Orvosi hetilap最新文献

Congenital epulis is a rare, benign, neonatal tumor in the oral cavity. Its size can reach several centimeters, posing an obstruction to breathing and feeding. Prenatal diagnosis provides an opportunity to adequately prepare for delivery, including securing the airway, or even ex utero intrapartum treatment. The authors present the case of a newborn girl, whose postnatally discovered lesions suggested congenital epulis. The operation took place a few hours after birth, the histological examination of the excised tumor concluded the presumed diagnosis. Since its first description in 1871, less than 250 publications of congenital epulis have been reported. This is the first case report in Hungarian on the topic. The authors' goal is to exhibit this rare entity and raise awareness of questions that might arise during medical care. Orv Hetil. 2026; 167(6): 243-246.

Introduction: Using Global Burden of Disease 2023 data, this study examines the structure of health losses in Hungary, focusing on diseases, risk factors, and international comparisons.

Objective: To identify which diseases and risk factors contribute most to Hungary's health burden, how these relate to disability and premature mortality, and how patterns differ by gender and in comparison, with Central European countries.

Method: Age-standardized values per 100,000 inhabitants, broken down by gender and disease/risk category, were analyzed for Hungary and compared with Austria, the Czech Republic, Poland, and Slovakia.

Results: Cardiovascular diseases, cancers, and musculoskeletal disorders caused the largest losses. High blood pressure was the leading risk factor. Premature mortality was substantially higher in Hungary; men showed especially elevated levels due to smoking, diet, and hypertension. Morbidity-related losses were dominated by musculoskeletal and mental disorders.

Discussion: Hungary's burden stems not only from mortality but also from chronic disabling conditions. The mortality component is particularly unfavourable in international comparison.

Conclusion: Improving treatment quality, timely care, and early diagnosis is essential, while reducing morbidity requires stronger long-term care and rehabilitation. Effective policy should complement lifestyle-focused prevention with better access to high-quality curative care and gender-responsive interventions. Consistent use of objective burden-of-disease data can support decision-making. A systemic approach - combining prevention, supportive environments, and a strengthened healthcare system - is needed to reduce health losses in Hungary. Orv Hetil. 2026; 167(6): 232-242.

Despite advances in modern medicine, classic laboratory parameters are still crucial pillars of clinical decision-making. The report focuses on four routinely measured analytes: serum creatinine levels, liver transaminase activities and albumin levels. In 2024, these accounted for more than 15% of laboratory determinations in Hungary. Laboratories measure serum creatinine levels using two methods: the Jaffé or the enzymatic method. Although both are suitable for estimating the glomerular filtration rate (GFR), the results may differ by 5-14% from each other. According to the professional opinion, both methods can be used, but they should be indicated on the report. The presence of pyridoxal phosphate (vitamin B6) in the reagent is critical for the determination of transaminase activities (GOT/AST, GPT/ALT). In its absence, the measured values may be 15-30% lower, which may lead to misdiagnosis, especially when calculating the FIB4 score for estimating the severity of liver fibrosis. Therefore, the use of reagents containing pyridoxal phosphate is recommended for measuring transaminase activities. In the case of albumin determination, the use of bromocresol red reagent is recommended instead of bromocresol green, as the former gives inaccurate results in liver disease and renal failure. Method changes should be made in consultation with clinicians, and it should be noted that the LOINC codes (an international standard for parameter identification) for the tests may change. Orv Hetil. 2026; 167(6): 211-216.

Introduction: Periprosthetic joint infection is one of the most severe complications of joint arthroplasty and is often associated with considerable psychological distress.

Objective: This study aims to explore the psychological consequences of periprosthetic joint infection from a health psychology perspective.

Method: A narrative review of 23 studies published between 2003 and 2025 was conducted, focusing on the psychosocial effects of periprosthetic joint infection, including both quantitative and qualitative research.

Results: Among patients who have experienced periprosthetic joint infection, the prevalence of depression and depressive symptoms is markedly high, with approximately one-third of those undergoing revision surgery having a diagnosed depressive disorder prior to surgery. The infection and prolonged treatments impose significant psychological burden, with anxiety, fear, and uncertainty related to potential complications being common. Periprosthetic joint infection negatively affects the quality of life and functional status: most patients experience physical limitations, impaired mobility, and social isolation. Depressive and anxiety symptoms may persist for years even after successful treatment. Patients often perceive the infection as a traumatic experience, causing substantial emotional suffering and reduced quality of life, while their need for social support is heightened.

Discussion: Mental health is closely linked to physical recovery. A lack of psychological support may hinder rehabilitation, whereas targeted interventions can improve outcomes.

Conclusion: Periprosthetic joint infection constitutes a complex biopsychosocial crisis. Integrating psychological care and adopting an interdisciplinary approach are essential for complete recovery and effective patient support. Orv Hetil. 2026; 167(6): 225-231.

