Gábor Viktor Szabó

Peripheral blood-derived autologous stem cell therapy for the treatment of patients with late-stage peripheral artery disease—results of the short- and long-term follow-up

BACKGROUND AIMS Regeneration of the occluded peripheral arteries by autologous stem cell therapy is an emerging treatment modality for no-option patients with peripheral artery disease (PAD). The purpose of this study was to assess safety and efficacy of in vitro-expanded, peripheral blood-derived, autologous stem cells (VesCell) in no-option patients with PAD. METHODS A phase II, open-label, randomized clinical study was performed on 20 patients to investigate the safety and efficacy of VesCell therapy at 1 and 3 months of follow-up. The long-term (2 years) efficacy of the therapy was also evaluated. RESULTS No side effects of VesCell therapy were found. During the 3 month follow-up in the control group, one death occurred and six major amputations were performed; in the treated group, there were no deaths or major amputations. The difference of limb loss is significant between the two groups. At 2-year follow-up in the control group, two deaths and six major amputations occurred; in the treated group, there were three major amputations. At 3-month follow-up, the change in hemodynamic parameters showed a significant increase in the treated group over the control group; in the treated group, further improvement was detected at 2 years. As the result of the VesCell treatment, change in pain score, wound healing and walking ability test showed an improvement compared with the control group; at 2 years, incremental improvement was observed. CONCLUSIONS Peripheral blood-derived, in vitro-expanded autologous angiogenic precursor therapy appears to be a safe, promising and effective adjuvant therapy for PAD patients.

Tumornecrosis-factor-α 308 GA polymorphism in atherosclerotic patients.

The development of the atherosclerosis is a multifactorial process, where the clinical pattern is determined by environmental and genetic factors. Except for the classical risk factors of atherosclerosis (hypertension, lipid-metabolic disorders, diabetes, smoking) the clinical signs can be influenced by the genetic variants (polymorphisms) of the enzymes, which are responsible for the endothelial cell function and for the thrombotic factors. In our examination our aim was to define the TNF-α 308GA polymorphisms in atherosclerotic diabetic, atherosclerotic non-diabetic and healthy patients. We found correlation of the frequency of myocardial infarction and stroke in atherosclerotic diabetic and atherosclerotic non-diabetic patients. We proved that among patients with mutant TNF-α AA genotype the occurrence of cardiovascular events is significantly higher: Mutant AA homozygous genotype: control group 1, 6%, MI group 10,7%, p < 0,005, OR: 8,17 versus Normal GG allele: control group 76,7%, MI group 61,3%. The TNF-α AA genotype can have a clinical importance as a prognostic and therapeutic marker, although further studies are needed to confirm this hypothesis.

Methylentetrahydrofolate reductase and nitric oxide synthase polymorphism in patients with atherosclerosis and diabetes

The development of the atherosclerosis is based on multifactorial causes. In addition to the traditional risk factors, gene polymorphisms can play a role in the disease. Therefore in this study we investigated whether the eNOS and MTHFR gene polymorphisms is associated with myocardial infarction and stroke in patients with or without diabetes. We have identified polymorphisms in the NOS 3 gene and one of these polymorphisms, Glu298→Asp, was found to be a major risk factor for carotid artery disease and myocardial infarction. Our results indicate that the MTHFR G677T allele is significantly associated with MI. MTHFR 677 G/T genotyping may be of clinical importance as a prognostic and therapeutic marker, although further studies are needed to substantiate this hypothesis.

A diabeteses láb ischaemiás eredete. Epidemiológia, a diagnózis nehézségei, prevenciós és revascularisatiós lehetőségek

Absztrakt: A „diabeteses lab” mint multifaktorialis megbetegedes hattereben a neuropathia, infekcio, csont- es lagyresz-elteresek mellett a legutobbi evek epidemiologiai adatai alapjan az also vegtagi ischaemia szerepe egyre inkabb hangsulyossa valik. Cukorbetegsegben az also vegtagi utőerszűkulet rendkivuli mertekben fokozza az also vegtagi fekelykepződes, valamint a minor es major amputacio kockazatat. A diabetesre jellemző klinikai megjelenes miatt az also vegtagi utőerszűkulet felismeresere a hagyomanyos diagnosztikus eljarasok korlatozottan alkalmazhatok. A hatekony diagnosztika alapfeltetele olyan vascularis kozpontok elerhetősege, amelyek a szakmai ismeretek es rendelkezesre allo diagnosztikus eszkozok segitsegevel alkalmasak a cukorbetegcsoportban az erbetegseg időben tortenő detektalasara. Az ischaemias korokra visszavezethető diabeteses lab kezelese soran a hatekony gyogyszeres kezeles mellett az eratjarhatosag helyreallitasanak kiemelt fontossagot tulajdonitanak. Az ersebeszeti es intervencios ...

