László Farkas

SHORT-TERM CHANGES IN RENAL FUNCTION AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY IN CHILDREN

PURPOSE To our knowledge despite numerous studies the biological effect of extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) on the function of the immature kidney has not yet been evaluated. We determined the short-term effect of ESWL on renal function in children. MATERIALS AND METHODS In a 5-year period 65 children were treated for 77 kidney stones by ESWL and followed regularly at our department. In 16 children the short-term effect of shock wave energy was studied by measuring blood parameters (sodium, potassium, urea, creatinine and C-reactive protein), urinary electrolytes (sodium, potassium and creatinine), urinary enzyme activity (aspartate transaminase, alanine transferase, alkaline phosphatase and lactate dehydrogenase) and the excretion of beta 2-microglobulin. Samples were obtained immediately before and 2 hours after ESWL, and on days 1, 2, 8, 15, 30 and 90 after treatment. RESULTS Morphological changes in the kidneys were not detected by ultrasound during followup. No significant changes were noted in overall renal function, serum parameters or urine electrolytes. A significant elevation in the excretion of aspartate transaminase, alkaline phosphatase, lactate dehydrogenase and beta 2-microglobulin was observed, indicating proximal tubular dysfunction and cell destruction. Enzyme levels returned to baseline within 15 days. CONCLUSIONS Our results demonstrate that shock wave energy induces transient functional damage of tubular function in children. Minimizing the kV. and number of shocks may decrease the deleterious effect. When considering functional regeneration time, the minimal interval between 2 shock wave treatments should be at least 15 days. The long-term effect needs further investigation.

High Frequency of Metastatic Leydig Cell Testicular Tumours

690 patients were treated for testicular tumour in the course of 18 years. The histology of 7 cases showed Leydig cell tumour. In 4 of the 7 cases, a metastatic process leading to death was observed. At the time of diagnosis, 5 patients were found to have low stage, whereas 2 of the patients had advanced lymphatic involvement. The hematogenous and lymphatic metastases proved to be resistant to chemotherapy. Contrary to the major part of the literature, retroperitoneal lymphadenectomy should be performed with this histological type for the exact pathological staging immediately following orchiectomy.

Laparoscopic Repair of Circumcaval Ureter: One-year Follow-up of Three Patients and Literature Review

OBJECTIVES To describe our experience and 1-year follow-up of 3 patients with circumcaval ureter (CU) treated laparoscopically, with the introduction of a new stenting method and review of the published data. Because of its rarity, more reports are needed to advocate more comprehensive knowledge about the preferred surgical technique for the treatment of CU. METHODS Since November 2005, 3 patients with symptomatic CU have undergone laparoscopic repair of their anomaly at our institutes. In all 3 cases, the ureter was transected and positioned anteriorly with an end-to-end anastomosis. In 2 cases, the retrocavally located ureteral segment was resected. RESULTS The mean operative time in our series was 210 minutes, without any intraoperative or early postoperative complications. In 1 patient, a slight ureteral stricture was detected that resolved with reinsertion of a double-J stent. Histopathologic examination of the resected ureteral segments revealed sclerosis and muscular hypertrophy. All patients remained symptom free during the 1 year of follow-up. CONCLUSIONS With all the advantages of a minimally invasive procedure and preserving therapeutic efficacy, the laparoscopic approach should be considered a standard choice for surgical treatment of CU in symptomatic patients. Care should be taken to diagnose and excise the pathologically narrowed ureteral segment.

Urovysion: Considerations on modifying current evaluation scheme, including immunophenotypic targeting and locally set, statistically derived diagnostic criteria

Urovysion multitarget fluorescence in situ hybridization (FISH) assay is a promising tool for detection of bladder cancer, however, there is still no consensus regarding abnormal signal pattern and cut‐off level, and the recommended targeting carries limitations similar to urine cytology. Aim of this study was to explore diagnostic benefits of a recently introduced method featuring target specific genotyping, as well as to investigate the feasibility of locally and statistically determined cut‐off, compared with conventional evaluation scheme. Histology, cytology, and comparative FISH approaches were performed on 42 patients with high clinical suspicion for urothelial carcinoma (UC). FISH parallels were (1) Urovysion‐alone (according to manufacturers instruction); (2) Targeted‐Urovysion (cytokeratin7 immunophenotyping followed by Urovysion), both of which evaluated by both conventional and statistical evaluation scheme. For statistical evaluation cut‐offs and sufficient sample size were determined on controls and ratio of positive cells was recorded, whereas conventional evaluation relied on manufacturers recommendations. The specificity of cytology, Urovysion‐alone in general and targeted‐Urovysion in general appeared 86%, 86%, and 100%, respectively. In the same comparison, overall sensitivity was 60%, 80%, and 93%, respectively. In superficial cases sensitivity was 48% for cytology, 72% for Urovysion‐alone and 91% for targeted‐Urovysion, while no prominent differences were seen in muscle invasive cases. The ratio of FISH positive cells was proportionate with both stage and grade, however, targeted genotyping could separate high grade/high stage cases more effectively. In conclusion, CK7 targeting raises diagnostic efficiency of Urovysion, and could be an ideal tool for identifying tumor cells in ambiguous cases or when other tumors are present. Statistical evaluation produces accuracy comparable with results of conventional evaluation, and with laboratories setting cut‐offs individually but according harmonized protocol, it could aid method standardization. Furthermore, by providing additional quantitative information about tumor characteristics, is likely to have therapy relevant value in the future.

