a sharp edge towards the lung and containing a small amount of contrast agent. The radiologist recommended histological sampling of the mass. The tumor was removed by Video-Assisted Thoracic Surgery (VATS) in August of 2015. The patient was discharged on the fifth postoperative day without complication. Myelolipoma was diagnosed by histological examination. Recurrence was not detected during the one-year-follow-up period. DISCUSSION Myelolipoma is a benign tumor consisting of mature lobulated adipose tissue and hemopoetic bone marrow. It arises mainly from the adrenal gland. Surgical resection is recommended due to the potential of progressive enlargement. Although the extraadrenal myelolipoma is an uncommon entity, in case of mediastinal, encapsulated, slow-growing tumor, myelolipoma should be considered as a differential diagnosis.
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Affiliation(s)
- Tamás Zombori
- Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6725 Szeged, Állomás u. 1
| | - Noémi Tóth
- Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6725 Szeged, Állomás u. 1
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Zsolt Berényi
- Radiológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - László Tiszlavicz
- Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6725 Szeged, Állomás u. 1
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Moldvay J, Fabian K, Jäckel M, Németh Z, Bogos K, Furák J, Tiszlavicz L, Fillinger J, Schaff Z, Dome B. P2.01-039 Prognostic Significance of Claudin Protein Expression in Histological Subtypes of Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1091] [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: 11/29/2022]
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Fabian K, Gyulai M, Furák J, Várallyay P, Jäckel M, Bogos K, Dome B, Pápay J, Tímár J, Szallasi Z, Moldvay J. P2.03b-005 Correlation between Primary Tumor Location and Brain Metastasis Development or Peritumoral Brain Edema in Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1286] [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: 11/29/2022]
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Moldvay J, Fábián K, Jäckel M, Németh Z, Bogos K, Furák J, Tiszlavicz L, Fillinger J, Döme B, Schaff Z. Claudin-1 Protein Expression Is a Good Prognostic Factor in Non-Small Cell Lung Cancer, but only in Squamous Cell Carcinoma Cases. Pathol Oncol Res 2016; 23:151-156. [PMID: 27687058 DOI: 10.1007/s12253-016-0115-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 08/05/2015] [Accepted: 09/09/2016] [Indexed: 01/15/2023]
Abstract
The aim of the study was to investigate the correlation between claudin (CLDN) protein expression and clinicopathological parameters as well as survival in histological subtypes of non-small cell lung cancer. Archived surgical resection specimens of 137 pathologic stage I primary bronchial cancers including 49 adenocarcinomas of non-lepidic variants (ADC), 46 adenocarcinomas of lepidic variants (L-ADC), and 42 squamous cell carcinomas (SCC) were examined. Immunohistochemistry (IHC) using antibodies against CLDN1,-2,-3,-4,-7 proteins as well as semiquantitative estimation (IHC scores 0-5) were performed. Claudin IHC scores of L-ADC differed significantly from ADC (CLDN1: p = 0.009, CLDN2: p = 0.005, CLDN3: p = 0.004, CLDN4: p = 0.001, CLDN7: p < 0.001, respectively) and SCC (CLDN1: p < 0.001, CLDN3: p < 0.001, CLDN7: p < 0.001, respectively). Highly significant CLDN3-CLDN4 parallel expression could be demonstrated in ADC and L-ADC (p < 0.001 in both), which was not observed in SCC (p = 0.131). ADC and SCC showed no correlation with smoking, whereas in case of L-ADC heavier smoking correlated with higher CLDN3 expression (p = 0.020). Regarding claudin expression and survival, in SCC significant correlation could be demonstrated between CLDN1 IHC positivity and better survival (p = 0.038). In NSCLC as a whole, high CLDN2 expression proved to be a better prognostic factor when compared with cases where CLDN2 IHC score was 0-1 vs. 2-5 (p = 0.009), however, when analyzed separately, none of the histological subgroups showed correlation between CLDN2 expression and overall survival. The claudin expression pattern was significantly different not only between the SCC-ADC and SCC-L-ADC but also between the L-ADC and ADC histological subgroups, which strongly underlines that L-ADC represents a distinct entity within the ADC group. CLDN1 overexpression is a good prognostic factor in NSCLC, but only in the SCC subgroup.
