Biomedical subjects

Péter Kupcsulik

Publications and source records attributed to Péter Kupcsulik.

13 recordsLinked to original sources

PubMed2006

[Endoscopic mucosal resection of early esophageal cancer].

INTRODUCTION: Endoscopic mucosal resection (EMR) is now thoroughly established as a therapeutic method for early oesophageal cancer. In adequately selected patients, EMR provides a comparable outcome to traditional surgical operations. PATIENTS AND METHOD: 5 patients with early oesophageal cancer were treated fey simple snare resection in 2004 and 2005. These selected patients had distinct backgrounds one was known to have underlying Barrett's oesophagus, two of them had oesophageal varices, one case was an incidental finding for investigating abdominal pain, one was diagnosed during cancer surveillance of partial oesophagectomy. All these lesions were biopsy proven and evaluated by endoscopic ultrasound. RESULTS: No acute complications were noticed after the procedure. Post-procedure oncological chemotherapy was given to the last four patients. Control exam was performed to all patient 1st, 3rd and every 3rd month after the procedure. Patient with recurrent cancer after partial oesophagectomy had recidive tumor. CONCLUSION: Endoscopic mucosal resection of superficial oesophageal cancer can be performed without major complications representing a useful alternative treatment of oesophageal cancer.

Aged, 80 and over↗

PubMed2006

[Change in location of colorectal cancer in Hungarian patients between 1993-2004].

UNLABELLED: The incidence of proximal tumours in Western countries has steadily increased while that of distal tumours has shown a corresponding decrease. Our aim was to investigate the prevalence, location and histology of colorectal cancers in the last twelve years in Hungarian patients. PATIENTS AND METHODS: Clinical data of 1738 patients diagnosed with colorectal tumors (M/F: 940/798, mean age at diagnosis: 65.2 +/- 12.5 years) between 1st of January 1993 and 31st of December 2004 at the 1st Internal Medicine and 1st Surgery Department of Semmelweis University were enrolled. Pathology and clinical data were analysed retrospectively. The observed periods were the following 1993-1998 and 1999-2004. RESULTS: 1694 (97.5%) of the patients had adenocarcinoma (CRC), 15 anaplastic cancers, 9 carcinoid, 6 planocellular, 5 GIST, 3 leiomyoma and 2-2 melanoma, lymphoma and shigillocellular cancers were diagnosed. 75.7% (943/1246) of the CRCs were diagnosed at locally advanced stage (T3-T4), and 47.7% (521/1093) of CRC patients had lymph node metastasis at the time of diagnosis. 11.0% of the CRCs were diagnosed in <50 year-olds (<40 years: 2.5%, <30 years: 0.5%). The location of the CRC was distal in 1186 (rectum: 53.9%, sigmoid/descending: 46.1) and proximal in 508 cases. Synchronous cancers were detected in 12 patients (age: 68.8 +/- 11.6 years, gender: 11 male/1 female, location: rectum and transverse in 6, rectum and ascending/caecum in 5 patients). Age at diagnosis was not different according to gender (M/F: 64.8 +/- 12.0 years vs. 65.8 +/- 12.9 years), but it was lower in patients with rectal cancer compared to left or right sided cancers (64.1 years vs. left: 66.1 years, right: 66.0 years, p = 0.02). Rectal CRC was more common in males, while the proportion of proximal cancers was lower (rectum, M/F: 41.2% vs. 33.5%, proximal M/F: 26.8% vs. 33.8%, p = 0.003). The proportion of rectal cancers increased over the observed period (1993-1998: rectal: 31.6% vs. 1999-2004: 42.1%, p = 0.002). CONCLUSIONS: In contrast to Western countries, the proportion of proximal CRC did not become higher in Hungary. Still more than two-third of the patients were diagnosed to have distal cancers. The proportion of male patients was higher in this subset of CRC. The high percentage of locally advanced and metastatic cancers supports the need for colorectal screening program in Hungary.

Adenocarcinoma↗

PubMed2006

Reduced antioxidant level and increased oxidative damage in intact liver lobes during ischaemia-reperfusion.

