Thromboembolic complications in COVID-19 patients / Thromboemboliás szövodmények COVID-19-betegekben.

Összefoglaló. Bevezetés: A koronavírus-2 által okozott fertozések igen gyakran súlyos, akut légzoszervi károsodás kialakulásához vezetnek, melynek következtében légzési elégtelenség manifesztálódik. A pneumoniák kialakulásának kezdete (2019. december) óta igen sok beteg szorult kórházi kezelésre. A súlyos tüdogyulladások ellátása során igazolódott, hogy a légzoszervi gyulladásos folyamatok során a betegek jelentos részében vénás, ritkábban artériás thrombosisok alakulnak ki, tovább súlyosbítva a klinikai állapotot. Célkituzés: A 2020. szeptember és 2021. március közötti idoszakban 1590, koronavírus-2 által megfertozött, tüdogyulladással szövodött beteget láttunk el osztályunkon. Betegeinkben azt vizsgáltuk, hogy milyen jellegu és arányú a thromboemboliás szövodmények elofordulása. Módszer: Az 1590, koronavírus-2 által fertozött beteg mindegyikében meghatároztuk a pneumonia súlyosságát; klinikai gyanú eseteiben alsó végtagi Doppler-ultrahangvizsgálatot, valamint komputertomográfiával végzett tüdoangiográfiát végeztünk. Eredmények: A képalkotó vizsgálatok eredményei azt igazolták, hogy a koronavírus-2 által okozott tüdogyulladással kezeltekben 13%-os gyakorisággal fordult elo mélyvénás thrombosis; akut tüdoemboliát a betegek 17%-ában kórisméztünk. Következtetés: A koronavírus-2 által okozott fertozésekben elsosorban a tüdoben, de egyéb szervekben is (szív, vese, máj) súlyos gyulladással járó kórfolyamatok alakulhatnak ki, amelyek hatására fokozott thrombosiskészség jelentkezik a gyulladásos és koagulációs rendszer interakciója következtében. A fokozott thrombosishajlam végeredményeként vénás és ritkábban artériás thrombosisok kialakulása súlyosbítja a betegek klinikai állapotát, s kedvezotlen hatást gyakorol az életkilátásra. Orv Hetil. 2021; 162(43): 1710-1716. INTRODUCTION: The infections caused by coronavirus-2 very often lead to severe, acute respiratory damages, because of which respiratory insufficiency is manifested. As a result, since the development of pneumonias (December, 2019), many patients have required hospitalization. When treating the severe pneumonia cases, it was proved that in a significant number of patients with respiratory inflammatory processes, venous, less often arterial thrombosis occured, making the clinical state even more severe. OBJECTIVE: We treated 1590 coronavirus-2 infected, pneumonia-connected patients between September, 2020 and March, 2021 at our department. We examined the nature and the proportion of the thromboembolic complications. METHOD: We determined the severity of pneumonia in the 1950 coronavirus-2 infected patients; when clinically suspected, they had lower limb Doppler ultrasound examination and angiography carried out with computer tomograph. RESULTS: The result of imaging examinations proved that in 13% of cases deep vein thrombosis occured; in 17% of cases acute pulmonary embolia occured with pneumonia caused by coronavirus-2. CONCLUSION: In coronavirus-2 infected cases, mainly in the lung, but also in other organs (heart, kidney, liver), severe inflammatory disease-processes may occur, as a result of which increased thrombosis tendency shows because of the ineraction of the inflammatory and coagulatory system. As a result of the increased thrombosis tendency, venous and less often arterial thrombosis worsen the clinical state of patients, and have unfavourable effect on life expectancy. Orv Hetil. 2021; 162(43): 1710-1716.

[Disorders of hemostatic system in patients with malignant disease, especially in view of venous thromboembolism]. / A haemostasisrendszer kóros irányú eltérései szolid malignus kóresetekben, különös tekintettel a vénás thromboemboliák kialakulására.