Prevalence and Type Diversity of Human Papillomaviruses in Penile Cancers in Hungary

To the editor Penile cancers are one of the rare forms of oncological diseases as in developed countries their prevalence is less than 1 %. Epidemiological studies suggested the role of oncogenic HPV-types as a causative agent of penile tumors [1, 2]. Around 40 % of patients with penile cancer had also been affected by HPV with type 16 being the most prevalent [3]. Currently available literature data explain HPV-induced tumors with the integration of virus into the epithelial cells’ genome, and its genetic manipulation of the host DNA. Another interesting fact is that HPV infection is much more frequently associated with certain types of penile cancers, than other malignant manifestations [3]. Clinical course and prognosis of patients with penile cancer is unequivocally determined by the lymphatic node status. Five year survival rate of pathologically negative lymph nodes (pN0) is 85–100 %, whereas the involvement of pathologically verified metastatic lymph nodes in the inguinal region dramatically reduces this rate [4]. A retrospective study including 145 male patients describes: tumor thickness and lymphatic or vascular invasion as prognostic factors for lymph node involvement. Interestingly, no statistical correlations can be indicated in lymphatic involvement in connection with T status and the grade of cancer [5]. The aims of the present study were i) to identify and estimate the prevalence of high-risk HPV (hrHPV) genotypes in both primary penile tumors and metastatic lymph nodes, ii) to analyse the potential correlation between the hrHPV positivity and the severity and progression of the cancer. Tissue samples were taken from both the primary tumor and the regional lymph nodes, in over the course of operations of penile cancers in the Department of Urology, University of Pécs, Hungary, between 2002 and 2012. Samples were forwarded to histopathological processing where tissues were fixed in formalin and embedded into paraffin for histological processing. For retrospective molecular studies, 10 μm sections of the paraffin blocks were deparaffinated. Subsequently, DNAwas extracted for the purpose of HPV-identification. Cells were disintegrated using TissueLyser (Qiagen), and subcellular structures were digested enzymatically using Proteinase-K. DNA was purified from tissues using QIAmp DNA FFPE Tissue Kit (Qiagen), according to the manufacturer’s recommendations. HPV DNA was detected by virus-specific TaqMan PCR (DIAGON Ltd., Hungay). In case of HPV positive samples Linear Array HPV Genotyping Test (Roche) was further used for genotyping. A total of 35 patients were involved in the current clinical study. High-risk HPV was identified from primary tumors in 17 cases (48.5 %), regional (inguinal) lymph nodes were positive in 3 cases. The average age of hrHPV positive males was 55 years (range: 44–87 years) while HPV negative patients were slightly older, averaging 66 years of age (range: 50– 82 years). Genotyping using high-sensitivity molecular assays was available for 14 cases out of the 17 hrHPV-positive patients. HPV 16 was identified in 11 of 14 samples (78.5 %), HPV 59 and 82 were detected in two separate cases, while * Ferenc Jakab jakabf@gamma.ttk.pte.hu

New methods in the treatment of localized prostate cancer: usage of dynamic arc therapy and kV cone-beam CT positioning