AIM: To determine whether increased blood flow of the liver can cause oxidative stress and hepatocyte damage, and to elaborate methods suitable for measuring the antioxidant defence during hepatic surgery on rat model. METHODS: In nembutal narcosis, the left lateral and the medial lobes of the liver were clipped for 45 min to make the total blood supply flow through the other lobes. Total antioxidant status, glutathione peroxidase and superoxide dysmutase activity, as well as the concentrations of diene conjugates and free sulphydril groups, H-donating ability and reducing power of the liver samples were determined. Chemiluminescent intensity of the liver was also measured. Metal ions (Al, Ca, Cu, Fe, Mg, Mn, Zn) and P and S concentrations of the liver were determined with an inductively coupled plasma optical emission spectrometer and Se content was measured by cathodic stripping voltammetry. RESULTS: Glutathione peroxidase and superoxide dysmutase activities of the liver decreased significantly in the hyperemia group compared to those observed in the sham operated group. The level of total antioxidant status was also significantly lower in the hyperemia group. H-donating ability, reducing power and free sulphydril group concentration showed the same tendency. A significant correlation (P<0.05) was found between the changes in non-specific antioxidant activities. This pointed to simultaneous activity of the antioxidant defence system. Al, Cu, Mn, Zn, and S were lower in the hyperemia group than in the sham operated group when the levels of Ca, Fe, Mg, Se and P ions were higher during hyperemia. CONCLUSION: Oxidative stress is one of the main factors for the injury of intact liver lobes during ischaemia-reperfusion.

Analysis of Variance↗

PubMed2006

Fatal outcome from extreme acute gastric dilation after an eating binge.

OBJECTIVE: A 22-year-old woman is presented with acute gastric dilation after an eating binge, who died of complications of acute reperfusion syndrome. METHOD: A young patient was admitted in our clinic with critical condition without any significant previous medical history. Her initial complaints--diarrhea, vomiting and abdominal pain--began after an enormous food intake. There was no history of medications or toxic substances. Physical examination showed a normally-developed, well-nourished female in severe distress with an extremely distended abdomen. Femoral pulses were absent. The US and CT scan showed a dilated stomach, extended into the pelvis, dislocating the intestinal organs and compressed the aorta and mesenteric veins. RESULTS: Urgent laparotomy was performed. An enormously distended stomach was encountered without volvulus, obstruction or adhesions. About 11 liters of gastric content was removed gastrotomy and nasogastric tube. Following the gastric decompression, the mesenteric and femoral pulses reappeared. During the operation, the cardio-respiratory status was stabilized, but in the following 24 hours irreversible shock developed, possibly due to the reperfusion of the retroperitoneal organs and the lower extremities. In the postoperative period disseminated intravascular coagulopathy developed. In an uncontrollable state of diffuse bleeding, 36 hours post-operation, the patient died. In retrospective investigation, the family confessed that previous psychological treatments which aimed at her bulimic attacks. CONCLUSION: Acute gastric dilatation is very uncommon and is of various etiologies, two of these being anorexia nervosa and bulimia. Several cases documenting complications of gastric dilatation were published; however, such severe complications, involving gastric infarction and compression of the aorta with ischemic injury of the bowels and lower extremities, are rare.

Acute Disease↗

PubMed2006

Claudin-4 differentiates biliary tract cancers from hepatocellular carcinomas.

The recently identified claudins are dominant components of tight junctions, responsible for cell adhesion, polarity and paracellular permeability. Certain claudins have been shown to have relevance in tumor development, with some of them, especially claudin-4, even suggested as future therapeutic target. The aim of the present study was to analyze the expression of claudin-4 in the biliary tree, biliary tract cancers and hepatocellular carcinomas. A total of 107 cases were studied: 53 biliary tract cancers, 50 hepatocellular carcinomas, 10 normal liver and 10 normal extrahepatic biliary duct samples. Immunohistochemical analysis was performed on conventional specimens and on tissue microarrays as well. Claudin-4 was further investigated by Western blot analysis and real-time RT-PCR. Intense membranous immunolabeling was found for claudin-4 in all biliary tract cancers unrelated to the primary site of origin, namely intrahepatic, extrahepatic or gallbladder cancers. Normal biliary epithelium showed weak positivity for claudin-4. In contrast, normal hepatocytes and tumor cells of hepatocellular carcinomas did not express claudin-4. The results of Western immunoblot analysis and real-time RT-PCR were in correlation with the immunohistochemical findings. Cytokeratins, as CK7 (92%) and CK19 (83%) were mostly positive in biliary tract cancers, however, one-third of hepatocellular carcinomas also expressed CK7 (34%). HSA antibody (HepPar1) reacted with the majority of hepatocellular carcinomas (86%), while being positive in a low percentage of the biliary tract cancers (8%). In conclusion, this is the first report of a significantly increased claudin-4 expression in biliary tract cancers, which represents a novel feature of tumors of biliary tract origin. Claudin-4 expression seems to be a useful marker in differentiating biliary tract cancers from hepatocellular carcinomas and could well become a potential diagnostic tool.