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Affiliation(s)
- Judit Moldvay
- National Korányi Institute of Pulmonology, Pihenő u. 1, Budapest, H-1122, Hungary. .,Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Ráth György u. 7-9, Budapest, H-1122, Hungary.
| | - Katalin Fábián
- Department of Pulmonology, Semmelweis University, Diósárok u. 1/c, Budapest, H-1125, Hungary
| | - Márta Jäckel
- Department of Pathology, Military Hospital, Róbert Károly krt. 44, Budapest, H-1134, Hungary
| | - Zsuzsanna Németh
- Centre for Cancer Research and Cell Biology, Queen's University, 97 Lisburn Road, Belfast, BT9 7AE, Ireland
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Pihenő u. 1, Budapest, H-1122, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Szőkefalvi-Nagy u. 6, Szeged, H-6720, Hungary
| | - László Tiszlavicz
- Department of Pathology, University of Szeged, Állomás u. 2, Szeged, 6720, Hungary
| | - János Fillinger
- Department of Pathology, National Institute of Oncology, Ráth György u. 7-9, Budapest, H-1122, Hungary
| | - Balázs Döme
- National Korányi Institute of Pulmonology, Pihenő u. 1, Budapest, H-1122, Hungary.,Department of Thoracic Surgery, National Institute of Oncology-Semmelweis University, Ráth György u. 7-9, Budapest, H-1122, Hungary.,Division of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23,, 1090, Vienna, Austria
| | - Zsuzsa Schaff
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
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Furák J, Pécsy B, Ottlakán A, Németh T, Géczi T, Tiszlavicz L, Lakatos A, Lázár G. [Results of the video-assisted thoracic surgery lobectomy at our department in the last five-year periode]. Magy Seb 2016; 69:100-4. [PMID: 27644925 DOI: 10.1556/1046.69.2016.3.2] [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
OBJECTIVES Herein we present the results of lobectomies performed with minimally invasive approach (video-assisted thoracic surgery - VATS) at our department during a period of five years. METHODS Between 1 January 2011 and 31 December 2015, 197 lobectomies (malignant lesions: 176 cases, benign lesions: 21 cases) were performed by three thoracic surgeons and one resident. Demographical data are as follows: 119 female/78 male, mean age: 62.4 years (range: 41-82 years). In 2011 three VATS lobectomies were performed, equaling 2.2 % of all lobectomies in that year. During the upcomig years the number of VATS lobectomies were as follows: 2012: 7 (7.3%), 2013: 13 (12%), 2014: 59 (34.5%) and 2015: 119 (68.5%). In 153 cases multiportal (78%) and in 44 cases uniportal (22%) anterior approach was performed. The resected lobes showed the following distribution: right upper: 85, mid lobe: 5, right lower: 28, left upper: 44, left lower: 34, upper bilobectomy: 1. In two cases sleeve lobectomy was performed. In 8 cases (4%) conversion to thoracotomy was needed and among the 46 uniportal procedures, 5 cases needed to be expanded into biportal approach (11%). RESULTS During the study period, no intraoperative, or perioperative mortality occured. Mean operative time was 123 minutes (range: 60-135 minutes) and mean time of chest drainage was 4.3 days (range: 1-27 days). Air leakage lasting more than 7 days was present in 11.7%. Reoperation was needed in 4 cases (2%), in two cases due to bleeding, and in two cases because of expansive difficulties due to extended subcutaneous emphysema. Among the 176 VATS lobectomies performed due to malignant lesions, 169 lung cancers and 7 metastases were removed. The distribution according to the stage and histology of lung cancers was as follows: IA: 100 cases, IB: 28 cases, IIA: 17 cases, IIB: 3 cases, IIIA: 16 cases, IIIB: 1 case, and IV: 4 cases; adenocarcinoma: 128 cases, squamous cell carcinoma: 26 cases, large cell carcinoma: 3 cases, small cell lung cancer: 1 case, typical carcinoid: 10 cases, and atypical carcinoid: 1 case. CONCLUSIONS Over the years VATS lobectomy became a rutin procedure at our institution. Nowadays more than two-thirds of lobectomies are performed with minimally invasive technique. Taking the learning curve of the four thoracic surgeons into consideration, our results correlate with international data.
