Orvosi hetilap最新文献

Introduction: Elevated serum cholesterol is a major cardiovascular risk factor. Population-level trends in total cholesterol reflect changes in lifestyle, diet, and pharmacological treatment.

Objective: To assess temporal changes in serum total cholesterol levels in the population of a South Hungarian village over a 30-year period.

Method: Serum total cholesterol was measured in Méhkerék residents in 1994 and 2014 following professional guidelines, and re-examined in 2024. Temporal trends were analyzed using multiple regression and analysis of covariance.

Results: The study included 760 individuals in 1994, 391 in 2014, and 544 in 2024. Due to changes in age and sex composition, analyses were standardized for 40-, 50-, and 70-year-old men and women. Among 40-year-old women, cholesterol decreased by 3% from 1994 to 2024, and by 10% and 25% among 50- and 70-year-olds, respectively. In men, the corresponding reductions were 11%, 17%, and 28%. No significant difference was found between 1994 and 2014 (p = 0.117), but the decline became significant by 2024 (p<0.001). Cholesterol levels were significantly associated with sex (p = 0.005) and age (p<0.001), and a time × age interaction indicated a more pronounced decline in older participants.

Conclusion: According to a detailed review of the available literature, this is the first comprehensive epidemiological study conducted on a Hungarian population over a 30-year period, which follows the serum total cholesterol levels of the entire population of a settlement. The significant long-term reduction likely reflects combined effects of medical therapy and lifestyle improvements. These findings emphasize the preventive role of general practice and the need for more focused cardiovascular prevention among younger individuals and women. Orv Hetil. 2026; 167(1): 9-15.

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but potentially curable form of pulmonary hypertension. Pathology is characterized by persistent, organized thrombi causing mechanical vascular obstruction, often accompanied by a small-vessel vasculopathy. In 2023, balloon pulmonary angioplasty (BPA) was introduced in our institution as a new treatment option for managing CTEPH.

Objective: To present the initial clinical and hemodynamic outcomes of BPA interventions launched as part of the complete CTEPH program established at Gottsegen György National Cardiovascular Center.

Method: In this retrospective study, we analyzed 38 inoperable patients diagnosed with CTEPH who underwent at least one BPA procedure between 2023 and 2024. Diagnosis was established according to the national guidelines. During BPA, balloon dilation was performed on stenosed or occluded segmental and subsegmental pulmonary arteries. The therapeutic efficacy was evaluated using echocardiographic, functional, laboratory, and hemodynamic parameters.

Results: The majority of CTEPH patients were categorized within WHO functional class II and III. A total of 119 BPA sessions were performed in 38 patients. At the time of data analysis, the majority of patients (81.5%) had not yet completed their full BPA treatment course. In patients treated with BPA, TAPSE/SPAP ratio improved significantly from 0.3 ± 0.03 to 0.4 ± 0.05 mm/mmHg (p<0.05). A trend towards improvement was also observed in the 6-minute walk distance and NT-proBNP levels (409 ± 28 vs. 418 ± 32 m, p = 0.07; 2984 ± 1083 vs. 1168 ± 279 pg/mL, p = 0.05, respectiveli). BPA treatment led to significant reductions in mean pulmonary artery pressure (40 ± 2.3 vs. 35 ± 2.1 mmHg, p<0.05), mean right atrial pressure (9.4 ± 1.0 vs. 6.2 ± 0.8 mmHg, p<0.05), and pulmonary vascular resistance (PVR [based on thermodilution]: 7.1 ± 0.8 vs. 5.5 ± 0.5 WU, p<0.05). No periprocedural mortality occurred, and major complications were observed in only 1.7% of sessions.

Conclusion: BPA appears to be a safe and effective alternative therapy for CTEPH patients, providing notable hemodynamic improvement. The initial results of our program are promising for the future of CTEPH management in Hungary. Orv Hetil. 2026; 167(1): 23-29.

A case of thyrotoxicosis-induced pericarditis and pleuritis is presented, detailing the potential pitfalls of diagnosis and therapy. The authors wish to draw attention to the fact that this thyroid disease should also be considered in cases of acute pericarditis, so that cause-related treatment can be initiated as soon as possible. Orv Hetil. 2026; 167(1): 37-40.

Objective: The aim of this study was to investigate whether using radial access for coronary chronic total occlusion recanalization is effective and safe.

