Radiation therapy of orbital lymphoid tumors: introduction of lens-sparing techniques in Hungary.
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Aged↗
Biomedical subjects
G Németh
Publications and source records attributed to G Németh.
[The state of radiotherapy in 1996 Hungary and principles of its development].
Although the number of radiation treatments (external) fields and brachytherapeutic insertions) increased substantially, by 9% of a year, in Hungary in 1994 and 1995, about half of the patients who needed radiotherapy did not receive this form of treatment. The regionalization of radiotherapeutic care resulted in the establishment of 12 centres, with considerable discrepancies in infrastructural and staff conditions, characterized by presence of Western European conditions in 1 institution or by close to them in 3 institutions, but by lack of the required infrastructure or personnel in two-thirds (8) of the centres. To reach the minimum recommended infrastructural level, Hungarian radiotherapeutic care requires the following items for the 12 centres: 4 radioprotected treatment rooms, 8 linear accelerators of dual energy, 4 low-monoenergetic linacs/telecobalt units, 5 after-loading set-ups, 6 simulators, 6 CT-based treatment planning systems and 6 automatic water phantoms. With respect to the present workload, the number of personnel in the different groups is low; the situation is especially problematic in newly organized or reconstructed centres. Furthermore, provision of radiation treatment to all cancer patients who need it, requires development at every level of the staff. Increases in the infrastructural and staff conditions of the currently existing radiotherapeutical centres should be the actual goal, and not the foundation of new centres. The most important aspects of the priority in the development of the infrastructure are the following: higher number of adequately trained staff, academic obligations (universities), change of the amortized facilities and supplementation of the currently empty radioprotected rooms with equipment.
Forecasting↗
[Overview of the development of clinical and dosimetric methods for radiotherapy planning for cancer patients in Hungary].
Authors review the three-decade development and clinical application of treatment planning in Hungary from the beginning of high energy radiotherapy till today. Before 1978 the dose plans have been prepared manually in the external therapy. In 1978 the National Computer Network for Treatment Planning was organized and put into practice. In a few therapy centres [National Institute of Oncology, Budapest (NIO), Uzsoki Hospital, Budapest (UH) and Medical University, Pécs] local initiatives resulted in new softwares. Program tests were made in each therapy centres. Dose computation and measurement methods in the field of other technics, as brachytherapy (UH and NIO), stereotactic and total body irradiation (NIO), are also reviewed. Most important results were reached in the UH and NIO in the field of clinical application of dose planning methods. Upon summing up the results it can be stated that although the infrastructure in Hungarian radiotherapy is still undeveloped the treatment planning has achieved an adequate level, due to the managing and developing work of radiation physicists and radiooncologists. The conclusion of the paper is that presently we are not able to meet the requirement prescribed by the ICRU standards appeared in 1986. It means that there is a real demand in each centres to install up-to-date (3D) softwares in treatment planning and appropriate dose meters. In the National Institute of Oncology, Budapest the problem was settled in a very cost-saving way--joining to an international 3D treatment planning project.
Humans↗
[Survival potentials of patients with papillary carcinoma of the thyroid gland in Hungary].
The typically benign, but occasionally rapid fatal clinical course of papillary thyroid cancer has raised the need for individual survival probability estimation, to tailor the treatment strategy exclusively to the given patient. A retrospective study was performed on 400 papillary thyroid cancer patients, with a mean follow-up time of 10.3 years, to establish a clinical database for uni- and multivariate analysis of the survival probability-related prognostic factors (Kaplan-Meier product limit method and Cox regression). For a more precise prognosis estimation, in the next step the most important clinical events were investigated and survival functions for each patient were calculated on the basis of a Markov renewal model. The basic concept of this approach is as follows: each patient has an individual disease course, which (besides the initial clinical categories) is affected by special events, e.g. internal covariates (local/regional/distant relapses), that a patient experiences throughout the course of the disease. On the supposition that these events and the cause-specific death are influenced by the same biological process, the parameters of transient survival probability characterizing the speed of the course of the disease for each sequence of clinical events were determined. The individual survival curves for each patients were calculated by using the former parameters and the independent, significant clinical variables, summation of which resulted in an overall cause-specific survival function valid for the entire group. The patient's age, a distant metastasis at presentation, the extent of the surgical intervention, the primary tumour size, the dosage of the external irradiation and the degree of the TSH suppression proved to be statistically significant (in that sequence) and independent prognostic factors as concerns cause-specific survival in multivariate studies. During follow-up 14%, 14%, 9% and 12% of the patients underwent local/regional/distant relapses and thyroid cancer-related death. Through use of the above six independent clinical variables and the parameters relating to the interrelations of the four clinical events, mean cause-specific survival probabilities of 88%, 83% and 78% were determined at 10, 20 and 30 years, respectively. The 30-year individual survival probability prediction for these study cases showed that no cancer-related death occurred > or = 92% (low-risk group), while the tumour-related deaths were considerable (31%) < or = 78% (high-risk group), and there were only 6% deaths in the intermediate-risk group. The constructed survival function permits a prediction of the individual survival probability of extra-study cases under the given treatment conditions and within the given population, and thus affords a rationale for individualization of the treatment of papillary thyroid cancer patients.
