Orvosi hetilap最新文献

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.

Introduction: In cases of biochemical recurrence following radical prostatectomy, the European Association of Urology recommends PSMA PET/CT imaging, which has become increasingly available in Hungary in recent years.

Objective: Our aim was to evaluate the clinical applicability of 18F-JK-PSMA-7, a fluorine-18-labeled radiopharmaceutical suitable for routine use, in the detection of recurrent prostate cancer in patients presenting with biochemical recurrence.

Method: We retrospectively analyzed 67 patients who underwent 18F-JK-PSMA-7 PET/CT due to rising PSA levels (>0.2 ng/ml) following definitive treatment (radical prostatectomy ± adjuvant treatment). Images were assessed for local recurrence, lymph node, and distant metastases. Patients were stratified into subgroups based on pre-scan PSA level (>1 ng/ml vs. ≤1 ng/ml) and PSA doubling time (PSAdt, <6 months vs. ≥6 months). Detection rate was calculated, and in positive cases, correlations were analyzed between the maximum standardized uptake value (SUVmax) of the most intense lesion and PSA or PSAdt values.

Results: PSMA-avid lesions consistent with prostate cancer were detected in 51 patients (76.1%). Detection rate was significantly higher in the PSA >1 ng/ml group (88.1% vs. 56%; p = 0,019). Among positive cases, SUVmax values were also significantly elevated in patients with higher PSA and shorter PSAdt.

Discussion: Our results confirm the clinical relevance of PSMA PET/CT in detecting biochemical recurrence. PSA level significantly influenced both detection rate and lesion avidity, supporting the need for a predictive PSA threshold in patient stratification. In contrast, PSAdt had less impact on detectability, though some correlation with SUVmax was noted. The 18F-labeled compound's technical advantages further support its clinical utility.

Conclusion: 18F-JK-PSMA-7 PET/CT is a sensitive imaging modality for identifying recurrent prostate cancer. Stratifying patients by PSA levels may enhance diagnostic yield and clinical decision-making. Orv Hetil. 2025; 166(51): 2018-2023.

The prevalence of osteoarthritis is very high and most often affects the knee joint in addition to the hip. A new, innovative option in the treatment strategy of knee osteoarthritis is embolization of the descending genicular artery which arises from femoral artery. This procedure is most often performed in cases of knee osteoarthritis that does not respond to conservative treatment, but it can also be successfully used in cases of hemarthros or persistent pain following total knee replacement surgery. The procedure treats knee osteoarthritis pain by reducing synovial blood flow, which is believed to reduce knee pain associated with inflammation, neovascularity and neoinnervation. In our case report, we managed to significantly reduce severe pain following successful knee total endoprothesis surgery with selective embolization of the descending genicular artery, which did not improve with other treatments. Orv Hetil. 2025; 166(51): 2024-2028.

Introduction: The glomus caroticum, located at the carotid bifurcation, contains chemoreceptors and is essential for the rapid physiological adaptation to changes in blood oxygen, carbon dioxide, and pH levels. Paragangliomas of the glomus caroticum are rare, slow-growing, hypervascularized neuroendocrine tumors of parasympathetic origin, typically located on the neck and potentially infiltrating adjacent structures.

Objective: To analyze and summarize surgical outcomes of glomus caroticum paragangliomas treated at our institution between 2015 and 2024.

Method: In our retrospective analysis, patient demographics, surgery duration, hospitalization time, complications, histological diagnoses, and follow-up data were analyzed.

Results: A total of 17 patients (7 males, 10 females) underwent 19 surgeries. Mean age was 56.41 years (median: 58). Mean operative time was 104 minutes; mean hospitalization was 5.84 days (median: 6). Preoperative embolization was performed in 9 cases, with a longer average surgical time (117 minutes) compared to non-embolized cases (94 minutes). Histology confirmed paraganglioma in 16 cases, Antoni type A schwannoma in 1, metastatic breast ductal carcinoma in 1, and colloid calcified struma nodosa in 1 case. Carotid revascularization was required in 2 cases using Dacron and polytetrafluoroethene grafts, respectively. Neurological complications occurred in 9 cases, including hoarseness and difficulties with speech or swallowing. 1 patient with polytetrafluoroethene graft experienced visual field loss and ptosis.

Discussion: Contrary to prior findings, preoperative embolization did not reduce operative time in our cohort. However, due to the limited sample size, further studies are necessary.

Conclusion: In order to promote the essential multidisciplinary approach in patient care, we advocate the establishment of an endocrine/paraganglioma team in centers with a high level of progressivity. Orv Hetil. 2025; 166(51): 2012-2017.