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Kecskemét, Hungary

Ruzsa Z.,Semmelweis University | Huttl K.,Semmelweis University | Toth K.,Bacs Kiskun County Hospital | Merkely B.,Semmelweis University
Interventional Medicine and Applied Science | Year: 2010

Rotational atherectomy (RA) in peripheral circulation is an advanced revascularization procedure, often used in cases where traditional percutaneous transluminal angioplasty (PTA) is inadequate and bypass grafting is either unavailable or undesired. We report on a case, where RA was successfully performed after failed traditional PTA. The case highlights the importance of RA in peripheral cases where severe calcification occurs and the lesion is not suitable for PTA (cannot be passed with balloon or is undilatable). © 2010 Akadémiai Kiadó, Budapest.

Ruzsa Z.,Bacs Kiskun County Hospital | Forster T.,University of Szeged | Nemes A.,University of Szeged
Polski Przeglad Kardiologiczny | Year: 2010

The treatment of chronic limb ischaemia is a very challenging topic for vascular doctors. Among the tools available, percutaneous rotational atherectomy (Rotablator), a high speed rotational burr appears a useful alternative to surgical revascularisation to open arterial lesions in both diffuse and segmental peripherial artery disease. When thinking on a limb salvage in patients with diffuse peripherial artery disease, decreased hospital stay, morbidity and mortality, and improved quality of life are all factors considering the method of therapy. In the present report we aimed to highlight attention on the fact that Rotablator treatment can be combined with balloon angioplasty and drug-eluting stent implantation (DES) as a method of choice in the treatment of patients with chronic limb ischaemia. The postoperative antithrombotic regimen in below-the-knee rotational atherectomy is not well studied. The rationale for dual antiplatelet agents can be predicated on extensive coronary DES data demonstrating improved stent patency with combined aspirin and thienopyridines. However, based on literature findings patients should always be frequently followed for thrombemboli and restenosis. Copyright © 2010 Cornetis.

Ruzsa Z.,Bacs Kiskun County Hospital | Pinter L.,Augusta Hospital | Kolvenbach R.,Augusta Hospital
Catheterization and Cardiovascular Interventions | Year: 2012

Management of critical limb ischemia (CLI) requires a combined treatment approach: optimal medical therapy and revascularization procedures are both essential for favorable outcome. With the development of endovascular interventions these new modalities took the primary role in limb revascularization, especially in CLI patients, where the culprit lesion is often located below the knee (BTK) level, making the surgical procedure unfeasible. In our present case report, we demonstrate a successful percutaneous recanalization of a surgically non-treatable tibioperoneal trunk occlusion. The procedure was performed with dual access from anterograde and retrograde transpedal approach, and modified "V stenting" technique was used. We describe feasibility of bail out stenting using retrograde posterior tibial artery access after failed retrograde guidewire externalization. Our report discusses the feasibility, safety, and efficacy of the retrograde approach applying 4F compatible devices. Copyright © 2012 Wiley Periodicals, Inc.

Veszeli N.,Semmelweis University | Fust G.,Semmelweis University | Csuka D.,Semmelweis University | Trauninger A.,University of Pecs | And 9 more authors.
Molecular Immunology | Year: 2014