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Affiliation(s)
- József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem 6721 Szeged, Szőkefalvi-Nagy Gyula u. 6
| | - Balázs Pécsy
- Sebészeti Klinika, Szegedi Tudományegyetem 6721 Szeged, Szőkefalvi-Nagy Gyula u. 6
| | - Aurél Ottlakán
- Sebészeti Klinika, Szegedi Tudományegyetem 6721 Szeged, Szőkefalvi-Nagy Gyula u. 6
| | - Tibor Németh
- Sebészeti Klinika, Szegedi Tudományegyetem 6721 Szeged, Szőkefalvi-Nagy Gyula u. 6
| | - Tibor Géczi
- Sebészeti Klinika, Szegedi Tudományegyetem 6721 Szeged, Szőkefalvi-Nagy Gyula u. 6
| | | | - Anna Lakatos
- Tüdőgyógyászati Tanszék, Szegedi Tudományegyetem Szeged
| | - György Lázár
- Sebészeti Klinika, Szegedi Tudományegyetem 6721 Szeged, Szőkefalvi-Nagy Gyula u. 6
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Zombori T, Tiszlavicz L, Ottlakan A, Pécsy B, Furák J, Géczi T. P-201MICROPAPILLARY CARCINOMA: THE WORST PROGNOSIS AMONG STAGE IA LUNG ADENOCARCINOMAS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.199] [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: 11/12/2022] Open
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40
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Fábián K, Gyulai M, Furák J, Várallyay P, Jäckel M, Bogos K, Döme B, Pápay J, Tímár J, Szállási Z, Moldvay J. Significance of Primary Tumor Location and Histology for Brain Metastasis Development and Peritumoral Brain Edema in Lung Cancer. Oncology 2016; 91:237-242. [DOI: 10.1159/000447517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/03/2016] [Indexed: 11/19/2022]
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Ottlakán A, Géczi T, Pécsy B, Borda B, Lantos J, Lázár G, Tiszlavicz L, Klivényi P, Furák J. [In Process Citation]. Magy Seb 2015; 68:219-24. [PMID: 26654355 DOI: 10.1556/1046.68.2015.6.1] [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
OBJECTIVES Different methods of open or minimally invasive thymectomies have been recommended for the treatment of myasthenia gravis (MG). We compared the results of standard transsternal thymectomy (TS) and two different types of minimally invasive thymectomies [video-assisted thoracoscopic extended thymectomy (VATET) and classic Video-Assisted Thoracoscopic Surgery (cVATS)] performed at the same department. METHODS During three different time periods 71 patients (60 female and 11 male; mean age 31 [range, 14-84] years) underwent thymectomy for MG. Twenty-three underwent standard transsternal thymectomy (January 1995 - September 2004), 22 VATET (September 2004 - August 2009), and 26 cVATS (September 2009 - December 2011) thymectomy for the right side. Operative data, MG- and surgery-related postoperative morbidity and early improvement of MG during the initial 1-year follow-up period were compared among the three methods. RESULTS There were no perioperative deaths during the study period. Operative time was 112, 211, and 116 minutes (p = 0.001) in the TS, VATET and cVATS, respectively, and the length of hospital stay was 8.9, 5.6, and 4.0 (p = 0.001) days. Postoperative MG-related neurological morbidity affected 21.7%, 18.2%, and 7.7% (p = 0.365) of the patients and the surgery-related morbidity rate was 4.3%, 13.7%, and 0% (p = 0.118) in the TS, VATET and cVATS groups, respectively. Symptom improvement rates were 91.3%, 94.7%, and 87.5% (p = 0.712), and complete remission rates were 13%, 10.5%, and 11.5% (p = 0.917) after TS, VATET and cVATS thymectomies, respectively. CONCLUSIONS In terms of operative time and hospital stay the best results were found after cVATS. The use of a less invasive surgical intervention resulted in less surgical-, and MG related neurological complications. The improvement of MG symptoms was excellent and results were similar after different types of thymectomies.