Method: We enrolled 308 patients with chronic total coronary occlusion in our prospective study, between 2016 and 2019, in two cardiovascular centers. We included all transradial chronic total coronary occlusion percutan coronary interventions performed and all transfemoral cases were excluded from the study. A successful procedure was defined as recanalization of the target artery to <50% stenosis with successful stenting. We have investigated the procedural success rate, major adverse cardiac and cerebral events ratio, vascular complication rate, and the procedure related factors.

Results: During the 3-year period, we enrolled 272 cases with complex transradial chronic total occlusion percutan coronary intervention. The average age was 73 ± 9 years, and 74% were men. The procedural success was 83.4%, while the technical success was 64.7%. The 1-year rate of major adverse cardiac and cerebral events ratio was 15.6%. The rate vascular access complications was 2.57%. Procedural complications were observed in 4.78%. In 1.8% of cases, it was necessary to convert from transradial to transfemoral access during the procedure due to technical reasons. The rate of vascular access complications was 2.57%. The average contrast consumption was 178.1 ml (176-211), the average procedure time 52.3 min (51.3-66.2), the radiation 2140 mGy (2110-2998).

Conclusion: Transradial access for chronic total occlusion recanalization is safe and effective and it is also associated with acceptable amount of access site complication rate. Orv Hetil. 2026; 167(1): 16-22.

Introduction: Mechanical circulatory support devices play a key role in stabilizing patients with end-stage heart failure and preparing them for heart transplantation. These devices significantly reduce waitlist mortality, especially in the pediatric population, where donor shortage and treatment challenges pose major difficulties.

Objective: The aim of our study was to summarize domestic experiences with long-term mechanical circulatory support in pediatric patients and compare our outcomes with international data.

Method: We retrospectively analyzed data from 27 pediatric patients implanted with ventricular assist devices between 2008 and 2025. The patients were categorized into pulsatile and continuous-flow device groups. Anthropometric data, clinical status (INTERMACS profiles), organ perfusion, perioperative parameters, and long-term outcomes were evaluated.

Results: The mean age of the 27 children was 9.14 years, with an average weight of 36.6 kg and an average height of 130 cm. The average duration of mechanical support was 217 days, significantly shorter in the pulsatile group compared to the continuous-flow group (141 vs. 312 days, p = 0.009). The pulsatile group consisted of younger and smaller patients (5.3 vs. 13.9 years, p<0,001; 21 vs. 56 kg, p<0.001). More than 70% of the patients were successfully bridged to transplantation, with rates of 66% in the pulsatile and 83% in the continuous-flow groups. Continuous-flow devices were associated with fewer complications (33% vs. 60%), and less need for intensive care ventilatory support (6 vs. 20 days). No significant differences were found in organ perfusion and immunological sensitization between the groups. Post-transplant rejection rates were low and similar in both groups.

Discussion: Mechanical circulatory support represents a significant advancement in the care for advanced heart failure children. Continuous-flow devices show a more favorable complication profile. However, significant risks remain in lower-weight patients (e.g., under 1 year of age), reflecting current technological and protocol limitations.

Conclusion: The domestic use of mechanical circulatory support in pediatric patients is effective and enables successful transplantation. Continuous-flow devices offer advantages due to lower complication rates and feasibility of outpatient care. Larger prospective studies are needed to further improve outcomes. Orv Hetil. 2026; 167(1): 30-36.

Introduction: Sentinel lymph node biopsy is the standard procedure in the treatment of breast cancer. After neodjuvant therapy, patients with initially positive axillary nodes (cN1) may convert to clinically negative status (ycN0). In these cases, the use of sentinel lymph node biopsy alone may be questionable due to its relatively high false-negative rate exceeding 10%.

Objective: To observe whether targeted axillary dissection combining with biopsy of a previously marked lymph node, offers a potential solution.

Method: Between June 20, 2023 and November 6, 2024, SAVI SCOUT® radar reflector localization was used in 18 breast cancer patients with cT1-cT2cN1cM0 status. Sentinel lymph node biopsy was performed using dual tracers, while marked lymph node biopsy was guided by the SAVI SCOUT® system. If conversion from cN1 to ycN0 was confirmed after neoadjuvant therapy, targeted axillary dissection was performed. When no metastasis was detected in the excised lymph nodes, no further axillary surgery was carried out; if micrometastasis or macrometastasis was confirmed histologically, axillary lymph node dissection followed.

