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World Journal of Gastroenterology 2005年第15期11卷 2357-2359页

作者： Elod Papp zsuzsanna keszthelyi Nagy Karoly Kalmar Lajos Papp Csaba Weninger Tamas Tornoczky Endre Kalman Kalman Toth Tamas Habon 1st Department of Medicine Department of Surgery Heart Institute Department of Radiology Department of Pathology

Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.

关键词： Hepatocellular carcinoma Intracardiac penetration Pulmonary embolization

Update on pathogenesis and predictors of response of therapeutic strategies used in inflammatory bowel disease

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World Journal of Gastroenterology 2015年第44期21卷 12519-12543页

作者： Emilio G Quetglas Zlatan Mujagic Simone Wigge Daniel keszthelyi Sebastian Wachten Ad Masclee Walter Reinisch Project Strategy and Science Grünenthal GmbH Internal Medicine University of Maastricht Medical Center Translational Science Grünenthal GmbH Molecular Pharmacology Grünenthal GmbH Internal Medicine. Mc Master University

The search for biomarkers that characterize specific aspects of inflammatory bowel disease(IBD), has received substantial interest in the past years and is moving forward rapidly with the help of modern technologies. Nevertheless, there is a direct demand to identify adequate biomarkers for predicting and evaluating therapeutic response to different therapies. In this subset, pharmacogenetics deserves more attention as part of the endeavor to provide personalized medicine. The ultimate goal in this area is the adjustment of medication for a patient's specific genetic background and thereby to improve drug efficacy and safety rates. The aim of the following review is to utilize the latest knowledge on immunopathogenesis of IBD and update the findings on the field of Immunology and Genetics, to evaluate the response to the different therapies. In the present article, more than 400 publications were reviewed but finally 287 included based on design, reproducibility(or expectancy to be reproducible and translationable into humans) or already measured in humans. A few testshave shown clinical applicability. Other, i.e., genetic associations for the different therapies in IBD have not yet shown consistent or robust results. In the close future it is anticipated that this, cellular and genetic material, as well as the determination of biomarkers will be implemented in an integrated molecular diagnostic and prognostic approach to manage IBD patients.

关键词： Mucosal immunology Biomarkers Pharmacology Mode of

The role of electrocardiography in the elaboration of a new paradigm in cardiac resynchronization therapy for patients with nonspecific intraventricular conduction disturbance

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Journal of Geriatric Cardiology 2016年第2期13卷 118-125页

作者： Andras Vereckei Gabor Katona zsuzsanna Szelenyi Gabor Szenasi Balint Kozman Istvan Karadi The 3rd Department of Medicine School of Medicine Semmelweis University Budapest Hungary Institute of Pathophysiology Semmelweis University Budapest Hungary Ardinsys Ltd. Budapest Hungary

Cardiac resynchronization therapy （CRT） is associated with a favorable outcome only in patients with left bundle branch block （LBBB） pattern and in patients with a QRS duration 〉 150 ms, in patients with non-LBBB pattern with a QRS duration of 120-150 ms usually is not beneficial. After adjusting for QRS duration, QRS morphology was no longer a determinant of the clinical response to CRT. In contrast to the mainstream view, we hypothesized that the unfavorable CRT outcome in patients with non-LBBB and a QRS duration of 120-150 ms is not due to the QRS morphology itself, but to less dyssynchrony and unfavorable patient characteristics in this subgroup, such as more ischemic etiology and greater prevalence of male patients compared with patients with LBBB pattern. Further, the current CRT technique is devised to eliminate the dyssynchrony present in patients with LBBB pattern and inappropriate to eliminate the dyssynchrony in patients with non-LBBB pattern. We also hypothesized that electrocardiography may also provide information about the presence of interventricular and left intraventricular dyssynchrony and the approximate location of the latest activated left ventricular （LV） region. To this end, we devised new ECG criteria to estimate interventricular and LV intraventricular dyssynchrony and the approximate location of the latest activated LV region. Our preliminary data demonstrated that the latest activated LV region in patients with nonspecific intraventricular conduction disturbance （NICD） pattern might be at a remote site from that present in patients with LBBB pattern, which might necessitate the invention of a novel CRT technique for patients with NICD pattern. The application of the new interventricular and LV intraventricular dyssynchrony ECG criteria and a potential novel CRT technique might decrease the currently high nonresponder rate in patients with NICD pattern.

关键词： Cardiac resynchronization therapy Electrocardiography Heart failure

Quality of care in inflammatory bowel diseases: What is the best way to better outcomes?