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Affiliation(s)
- Aurél Ottlakán
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6720 Szeged, Szőkefalvi-Nagy Béla u. 6
| | - Tibor Géczi
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6720 Szeged, Szőkefalvi-Nagy Béla u. 6
| | - Balázs Pécsy
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6720 Szeged, Szőkefalvi-Nagy Béla u. 6
| | - Bernadett Borda
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6720 Szeged, Szőkefalvi-Nagy Béla u. 6
| | - Judit Lantos
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6720 Szeged, Szőkefalvi-Nagy Béla u. 6
| | - György Lázár
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6720 Szeged, Szőkefalvi-Nagy Béla u. 6
| | - László Tiszlavicz
- Patológiai Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Péter Klivényi
- Neurológiai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - József Furák
- Sebészeti Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar 6720 Szeged, Szőkefalvi-Nagy Béla u. 6
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Abstract
OBJECTIVES The 'gold standard' practice following insertion of a chest tube after lobectomy is daily chest radiography (CXR), but this is not always followed. We compared the outcomes associated with the use of these two methods in our practice. METHODS Data from 148 patients who underwent uncomplicated lobectomies with insertion of one chest drain were analysed. In the routine CXR group (R-CXR) (50 patients), an immediate postoperative CXR, daily routine radiography during the drainage period, and one after surgical drain removal were performed. In the symptomatic CXR group (S-CXR) (98 patients), a CXR was performed only for symptomatic patients (fever, hypoxia, subcutaneous emphysema, air leak) and/or a single radiograph was taken after surgical drain removal. The following postoperative data were compared: fever, CXR abnormalities (pneumothorax, fluid, atelectasis, subcutaneous emphysema, haematoma), number of radiographs, drainage time, and new drain insertion. RESULTS The mean chest tube duration was 3.7 and 3.8 days in the R-CXR and S-CXR groups, respectively. Abnormal CXRs after surgical drain removal were reported in 50% (25/50) and 46.9% (46/96) (p = 0.724) of patients in the R-CXR and S-CXR groups, respectively, but new drain insertion was only necessary in 3/25 (12%) and 7/46 (15.2%) of these cases. The mean number of CXRs for each patient was 5.0 and 2.3 (p = 0.0001) in the R-CXR and S-CXR groups, respectively. CONCLUSIONS If CXRs are limited to symptomatic patients then the number of radiographs can be reduced by around 50%. There were no more postoperative complications or abnormal final CXR findings if the CXR was only ordered for symptomatic patients instead of as 'daily routine' during the postoperative period. Only 12-15% of the CXR abnormalities required surgical intervention.
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Affiliation(s)
- József Furák
- Szegedi Tudományegyetem Sebészeti Klinika 6701 Szeged Szőkefalvi-Nagy Béla u. 6
| | - Tibor Géczi
- Szegedi Tudományegyetem Sebészeti Klinika 6701 Szeged Szőkefalvi-Nagy Béla u. 6
| | - Balázs Pécsy
- Szegedi Tudományegyetem Sebészeti Klinika 6701 Szeged Szőkefalvi-Nagy Béla u. 6
| | - Zita Morvay
- Szegedi Tudományegyetem Radiológiai Klinika Szeged
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Fábián K, Németh Z, Furák J, Tiszlavicz L, Pápay J, Krenács T, Tímár J, Moldvay J. Protein expression differences between lung adenocarcinoma and squamous cell carcinoma with brain metastasis. Anticancer Res 2014; 34:5593-5597. [PMID: 25275061] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM We investigated tissue biomarkers in non-small cell lung cancer (NSCLC) to find indicators of brain metastasis and peritumoral brain edema. PATIENTS AND METHODS Fifty-two cases were studied out of which 26 had corresponding brain metastatic tissue. Clinicopathological characteristics of tumors were correlated with biomarkers of cell adhesion, cell growth, cell cycle and apoptosis regulation that were previously immunohistochemically studied but never analyzed separately according to histological subgroups, gender and smoking history. RESULTS Increased collagen XVII in adenocarcinoma (ADC) and increased caspase-9, CD44v6, and decreased cellular apoptosis susceptibility protein (CAS) and Ki-67 in squamous cell carcinoma (SCC) correlated significantly with brain metastasis. Increased β-catenin, E-cadherin and decreased caspase-9 expression in primary SCC, and decreased CD44v6 expression in brain metastatic SCC tissues showed a significant correlation with the extent of peritumoral brain edema. Positive correlation between smoking and biomarker expression could be observed in metastatic ADCs with p16 and caspase-8, while-negative correlation was found in SCC without brain metastasis with caspase-3, and in SCC with brain metastasis with p27. CONCLUSION Our results highlight the importance of separate analysis of biomarker expression in histological subtypes of NSCLC.