Adenocarcinoma↗

PubMed2006

[Laparoscopic colorectal surgery].

Laparoscopic surgery have earned a firm place in the treatment of benign colon diseases. Concerning the treatment of malignant colorectal tumors the value of LAP surgery has evoked controversial assessments. On the basis of onco-surgical guidelines for colorectal carcinoma conventional standards began to sway. Independent factors like tumor stage, R0 resection, histological parameters and surgeon determine prognosis. Previous discussions about port site metastases and tumor cell dissemination by pneumoperitoneum have silenced. Several randomized studies have proven the short term superiority of LAP resection in term of postoperative pain management, bowel movement, hospital stay and rehabilitation over open methods. The late survival was as good, or better presented by some single center studies in the last five years. Newly, more multicentric randomized trials were conducted on late results of LAP surgery for malignant colorectal tumors which has been proved nonsignificantly better or equal to conventional surgery. Based on the above mentioned data laparoscopic colorectal surgery became an accepted option for treatment of colorectal carcinoma.

Colonic Diseases↗

PubMed2005

Claudin expression in Barrett's esophagus and adenocarcinoma.

Claudins (CLDNs) are key molecules in cell adhesion, polarity, and control of paracellular solute transport. Several studies suggested that changes in claudin pattern have a role in cancer development. This study aimed to detect alterations in CLDN 1, 2, 3, 4, and 7 expression patterns in Barrett's esophagus (BE) and adenocarcinoma (ACC) compared with that in foveolar epithelium (FOV), normal squamous epithelium (SQ), and squamous cell carcinoma (SQCC). One hundred twenty five surgically or endoscopically removed, paraffin-embedded cases were studied by immunohistochemistry and analyzed statistically. BE, ACC, and FOV were dissected from 30 paraffin-embedded samples for further mRNA expression analysis. CLDN 7 was the dominating type in all epithelia and carcinomas, but its expression did not differ in normal and altered tissues. CLDN 1 expression was significantly increased in SQCC compared with that in SQ. CLDNs 3 and 4 were significantly elevated both in BE and ACC compared with that in FOV. CLDN 2 expression increased significantly in ACCs compared with that in BE. This is the first report proving similarities and differences regarding claudin expression pattern in BE and ACC compared with that in FOV and SQ. Our data prove a close link in CLDN pattern between BE and ACC, adding further evidence that BE is an alteration preceding esophageal ACC.

Adenocarcinoma↗

PubMed2005

[Incidence and pathologic distribution of esophageal cancers at the gastro-esophageal junction between 1993-2003].

UNLABELLED: There was a significant change in the histology of oesophageal cancers in the last few decades. The incidence of oesophageal adenocarcinoma has risen considerably, now it is equally or even more prevalent than squamous cell cancers in some North American and Western European countries. As no Hungarian data is available, the authors' aim was to investigate the prevalence and histology of oesophageal and gastrooesophageal junction cancers in the last decade. PATIENTS AND METHODS: 451 patients diagnosed with oesophageal (n = 371, 296 male/75 female, mean age at diagnosis: 57.9 SD 10.1 years) or cardia (n = 80, 58 male/22 female, mean age at diagnosis: 65.2 SD 13.4 years) cancer between 1st of January 1993 and 31st of December 2003 at the 1st Internal Medicine and 1st Surgery Department of Semmelweis University were enrolled. Pathology and clinical data were analysed retrospectively. RESULTS: 93% (n = 345) of the patients with oesophageal cancer had squamous cell carcinomas, while adenocarcinoma was only diagnosed in 15 (4%) patients. Mean age at diagnosis was lower in patients with squamous cell cancer (57.4 SD 10.0 years) compared to patients with adenocarcinoma (66.9 SD 8.8 years, p = 0.001). Male-to-female ratio was 4:1 in patients with squamous cell carcinoma (277/68) and undifferentiated carcinoma (9/2), while it was 2:1 in patients with adenocarcinoma (10/5). According to the location 1.3% of cancers of the midthoracic oesophagus and 8.6% of the lower oesophagus were adenocarcinoma. The proportion of adenocarcinoma remained stable over the observed period (1993-1997: 3.7% vs. 1998-2003: 4.3%). In contrast, 71.25% (57/80) of the gastrooesophageal junction cancers and overall 15.9% (72/451) of the cancers of the oesophagus and gastrooesophageal junction were adenocarcinoma (1993-1997: 17.2% vs. 1998-2003: 14.7%). CONCLUSIONS: Since only a few percentages of authors patients with oesophageal cancers were diagnosed to have adenocarcinoma and its proportion remained stable over the observed period, it seems that in contrast to North American and Western European countries, adenocarcinoma is still infrequent in Hungary.

