Zsófia Simon

Retrospective Analysis of the Prognostic Role of Tissue Eosinophil and Mast Cells in Hodgkin's Lymphoma

The composition of reactive cell populations, which constitute the majority of tumor load in Hodgkin’s lymphoma (HL), can influence the prognosis of the disease. Besides widely accepted and applied prognostic scores, the authors evaluate biological factors that may have a prognostic impact. Previous data indicate that the rate of eosinophils and mast cells in the reactive cell population, determined already at diagnosis, can be used for this purpose. Histological samples from 104 patients with HL with an average follow-up period of 110 (24–214) months were retrospectively analyzed. Mast cell positivity was associated with better overall survival, although this difference was only of borderline statistical significance (p=0.092). No significant difference was found in parameters like overall survival (OS, p=0.906) or event-free survival (EFS, p=0.307) of eosinophil-positive vs. -negative cases or in EFS (p=0.742) of mast cell-positive vs. -negative individuals (criterion for a positive specimen was more than 5% of appropriate cells in the reactive cell population). Looking at the effect of eosinophilia and mastocytosis together, there was no significant difference between the subgroups categorized according to the combined presence of the two cell types. It seems that tissue eosinophil and mast cell predominance have no prognostic value that could be used in clinical practice, although a tendency for correlation of mast cell positivity with overall survival could be seen. For a definitive statement, multicenter studies should be performed involving a higher number of patients suffering from HL.

Epidural malignant lymphomas of the spine: collected experiences with epidural malignant lymphomas of the spinal canal and their treatment.

Study design:Retrospective study of 13 patients treated by the authors.Objective:To examine the course of the disease of malignant lymphoma (ML) presenting in the epidural area of the spine.Setting:Department of Neurosurgery, Third Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.Subjects and methods:The epidural presentation in eight patients was heralded by motor signs (paraparesis and plegia), in one by a lesion of the posterior columns of the spinal cord (ataxia), and in three by pain. One patient was free of complaints and symptoms. The affected epidural area was diagnosed previously by myelography and computerized tomography (CT), and later by magnetic resonance (MR), over the course of which the location was verified as thoracic in eight patients, cervical in one, and lumbar in four. The authors recommended surgical intervention in 9 out of 13 cases, in seven cases of Hodgkins and six cases of non-Hodgkins lymphoma. Seven patients were treated for recognized manifestations of malignant lymphoma while six were diagnosed by intraoperative-histological examination.Results and conclusion:The decompression operations for tumors resulted in limited improvement in seven patients (reduction in pain and return of ability to walk). Four patients were not operated on, two of which had significant improvement in their neurological symptoms. Paraparesis remained unchanged in one patient. One patient remained symptom-free. The authors emphasize the importance of interdisciplinary consultation and weighing individual priorities in the indications for operation on epidural ML.

Quality of life and fatigue in Hodgkin's lymphoma patients.

Aims and background Quality of life and survival of patients with malignant diseases are improving thanks to the development in diagnostics and therapy. Methods We determined the quality of life and frequency and severity of fatigue with an EORTC QLQ-C30 questionnaire in 168 Hodgkins lymphoma patients (85 women, 83 men). We scored all functional and symptom scales in cured patients (who were in complete remission for at least 10 years; mean period of survival after the treatment(s) was 16.61 years) and in those who suffered from late complications. Results The global health status score (QL2) was significantly lower in patients who had late complications (mean QL2, 45.53) than in patients with no complications (mean QL2, 67.57, P <0.001) and in cured patients (mean QL2, 52.5) than in those who were not disease free 10 years after the treatment or who were treated actively (mean QL2, 67.48, P <0.001). We found that fatigue level (FA) was significantly higher in patients who had been treated more than 20 years before (FA score, 53.37) than in those who were undergoing treatment (FA score, 29.35, P = 0.03). A significantly higher FA score (FA, 48.72) was observed in patients who suffered from late complications of the treatment than in those who had no complications (FA, 31.88; P = 0.001). More co-morbidity can cause higher fatigue scores than observed in these groups of Hodgkins lymphoma patients. Conclusions Fatigue is more frequent than we think, and it has a strong effect on quality of life, so its early recognition and treatment is important and needs multidisciplinary cooperation.

