[Pulmonary histiocytic sarcoma]. / A tüdo histiocytás sarcomája.

Histiocytic sarcoma is an uncommon hematological malignancy. Its occurrence in the lung is very rare. Due to the small number of cases and the clinical and pathological features of the disease, the diagnosis can be challenging. Its optimal treatment is not yet known, in locally confined cases - depending on the location and size - surgical removal is part of complex oncotherapy. We report the case of a 52-year-old man with a tumor of central localization in the left lung. Pulmonectomy was performed. Histology verified histiocytic sarcoma of the lung. An overview of clinical features of the entity is presented in connection with our case report. Orv Heti. 2023; 164(34): 1350-1357.

Modern treatment of massive hemothorax / A masszív haemothorax modern kezelése

Introduction and objective: Hemothorax is an umbrella term for pathologies with an extremely wide range of etiology and severity. Most commonly it is of tramuatic origin, frequently iatrogenic (intervention, blood coagulation altering therapy) and rarely unknown. Depending on the cause, volume, and dynamics, it requires a patient-adapted treatment determined by access to certain therapeutical methods. We aim to provide a practical overview of these. Methods: Retrospective analysis of patients treated for haemothorax at the Thoracic Surgery Department of Borsod-Abaúj-Zemplén County Teaching Hospital in the period 1 January 2017­31 December 2021 has been performed. We used the hospital's database to collect data. In this paper, we analyze the cause of hemothorax, method of treatment, the efficacy of chosen therapeutic modality, duration of hospital stay, complication rate, 30-day survival. Results: 77 patients were treated with hemothorax, 57 male, 20 female patients. Average age was 53,4 (23­90, SD:14,9) years. Surgery was performed in 31 cases, with 10 cases needing reintervention. In 7 cases, multimodal approach was chosen, with chest wall stabilization. Average hospital stay: 14 (2­79) days. 30-day survival: 95%. Discussion: Thoracic drainage is our first therapeutic choice. The methods used in the treatment of hemothorax in our practice have been extended with the use of digital subtraction angiography (DSA), which yields immediate and effective bleeding control. We performed video-assisted thoracoscopic surgery (VATS) in increasing numbers. Conclusions: As long as the intensity of bleeding and patient's general status allows it, after drainage, the first therapeutic option ­ when accessible ­ should be DSA bleeding control. In cases which do not resolve after drainage, VATS evacuation of hematoma is a safe method used in the treatment of hemothorax. In the past 5 years, we used thoracoscopy in increasing numbers while treating this entity. Based on our results and the literature, we can safely state that the use of thoracoscopy in the treatment of hemothorax is a safe and reliable option in eligible patients, and the results are comparable with those treated by thoracotomy.

Copyright and Digital Teaching Exceptions in the EU: Legislative Developments and Implementation Models of Art. 5 CDSM Directive.

Article 5 of the 2019 EU Directive on Copyright in the Digital Single Market (CDSM) attempted to modernize the regime of copyright exceptions and limitations related to teaching activities. Its aim is to enhance the flexibility behind permitted uses to the benefit of educational institutions regarding their digital and cross-border teaching. The pressing need for such a legislative reform was confirmed by the outbreak of the COVID-19 pandemic, which dramatically moved teaching environments to online platforms. This paper dissects Art. 5 CDSM Directive unveiling three layers of analysis. First, the substance, logic, and promises of the new provision are introduced. Second, it identifies diverging national implementation models, developing a comparative study of the Hungarian, German, and Italian experiences. Third, drawing from the comparative study, the paper provides fundamental guidance in understanding whether Art. 5 CDSM Directive can be considered an evolution or, rather, a devolution of the copyright teaching exceptions in Europe. Focusing on the systematic concerns arising from the new provision, its embedded limits, and the strategic uses of the licensing carve-out, we conclude that the EU legislature has only partially achieved the goal of striking a more European, modern, and sustainable balance between copyright protection and the right to education in the digital environment.

[Spontaneous haemothorax - thoracic surgeon and intervention radiologist successful cooperation]. / Spontán haemothorax ­ mellkassebész és intervenciós radiológus sikeres együttmuködése.

The definition of spontaneous haemothorax is accumulation of blood within the pleural space without trauma or iatrogenic causes. A case of a 17-year-old male patient with a history of multiple abnormal arterial fistulas between systemic circulation and pulmonary circulation as a cause of bleeding is presented. An overview of the causes, the clinical features of haemothorax and the interventional radiological methods that can solve some causes of haemothorax are presented in connection of our case report.

[A giant inflammatory fibroid polyp of the esophagus]. / A nyelocso óriás inflammatorikus fibroid polipja.

Inflammatory fibroid polyp (IFP) is an uncommon benign tumor of the gastrointestinal tract. IFP in the esophagus is very rare, in particular in giant size. A case of a 63 year old woman with a 13 × 7 × 4.5 cm polyp originated of the lower third of the oesophagus is presented. Her esophageal polyp extended proximally from the level of the tracheal bifurcation, prolapsing through the cardia as well as the herniated stomach, and entered distally into the abdominal part of the stomach. Resection of the polyp was performed via a right oesophago-gastrotomy. Histology verified inflammatory fibroid polyp of the esophagus. An overview of clinical features of the inflammatory fibroid polyp is presented in connection of our case report.

[Management of malignant pericardial effusion with parasternal fenestration]. / Malignus eredetu pericardialis folyadékgyülemek ellátása parasternalis fenestratióval.

Numerous methods exist for the treatment of pericardial effusions. These methods, however, can be applied with limitations only for long-term eradication of malignant pericardial effusion. Lately, several new methods, including minimally invasive procedures, have been published, and the VATS technique has become fairly popular. This technique needs special instruments and single lung ventilation, which is relatively risky in case of contralateral malignancy. We apply a new and simple minimally invasive fenestration method using the well-known approach of the parasternal mediastinoscopy by Stemmer. No recurrence of pericardial effusions was noted in long-term follow-up. In the past 10 years 73 patients were treated for pericardial effusion in our department and 22 pericardium fenestrations have been performed with parasternal approach. This method is recommended for the definitive treatment of pericardial effusion with malignant origin.