Adult↗
[60 years of the Radiotherapy Department of the Hungarian National Institute of Oncology].
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Academies and Institutes↗
[Malignant thyroid tumors in Hungary: morbidity and mortality].
In 1993, 181 new cases (36 men and 145 women) of thyroid cancer were diagnosed pathologically in Hungary, i.e. a morbidity of 1.8/100,000 for the total population, and of 0.7/100,000 and 2.7/100,000 for men and women, respectively. The distribution of the histological diagnoses: 61% papillary, 25% follicular, 5% medullary and 3% anaplastic carcinomas, and 6% others. In the same year, 125 patients (31 men and 94 women) died from thyroid cancer, i.e. a mortality rate of 1.2/100,000 for the total population, and of 0.6/100,000 and 1.8/100,000 for men and women, respectively. The relatively low morbidity reflects the fact that no new strong aetiological factor is operative in Hungary. The substantial mortality rate, however, is influenced by the geographically determined aggressivity of the disease, the inadequacy of the diagnostic procedures and therapeutic measures, and lack of the active follow-up. The latter facts are especially prominent in centres with a low patient turnover. In the field of health care, various measures must be introduced to prevent an increase in the morbidity and to diminish the mortality. Reduction of the iodine deficiency, rationalization of the medical use of ionizing irradiation, and implementation of the necessary hormonal medication for all patients operated by resection for thyroid diseases are needed for tumour prophylaxis. Before any medical decision-making, the achievement of complete diagnostic information, including the pathological revision of clinically questionable cases, is of paramount importance. The fundamental goals as concerns the treatment modalities are as follows: increased surgical skill and level of performance of external irradiation, the availability of radionuclide therapy, and guidance of all types of thyroxine medication by endocrine experts.
Adult↗
Passive knee muscle moment arms measured in vivo with MRI.
OBJECTIVE: To determine moment arm lengths from seven knee muscles and the patellar tendon. The knee muscles were the biceps femoris, semitendinosus, semimembranosus, gracilis, sartorius, and the lateral and medial gastrocnemius muscles. DESIGN: The moment arms were calculated based on MRI measurements. BACKGROUND: Moment arm lengths of different muscles with respect to the joint centre of rotation (CR) or the centre of the contact point between joint surfaces are necessary basic data for biomechanical models predicting joint load. METHODS: Ten male and seven female subjects participated. Using a 1.5 Tesla magnetic resonance imaging system, 3-dimensional coordinates of relevant points were recorded from a 3-D volume reconstruction of the right knee at knee flexion angles of 0, 30 and 60 degrees. Muscular moment arms were calculated in both the sagittal and frontal planes. The recordings were all made during passive mode, which means that no muscular contraction was performed. RESULTS: All muscles except the lateral gastrocnemius showed statistically significant differences (P<0.05) of moment arm lengths between gender in the frontal plane. All muscles except biceps femoris and sartorius showed significant differences (P<0.05) of moment arm lengths between gender in the sagittal plane. Most muscles also showed a linear or quadratic trend of changing moment arms with varying knee angle. CONCLUSIONS: Our results indicate that for most biomechanical analyses involving knee muscles, gender- and angle-specific moment arms should be used.
Journal Article↗
Amplitude and timing of electromyographic activity during sprinting.