Adenocarcinoma↗

PubMed2005

[Esophago-respiratory fistulas of tumorous origin].

Esophago-respiratory fistulas developing in malignant disease have serious consequences by continuous airway contamination. Between 1984 and 1999 in the 1st Department of Surgery of Semmelweis University 1439 patients were treated with esophageal cancer. During regular examinations esophago-respiratory fistulas were detected in 163 patients (11.3% incidence). By analyzing data about these patients, we examined the causes, the characteristics of the disease and the possibilities and the efficiency of treatment. The mean age of these 163 patients was 55 (21-83) years, the ratio between men and women 3.7:1. By analyzing data of these patients according to their age, history, degree of dysphagia, weight loss, tumor size and survival rate, it can be noticed that there are two specific peaks, which differs from the average patients with esophageal tumors. Presumably, patients with esophago-respiratory fistulas can be divided into two groups. One consists of relatively younger patients with biologically more aggressive carcinomas, while the other group is of older patients where the fistula formation is the end stage of the slower progressing tumor. Twenty eight patients received irradiation before the fistula developed, most likely the longer survival rate contributed to the rise of the number of the fistulas. Ninety-five patients underwent endoscopic endoprosthesis implantation, 24 had the position of a stent corrected, 44 patients received palliative therapy, gastrostomy was performed in 15 patients. The median survival period was 5.0 months (0-46 months). Patients with endoprosthesis, gastrostomy and palliative treatment only had mean survival periods of 6.2 (1-46), 1.7 (0-5) and 1.6 (0-5) months. By sealing off the fistula, a successful endoscopic stent can end the serious airway contamination and the dysphagia, improving the quality of life and length of survival. Endoscopic endoprosthesis implantation is a feasible method in the treatment of patients with esophago-respiratory fistula.

Adult↗

PubMed2004

[The relationship between benign liver tumors and free radicals].

The purpose of this review was to summarise what is known about the benign hepatic tumors, especially the role that free radicals play in the etiology and in the complications of these neoplasms. Nowadays benign liver tumors are considered as common entities. With the technical developments of radiology their diagnosis has become much easier, but still it is the major difficulty for the doctor to handle. There are different types of benign hepatic neoplasms: liver cyst, hemangioma, hepatocellular adenoma, focal nodular hyperplasia and there are also some rare tumor types. The relationship between hepatocellular adenoma and the use of oral contraceptives is well known. The oral contraceptives reduce the antioxidant capacity of the blood, this could be an explanation for the generation of these neoplasms. Benign liver tumors are also associated to thrombotic reactions. These neoplasms may require surgical treatment, so the oxidative stress is one of the main prognostic factors of the patients' survival.

Adenoma, Liver Cell↗

PubMed2004

[Esophageal tumors at our outpatient clinic].