Successful administration of rituximab–bendamustine regimen in the relapse of Hodgkin lymphoma after autologous hemopoietic stem cell transplantation

Objectives. Treatment options for relapsing Hodgkin lymphoma (HL) are controversial after autologous hemopoietic stem cell transplantation (HSCT). Nevertheless, allogeneic HSCT may be curative if it is performed in complete remission. Case report. In 2007, a 22‐year‐old female patient was diagnosed with nodular sclerosis subtype of classical HL. Her clinical stage was IIAX with unfavorable prognosis. Eight courses of doxorubicin, bleomycin, vinblastine and dacarbazine chemotherapy and involved field irradiation were applied, but after 3 months of complete remission, disseminated relapse was recognised by 18FDG‐PET/CT. After two cycles of salvage dexamethasone, cisplatinum, and cytosine arabinoside therapy, further progression was noticed, so the treatment was modified to ifosfamide, gemcitabine, vinorelbine, and prednisone (IGEV) regimen. After two cycles of IGEV regimen, she achieved a complete metabolic remission, which was confirmed by a 18FDG‐PET/CT scan again. She was referred for autologous‐HSCT, and a successful stem cell collection was performed in August 2008. However, a rapid progression was detected again, so total body irradiation was applied before the conditioning therapy with R‐mini‐BEAM regimen. The 18FDG‐PET/CT scan performed 100 days after the autologous‐HSCT was still positive. In December 2009, multiple nodal and extranodal progression was detected, so ifosfamide, carboplatine, etoposide, mesna protection rescue treatment was started, but it was ineffective. Based on sporadic data of the literature, rituximab–bendamustine therapy was started in March 2010. After four cycles, she achieved complete metabolic remission, which was verified by 18FDG‐PET/CT. The patient has been referred for an allogeneic HSCT with reduced intensity conditioning. Conclusions. Based on our experience, bendamustine–rituximab salvage therapy can be a suitable option for the treatment of post‐transplant progression or relapse of HL. Copyright

Rare association of Hodgkin lymphoma, Graves’ disease and myasthenia gravis complicated by post-radiation neurofibrosarcoma: coincidence or genetic susceptibility?

With Hodgkin lymphoma (HL), other (autoimmune) diseases may occasionally occur or associate, whereas as a late treatment-complication, second tumour may develop. In our patient HL was diagnosed in 1996 and consequently received COPP/ABV and mantle irradiation. Due to the residual mediastinal tumour CRu was declared but later on no progression/relapse could be proved by PET. In 2000 Graves’s disease, in 2001 myasthenia gravis was diagnosed, which showed resistance for immunosuppressant drugs, thus plasmapheresis, intravenous immunoglobulin treatments were applied. In 2005, the residual mediastinal tumour started progressive growth, which leads to thoracotomy in which the tumour was removed, it was malignant peripheral nerve sheath tumour. The disease showed progression despite the chemotherapy applied and the patient died in 2007 due to respiratory failure. Not even the postmortem histopathologic examination revealed the relapse of HL. Association of Hodgkin lymphoma, and two antibody-mediated autoimmune diseases, Graves’ disease and myasthenia gravis, is rare and has not yet been reported in the literature. The etiologic role of genetic predisposition and immune regulatory disorder must definitely be thought of, as the possibility of mere coincidence is extremely small. Malignant peripheral nerve sheath tumour is a rare complication of irradiation, which underlines the importance of the risk or/and response adapted therapy of HL.

Thromboembolic Events in Polycythaemia Vera Patients:An Audit of the Hungarian Philadelphia Negative Chronic Myeloproliferative Neoplasia Register

Objective: The Hungarian National Registry for Philadelphia chromosome negative myeloproliferative neoplasms was used to assess the clinical characteristics of Hungarian patients with polycythemia vera. Methods: Data from 351 JAK2 V617F-positive patients diagnosed with PV were collected online from 15 haematology centres reporting clinical characteristics, therapeutic interventions, venous and arterial thromboembolic events, and myelofibrotic or leukaemic transformations. Vascular events (thromboembolic and haemorrhagic) were evaluated before and after diagnosis based upon the Landolfi risk assessment scale. Results: TE were reported on 116 occasions (106 patients) before diagnosis and 152 occasions (102 cases) during follow-up. Compared to before diagnosis, after diagnosis frequency of major arterial events decreased from 11.7% to 2.6% (p<0.0001), and minor venous events increased from 2.0% to 14.2% (p<0.0001); there was no significant change in number of major venous events (from 6.3% to 8.8%; p=0.25) or minor arterial events (from 13.1% to 17.7%; p=0.12). Bleeding events were recorded in 6.4% of patients. Despite treatment, 42.2% of patients with prior thromboembolic events had recurrent thromboembolic complications. After diagnosis age and prior history of thromboembolic events were independent risk factors for arterial events, and white blood cells and diabetes for venous events. Hydroxyurea use in the low+moderate risk Landolfi group slightly, but not significantly, increased thromboembolic event risk (p=0.74). Conclusions: This registry enables characterisation of patients with polycythemia vera. Data suggest the need for accuracy of diagnostic criteria and compliance with risk-adapted therapeutic guidelines.