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Affiliation(s)
- Katalin Fábián
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Németh
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - József Furák
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Judit Pápay
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University of Medicine, Budapest, Hungary
| | - Tibor Krenács
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University of Medicine, Budapest, Hungary
| | - József Tímár
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Judit Moldvay
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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Furák J, Géczi T, Pécsy B, Maráz A, Morvay Z. F-062DAILY ROUTINE CHEST X-RAYS ARE NOT NECESSARY IN ASYMPTOMATIC PATIENTS WITH CHEST TUBE AFTER LOBECTOMY. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.62] [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: 11/14/2022] Open
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Maráz A, Furák J, Varga Z, Kahán Z, Tiszlavicz L, Hideghéty K. Thrombocytosis has a negative prognostic value in lung cancer. Anticancer Res 2013; 33:1725-1729. [PMID: 23564823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Solid tumours have worse prognosis when associated with thrombocytosis. Our study assessed the prognostic value of thrombocytosis, and its relation with smoking habits in lung cancer. PATIENTS AND METHODS A total of 398 patients were operated on then divided into two groups, those with normal platelet counts (n=312), and those with thrombocytosis (n=86); 348 out of 398 patients had data for smoking habits (99 non-smokers, 249 smokers). RESULTS The frequency of thrombocytosis was 18.6%, 19.3%, 27.5 and 28.6% in patients with tumor stages I to IV, respectively. Thrombocytosis appeared most frequently in patients with squamous cell lung cancer, and among smokers. The overall 5-year survival was worse in patients with thrombocytosis (p<0.001). By uni- and multivariate analyses, platelet count, and T and N status were found to be independent prognostic factors. CONCLUSION Our study indicates that the presence of perioperative thrombocytosis in patients undergoing surgery should be considered as an independent prognostic factor of poor survival, and should be taken into account in regard to therapy.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.
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Maráz A, Furák J, Varga Z, Fodor E, Együd Z, Borzási E, Kahán Z, Pálföldi R, Tiszlavicz L, Hideghéty K. Acute oesophageal toxicity related to paclitaxel-based concurrent chemoradiotherapy for non-small cell lung cancer. Anticancer Res 2013; 33:1737-1741. [PMID: 23564825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Dosimetric data and acute oesophageal toxicity (AET) during chemoradiotherapy (CRT) were evaluated in patients with non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Fifty patients were treated with paclitaxel-based conformal CRT with a mean ± SD dose of 60.7 ± 9.8 Gy. The oesophageal toxicity was prospectively registered and evaluated in relation to the maximal dose (Dmax), mean dose (D(mean)), length and volume of oesophagus irradiated with 35-60 Gy (V(35-60Gy)), and according to the seriousness of AET. RESULTS Dmax and D(mean) to the oesophagus were 57.0 ± 10.8 Gy and 24.9 ± 9.0 Gy, respectively. AET of grade 1, 2 and 3 developed in 16 (32%), 14 (28%) and three (6%) cases, respectively. The Dmax, D(mean), length and the V(35-60Gy) were all related to dysphagia (p<0.001). V(45Gy) was the most reliable predictor of AET of grade 2 or more. CONCLUSION Our results indicate that keeping oesophageal V(45Gy) below 32.5% can prevent severe AET during CRT of NSCLC.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary.
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Géczi T, Paszt A, Simonka Z, Furák J, Lázár G. [Rare complication following oesophagectomy: early peptic ulcer perforation of the tubal stomach]. Magy Seb 2011; 64:239-41. [PMID: 21997528 DOI: 10.1556/maseb.64.2011.5.4] [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: 11/19/2022]
Abstract
CASE REPORT We report the case of a 45-year-old male patient who developed an acute peptic ulcer perforation of the tubal stomach on the second postoperative day after oesophagectomy. The patient underwent emergency surgery (perforation was closed with a Graham patch) followed by treatment in intensive care, and was finally discharged on the 19th postoperative day. DISCUSSION Gastric pull-up is a surgical technique that is widely used to re-establish the continuity of the gastrointestinal tract after oesophagectomy. Various early and late complications of reconstruction with the tubal stomach are well-known, such as gastric necrosis, gastritis, gastric ulcer, as well as benign and malignant tumors. The precise etiology of gastric tube ulceration is not known yet, however, it can develop not only in the late, but also in the early postoperative period, as well.