INTRODUCTION: In the 1984-1997 period 1179 tumorous patients presented themselves at the oesophagus consultation of the Ist. Department of Surgery of Semmelweis University. The authors examined the changes in the characteristic features of these patients and the task of supply. OBJECT: The aim of analysis was estimating of the place and importance of the therapeutic methods applicable to ambulatory patients. METHODS: Essential task of the outpatients service was to summarize the diagnostic results and to supply the lacks for the therapeutic plan of the patients. Having possession of the results they had to make decisions of the necessary and possible method of therapy. From the 1179 patients it was necessary the ward admittance of 787 patients, in 512 cases in hope of resective operation, and in 275 cases in order to carry out palliative intervention under hospitalized circumstances. 392 patients were treated as outpatients. To outpatients in 296 cases tube endoprosthesis was implanted by endoscopic method for palliative purposes, there were made 14 dilating nasogastric tube treatments, in 2 cases percutaneous endoscopic gastrostomy, and in the case of 116 patients there were collaborations in intraluminal after-loading irradiation treatments. RESULTS: It appeared from the age-characteristics of the patients that the incidence in the examined period increased in the younger age-groups. The patients' main complaint was dysphagia, their average anamnesis-time was 4.03 months and it did not change during the 13 years. The incidence of the oesophago-respiratory fistula was 11.1% in the patient-population, and the incidence of reflectory dysphagia was 13.2%. There was an improvement in respect of the medical check-up of patients and the verification by histological examination of the tumorous process. In the case of 597 patients it was observed dysphagia requiring palliation and in 482 cases it succeeded to perform it by implanting endoprosthesis. There were 36 unsuccessful implantation attempts and in the case of 79 patients there were no conditions of intervention. CONCLUSIONS: In the treatment of oesophageal tumorous patients the interventions made in favour of the palliative improvement of agglutination were executable within the frame of the outpatient service, from among of which the implantation of endoscopic tube appeared to be the method improving the patients' quality of life and survival with the best result. In the course of years palliative treatments were made more and more in the frame of outpatient service. The authors feel it necessary to consider all the condition-ameliorating treatment possibilities and applications, which may not be alternatives of each other but complementaries.

Adult↗

PubMed2003

[Role of minimally invasive interventions in the treatment of complications caused by recidive Klatskin tumors].

BACKGROUND: The hilar cholangiocarcinoma grows slowly and gives metastases very rarely. The first prominent sign of this cancer is the jaundice. In spite of the small size of the tumour, oncologically radical resection is only feasible--owing to the anatomical position--in approximately 35-50% of the cases. This makes recidivity frequent. The recidive cancer involves the hilus of the liver, compresses the surrounding organs and develops different complications. METHODS: 37 patients underwent surgical resection in the 1st Surgical Department of Semmelweis University in the last ten years. Complete tumour-free surgical margins were found in only 48.6% of the cases. The mean follow-up was 23.2 (8-47) months. RESULTS: 9 patients were treated for complication caused by local recurrence. These were mechanical jaundice (9 cases), bleeding oesophageal varices (2 cases), gastric outlet obstruction (2 cases), liver abscess (3 cases) and pain caused by the infiltration of the coeliac ganglion (3 cases). Most part of the complication could be solved by minimal invasive therapy (percutane transhepatic endoprosthesis or drainage, endoscopic sclerotherapy, ultrasound-guided drainage, percutane blockade of the celiac ganglion). CONCLUSIONS: The fact that resected patients may survive several years as long as patients treated with endoprosthesis and irradiation only survive half a year, has brought a change in the way Klatskin cancer surgery is considered: resection of the tumour should be striven for--even by way of R1 resection. Therefore the risk of recurrence will increase. This is the first article in the literature, which has ever dealt with the complication caused by recidive cancer after resection of Klatskin tumour.

Adult↗

PubMed2003

Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study.

BACKGROUND AND AIMS: Doppler-guided hemorrhoid artery ligation is a new approach for treating hemorrhoids. Early and 1-year follow-up results of the procedure are presented and compared with those of closed scissors hemorrhoidectomy in a prospective randomized study. PATIENTS AND METHODS: Sixty consecutively recruited patients were randomized into two groups: group A ( n=30) was treated with standardized closed scissors hemorrhoidectomy and group B ( n=30) with Doppler-guided hemorrhoid artery ligation. The follow-up period was 11.7+/-4.6 months. RESULTS: The average need for minor analgesics was 11.7+/-12.6 doses in group A and 2.9+/-7.7 in group B. Patients in group A spent 62.9+/-29.0 hours in hospital postoperatively and those in group B 19.8+/-41.8 hours. Return to normal daily activities took 24.9+/-24.5 days in group A and 3.0+/-5.5 days in group B. Neither the disappearance (26 vs. 25 patients) nor the recurrence of preoperative symptoms (5 vs. 6 patients) differed significantly between the two groups. CONCLUSION: Both procedures were effective in treating hemorrhoids. The 1-year results of Doppler-guided hemorrhoid artery ligation do not differ from those of closed scissors hemorrhoidectomy. Doppler-guided hemorrhoid artery ligation seems to be ideal for 1-day surgery, and it fulfills the requirements of minimally invasive surgery.

Anal Canal↗