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World Journal of Gastroenterology 2018年第22期24卷 2363-2372页

作者： Matthew Strohl Lorant Gonczi zsuzsanna Kurt Talat Bessissow Peter L Lakatos Division of Gastroenterology McGill University Health Center First Department of Medicine Semmelweis University

Inflammatory bowel disease(IBD) is a lifelong, progres-sive disease that has disabling impacts on patient's lives. Given the complex nature of the diagnosis of IBD and its management there is consequently a large economic burden seen across all health care systems. Quality in-dicators(QI) have been created to assess the different fa?ades of disease management including structure, process and outcome components. Their development serves to provide a means to target and measure quality of care(Qo C). Multiple different QI sets have been published in IBD, but all serve the same purpose of trying to achieve a standard of care that can be attained on a national and international level, since there is still a major variation in clinical practice. There have been many recent innovative developments that aim to improve Qo C in IBD including telemedicine, home biomarker assessment and rapid access clinics. These are some of the novel advancements that have been shown to have great potential at improving Qo C, while offloading some of the burden that IBD can have vis-a-vis emergency room visits and hospital admissions. The aim of the current review is to summarize and discuss available QI sets and recent developments in IBD care including telemedicine, and to give insight into how the utilization of these tools could benefit the Qo C of IBD patients. Additionally, a treating-to-target structure as well as evidence surrounding aggressive management directed at tighter disease control will be presented.

关键词： Inflammatory bowel disease Telemedicine Quality indicators Quality of care Treat-to-target

Prevalence and predictors of hospitalization in Crohn's disease in a prospective population-based inception cohort from 2000-2012

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World Journal of Gastroenterology 2015年第23期21卷 7272-7280页

作者： Petra A Golovics Laszlo Lakatos Michael D Mandel Barbara D Lovasz zsuzsanna Vegh zsuzsanna Kurti Istvan Szita Lajos S Kiss Tunde Pandur Peter L Lakatos First Department of Medicine Semmelweis University Department of Medicine Csolnoky Ferenc Province Hospital

AIM: To analyze the prevalence, length and predictors of hospitalization in the biological era in the populationbased inception cohort from Veszprem ***: Data of 331 incident Crohn's disease(CD) patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed(median age at diagnosis: 28; IQR: 21-40 years). Both in- and outpatient records were collected and comprehensively ***: Probabilities of first CD-related hospitalization and re-hospitalization were 32.3%, 45.5%,53.7% and 13.6%, 23.9%, 29.8%, respectively after one, three and five years of follow-up in Kaplan-Meier analysis. First-year hospitalizations were related to diagnostic procedures(37%), surgery or disease activity(27% and 21%). Non-inflammatory disease behavior at diagnosis(HR = 1.32, P = 0.001) and perianal disease(HR = 1.47, P = 0.04) were associated with time to first CD-related hospitalization, while disease behavior change(HR = 2.38, P = 0.002) and need for steroids(HR = 3.14, P = 0.003) were associated with time to first re-hospitalization in multivariate *** CD-related hospitalization(within the year of diagnosis) was independently associated with need for immunosuppressives(OR = 2.08, P = 0.001) and need for surgeries(OR = 7.25, P < 0.001) during the disease ***: Hospitalization and re-hospitalization rates are still high in this cohort, especially during the first-year after the diagnosis. Non-inflammatory disease behavior at diagnosis was identified as the pivotal predictive factor of both hospitalization and rehospitalization.

关键词： Crohn's disease Hospitalization Recurrence Predictor Population-based Biological therapy

Positioning of old and new biologicals and small molecules in the treatment of inflammatory bowel diseases

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World Journal of Gastroenterology 2018年第32期24卷 3567-3582页

作者： Jason Reinglas Lorant Gonczi zsuzsanna Kurt Talat Bessissow Peter L Lakatos Department of Gastroenterology McGill University Health CenterMontrealQuébec H4A 3J1Canada First Department of Medicine Semmelweis UniversityH-1083BudapestKoranyi S.2AHungary

The past decade has brought substantial advances in the management of inflammatory bowel diseases(IBD). The introduction of tumor necrosis factor(TNF) antagonists, evidence for the value of combination therapy, the recog-nition of targeting lymphocyte trafficking and activation as a viable treatment, and the need for early treatment of high-risk patients are all fundamental concepts for current modern IBD treatment algorithms. In this article, authors review the existing data on approved biologicals and small molecules as well as provide insight on the current positioning of approved therapies. Patient stratification for the selection of specific therapies, therapeutic targets and patient monitoring will be discussed as well. The thera-peutic armamentarium for IBD is expanding as novel and more targeted therapies become available. In the absence of comparative trials, positioning these agents is becoming difficult. Emerging concepts for the future will include an emphasis on the development of algorithms which will facilitate a greater understanding of the positioning of novel biological drugs and small molecules in order to best tailor therapy to the patient. In the interim, anti-TNF therapy remains an important component of IBD therapy with the most real-life evidence and should be considered as first-line therapy in patients with complicated Crohn's disease and in acute-severe ulcerative colitis. The safety and efficacy of these ‘older' anti-TNF therapies can be optimized by adhering to therapeutic algorithms which combine clinical and objective markers of disease severityand response to therapy.

