Introduction: Orbital tumors are rarely occurring in significant
quantities apart from a few tertially referral centers, so statistically our
data represent national proportions and characteristics of the affected patient
group. Objective: Review of the tumor surgeries performed
during the first three and a half years of the Semmelweis University Orbital
Surgery Team (from February 2019 to August 2022). Analysis of the 94 operative
cases, mainly based on age distribution, tumor dignity, location, and the type
of surgery performed. Method: This is a retrospective study,
made by the review of the entire outpatient and surgical patient records of
three and a half years in our IT system. We collected and classified the
patients’ data according to various aspects, then compared our results to
international publications. Only patients with histologically confirmed cancer,
operated by colleagues of our workgroup between February 2019 and September
2022, were included in our analysis. Excision of skin lesions affecting only the
dermis and subcutaneous tissues, removal of circumscribed conjunctival cysts,
and enucleations were excluded from the examined patient group. This is how we
dealt with the significant number of orbital surgeries in which the presence of
tumor cell proliferation was not confirmed after biopsy.
Results: During the three and a half year period, 94
operations were performed due to intraorbital tumor involvement. The surgeries
were preceded by physical examination and imaging. We performed biopsy in 38.3%
(n = 36), tumor mass reduction in 18.1% (n = 17), complete removal in 43.6% (n =
41) of the cases. Based on the histological findings, 53.2% (n = 50) of the
tumors were benign and 46.8% (n = 44) were malignant. The average age was 60.5
years in the malignant, and 39.5 years in the benign group. The most common
benign tumor was cavernous hemangioma in 13.8% (n = 13), and the most common
malignant tumor was lymphoma in 31.9% (n = 30). Discussion:
Benign tumors can mostly be removed in toto, without residual
symptoms. In the case of malignant tumors of the orbit, often only the reduction
of the tumor mass can be achieved. In significant amount of cases, we plan to
take a biopsy based on their morphological characteristics and the anamnesis.
This is how we proceed in the case of lymphoma, the therapy of which is
conservative. Conclusion: Various tumors can affect the orbit.
In our publication, we process the data of 94 patients with intraorbital tumor
surgery. 53.2% of the tumors were benign and 46.8% were malignant. The rate of
malignant tumors increased with age, and lymphoma is by far the most common of
them. 70% of the benign tumors were either vascular, lymphatic or peripheral
nerve tumors or dermoid cysts. Benign tumors proved to be completely resectable
in 76% of the cases. Orv Hetil. 2023; 164(49): 1947–1953.
Introduction: The rapid development of minimally invasive
techniques did not leave neurosurgery untouched either. New surgical
interventions, both skull and spine surgery, are gaining more and more
popularity. Due to the aging society, previously inoperable degenerative
abnormalities are also receiving more and more attention. In the treatment of
spinal canal stenosis caused by degenerative changes, the initially used
laminectomy was replaced by unilateral “over-the-top” surgery, and in recent
years, by techniques that ensure the least possible collateral tissue damage,
such as tubular retractor and then spinal endoscopy. Objective:
The purpose of this study is to use the experiences of the past years to present
the decompression surgeries performed with two minimally invasive techniques,
i.e., the tube explorer and the endoscope, and their
results, providing an insight into international spine surgery trends.
Method: From January 1, 2022 to December 31, 2022, we
operated 43 patients with spinal canal stenosis using this techniques. In 27 of
these cases, we used a tube retractor and a microscope, while in 16 cases, we
used an endoscopic technique. In order to evaluate the results, we took a visual
analogue scale value before and after the intervention to evaluate neurogenic
claudication, lower back pain that worsens with exercise, and radicular pain at
rest. Based on this, the patients were divided into four groups: using unchanged
(0–30%), moderate (31–50%), good (51–75%) and excellent (76–100%) ratings. We
separately analyzed surgeries for stenosis combined with spondylolisthesis. We
evaluated our short-term results based on the average value of hospitalization
days. Results: We achieved excellent postoperative results for
all examined symptoms, i.e., neurogenic claudication in 95.3%,
lower back pain in 72.4%, while the symptoms of restlessness disappeared almost
completely in 86.9% of the cases. Accordingly, we experienced good and moderate
results in much smaller proportions. The results after decompression surgery for
spinal canal stenosis caused by spondylolisthesis were evaluated separately,
based on which the postoperative results of neurogenic claudication in 92.8% of
cases, low back pain in 70%, and pain at rest in 100% proved to be excellent.
