Diagnostic difficulties and therapeutic options of a giant chest paraganglioma / Óriás mellkasi paraganglioma diagnosztikai nehézségei és terápiás lehetoségei

Paragangliomas are mostly benign tumors originating from the sympathetic or parasympathetic ganglions, but malignant forms are also known. They are in the region of the head and neck, in the glomus caroticum, intra-abdominally as well as in the thorax. The investigation of the 39-year-old male patient began due to extremely high blood pressure, night sweats and a 10 kg weight loss. Chest CT scan described a huge mass in the right hilum, bronchoscopic sampling was inconclusive. Tumor biopsy was performed through right thoracotomy, but complete resection was not possible due to tissue adhesions and cardiac involvement. Histological examination verified paraganglioma, which was also confirmed by laboratory tests. Accordingly, somatostatin analog therapy was initiated, followed by I-131-MIBG treatment with good clinical effect. Coronary angiography confirmed that the right coronary artery contributed with two marginal branches to the blood supply of the thoracic mass. The tumor was successfully removed and after the cardio-thoracic surgery, the patient's antihypertensive therapy was stopped. There was no sign of relapse during follow-ups. During the medical investigation of severe blood pressure elevations, the possibility of paraganglioma should be considered. In these cases, invasive procedures, if not preceded by proper medication, can be fatal. By taking advantage of the ever-expanding therapeutic options and the cooperation between institutions, even patients with a giant paraganglioma can become tumor-free.

[Nurse style of central vein! Our experience in the peripherally inserted central venous catheter]. / "Centrális véna ­ novér módra?" Perifériáról bevezetett centrális vénás kanülökkel szerzett tapasztalataink.

What is PICC line insertion? The PICC is a soft, flexible catheter which is made of polyurethane or silicone, and is inserted via an upper or lower extremity peripheral vein into superior or inferior vena cava. The origin of PICC line dates back to the early 1950s. Since the introduction of the PICC catheter, this method of venous catheterization has gone through many changes as regards the technique of insertion or the type of catheter used. Despite the routine use of PICC line worldwide, little progress has been made in its use in Hungary. In this short review we will briefly summarise the use of PICC line, its indications, advantages, disadvantages, and on complementary devices which are necessary during the procedure. We discuss our experience in insertion of PICC line at Pécs University, where the procedure is solely done by a certified registered nurse. We hope that with continuous progression of nurse competency, this procedure will be implemented at a higher scale in Hungary. Orv Hetil. 2017; 158(22): 856-863.

Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study.

OBJECTIVE: The role of cortisol in the prediction of mortality risk in critical illness is controversial in the literature. The aim of this study was to evaluate the prognostic value of cortisol concentrations in a mixed population of critically ill patients in medical emergencies. DESIGN: In this prospective, observational study, measurement of total (TC) and free cortisol (FC) levels was made in the serum samples of 69 critically ill patients (39 males and 30 females, median age of 74 years) at admission (0 h) and 6, 24, 48, and 96 h after admission. METHODS: Cortisol levels were determined using HPLC coupled high-resolution ESI-TOF mass spectrometry. The severity of disease was calculated by prognostic scores. Statistical analyses were performed using the SPSS 22.0 software. RESULTS: The range of TC varied between 49.9 and 8797.8 nmol/l, FC between 0.4 and 759.9 nmol/l. The levels of FC at 0, 6, 24, and 48 h and TC at 0, 6 h were significantly elevated in non-survivors and correlated with the predicted mortality. The prognostic value of these cortisol levels was comparable with the routinely used mortality scores. In predictive models, FC at 6, 24, and 48 h proved to be an independent determinant of mortality. CONCLUSIONS: The predictive values of FC in the first 2 days after admission and TC within 6 h are comparable with the complex, routinely used mortality scores in evaluating the prognosis of critically ill patients. The cortisol response probably reflects the severity of disease.