Bevezetes: A prosztatarak az idősebb eletkor es a fejlett vilag daganatos megbetegedese. Lokalizalt prosztatarak eseteben a műteti ellatas mellett komoly szerepe van a definitiv sugarkezelesnek. Celkitűzes: A szerzők intezeteben telepitett Novalis TX gyorsito segitsegevel ugynevezett intenzitasmodulalt sugarterapia, annak dinamikus ivbesugarzassal elvegzett formaja, illetve verifikacio soran haromdimenzios lagy szoveti kepellenőrzest biztosito, integralt kilovoltos cone-beam komputertomografiaval vegzett kepvezerelt sugarterapia kerult bevezetesre, amely modszerekkel szerzett első tapasztalataikat ismertetik a szerzők. Modszer: 2011 decembere es 2013 februarja kozott, doziseszkalaciot kovetően, 102 dinamikus ivbesugarzassal elvegzett kezelest vegeztek, majd 10-10 szelektalt, alacsony es magas kockazatu betegnel (atlageletkor 72,5 ev) elkeszitettek a haromdimenzios konformalis besugarzasi terveket is. Azonos celterulet-lefedettseg mellett osszevetettek a rizikoszervek dozisterheleset. Eredmenyek: A dinamikus ivbesugarzassal elvegzett kezelesek mellett a rizikoszervek szignifikansan alacsonyabb dozisterheleset ertek el, amelyet a kedvező korai mellekhatasprofil is alatamaszt. Kovetkeztetesek: Az intenzitasmodulalt sugarterapia dinamikus ivbesugarzassal elvegzett formaja biztonsaggal alkalmazott standard kezelesi modozatta valt a szerzők intezeteben. Kesői mellekhatasok es lokalis kontroll tovabbi vizsgalata szukseges. Orv. Hetil., 2014, 155(32), 1265–1272. | Introduction: Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. Aim: The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. Method: Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. Results: Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. Conclusions: The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.INTRODUCTION Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. AIM The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. METHOD Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. RESULTS Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. CONCLUSIONS The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.

Új módszerek a prosztatadaganatok sugárkezelé sében: dinamikus ívbesugárzás és kilovoltos .,cone-beam" komputertomográfiás ellenorzés

Bevezetes: A prosztatarak az idősebb eletkor es a fejlett vilag daganatos megbetegedese. Lokalizalt prosztatarak eseteben a műteti ellatas mellett komoly szerepe van a definitiv sugarkezelesnek. Celkitűzes: A szerzők intezeteben telepitett Novalis TX gyorsito segitsegevel ugynevezett intenzitasmodulalt sugarterapia, annak dinamikus ivbesugarzassal elvegzett formaja, illetve verifikacio soran haromdimenzios lagy szoveti kepellenőrzest biztosito, integralt kilovoltos cone-beam komputertomografiaval vegzett kepvezerelt sugarterapia kerult bevezetesre, amely modszerekkel szerzett első tapasztalataikat ismertetik a szerzők. Modszer: 2011 decembere es 2013 februarja kozott, doziseszkalaciot kovetően, 102 dinamikus ivbesugarzassal elvegzett kezelest vegeztek, majd 10-10 szelektalt, alacsony es magas kockazatu betegnel (atlageletkor 72,5 ev) elkeszitettek a haromdimenzios konformalis besugarzasi terveket is. Azonos celterulet-lefedettseg mellett osszevetettek a rizikoszervek dozisterheleset. Eredmenyek: A dinamikus ivbesugarzassal elvegzett kezelesek mellett a rizikoszervek szignifikansan alacsonyabb dozisterheleset ertek el, amelyet a kedvező korai mellekhatasprofil is alatamaszt. Kovetkeztetesek: Az intenzitasmodulalt sugarterapia dinamikus ivbesugarzassal elvegzett formaja biztonsaggal alkalmazott standard kezelesi modozatta valt a szerzők intezeteben. Kesői mellekhatasok es lokalis kontroll tovabbi vizsgalata szukseges. Orv. Hetil., 2014, 155(32), 1265–1272. | Introduction: Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. Aim: The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. Method: Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. Results: Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. Conclusions: The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.INTRODUCTION Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. AIM The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. METHOD Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. RESULTS Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. CONCLUSIONS The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.

Új módszerek a prosztatadaganatok sugárkezelésében: dinamikus ívbesugárzás és kilovoltos „cone-beam” komputertomográfiás ellenőrzés@@@New methods in the treatment of localized prostate cancer: usage of dynamic arc therapy and kV cone-beam CT positioning