The average number of the hospitalisation days was 3.7. Discussion and
conclusion: Our experience is in line with the international
results, which suggest that the results of minimally invasive techniques using
the tube explorer and the endoscope can be further improved both in the short
and long term. With the introduction of new techniques, we not only offer our
patients a less invasive approach with better results, but due to the efficiency
of the procedures, more patients can undergo surgery in a shorter time. Orv
Hetil. 2023; 164(49): 1926–1937.
Introduction: Cardiac implantable electronic device-related
complications may require transvenous lead extraction. Data on procedure
complexity and outcomes are derived from international registries. However,
patient characteristics vary considerably between countries.
Objective: To summarize the results of the 10-year
systematic institutional extraction program and compare it with international
data. Methods: We retrospectively analyzed consecutive patients
undergoing extraction between 2012 and 2020. Data regarding patient
characteristics, indications, techniques and outcomes of the procedures were
collected and compared with the results of the largest comprehensive European
registry (ELECTRa). We also examined success rates at different levels of the
“stepwise approach”. Results: 200 patients (65 ± 14.3 years,
74.5% male) were included. The indication of extraction was predominantly
infectious, exceeding the rate reported in ELECTRa (87.5% vs.
52.8%, p<0.001). Lead dwelling time was also longer in our study (7.8 ± 6.2
vs. 6.4 ± 5.4 years). The number of passive fixation leads
was found to be also significantly higher (62.2% vs. 46.6%,
p<0.001). One fifth of our patients had previously undergone a failed
extraction attempt. A higher proportion of patients required the use of locking
stylets (81.9% vs. 71.1%, p<0.001) and active extraction
sheaths (71.8% vs. 27.1%, p<0.001). Major complications
occurred in 4.5% and procedural death in 4 cases (2%). Procedural success was
88.2%, which is lower than the 95.7% reported in ELECTRa. In the stepwise
approach analysis, cumulative clinical success rate was 24.8% with locking
stylets, 74.2% with the primary active sheaths, 91.3% with advanced extraction
techniques (crossover, femoral snare) and 96.6% with non-emergency cardiac
surgery. Discussion and conclusion: In the last 10 years, a
successful lead extraction program has been developed in our institution.
Patient risk and procedure complexity far exceed those reported by international
registries. To achieve optimal outcomes, the availability of diverse extraction
techniques, experience as well as close educational and referral cooperation
with implanting centers are essential. Orv Hetil. 2023; 164(49): 1954–1964.
Introduction and objective: Laparoscopic complete mesocolic
excision (CME) with central vascular ligation is gaining acceptance for the
treatment of right colon cancers, however, variable mesenteric vascular anatomy
can be a surgical challenge, thus affecting results. The aim of our study is to
investigate the usefulness of a 3D virtual vascular model reconstructed from
CT–angiography. In this article, we demonstrate the application of 3D technology
in a surgical area difficult to comprehend with conventional techniques.
Method: In this randomized, controlled trial, we plan to
enroll 40 patients with AJCC stage I–III right colonic cancer scheduled for
laparoscopic CME surgery. Patients are randomized preoperatively one-to-one. The
experimental group (A) has a 3D virtual vascular model created for pre- and
intraoperative use, the control group (B) has no model available. Demographics,
blood loss, vascular injuries, procedure duration, lymph node harvest, specimen
quality, postoperative complications and length of stay are recorded. Surgeons
rate the model postoperatively on a 0–10 scale. Long term oncologic outcomes
will be recorded. Results: At submission of the abstract, 29
patients were enrolled (A = 18, B = 11). Demographics in the two groups are
comparable. Blood loss (p = 0.40), conversion rate (p = 0.75), postoperative
complications (p = 0.82) and hospital stay (p = 0.40) do not show significant
difference, while lymph node yield (p = 0.76) and specimen quality are also
comparable. Duration of standard surgical steps of central vascular ligation are
comparable. Surgeons rate the overall usefulness of the 3D model 7.6/10, with
the highest scores given for identifying ileocolic vessels (7.8) and Henle’s
trunk (8.3). The model was rated less useful for assisting gastroepiploic
dissection (5.2). No patient dropout occurred to this date.
