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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.

Vaccination is the main strategy to control severe dehydrating gastroenteritis caused by rotaviruses in early childhood. The availability of new generation rotavirus vaccines has led to an intensification of strain surveillance worldwide, in part, to gauge the impact of the possible vaccine-driven immune selection of wild-type rotavirus strains. In the present study, authors describe the strain prevalence data obtained in 2007, with the involvement of different regions of Hungary. Genomic RNA was extracted from rotavirus-positive stool samples collected mainly from children and then subjected to genotyping using multiplex RT-PCR assay. Type-specific primers targeted G1 to G4, G6, G8 to G10, and G12 VP7 specificities, and P[4], P[6], and P[8] to P[11] VP4 specificities were used. Out of 489 rotavirus-positive specimens, collected from 482 patients, 466 and 474 were successfully G and P typed, respectively, and both G and P type specificities could be assigned for 457 strains. Prevalence data showed the predominance of G4P[8] (31.5%) strains, followed by G1P[8] (28.3%), G2P[4] (19.3%), and G9P[8] (10.2%). Minority strains were G1P[4] (0.4%), G2P[8] (1.3%), G3P[9] (0.2%), G4P[6] (0.7%), G6P[9] (0.4%), G8P[8] (0.2%), G9P[4] (0.2%), G9P[6] (0.8%), and G12P[8] (0.4%). Mixed infections were found in 1.2% of the samples, while 4.9% remained partially or fully non-typified. Our data indicate that the antigen specificities of medically important rotavirus strains identified in this 1-year study are well represented in the vaccines available in the pharmaceutical private market in Hungary. Depending on the vaccination coverage achievable in the forthcoming years, the post-vaccination rotavirus strain surveillance may allow us to gain comprehensive information on the impact of rotavirus vaccines on the prevalence of circulating rotavirus strains.

Unlabelled: Hepatitis E virus (HEV) is one of a common cause of acute, fecally transmitted hepatitis in developing countries. Identification of HEV in indigenous human infection and in domestic pig raises the possibility that HEV infection is also a zoonosis., Aim/methods: Molecular detection and epidemiology of HEV in humans with acute hepatitis and in domestic (pig, cattle) and wild (boar and roe-deer) animals by ELISA and RT-PCR in Hungary., Results: Between 2001 and 2006, a total of 116 (9.6%) human sera were positive by HEV IgM ELISA and 13 (24.5%) of 53 samples were also confirmed by RT-PCR and sequencing. Forty-two, 11 and 9 samples were RT-PCR-positive from swine (feces: 22.7%; liver: 30.8%), roe-deer (liver: 34.4%) and wild boar (liver: 12.2%), respectively. Except for an imported infection caused by genotype 1, 19 sequences (human: 12, swine: 4, roe-deer: 1, wild boar: 2) belong to genotype 3 HEV. Genetically identical strains were detected in human and roe-deer and in 2 other human clusters., Conclusions: HEV is an endemic agent in Hungary. Consumption of raw or undercooked meat-products is one of the possible sources of the indigenous HEV infections. Cross-species infection with genotype 3 HEV involves a food-borne transmission route in Hungary.

Endocardial radiofrequency catheter ablation was performed because of frequent, 150/min monomorphic ventricular tachycardia (VT). In February 2005 it was many times terminated only by ICD shock in a 55-year-old postinfarction patient who received an implantable cardioverter defibrillator (ICD) 5 years ago because of rapid, monomorphic VT. After being asymptomatic for two months, a slower, 120/min, however, incessant ventricular tachycardia was present which was untreatable by a repeated endocardial ablation. Combined antiarrhythmic treatment was not effective either. In June 2005, after another unsuccessful endocardial ablation, epicardial ablation was decided as an "ultimum refugium". After subxyphoidal percutaneous pericardial punction we positioned the ablation catheter in the pericardial space, and ablation at the earliest activation point terminated the permanently ongoing arrhythmia for one and a half month within 5 seconds. After another three ablations we were unable to induce ventricular arrhythmia even with programmed ventricular extrastimulation. During a three-year follow-up, ventricular tachycardia was noticed in only two cases, ICD terminated both arrhythmias with the first antitachycardia pacing. The patient is in NYHA stage II at present. According to our knowledge, our case is the first successful epicardial ablation of incessant ventricular tachycardia in a postinfarction patient in Hungary.