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Affiliation(s)
- Tibor Géczi
- Szegedi Tudományegyetem Sebészeti Klinika 6720 Szeged Pécsi u. 6
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Abstract
UNLABELLED The authors discuss the management of an enormous fibrolipoma which rarely occurs in the mediastinum. A 54-year-old patient underwent an extended posterolateral thoracotomy and resection of a mass which was preoperatively diagnosed as liposarcoma. The size of the removed specimen was 42×35×23 cm and weight was 5200 g. Final histology revealed a primary mediastinal fibrolipoma. Following a long-standing lung compression, the lung has fully expanded after a temporary postoperative failure of expansion. Postoperative serial chest x-rays confirmed that the marked mediastinal midline shift gradually resolved, and the patient's complaints improved considerably, too. DISCUSSION the vast majority of tumors located in the mediastinum needs to be operated on. Surgical techniques available involve open or videothoracoscopic methods. The latter is limited though by the patient's general condition and the size of the mass needs to be resected. In cases when the tumour is deemed to be irresectable, surgical debulking and oncological adjuvant treatment can be justified to improve quality of life.
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Affiliation(s)
- Tibor Németh
- Szegedi Tudományegyetem Sebészeti Klinika 6720 Szeged Pécsi u. 6.
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Abstract
BACKGROUND The authors present the technique and results of minimally invasive thymectomy via the right chest based on their clinical practice. PATIENTS AND METHODS Between 1 June 2009 and 31 March 2011 27 patients (22 females, 5 males; mean age 35.1 [17-84] years) underwent thymectomy without sternotomy at the division of thoracic surgery of the Department of Surgery, University of Szeged. Indications were myasthenia gravis in 24 and thymoma in 3 patients. The incisions were the following: two 1.5 cm in the right breast fold and one 3 cm incisions in the axillara. There were no incisions in the neck or no sternotomy was carried out either. Preparation and removal of the thymus were performed by conventional and endoscopic instruments, and a drain was inserted into the right chest cavity up until the mediastinum. RESULTS Mean time for surgery was 119 minutes (45-285). There was no conversion and no transfusion needed. Further, there was no surgical mortality or morbidity detected. Mean time for chest drain removal was 2.05 (1-3) days, and mean length of hospital stay was 4.56 (4-7) days. Two patients were admitted to the intensive care unit for myasthenia symptoms. Importantly, myasthenia gravis improved in 91.6% of the patients. CONCLUSIONS Minimally invasive thymectomy is a safe procedure with excellent cosmetic results. Improvement in myasthenia gravis was similar to published literature data.
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Affiliation(s)
- József Furák
- Szegedi Tudományegyetem Sebészeti Klinika 6701 Szeged Pécsi u. 6
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Moldvay J, Pápay J, Puskás R, Furák J, Losonczy G, Matolcsy A. [Examination of ERCC1 expression in lung cancer patients treated with platinum-based chemotherapy]. Magy Onkol 2011; 55:105-109. [PMID: 21655476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 02/07/2011] [Indexed: 05/30/2023]
Abstract
Platinum-based chemotherapies are widely used in the treatment of lung cancer. However, little is known about their effect in the expression of certain tissue biomarkers. We have studied the ERCC1 (excision repair cross-complementation group 1) expression in tissue samples of patients treated with neoadjuvant chemotherapy. Fifty lung cancer tissue blocks of 25 patients (15 males, 10 females) were studied. They included 25 bronchoscopic biopsies (14 squamous cell carcinomas and 11 adenocarcinomas) together with their corresponding surgical biopsies after neoadjuvant chemotherapy. Immunohistochemistry was performed on formalin-fixed, paraffin-embedded tissues to study the expression of ERCC1. Staining scores (0-300) were calculated by multiplying the percentage of positive tumor cells (0-100) by the staining intensity (0-3). All but one bronchosopic squamous cell carcinoma tissues (13/14) expressed ERCC1. Four of these cases became negative after neoadjuvant therapy, and in 8 cases the level of expression decreased. In the adenocarcinoma group all but one bronchosopic tissues (10/11) expressed ERCC1. Six of these cases became negative after neoadjuvant therapy, and in 4 cases the level of expression decreased. Comparison of staining scores before and after chemotherapy revealed more pronounced decrease in adenocarcinomas and in female patients. There was no newly expressed ERCC1-positive case in the surgical biopsy group. The results of the present study suggest that platinum-based chemotherapy affects the expression of tissue biomarker (ERCC1) which may have predictive value, and probably induces a selection of tumor cells with more aggressive phenotype. This knowledge might be of importance when designing treatment protocols for non-small cell lung cancer patients.
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Affiliation(s)
- Judit Moldvay
- Pulmonológiai Klinika, Semmelweis Egyetem, Budapest, Hungary.
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