[Surgical treatment of acute type-B aortic dissection associated with cocaine use].

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.

Homograftok szerepe az alsó végtagi érrekonstrukciókban

INTRODUCTION Vascular homografts are used for limb salvage in cases of graft infection after previous reconstructive vascular surgery or inadequate autologous veins. During multi-organ donation the thoracic aorta segment, aortic bifurcation, iliac arteries, femoral arteries, popliteal arteries, femoral veins and greater saphenous veins can be harvested. Our aim was to optimize the use of homografts by analyzing the results of previous procedures. METHODS The patient information was processed retrospectively, using the clinical computer system. 162 procedures were performed on 144 patients between 2007 and 2014. The short- and long-term patency, hemorrhagic complication rate, amputation rate and mortality was examined in our study. The location, graft type and length of cryopreservation were taken into consideration. Aortoiliac and femoropopliteal reconstructions with arterial and venous homografts were examined. RESULTS The mean age of the patients was 63.6 ± 10.7 years, the mean follow-up period was 36 ± 28 months. The primary patency rates at the postoperative 1, 3 and 6 months were 83.7%, 75.0% and 63.4%. In this study the arterial and deep venous homografts had better primary patency rates compared to the superficial venous homografts: at the postoperative 1, 3, 6 months the arterial homograft results were 85.6%, 78.6% and 74.3%, the greater saphenous vein homograft results were 81.4%, 70.4% and 47.7% in the same intervals. CONCLUSION The reconstructive surgical procedures in septic area mean serious challenge for the vascular surgeons. The AB0 compatibility of the graft and the recipient did not result better long-term outcomes compared to the non-compatible grafts. According to our data the ideal choice of homogenous graft is an arterial homograft which was not cryopreserved longer than 6 months.

Fenesztrált stent-graft beültetés Magyarországon

Absztrakt Esetismertetesek: Első beteg: A 77 eves ferfi, multimorbid anamnezissel, egy 5,6 cm legnagyobb atmerőjű juxtarenalis aneurysma megoldasara jelentkezett. A jobb vese korabban elpusztult, a mesenterica superior mar nem volt erintve. Az egyeduli műkodő bal arteria renalis megmentese erdekeben fenesztralt stent-graft beultetest hataroztunk el. A gyarto ceggel tortent egyeztetes utan megtortent a szovődmenymentes beultetes. Az egy honapos kontroll-CT-vizsgalat korrekt keringesi viszonyokat mutatott endoleak nelkul. Negy honap mulva a bal arteria renalis elzarodott akut uraemiat okozva. Ujabb stentbehelyezessel a vese keringese helyreallt. Masodik beteg: A 71 eves multimorbid anamnezisű ferfi 80 mm-es maximalis atmerőjű juxtarenalis aneurysmaval kerult felvetelre. Kardialis ok miatt a nyitott műtet nem jott szoba, ezert fenesztralt stent-graft beultetes (FEVAR) mellett dontottunk. A mesenterica superior es mindket arteria renalis stentelesere is szukseg volt. A 2014. december 4-en tortent beavatkozas ...

Diffuse leakage through an 8-month-old Dacron graft after thrombolysis with tissue plasminogen activator.

A 56-year-old man was admitted to our department with acute critical left leg ischemia. He had undergone multiple arterial reconstructions of the affected leg over the past 2 years. The last reconstruction was a femorotibial composite silver-impregnated Dacron autologous saphenous vein bypass. Digital subtraction angiography (DSA) showed occlusion of the graft; therefore, selective transcatheter thrombolysis with tissue plasminogen activator ([tPA] alteplase) was started. The 10-mg bolus dose was followed by continuous infusion at a rate of 2.0 mg/h.

B típusú aortadissectio sebészi kezelése kokaint használó beteg esetében@@@Surgical treatment of acute type B aortic dissection associated with use of cocaine

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.

Surgical treatment of acute type B aortic dissection associated with use of cocaine

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.