Anagrelide reduces thrombotic risk in essential thrombocythaemia vs. hydroxyurea plus aspirin

To evaluate the reduction in thrombotic events (TE) in patients with essential thrombocythaemia (ET) treated with anagrelide versus hydroxyurea + aspirin (HU + ASA).

Our experiences in treating patients with Hodgkin disease in the last decade

Bevezetes: A Hodgkin-lymphoma diagnosztikajaban, kezeleseben az elmult evtizedben jelentős valtozasok kovetkeztek be. Cel: Ennek tukreben a szerzők celul tűztek ki az 1995–2004 kozott a DEOEC III. sz. Belgyogyaszati Klinikan elsődlegesen kezelt Hodgkin-lymphomas betegek adatainak attekinteset 2006 januarjaban, atlagosan 69 (12–132) honap kovetes utan. Modszerek: a kortortenetek adatait SPSS statisztikai programmal ertekeltek. Eredmenyek: A 163 beteg atlageletkora a diagnoziskor 36 (14–75) ev volt, bimodalis koreloszlassal. A leggyakoribb (48,5%) a kevert sejtes altipus volt. A betegek 41,1%-a volt korai stadiumu, legkedvezőtlenebb prognozissal 15,7%-uk birt, bulky tumort 28,2%-ban eszleltek. 7 betegnel radioterapiat, 63-nal kemoterapiat es 92-nel tervezett kombinalt kezelest alkalmaztak. A sugarkezelesek 61,6%-a erintett mezős volt, 61 beteg cyclophosphamid, vincristin, procarbazin, prednisolon, adriamycin, bleomycin, vinblastin; 87 beteg adriamycin, bleomycin, vinblastin, 7 pedig egyeb kemoterapiat kapott. Az elsődleges kezelesre 146 komplett, 10 parcialis remisszio jott letre, 6 beteg nem reagalt. 10 reszleges remisszioban levő es 5 nem reagalo beteget tovabb kezeltek. 27 komplett remisszioban levő betegnel alakult ki relapszus, kozuluk 15-nel tortent nagy dozisu kezeles autolog periferias haemopoeticus őssejt-transzplantacioval. A kovetesi idő alatt 18 beteg halt meg, 11 a lymphoma progresszioja vagy a kezeles szovődmenye, 6 masodik tumor, 1 egyeb ok miatt. Betegeik 10 eves prognosztizalt teljes tulelese 83% (reszletesen: korai, majd előrehaladott kedvező vs kedvezőtlen: 100% vs 87,8%, 88,9% vs. 41,6%), az esemenymentes 70% (82,6% vs 70,8%, 64,5% vs 0%) volt. Konkluzio: Hodgkin-lymphomas betegeik kezelesi eredmenyei javultak, azonban arra is ramutatnak, hogy a korai, kedvező prognozisu betegeknel a kezelesi toxicitas csokkentendő, mig az előrehaladott, rossz prognozisu betegek (az osszes beteg kb. 10%-a) agresszivebb primer kezeleset akar a sulyosabb mellekhatasok, szovődmenyek ismereteben is vallalni kell. Introduction: Recently, in the diagnostics and treatment of Hodgkin’s disease significant developments have occurred. Aim: To sumarize the clinical and histological data of patients with Hodgkin’s disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995–2004. In 2006 January, the mean follow-up was 69 (12–132) months. Methods: Patients data was analyzed by using SPSS statistical software. Results: The mean age of the 163 patients at the diagnosis was 36 years (14–75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkin’s disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radioterapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients recieved cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycine, vinblastine, 87 adriamycine, bleomycine, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occured, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continoually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secundary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). Conclusion: The treatment results of our Hodgkin’s disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patiets) agressive primary treatment should be used even with more severe side effects and complications.INTRODUCTION Recently, in the diagnostics and treatment of Hodgkins disease significant developments have occurred. AIM To summarize the clinical and histological data of patients with Hodgkins disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995-2004. In 2006 January, the mean follow-up was 69 (12-132) months. METHODS Patients data was analyzed by using SPSS statistical software. RESULTS The mean age of the 163 patients at the diagnosis was 36 years (14-75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkins disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radiotherapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients received cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycin, vinblastine, 87 adriamycine, bleomycin, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occurred, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secondary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). CONCLUSION The treatment results of our Hodgkins disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patients) aggressive primary treatment should be used even with more severe side effects and complications.

