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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.

The paper examines some features of Chekhov’s early poetics (1880–1885) in comparison with the newspaper as a discourse contemporary to his time. In the first half of the 1880s, the daily newspaper emerged as the dominant organ in the new system of the press. This was also the birth of mass communication in Russia, a necessary part of which was the emergence of “the small press”, i.e. the sphere of humorous journals, thin magazines, and daily newspapers in which Chekhov began to publish his works.

The paper also summarizes the outcomes of the studies that reconstructed the cultural space of Russian newspapers and magazines of the period in question. The concept of “newspaper discourse” is introduced for the purposes of comparison and understood in the paper as a new and unified space that aims towards a universal modelling of the world through the production of texts. Newspaper discourse as a term is different from the concepts of “the small press” and “journalism”. At the end of the first part, the paper discusses the notions of discursive practice and interdiscursivity as one of the types of intertextuality defined by N. Fairclough.

The second part summarizes the typology created by A. Stepanov for Chekhov’s early texts based on mixing or displacing statements of different speech genres. Using this typology, the paper identifies the humorous texts in which newspaper speech genres are used. In comparison with the practice of newspapers, the most interesting structural type is the metonymic arrangement of utterances belonging to different speech genres or those belonging to the same speech genre. In these cases, the juxtaposed statements also lack a common referent. I. Sukhikh argues that it is a demand by newspapers and magazines of that time that manifests itself in the principle of metonymic ordering of trifles (creating cycles, series, and lists). Thoughts of Readers of Newspapers and Magazines and A Memo are interpreted as humorous pieces built on the principle of a list, mocking the common practice of newspaper discourse: its ambition for universality.

In the two humorous pieces, an element of parodic interdiscourse is highlighted: the composition is based on the principle of a list. This structural type leads, more in Chekhov’s creative evolution in general terms, to more complex, composite structures such as The Complaints Book. The newspaper genre of advertisements often used by the young Chekhov can also be reinterpreted as a composite structure of the series or the list type. In the creative laboratory of Chekhov, this element of interdiscourse is transformed into an artistic technique: the metonymic logic of the list becomes an index of the moral state and atmosphere of the depicted reality.