关键词： Inflammatory bowel disease Small molecule Positioning Biologic Therapeutic

Comparison of long-term outcome between patients aged 〈 65 years vs. ≥ 65 years after atrial fibrillation ablation

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Journal of Geriatric Cardiology 2017年第9期14卷 569-574页

作者： zsuzsanna Kis Anna ME Noten Mihran Martirosyan Astrid A Hendriks Rohit Bhagwandien Tamas Szili-Torok Department of Cardiology Erasmus MC University Medical Center Rotterdam the Netherlands

Background Atrial fibrillation （AF） is the most frequent arrhythmia, and its prevalence is increasing with aging. We aimed to com-pare the long-term outcome data of patients 〈 65 years vs.≥ 65 years who underwent catheter ablation （CA） for drug-refractory AF. MethodsConsecutive patients with primary pulmonary vein isolation performed between March 2001 and December 2011, and those who completeda five-year of follow-up were divided into two groups： patients aged 〈 65 years into group 1, and patients aged ≥ 65 into group 2. Long-termoutcome data concerning mortality, thromboembolic events （TE） and success rates were compared between these groups. Results A totalnumber of 390 patients were included, group 1 contained 310 patients, and 80 patients in group 2. In group 2, patients had more often impairedrenal function （P 〈 0.001） and thyroid disease （P = 0.047）. A total of fifteen patients died during the 6.63 ± 2.1 years of follow-up, with a sig-nificantly higher incidence in the older group （8/80 vs. 7/310 patients, P = 0.004）. The majority of fatal outcome was due to cancerous dis-eases in both groups. No difference was observed concerning the long-term TE rate （12/310 vs. 4/80 patients, P = 0.75）. Rhythm controlfailed in 25.9% of the patients, with no difference between the groups： 26.4% in group 1 vs. 23.7% in group 2 （P = 0,67）, ConclusionsDespite growing prevalence of AF in aging population, the elderly patients are underrepresented in CA procedures. Similar clinical successand TE complication rate are observed between the age-groups. Our data suggest more liberal criteria might be applied while selecting pa-tients for AF ablation.

关键词： Atrial fibrillation Catheter ablation Clinical outcome The elderly Thromboembolic complication

Non-pancreatic hyperlipasemia:A puzzling clinical entity

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World Journal of Gastroenterology 2024年第19期30卷 2538-2552页

作者： Krisztina Eszter Feher David Tornai zsuzsanna Vitalis Laszlo Davida Nora Sipeki Maria Papp Division of Gastroenterology Department of Internal MedicineFaculty of MedicineUniversity of DebrecenDebrecen H-4032Hajdu-BiharHungary Kalman Laki Doctoral School of Biomedical and Clinical Sciences Faculty of MedicineUniversity of DebrecenDebrecen H-4032Hungary

BACKGROUND Increased lipase level is a serological hallmark of the diagnosis of acute pancreatitis(AP)but can be detected in various other diseases associated with lipase leakage due to inflammation of organs surrounding the pancreas or reduced renal clearance and/or hepatic *** non-pancreatic hyperlipasemia(NPHL)is puzzling for attending physicians during the diagnostic procedure for *** would be clinically beneficial to identify the clinical and laboratory variables that hinder the accuracy of lipase diagnosis with the aim of improve it.A more precise description of the NPHL condition could potentially provide prognostic factors for adverse outcomes which is currently *** To perform a detailed clinical and laboratory characterization of NPHL in a large prospective patient cohort with an assessment of parameters determining disease *** A Hungarian patient cohort with serum lipase levels at least three times higher than the upper limit of normal(ULN)was prospectively evaluated over 31 *** were identified using daily electronic laboratory reports developed to support an ongoing observational,multicenter,prospective cohort study called the EASY trial(ISRCTN10525246)to establish a simple,easy,and accurate clinical scoring system for early prognostication of *** of NPHL was established based on≥3×ULN serum lipase level in the absence of abdominal pain or abdominal imaging results characteristic of *** A total of 808 patients[male,n=420(52%);median age(IQR):65(51-75)years]were diagnosed with≥3×ULN serum lipase levels.A total of 392 patients had AP,whereas 401 had NPHL with more than 20 different *** and acute kidney injury(AKI)were the most prevalent etiologies of NPHL(27.7%and 33.2%,respectively).The best discriminative cut-off value for lipase was≥666 U/L(sensitivity,71.4%;specificity,88.8%).The presence of AKI or sepsis negatively affected the diagnostic performance of *** w

关键词： Non-pancreatic hyperlipasemia Acute pancreatitis Glycoprotein 2 Acute kidney injury Sepsis Mortality

Striking elevation in incidence and prevalence of inflammatory bowel disease in a province of western Hungary between 1977-2001