The success of coronary bypass surgery fundamentally depends on the proper function of the new conduits. The aim of intraoperative monitoring is to prevent early conduit occlusion and improve long-term outcomes. The 'Transit Time Flow Measurement' technique enables real-time, quantitative flow assessment, providing objective information about the hemodynamic status of the conduit. Based on the principle of ultrasonic transit time, this method allows for the determination of mean blood flow through the conduit and the pulsatility index. 'Transit Time Flow Measurement' reduces the risk of early conduit failure and supports surgical decisions, particularly with uncertain anastomoses. The most important parameters include mean flow, pulsatility index, and diastolic filling ratio, which are evaluated according to standardized thresholds. The advantages of the technique are its simplicity and rapid results, while its limitations include technical sensitivity, variability of measurement conditions, and dependence on operator experience. Comparison of the technique with other intraoperative techniques, such as angiography, highlights that although it does not replace visual inspection, it is an important adjunct tool for ensuring conduit quality. Overall, integration of 'Transit Time Flow Measurement' technique into routine surgical practice represents a significant advancement in the safety and efficacy of coronary bypass procedures. Orv Hetil. 2026; 167(6): 217-224.

Introduction: The diagnostic work-up of patients presenting to the emergency department with chest pain remains a major clinical and health-economic challenge worldwide. Although most cases are caused by benign, non-cardiopulmonary conditions, the primary goal of emergency care is the timeous, but safe exclusion of life-threatening disorders - mainly acute coronary syndrome and pulmonary embolism. Excessive diagnostic testing increases both healthcare costs and emergency department overcrowding. Preliminary observations suggest that previously unrecognized spinal asymmetry or scoliosis is more prevalent among ambulatory adults presenting with pleuritic or musculoskeletal-type chest pain, potentially predisposing to costosternal or costovertebral subluxation as a mechanical pain generator.

Objective: The planned prospective, multicenter study aims to assess the prevalence and clinical significance of spinal asymmetry among ambulatory, low-risk adults presenting with chest pain, and to develop/validate a novel musculoskeletal chest pain clinical prediction model.

Methods: Primary outcome variables include pulmonary embolism and major cardiac events (non-ST-elevation myocardial infarction, unstable angina). Based on power calculations by Peduzzi et al. (1996), a total of 2,500 patients will provide adequate statistical power to avoid Type II error. Patients will be followed up at 30, 90, and 365 days for complications, recurrent visits, major adverse cardiac events, and mortality. Data will be analyzed using bootstrapping techniques for internal validation of the derived score.

Expected results: We hypothesize that spinal asymmetry independently correlates with acute musculoskeletal chest pain but does not confer an increased risk of short- or long-term mortality. The newly developed musculoskeletal chest pain clinical prediction model may facilitate early recognition and safe management of musculoskeletal chest pain in the emergency department setting.

Conclusion: This study is expected to refine diagnostic algorithms for low-risk chest pain, reduce unnecessary investigations, improve cost-effectiveness, and enhance patient satisfaction. Orv Hetil. 2026; 167(5): 180-187.

Acute bleeding can cause severe anemia-induced type 2 myocardial infarction in those with significant prior atherosclerotic coronary disease, but not plaque rupture. The authors present four cases where coronarography is presented together with the alarming ECG abnormalities. With their cases, they draw attention that suspected anemia in combination with extensive ST depression may cause type 2 myocardial infarction. In such cases, it is recommended to wait with the otherwise justified double antiplatelet or heparin treatment. In the case of severe anemia (hemoglobin <80 g/L) and extensive ST-depression, there is almost always a small increase in the high sensitivity troponin T and creatine kinase levels. Early transfusion with the appropriate management of bleeding source usually precedes coronary intervention. In three of their cases, even the most serious ischemic ECG abnormalities disappeared or regressed as a result of the transfusion. As far as they know, the authors present pathological Q-waves disappearing for blood transfusion first. Orv Hetil. 2026; 167(5): 188-195.

Introduction: Surface-guided radiotherapy is an increasingly widely used technique that can monitor patient body surface movement in real time in a non-invasive manner.

Objective: To evaluate the setup accuracy of surface-guided radiotherapy in lung stereotactic body radiotherapy compared to conventional cone-beam CT-based positioning.

Method: A retrospective single-center analysis was performed on 12 patients treated with lung surface-guided radiotherapy between 2022 and 2025. 6 patients were positioned using surface guidance with cone beam CT verification, while 6 were treated using cone-beam CT alone. Table couch corrections in three translational (vertical, longitudinal, lateral) and three rotational axes (pitch, roll, rotation) were recorded. Group differences were analyzed using the independent-samples Mann-Whitney U-test.

Results: The resultant 3D translational displacement was significantly lower in the surface-guided group (median: 0.40 cm) compared to the control group (0.63 cm; p = 0.002). Among individual translational components, only the vertical axis showed a significant reduction in the surface-guided group (p<0.001), while longitudinal and lateral shifts did not differ significantly (p>0.05). In contrast, the resultant 3D rotational displacement was higher with surface-guided radiotherapy (median: 2.19° vs. 1.13°; p = 0.013). None of the individual rotational axes (pitch, roll, rotation) showed statistically significant differences (p>0.05).

Discussion: These findings are consistent with previous literature demonstrating that surface guidance improves translational accuracy in thoracic radiotherapy, particularly in the vertical direction. The slightly increased rotational deviations observed in the surface-guided group may be attributed to the absence of a 6D treatment couch, as the system primarily optimizes translational alignment. Given the small sample size, further multicenter studies with larger cohorts and different surface guidance platforms are warranted.

Conclusion: Surface-guided radiotherapy enhances positioning accuracy in lung sterotactic radiotherapy, mainly by reducing translational displacements. However, optimal control of rotational errors may require the integration of 6D couch capabilities or dedicated rotational correction techniques. Orv Hetil. 2026; 167(5): 171-179.