Hodgkin-lymphomás betegeink kezelése során szerzett tapasztalatok az utóbbi évtizedben

Bevezetes: A Hodgkin-lymphoma diagnosztikajaban, kezeleseben az elmult evtizedben jelentős valtozasok kovetkeztek be. Cel: Ennek tukreben a szerzők celul tűztek ki az 1995–2004 kozott a DEOEC III. sz. Belgyogyaszati Klinikan elsődlegesen kezelt Hodgkin-lymphomas betegek adatainak attekinteset 2006 januarjaban, atlagosan 69 (12–132) honap kovetes utan. Modszerek: a kortortenetek adatait SPSS statisztikai programmal ertekeltek. Eredmenyek: A 163 beteg atlageletkora a diagnoziskor 36 (14–75) ev volt, bimodalis koreloszlassal. A leggyakoribb (48,5%) a kevert sejtes altipus volt. A betegek 41,1%-a volt korai stadiumu, legkedvezőtlenebb prognozissal 15,7%-uk birt, bulky tumort 28,2%-ban eszleltek. 7 betegnel radioterapiat, 63-nal kemoterapiat es 92-nel tervezett kombinalt kezelest alkalmaztak. A sugarkezelesek 61,6%-a erintett mezős volt, 61 beteg cyclophosphamid, vincristin, procarbazin, prednisolon, adriamycin, bleomycin, vinblastin; 87 beteg adriamycin, bleomycin, vinblastin, 7 pedig egyeb kemoterapiat kapott. Az elsődleges kezelesre 146 komplett, 10 parcialis remisszio jott letre, 6 beteg nem reagalt. 10 reszleges remisszioban levő es 5 nem reagalo beteget tovabb kezeltek. 27 komplett remisszioban levő betegnel alakult ki relapszus, kozuluk 15-nel tortent nagy dozisu kezeles autolog periferias haemopoeticus őssejt-transzplantacioval. A kovetesi idő alatt 18 beteg halt meg, 11 a lymphoma progresszioja vagy a kezeles szovődmenye, 6 masodik tumor, 1 egyeb ok miatt. Betegeik 10 eves prognosztizalt teljes tulelese 83% (reszletesen: korai, majd előrehaladott kedvező vs kedvezőtlen: 100% vs 87,8%, 88,9% vs. 41,6%), az esemenymentes 70% (82,6% vs 70,8%, 64,5% vs 0%) volt. Konkluzio: Hodgkin-lymphomas betegeik kezelesi eredmenyei javultak, azonban arra is ramutatnak, hogy a korai, kedvező prognozisu betegeknel a kezelesi toxicitas csokkentendő, mig az előrehaladott, rossz prognozisu betegek (az osszes beteg kb. 10%-a) agresszivebb primer kezeleset akar a sulyosabb mellekhatasok, szovődmenyek ismereteben is vallalni kell. Introduction: Recently, in the diagnostics and treatment of Hodgkin’s disease significant developments have occurred. Aim: To sumarize the clinical and histological data of patients with Hodgkin’s disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995–2004. In 2006 January, the mean follow-up was 69 (12–132) months. Methods: Patients data was analyzed by using SPSS statistical software. Results: The mean age of the 163 patients at the diagnosis was 36 years (14–75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkin’s disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radioterapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients recieved cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycine, vinblastine, 87 adriamycine, bleomycine, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occured, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continoually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secundary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). Conclusion: The treatment results of our Hodgkin’s disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patiets) agressive primary treatment should be used even with more severe side effects and complications.INTRODUCTION Recently, in the diagnostics and treatment of Hodgkins disease significant developments have occurred. AIM To summarize the clinical and histological data of patients with Hodgkins disease, treated at the 3rd Department of Internal Medicine, University of Debrecen between 1995-2004. In 2006 January, the mean follow-up was 69 (12-132) months. METHODS Patients data was analyzed by using SPSS statistical software. RESULTS The mean age of the 163 patients at the diagnosis was 36 years (14-75), with bimodal age distribution, the most frequent disease subtype was mixed-cell Hodgkins disease (48.5%). 41.1% of the patients was at early stage, 15.7% had the worst prognosis, while 28.8% had bulky tumor. 7 patients had radiotherapy, 63 had chemotherapy, while at 92 patients combined modality treatment was used. 61.6% of radiotherapies were involved field, 61 patients received cyclophosphamide, vincristine, procarbazine, prednisolone, adriamycine, bleomycin, vinblastine, 87 adriamycine, bleomycin, vinblastine, 7 had other chemotherapies. As the response to the primary treatment 146 complete, 10 partial remission occurred, while 6 patients showed no response. 10 patients with partial remission and 5 non-responders were continually treated. 27 patients with complete remission had relapse, while 15 had high dose treatment with autologous peripheral stem cell transplantation. During the follow-up 18 patients died, 11 due to the lymphoma progression, or as the result of treatment, 6 had secondary malignancies, 1 due to other reasons. The 10-year prognosed overall survival was 83% (in details: early, advanced, favourable vs. unfavourable: 100% vs. 87.8%, 88.9% vs. 41.6%), the event free survival was 70% (82.6% vs. 70.8%, 64.5% vs. 0%). CONCLUSION The treatment results of our Hodgkins disease patients improved, additionally we showed that patients with early stage favourable disease the treatment toxicity should be reduced, while patients with advanced, unfavourable prognosis (10% of all patients) aggressive primary treatment should be used even with more severe side effects and complications.