Conclusion: Surgeons appraise the quality and usefulness of
the model positively, especially for identifying ileocolic vessels and the
anatomy of Henle’s trunk. Orv Hetil. 2023; 164(49): 1938–1946.
Primary hypertrophic osteoarthropathy (HOA) is a rare condition with no identifiable cause, accounting for 3%–5% of all HOA cases. It is challenging to identify incomplete primary HOA, which can be misdiagnosed as other hypertrophic periostitis diseases. At least two of the four criteria set by Borochowitz and Rimoin (1990) must be present to diagnose primary HOA. Diagnostic difficulties due to incomplete or atypical manifestations are common. We present a case of incomplete primary PHOA at Hanoi Medical University Hospital in Vietnam. A 37-year-old male presented with ankle joint pain for nearly four years. X-ray and magnetic resonance imaging showed periostitis in the tibias and fibulas, which could not exclude Camurati–Engelmann disease. Finally, gene sequencing on the Illumina MiSeq system identified a missense mutation (c.295C>T) in the solute carrier organic anion transporter family member 2A1 (SLCO2A1) gene on chromosome 3. Our case report and literature review aim to improve specialists' understanding of incomplete primary HOA and reduce the frequency of missed diagnoses.
Studies have shown evidence for long-term effects of psychedelics on personality, but comprehensive models of psychedelic-mediated personality changes have yet to be explored.
The present study aims to investigate (1) perceptions of personality change in the general population, (2) moderators of perceived personality change including setting and drug type, and (3) whether personality predisposes individuals to use psychedelics.
Paid participants with experience using psychedelic (N = 218), non-users with interest in using psychedelics (N = 104), and non-users without interest in using psychedelic (N = 104) completed an online survey following recruitment from Amazon Mechanical Turk. Psychedelic users were asked to complete written open-ended accounts of perceived personality changes that they attribute to their most intense psychedelic experience. Thematic and factor analyses were undertaken to identify themes of perceived psychedelic change and their organizational structure.
Thematic analyses resulted in 52 unique personality change themes, and exploratory factor analyses yielded eight thematic factors (Unitive Spiritual, Gratitude Absorption, Purpose Freedom, Compassion Understanding, Emotional Stability, Openness Perspective, Connection to Self, and Neuroticism Caution). Interest in psychedelic use among non-users was associated with higher openness and neuroticism. Psychedelic users tended to be more open and extraverted, and less neurotic than non-users, and interested non-users tended to be higher in openness than uninterested non-users.
The present results inform a tentative model of how personality leads to psychedelic use, how psychedelic use leads to changes in personality, and how setting and drug moderate different types of changes in personality. Research and clinical implications are discussed, including (1) hypotheses for future prospective and experimental research, (2) the value of creating multi-faceted, holistic measures that reflect the diversity and organizational structure of possible psychedelic changes, and (3) the value of allowing such evidence to guide novel psychedelic-assisted therapeutics.
Time perception is a cognitive process involving both the ability to estimate the duration of an event (time estimation, TE) and the subjective perception of its passage (time passage, TP). Studies show that alteration in TE/TP is associated with substance use disorders. However, little is known about the impact of these alterations in potentially problematic online behaviors. We explore TE and TP while participants were exposed to cues related to videogames, pornography, and TV series, and the relationship of TE and TP with scores from instruments that measure problematic gaming (PG), problematic pornography use (PPU), and problematic binge-watching (BW).
Participants from three independent samples (40 men from Luxembourg; 99 Spanish men, 111 Spanish women) completed an experimental task designed to assess TE and TP while they were exposed to short clips related to videogames, pornography, TV series, and documentaries (control condition). Participants also completed different self-reports.