INTRODUCTION: An increased susceptibility to thrombosis demonstrated in laboratory analysis of solid malignant diseases develops as a result of the activating effect of malignant cells on the hemostatic system. The development of this activating effect is a consequence of interactions between malignant cells and the various components of the coagulation system (coagulation factors, platelets, endothelial cells, fibrinolytic system) which leads from a prothrombotic state to clinically identifiable disorders of the hemostatic system. AIMS: In a retrospective analysis, authors sought to answer what characteristics and frequency of hemostatic disorders developed in a great number of cases with malignant diseases. METHOD: Between 1996 and 2004, solid malignant diseases were diagnosed in 1381 patients by histological and/or cytological examinations. Most of the patients suffered from primary bronchopulmonary carcinoma ( n = 1140). In the rest of the cases, malignant processes were located in breast, colorectal system, kidney, bladder, thyroid gland and pancreas. Mesothelioma was diagnosed in six patients by histological analysis. Based on the examinations of clinical stage-definition, the malignant disease was in an advanced stage. The authors examined the characteristics and frequency of hemostatic disorders showed with special regard to the incidents of venous thromboembolism in patients with cancer. The role of existing non-malignant associative diseases concerning the development of hemostatic disorders was also given a special attention. RESULT: Out of the 1381 patients with malignant disease, clinically identifiable hemostatic disorders were found in 397 cases (28.7%). Venous thrombosis and acute pulmonary embolism happened to be the most frequent ones ( n = 305, 22%). Migrating superficial thrombophlebitis, septic thrombosis, acute diffuse intravascular coagulation, and microangiopathic hemolytic anemia developed in 71 patients (6.7%). CONCLUSION: Active cancer is often associated with hypercoagulable state, which perturbs the hemostatic balance between anticoagulant and procoagulant forces, creating a prothrombotic state. The interaction between tumor cells and host cells involves direct cell-cell interaction or indirect mechanism by cytokine release. Hypercoagulable state in patients with malignant disease may result in the occurrence of various clinically identifiable hemostatic system disorders: the most frequent one is venous thromboembolism (so-called secondary thrombosis). In cases of idiopathic venous thromboembolism, it is recommended to carry out specific clinical check-up to prove or to preclude asymptomatic malignant diseases.

[The effect of chemo-radiotherapy on the remission and survival in patients with limited stage small cell lung cancer]. / A korlátozott kiterjedésu kissejtes típusú tüdocarcinomában alkalmazott kemoradioterápia hatása a remisszió kialakulására es a túlélésre.

INTRODUCTION: The combined modality treatment used in case of limited stage small cell lung cancer assures the longest disease-free and average survival meanwhile maintaining an acceptable quality of life. OBJECT: The authors examined whether the combined modality treatment in case of limited-stage small cell lung cancer affects the remission positively or not: they presumed that the therapeutic response, early partial or complete clinical and oncological remission develops earlier than in patients treated with chemotherapy. The authors' other presumption was that the early therapeutic response could be the guarantee of the longest possible disease-free and average survival. PATIENTS AND METHOD: Small cell lung cancer (SCLC) was proved in 72 patients (23 women, 49 men, average 53 year-olds) with histological and/or cytological examination. Having examined which stage the patients were in, they proved to be in the limited stage. The patients were divided into two groups at random: cytotoxic chemotherapy containing cisplatin + etoposide was used in 36 cases, meanwhile in the other 36 cases the chemotherapy was completed with early concurrent thoracic radiotherapy. RESULTS: The therapeutic response happened earlier (early remission) in case of patients treated with chemo-radiotherapy than with chemotherapy treatment (average 10.4-12.6 weeks, SD = 1.22-1.99). The result of the "log rank" test showing the difference between the two groups is strongly significant in favor of the chemo-radiotherapy group (p = 0.0001). In patients with early remission receiving chemo-radiotherapy, the thoracic recidives and metastasis developed later (average 74.8 weeks, SD = 44.95), furthermore the average survival also proved to be longer (93.9 weeks, SD = 57.09). The average time until the development of tumor recidives and metastasis in patients belonging to the chemotherapy group was 44.5 weeks (SD = 30.23), and the average survival was 67.4 weeks (SD = 32.77). The result of the "log rank" test proved significant advantage for the chemo-radiotherapy group both for disease-free survival (p = 0.0010) and average survival (p = 0.0079 ). Another positive effect of chemo-radiotherapy was that less thoracic recidives and central nervous system metastasis could be diagnosed. Examination of treatment toxicity showed that one has to count primarily with esophagitis and pneumonitis related to the radiotherapy in patients receiving chemo-radiotherapy.

[Significance of acute pulmonary embolism for the exacerbation of chronic obstructive pulmonary disease]. / Akut pulmonális embólia jelentósége krónikus obstruktív tüdóbetegségek heveny exacerbatiójában.

The clinical diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease is often difficult because there is no characteristics sign of acute pulmonary embolic event. The presentation of an acute embolic event may mimic the symptoms of acute airway obstruction which is caused by different reasons. The presence of chronic obstructive pulmonary disease was recorded on a clinical history, physical examination, chest roentgenogram, and the result of pulmonary function studies. Among the 178 patients with chronic obstructive pulmonary disease in 49 patients (27.5 percent) were suspected of having pulmonary embolism. Pulmonary embolism was excluded by normal or low probability V/Q scan in 19 patients. Among 23 patients who demonstrated a high probability lung scan there was a high positive predictive value for pulmonary embolism effectively avoiding the need for further studies. Among the 7 patients with nondiagnostic or intermediate probability lung scan contrast-enhanced helical computed tomography was detected the pulmonary embolism in 3 patients. The present study was undertaken to better define the noninvasive clinical, laboratory, roentgenographic, lung scan, and computed tomography characteristics of acute pulmonary embolism in patients with chronic obstructive pulmonary disease.