The aim of this study was to make descriptive analyses of the muscle activities in the lower extremity during maximal sprinting. Nine healthy sprinters were examined during maximal sprinting using telemetric electromyography (EMG). Seven muscles of the lower extremities were investigated: biceps femoris, medial hamstrings (semimembranosus and semitendinosus), rectus femoris, gluteus maximus, tibialis anterior, lateral gastrocnemius and medial gastrocnemius. The recorded EMG levels during running were expressed as percentage of maximum voluntary isometric contractions (%max EMG). For each muscle, the normalized EMG was plotted during the whole running stride cycle and is presented for each muscle. The reason for using this method is to show that it is possible to compare different muscle activities in a runner as well as to make comparisons between runners. Lateral and medial hamstrings and gluteus maximus showed similar activities with peak levels of EMG during foot-strike. Rectus femoris had a two-peak activity, with one peak at the middle of the stance phase and the other during the swing phase. The tibialis anterior also showed a two-peak activity, but with the peaks at the beginning of the swing phase and just before foot-strike. The highest activities of the medial and lateral gastrocnemius occurred just before toe-off.
Adolescent↗
Low back pain in elite cross-country skiers. A retrospective epidemiological study.
Low back pain is a common complaint among competitive cross-country skiers. Fifty-three top male and 34 female skiers in the age group 16-25 were interviewed with a questionnaire regarding anthropometric parameters, training variables, back pain and other injuries. The frequency of back pain was 64% in the whole group, men affected slightly more often than women. Back pain was defined as previous or present recurrent skiing correlated backache that more or less affected skiing ability. Diagonal skiing style was the most commonly back pain-inducing style, whereas no skier experienced back pain when "skating" only. The low back was the predominant location of pain. Anthropometric and training variables seemed to be of little value in predicting back pain.
Adolescent↗
[Quality assurance, audit and quality control of radiotherapy at radiology departments in Hungary].
The first quality assurance, audit and control system in the Hungarian "'health" care industry" is described for the medical specialty of radiotherapy. The prerequisites of the elaboration of the programme were an exact knowledge of the current Hungarian infrastructural and staffing conditions, and the radiotherapeutic activities. The recommendations cover the 5 medical universities including the national institute (the Debrecen, Pécs, Semmelweis, Szent-Györgyk Albert Medical Universities, and Haynal Imre University of Health Sciences) and the 5 regional oncological centres in hospitals (Jósa András, Markusovszky, Petz Aladár, Szentpéteri kapu and Uzsoki Hospitals). The departmental functions (patient care, teaching-education, research work and scientific organizing activity) and the structure (organization, infrastructure, staffing conditions, etc.) are described first, followed by the therapeutic principles and clinical process (patient referral and selection, decision-making, priorities in therapy initiation, treatment preparation and execution, etc.). The informal daily/weekly quality assurance programme long applied in the routine patient care has been formalized and supplemented with a weekly audit conference. In the course of the medical audit, all relevant clinical data are reviewed and scored by an internal or an external expert (not participating directly in the treatment process), e.g. for the adequacy of the medical decision preparative process, conformation to the institutional treatment protocol, equipment selection, treatment planning, simulation and portal film, etc. If a major deviation is detected, an immediate correction is initiated; minor deviations need analysis and then preventive and correcting action. As concern the audit of the other activities of the departments, the important indicators and their minimally desirable level are defined. The final goal of the implementation of this programme is high-precision radiotherapy with the best achievable treatment result.
Dose-Response Relationship, Radiation↗
Self-administered examination versus conventional medical examination of the musculoskeletal system in the neck, shoulders, and upper limbs. The Stockholm MUSIC I Study Group.
A self-administered examination protocol of the musculoskeletal system in the neck, shoulders, and upper limbs was mailed to 350 subjects and the results were compared to those of a subsequent medical examination. The prevalences of reported positive findings were higher than in the medical examination. Validity ranged between poor and good. Acceptable validity was noted for items measuring tenderness. No systematic substantial exposure-related misclassification was noted. Self-administered examination of the musculoskeletal system is not suitable to replace a traditional medical examination in epidemiological studies. Self-administered examination of tenderness could, however, be used as a screening method in analytical studies of relations between exposure and disorders in the musculoskeletal system. Subjects reporting such findings at a self-administered examination could be further examined by professional examiners for definite diagnostic appraisal. Substantial savings in medical examination resources could thereby be obtained.
Adult↗
[Tridimensional radiation treatment planning].
The effectiveness of radiotherapy and the possibility that the patient will be cured are basically determined by the accuracy of the therapy planning and the treatment. The tumour with its environment is a three-dimensional (3D) phenomenon, and therefore 3D radiation treatment planning and performance are needed for adequate coverage of the target volume (tumour+safety zone). The prerequisities of the elaboration of the 3D radiotherapy planning were as follows: the availability of high-performance hardware, the establishment of interactive computer graphics, and the development and direct integration into the therapy planning process of the digitalized information derived from diagnostic imaging, and especially computer tomography. The introduction of 3D treatment planning will mean the modernization of the radiotherapy, the accuracy of which may permit more cures, i. e. more patients will recover their ability to work.