Philadelphia-negatív krónikus myeloproliferativ neoplasia regiszter magyarországi létrehozása

Absztrakt Bevezetes: A betegsegregiszterek kialakitasa es műkodese az epidemiologiai adatok gyűjtesen tul a korszerű betegellatas es a hosszu tavra is tervező egeszsegpolitikai dontesek meghozatalat segiti. Celkitűzes: A szerzők a magyarorszagi Philadelphia-negativ myeloproliferativ neoplasiaban szenvedő betegek es a betegseg hazai jellemzőinek osszegyűjteset tűztek ki celul. Modszer: A Tudomanyos es Kutatasetikai Bizottsag 2013. aprilis 8-an kelt engedelyenek birtokaban online elektronikus adatgyűjtes indult a magyarorszagi hematologiai ellatohelyeken. Az epidemiologiai adatok rogzitesen tul felmertek a betegsegek jellemzőit a diagnozis idejen (verkep- es csontvelőelteresek), valamint a kiserő cardiovascularis kockazati tenyezőket, amely alapjan kockazatstratifikacio is tortent. Vizsgaltak tovabba a hazai kezelesi szokasokat. Eredmenyek: 2015. junius 30-ig 901 beteg adatat rogzitettek 15 hazai centrumbol, tisztitas utan 858 beteg (426 polycythaemia veras, 350 essentialis thrombocythaemias es 82 myelofibr...INTRODUCTION The establishment and operation of disease registry can be used to collect data on epidemiology cases. In addition, the registry can help to work out medical and health economical and political decisions for longer term. AIM The aim of the authors was to collect and analyse data of patients with Philadelphia negative neoplasia in Hungary and draw conclusions about the basic types and features of the relevant disease. METHOD An online electronic data collection system has been established, based on the permission of the Regional and Institutional Committee of Science and Research Ethics obtained in April 8, 2013. Data collection has been initiated by hematology centres in Hungary. In addition to collection of the epidemiologic data, blood and bone marrow analysis data have been collected, as well. Also, based on cardiovascular factors, risk stratification has been established. Finally, the authors have investigated the method and practice of patient treatment in Hungary. RESULTS Data of 901 patients from 15 Hungarian haematology centres have been recorded up to the date of June 30, 2015. After clarification of the data, 426 polycythaemia vera, 350 essential thrombocythaemia and 82 myelofibrosis cases were used for analysis. CONCLUSIONS An online registry has been established which helps to clarify and analyse the basic features of certain medical cases and their treatment in Hungary. Including additional medical centres could help to improve the accuracy of medical analysis.