Neuromyelitis optica (NMO) is an autoimmune demyelinating inflammatory disorder, mediated by pathogenic autoantibodies against aquaporin 4 (AQP4), the main water channel of the central nervous system (CNS). NMO is characterized by local IgG deposition and complement activation within the CNS, but the three complement pathways have not been systematically investigated.We evaluated the overall activation of the classical, alternative, and MBL-lectin pathways in the peripheral blood of 25 patients with AQP4-seropositive NMO spectrum during remission and 113 healthy controls by three ways: (1) we measured the concentrations of native complement proteins of the three pathways [C1-inhibitor (C1-inh), C1q, C4, C3, C5, factor I, factor B, properdin]; (2) the concentrations of complement products suggesting in vivo activation (C1rC1sC1-inh, C3a, C3bBbP, and SC5b-9); and (3) the total activity of the three complement pathways. Additionally we measured levels of C1rC1sC1-inh, C3a, C3bBbP in cerebrospinal fluid (CSF) of 6 patients with relapsing NMO and of 18 patients with relapsing multiple sclerosis (MS).The serological studies indicated that total complement activity of the classical [median (interquartile range) 72 (61-82) vs. 65 (56-73) CH50/mL; p= 0.0122] and of the lectin pathways [73 (59-111) vs. 49 (3-92)%; p= 0.0078)] were elevated compared with the controls, whereas that of the alternative pathway was not significantly different. The levels of C3 [1.1 (0.9-1.3) vs. 1.4 (1.2-1.5). g/L; p<. 0.0001], factor B [89 (77-115) vs. 103 (93-113)%; p= 0.0397] and factor I [85 (69-95) vs. 101 (93-107)%; p= 0.0007], as well as of properdin [92 (74-104) vs. 108 (97-122)%; p= 0.0028] were significantly lower in the patients than in the controls. The only increase in the patients was ascertained in the relative concentration of C1rC1sC1-inh vs. the C1-inhibitor (42.3 [31.9-65.0] vs. 30.8 [13.5-43.5] AU/mg; p= 0.0007). The absolute and relative levels of the other complement activation products were not elevated in the patients. On the contrary, the serum concentrations of C3a, C3bBbP, and SC5b-9 of the patients were lower than those of the controls. The absolute concentration of the complement activation products (C1rC1sC1-inh, C3bBbP, C3a) and the ratio of C3bBbP/C1rC1sC1-inh did not differ in NMO and MS CSF samples. The ratio of C3bBbP/C1rC1sC1-inh was similar in NMO plasma and CSF samples. We found a higher ratio of C3bBbP/C1rC1sC1-inh in the plasma of control subjects compared to those in any pathological samples.Our results do not indicate substantial systemic complement activation if NMO activity is adequately controlled; nevertheless, the complement system is abnormally affected even during remission. The relative ancillarity of the alternative compared to the classical pathway may also suggest that suppression of the alternative pathway by treatment may be important to achieve remission. © 2013.

Langer C.J.,University of Pennsylvania | Albert I.,Matrai Gyogyintezet | Ross H.J.,Mayo Medical School | Kovacs P.,Debrecen University | And 11 more authors.
Lung Cancer | Year: 2014

Objective: This randomized phase II study assessed the efficacy and safety of obatoclax mesylate, a small-molecule Bcl-2 inhibitor, added to carboplatin/etoposide chemotherapy as initial treatment for extensive-stage small-cell lung cancer (ES-SCLC). Materials and methods: Chemotherapy-naïve subjects with ES-SCLC and Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2 received carboplatin/etoposide with (CbEOb) or without (CbE) obatoclax for up to six cycles. Responders to CbEOb could receive maintenance obatoclax until disease progression. The primary endpoint was objective response rate (ORR). Results: 155 subjects (median age 62, 58% male, 10% ECOG PS 2) were treated with CbEOb (n = 77) or CbE (n = 78); 65% and 59% of subjects, respectively, completed six cycles. ORR was 62% with CbEOb versus 53% with CbE (1-sided p = 0.143). Clinical benefit (ORR+ stable disease) trended better with CbEOb (81% versus 68%; p = 0.054). Median progression-free survival (PFS) and overall survival (OS) were 5.8 months (95% confidence interval [CI]: 5.3-6.5) and 10.5 months (8.9-13.8) with CbEOb and 5.2 months (95% CI: 4.1-5.7) and 9.8 months (7.2-11.2) with CbE. Median OS was 10.5 months (95% CI: 8.9-13.8) and 9.8 months (7.2-11.2) with a nonsignificant hazard ratio for OS, 0.823; 1-sided p = 0.121. Grade 3/4 adverse events (AEs) were primarily hematologic and similar in frequency between treatment arms. Obatoclax-related somnolence and euphoria were grade 1/2, transient, and did not require treatment discontinuation. Conclusion: Obatoclax was well tolerated when added to carboplatin/etoposide in first-line treatment of ES-SCLC, but failed to significantly improve ORR, PFS, or OS. © 2014 Elsevier Ireland Ltd.

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