Dose-Response Relationship, Radiation↗
Calcitonin-secreting ovarian strumal carcinoid.
A 3-mm strumal carcinoid was found incidentally in a mature ovarian cystic teratoma of a 38-year-old woman followed up for more than 9 years. Although the thyroid component disclosed a typical normal light microscopic appearance, no thyroglobulin and thyroxine were detected immunohistochemically. Immunoreactive calcitonin was demonstrated within the tumour cells. The close relationship between functionally imperfect thyroid tissue and a neuroendocrine marker-secreting tumour seems to be concordant with the theory of the existence of a pluripotential stem cell capable of differentiating multidirectionally.
Adult↗
[The current evaluation of radiotherapy treatment results].
PURPOSE: Efficacy of treatment is expressed in terms of postradiotherapeutic tumor volume decrease and halving time indicating regression rate. Tumors of the same histology and TNM stage were compared after different treatments. Prior to this comparative study tumor volume changes and halving time were tested for judging the efficacy of chemotherapeutic treatment of 765 patients with lung metastasis. PATIENTS AND METHODS: Tumor volume was determined by CT planimetry before and after radiotherapy in 56 tumor patients (42 lung tumors, 14 thyroid tumors). The rate of regression, i.e., the halving time was calculated on the basis of exponential curve. Fourteen thyroid tumor patients given telecobalt and photon irradiation for post-operative recurrence formed a separate group of patients. Halving time was determined at 30-day intervals, the values were qualified as "fast", "moderately fast", "moderately slow" and "slow". RESULTS: Partial remission rate of patients treated by telecobalt irradiation was not higher than 60%, accompanied by fast halving time. With those receiving photon irradiation, however, partial remission reached even 70%, also with a fast halving time. In both groups minimal remission was associated with moderately fast halving time. The partial remission of recurring thyroid tumor patients receiving telecobalt irradiation was partly fast, partly moderately fast. Their minimal remission data developed with a moderately fast halving time, although chemotherapy subsequent to radiotherapy did not result in regression. CONCLUSION: Appraisal of radiotherapeutic efficacy is based on the simultaneous monitoring of decrease in tumor volume (%) and halving time. It is to be stressed that neither the planimetric volume determination nor the halving time data can be taken as absolute values, since they are subject to other factors. In authors opinion, the most effective methods of the following of the tumor regression is the planimetric volume measurement calculated by CT, in the clinical praxis in recent time.
Cobalt Radioisotopes↗
Significance of three-dimensional radiation treatment planning.
A tumour and its environment constitute a three-dimensional (3D) phenomenon. Consequently, adequate management of the target volume (tumour + safety zone) is feasible only with a 30 treatment planning and irradiating system. The more precise planning and dose delivery involved in such a 30 treatment lead to an improved therapeutic effectiveness.
Humans↗
[Drug therapy of iatrogenic hypothyroidism in patients with differentiated thyroid cancer].
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Hypothyroidism↗
[Incidence of SLE in a patient thymectomized for myasthenia gravis].
The appearance of systemic lupus erythematosus (SLE) as well as thymopoietin (TP3) treatment in a patient who has undergone thymectomy because of myasthenia gravis (MG) is described. To the authors' knowledge this is the first case of this treatment upon the diagnoses above. The therapy was performed for 12 weeks by the Hungarian Thymotrinan (TP3) preparate according to a previous protocol worked out for Hodgkin's disease. At the beginning and during therapy, cellular and humoral immune parameters were monitored. Twenty months after the therapy the patient has remained in clinical remission for both diseases, MG and SLE, respectively. There is a brief survey of the biochemistry of thymic hormones as well as their clinical use, especially in the treatment of autoimmune disorders. The relative rarity of SLE after operative treatment of MG is under discussion together with the effectiveness of substitutional thymic hormone therapy.
Acquired Immunodeficiency Syndrome↗
[Degradation of succinylcholine chloride].
Quantitative thin-layer chormatographic method has been developed for the investigation of the degradation of injection formulations containing succinylcholinium chloride. The method is based on the denistometric determination of the main degradation product, choline at 430 nm after visualization with iodine vapour. The stability of the injection was investigated under various storage conditions and it has been stated that considerable decomposition takes place during as short a period as one week.
Chromatography, Thin Layer↗