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World Journal of Gastroenterology 2004年第3期10卷 404-409页

作者： Laszlo Lakatos Gabor Mester zsuzsanna Erdelyi Mihaly Balogh Istvan Szipocs Gyorgy Kamaras Peter Laszlo Lakatos 1~(st) Department of Medicine Csolnoky F.Province HospitalVeszpremHungary Department of Medicine Grof Eszterhazy HospitalPapaHungary Department of Medicine Municipal HospitalTapolcaHungary Department of Infectious Diseases Magyar Imre HospitalAjkaHungary 1~(st) Department of Medicine Semmelweis UniversityBudapestHungary

AIM:An investigation into inflammatory bowel disease and colorectal cancer in Veszprem Province was conducted from 1977 to ***: Both hospital and outpatient records were collected and reviewed comprehensively. The majority of patients were followed up ***:The population of the province was decreased from 386000 to 376000 during the period. Five hundred sixty new cases of ulcerative colitis (UC), 212 of Crohn's disease (CD), and 40 of indeterminate colitis (IC) were diagnosed. The incidence rates increased from 1.66 to 11.01 cases per 100 000 persons for UC, from 0.41 to 4.68 for CD and from 0.26 to 0.74 for IC. The prevalence rate at the end of 2001 was 142.6 for UC and 52.9 cases per 100 000 persons for CD. The peak onset age in UC patients was between 30 and 40 years, in CD between 20 and 30 years. A family history of IBD was present in 3.4% in UC and 9.9% in CD *** increased the risk for CD (OR=1.94) while it decreased the risk for UC (OR=0.25). Twelve colorectal carcinomas were observed in this cohort, the cumulative colorectal cancer risk after 10 years in UC was 2%, after 20 years 8.8%, after 30 years 13.3%.CONCLUSION:The incidence and prevalence rates of IBD have increased steadily in Veszprem Province, now equivalent to that in Western European countries. Rapid increase in incidence rates supports a probable role for environmental factors. The rate of colorectal cancers in IBD is similar to that observed in Western countries.

关键词： Adult Age Distribution Colorectal Neoplasms Female Health Surveys Humans Hungary Incidence Inflammatory Bowel Diseases Male Middle Aged Prevalence

Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype:Results of a 25-year follow-up study

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World Journal of Gastroenterology 2003年第10期9卷 2300-2307页

作者： Laszlo Lakatos Tunde Pandur Gyula David zsuzsanna Balogh Pal Kuronya Arpad Tollas Peter Laszlo Lakatos 1~(st) Department of Medicine Csolnoky F.Province HospitalVeszprem Department of Medicine Grof Eszterhazy HospitalPapa Department of Infectious Diseases Magyar Imre HospitalAjka Department of Medicine Mumcipal HospitalVarpalota 1~(st) Department of Medicine Semmelweis UniversityBudapestHungary

AIM:IBD is a systemic disease associated with a large number of extraintestinal manifestations (EIMs).Our aim was to determine the prevalence of EIMs in a large IBD cohort in Veszprem Province in a 25-year follow-up study. METHODS:Eight hundred and seventy-three IBD patients were enrolled (ulcerative colitis/UC/:619,m/f:317/302, mean age at presentation:38.3 years,average disease duration:11.2 years;Crohn's disease/CD/:254,m/f:125/129, mean age at presentation:32.5 years,average disease duration:9.2 years).Intestinal,extraintestinal signs and laboratory tests were monitored *** alteration suggesting an EIMs was investigated by a specialist. RESULTS:A total of 21.3% of patients with IBD had EIM (UC:15.0%,CD:36.6%).Age at presentation did not affect the likelihood of *** of EIMs was higher in women and in CD,ocular complications and primary sclerosing cholangitis (PSC) were more frequent in *** UC there was an increased tendency of EIM in patients with a more extensive *** complications were more frequent in CD (22.4% vsUC 10.2%,P<0.01).In UC positive family history increased the risk of joint complications (OR:3.63).In CD the frequency of type-1 peripheral arthritis was increased in patients with penetrating disease (P=0.028).PSC was present in 1.6% in UC and 0.8% in *** complications were present in 3.8% in UC and 10.2% in CD,the rate of ocular complications was around 3% in both *** complications were glomerulonephritis,autoimmune hemolytic anaemia and celiac disease. CONCLUSION:Prevalence of EIM in Hungarian IBD patients is in concordance with data from Western *** high number of EIM supports a role for complex follow-up in these patients.

关键词： Adolescent Adult Age Distribution Aged Aged, 80 and over Anemia, Iron-Deficiency Bile Duct Diseases Child Colitis, Ulcerative Crohn Disease Eye Diseases Female Follow-Up Studies Humans Hungary Joint Diseases Liver Diseases Male Middle Aged Phenotype Prevalence