Bevezetes: A prosztatarak az idősebb eletkor es a fejlett vilag daganatos megbetegedese. Lokalizalt prosztatarak eseteben a műteti ellatas mellett komoly szerepe van a definitiv sugarkezelesnek. Celkitűzes: A szerzők intezeteben telepitett Novalis TX gyorsito segitsegevel ugynevezett intenzitasmodulalt sugarterapia, annak dinamikus ivbesugarzassal elvegzett formaja, illetve verifikacio soran haromdimenzios lagy szoveti kepellenőrzest biztosito, integralt kilovoltos cone-beam komputertomografiaval vegzett kepvezerelt sugarterapia kerult bevezetesre, amely modszerekkel szerzett első tapasztalataikat ismertetik a szerzők. Modszer: 2011 decembere es 2013 februarja kozott, doziseszkalaciot kovetően, 102 dinamikus ivbesugarzassal elvegzett kezelest vegeztek, majd 10-10 szelektalt, alacsony es magas kockazatu betegnel (atlageletkor 72,5 ev) elkeszitettek a haromdimenzios konformalis besugarzasi terveket is. Azonos celterulet-lefedettseg mellett osszevetettek a rizikoszervek dozisterheleset. Eredmenyek: A dinamikus ivbesugarzassal elvegzett kezelesek mellett a rizikoszervek szignifikansan alacsonyabb dozisterheleset ertek el, amelyet a kedvező korai mellekhatasprofil is alatamaszt. Kovetkeztetesek: Az intenzitasmodulalt sugarterapia dinamikus ivbesugarzassal elvegzett formaja biztonsaggal alkalmazott standard kezelesi modozatta valt a szerzők intezeteben. Kesői mellekhatasok es lokalis kontroll tovabbi vizsgalata szukseges. Orv. Hetil., 2014, 155(32), 1265–1272. | Introduction: Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. Aim: The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. Method: Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. Results: Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. Conclusions: The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.INTRODUCTION Prostate cancer is a common disease among elderly male patients in developed countries. In addition to prostatectomy, definitive irradiation plays an increasing role in the treatment of localized disease. AIM The authors wanted to share their experience obtained with the use of the Novalis TX linear accelerator for the application of dose-escalation, dynamic, intensity modulated arc therapy with the routine usage of cone-beam computer tomography based or image guided radiotherapy in patients with prostate cancer. METHOD Between 2011, December and 2013, February the authors performed 102 treatments. In 10 low risk and 10 high risk prostate cancer patients (median age: 72.5 years) three-dimensional conformal plans with the same target volume coverage were created and tolerance doses of organs at risk (OAR) were compared. RESULTS Compared to three-dimensional conformal techniques, intensity modulated arc therapy treatments produced a significantly lower dose at organ at risk that led to a more favorable early toxicity rate. CONCLUSIONS The intensity modulated arc therapy with image guided radiotherapy proved to be a safe standard treatment mode in the daily routine in the institute of the authors. Late toxicity and local control rates need to be further examined.

High-tone electric muscles stimulation of thigh augments the impaired penile blood flow of diabetic patients without improving symptoms of erectile dysfunction

OBJECTIVE Erectile dysfunction (ED) is a major complication in diabetes mellitus. A novel method, high-tone external muscle stimulation (HTEMS), has been proven to be useful in the therapy of diabetic and uremic peripheral polyneuropathy. The aim of this study was to test the potential effect of HTEMS on ED in diabetic patients. DESIGN An open-label, self-controlled interventional prospective study was conducted at the 2nd Department of Internal Medicine and N.C. University of Pécs, Hungary. Six Type 2 diabetic patients (mean age 59 ± 7 years) with severe ED (International Index of Erectile Function (IIEF) score: 7.7 ± 8.5) and impaired renal function (eGFR: 61 ± 16 ml/min) were involved. INTERVENTION The thigh muscles of the patients were treated with HTEMS for 1 h 3 times per week for a duration of 4 weeks. MAIN OUTCOME MEASURES Penile peak systolic velocity (PSV) (in the flaccid state and semi-rigid (after 10 mg intracavernous papaverine injection)), IIEF score, quality of life and laboratory parameters. At the beginning also the acute effect of HTEMS on penile PSV was investigated. RESULTS Under basal conditions penile PSV was rather low. The first HTEMS session of the thighs induced an insignificant increase of PSV in the flaccid state (4.1 ± 1.2 to 6.3 ± 3.3 cm/s) and a significant rise of PSV in the semi-rigid penis (from 6.5 ± 2.5 to 8.9 ± 2.2 cm/s (p = 0.009)). After 4 weeks of HTEMS treatment, under basal conditions no significant change of penile PSV (flaccid and semirigid) was observed. Similarly, IIEF score did not improve over the time period (7.7 ± 8.1 vs. 6.7 ± 8.5, p > 0.05). Also, metabolic parameters and eGFR were not influenced. CONCLUSION In a pilot study of diabetic patients with severe ED HTEMS of the thighs induced an acute rise of penile PSV in the semi-rigid state. However, after 4 weeks of HTEMS therapy the basal PSV and symptoms of ED were not improved.