Whereas men underestimated the time that they were exposed to pornography and TV series, women overestimated it. For videogames, we showed a consistent pattern of overestimation of time duration. Time was systematically perceived as passing faster while participants were presented with TV series and pornography. Regarding the association between time perception and PG, PPU, and BW, TE did not correlate with any of the indicators of problematic engagement assessed; but TP correlated with several of these indicators.
Discussion and conclusions
The present preliminary results showed mixed evidence regarding the involvement of time perception in gaming, pornography use, and binge-watching.
Klebsiella pneumoniae is a major human pathogen as it is responsible for various infections. In the past years hypervirulent K. pneumoniae (hvKP) emerged and disseminated worldwide. In this review a summary will be given about epidemiology, detection and antibiotic resistance of hypervirulent K. pneumoniae. A common feature of hypervirulent K. pneumoniae is a combined expression of several virulence factors. A mucoviscosus phenotype, certain capsulare serotypes (e.g.: K1, K2, K28, K47, K63) together with additional genetic markers namely, magA, rmpA or iucABCD, are needed in combinations to achieve the hypervirulent pathotype. Plasmid coded virulence determinants are also detected, that indicates horizontal gene transfer of hypervirulence factors in K. pneumoniae.
Interestingly, infections caused by hypervirulent K. pneumoniae occur usually in the community in otherwise healthy people, and during these infections multiple infection sites are detected. Clinical pictures include both invasive infections and local abscess formation. Pyogenic liver abscess is the most frequently reported clinical manifestation and abscess formation in brain, spleen and lung are also diagnosed. Additionally, meningitis, endophthalmitis, trombophlebitis, pneumonia can also develop.
In the early reports, hypervirulent K. pneumoniae strains exhibited enhanced virulence but these were susceptible to commonly used antibiotics. However, recently KPC, VIM, NDM and OXA-48 carbapenemase producing hypervirulent K. pneumoniae strains are increasingly reported, furthermore, well-known high-risk K. pneumoniae clones (e.g.: ST11, ST147, ST307) can develop hypervirulent pathotype, that poses an even more alarming challenge.
The intertemporal and risk decision-making impairments are vital cognitive mechanisms in internet use disorder (IUD). However, the underlying neural mechanisms for these two decision-making dysfunctions in individuals with IUD remain unclear.
This study employed Functional Near-Infrared Spectroscopy (fNIRS) to record changes in blood oxygen concentration in the prefrontal cortex of individuals with IUD during intertemporal and risk decision-making tasks.
The findings revealed that the intertemporal decision-making deficits in IUD group were primarily associated with reduced activation in the left dorsolateral prefrontal cortex (dlPFC) and orbitofrontal cortex (OFC) and FC from the left dlPFC to the right dlPFC. On the other hand, risk decision-making impairments were linked to decreased OFC activation and weakened functional connectivity from the left dlPFC to the right dlPFC and OFC.
Discussions and Conslusions
These results suggested that while there were common neural mechanisms underlying intertemporal and risk decision-making impairments in individuals with IUD, specific neural foundations existed for each type of dysfunction.
Gaming disorder (GD) screening often involves self-report survey measures to detect the presence of symptoms. Studies have shown that gamers' responses vary greatly across survey items. Some symptoms, such as preoccupation and tolerance, are frequently reported by highly engaged but non-problematic gamers, and therefore these symptoms are thought to lack specificity and are suggested to be less important in classification decisions. We argue that the influence of response categories (e.g., dichotomous responses, such as ‘yes’ or ‘no’; or frequency categories, such as ‘rarely’ and ‘often’) on item responses has been relatively underexplored despite potentially contributing significantly to the psychometric performance of items and scales. In short, the type of item response may be just as important to symptom reporting as the content of survey questions. We propose some practical alternatives to currently used item categories across GD tools. Research should examine the performance of different response categories, including whether certain response categories aid respondents' comprehension and insight, and better capture pathological behaviours and harms.