Results: Before neoadjuvant therapy, 18 patients had metastatic axillary lymph nodes marked. Surgery has been completed in 10 patients. In 1 case, cN1 status persisted after neoadjuvant treatment, leading to axillary lymph node dissection. In 9 patients, conversion from cN1 to ycN0 occurred, and targeted axillary dissection was performed. The marked lymph node was successfully identified in all cases. In 4 cases, axillary lymph node dissection was avoided, and 2 patients achieved a pathological complete response. In the remaining 5 cases, micro- or macrometastases were detected, necessitating axillary lymph node dissection. No targeted axillary dissection-related complications occurred.

Conclusion: The SAVI SCOUT® radar reflector localization technique proved to be a safe and feasible method, allowing for the precise removal of metastatic lymph nodes marked prior to neoadjuvant treatment. Targeted axillary dissection was found to be an accurate and reliable staging procedure that may help avoid axillary lymph node dissection and reduce surgical morbidity. Orv Hetil. 2026; 167(1): 2-8.

The pregnancy and postpartum period represent a critical phase of physiological adaptation for the female body, requiring significant adjustments to support maternal and fetal health. Appropriately designed and implemented physical activity during this time is not only safe but also essential for reducing health risks and maintaining overall well-being. In the first trimester, hormonal changes and early symptoms may limit activity, while the relative stability of the second trimester provides an opportunity to sustain or introduce exercise programs. In the third trimester, adaptations to exercise intensity and type are necessary due to the growing fetus and maternal physiological changes. In the postpartum period, gradually reintroduced physical activity promotes recovery, reduces risks of complications such as thrombosis and depression, and improves the quality of life. For elite athletes, pregnancy and the postpartum period present unique challenges, necessitating carefully planned and monitored training regimens. This review highlights current scientific recommendations for physical activity during the trimesters of pregnancy and the postpartum period, emphasizing the importance of individualized exercise programs. Special attention is given to the specific needs of elite athletes and strategies for managing the challenges of competitive sports during pregnancy. Orv Hetil 2025; 166(52): 2055-2063.

The authors report the case of a patient diagnosed and treated with schizophrenia for nearly 20 years. A rapid change in the neurological status of the patient necessitated a diagnostic revision. The patient's additional medical history included narcolepsy and psoriasis. With a stable maintenance antipsychotic combination regime, one and a half years after the last inpatient treatment for a psychotic relapse, initially mild lower limb hyperkinesis developed. At first, this hyperkinesis was hypothesized to be antipsychotic side effects. The decrease of the antipsychotic daily dose resulted in no improvement of the motor symptoms. On the contrary, the generalization of the hyperkinesis and rapid progression of the motoric status were observed. Therefore, further neurological investigation was initiated. Finally, genetic testing confirmed Huntington's disease. The neuropsychological examination at the time of the diagnosis could not confirm major cognitive impairment, however, alterations in a number of cognitive domains were present. During the follow-up period, and by use of the combination of a low-dose partial dopamine receptor agonist and clozapine, no psychotic relapse was detected. The cognitive status exhibited a mild deterioration compared to baseline. In line with the prognosis of Huntington's disease, the motor symptoms slightly progressed despite the pharmacotherapy. We present our case in the context of a literature review. Orv Hetil. 2025; 166(52): 2064-2072.

The genotype of our cells is almost the same for all cells in our body, but due to epigenetic effects, their phenotype can show significant differences. Epigenetics is a relatively new field of molecular biology that deals with the changes affecting the heritable phenotype, gene expression and gene activity in addition to the given genotype. The gene expression of immune and tumor cells is regulated by epigenetic processes. These processes can enhance the immune system evasion mechanisms of various tumor cells, while the results of other processes can actually help the immune system function. Our paper explores the epigenetic aspects of gynecological tumors through a thorough review of the Hungarian and international literature, with particular attention to the tumor processes of the cervix, uterus, ovary and breast. It also affects gestational tumors. It discusses the epigenetics of endometriosis, which does not belong to the group of classic tumor diseases, but in terms of its pathomechanism shows many similarities with other tumors. Finally, the paper discusses new findings in epigenetic medicine and therapy. Orv Hetil. 2025; 166(52): 2043-2054.