Group A rotaviruses are the most common cause of severe gastroenteritis worldwide. The incidence and distribution of group A rotavirus sero/genotypes varies between geographical areas during a rotavirus season, and from one season to the next. In addition, cocirculation of genetically diverse multitypic rotaviruses and of intratypic variants in any one place and time is common. Assuming widespread use of rotavirus vaccine in the near future, comprehensive surveillance of natural rotavirus infections is vital. EuroRotaNet has been established in order to gather comprehensive information on the rotavirus types co-circulating throughout Europe. The main objectives of the network are to (i) develop methods and algorithms for effective rotavirus strain typing and characterisation, (ii) describe in detail the molecular epidemiology of rotavirus infections in Europe, (iii) monitor the effectiveness of current genotyping methods and respond to changes associated with genetic drift and shift, and (iv) monitor the emergence and spread of novel rotavirus strains within Europe. This infrastructure may serve as a platform for future surveillance activities and nested studies for evaluating the effectiveness of a rotavirus vaccine in the general population. Studies to monitor the reduction in disease associated with common rotavirus types, the possible vaccine-induced emergence of antibody escape mutants of genotypes other than those included in the vaccine and of reassortment between vaccine and naturally circulating wildtype strains are required.

Introduction: Hepatitis A virus (HAV) is one of the most important cause of fecally transmitted acute infectious hepatitis worldwide. In Hungary, beside the sporadic HAV infections, outbreaks also occur, particularly in Northeast part of the country where the subgenotype IA is endemic. The reported number of HAV cases was less than 10 per year in Southwest Hungary., Aims: A part of the European HAV surveillance, the author's aims were to follow and to analyze the outbreak of hepatitis A in Transdanubia (Southwest Hungary) in 2006 by molecular epidemiological methods., Materials and Methods: Sera samples from symptomatic patients were tested prospectively by enzyme-immunoassay (EIA) and reverse transcription-polymerase chain reaction (RT-PCR) followed by sequence- and phylogenetic analysis., Results: Between June and December 2006, a total of 115 serum samples were positive for HAV IgM antibody in Southwest Hungary. Thirty (76.9%) of the 39 samples were RT-PCR-positive and contain genetically identical subgenotype IB hepatitis A virus (HAV/Transdanubia/2006/HUN) which has 100% nucleotide identity to strain IT-MAR-02 from Italy in 2002. Until now, approximately 1200-1300 persons have been infected with the probably imported strain. The average age of patients was 18 years (years 1 to 80). In this study, detailed clinical and epidemiological data of the outbreak are presented., Conclusions: Only a prospective molecular epidemiological study could verify the connection between the first sporadic HAV cases in June, the outbreak in August and the endemic spread of the virus since September in Southwest Hungary. This epidemic calls attention to how a hepatitis A outbreak can develop anywhere and at any time in Hungary and to the importance of active HAV immunization in the primary prevention.

Nowadays the management strategy for primary gastric lymphoma is undergoing change due to the effectiveness of chemotherapy and immunotherapy. While earlier surgical resection was the primary treatment and chemotherapy was only a follow-on procedure, at the present time this arrangement seems to have been reversed. Early stage low-grade MALT lymphoma can be treated with Helicobacter pylori eradication. Total or subtotal gastrectomy with D2 lymphadenectomy and with adjuvant chemotherapy in R1 situation is proposed up to stage II.1. The strategy is similar in the case of high-grade gastric lymphoma, but resection is useful only in those cases when one can be assured the result will be an R0 situation. With the exception of these cases, the only indication for resection is chemo-resistance. There is no reason for operating in advanced stages of the disease. The only purpose can be to manage complications. Unfortunately, the exact diagnosis is difficult. The diagnosis of lymphoma can often only be made after the operation. In the 6-year period between 1st January 2000 and 31st December 2005 we treated 38 patients for primary gastric lymphoma. Altogether 9 patients were operated on. Resection was performed in 6 cases. The diagnosis of lymphoma was known preoperatively only in one case. Nowadays surgery seems to be only secondary to chemotherapy and immuno-chemotherapy in the treatment of primary gastric MALT lymphoma. Our own cases also mirror this change.

Introduction: Hepatitis E virus (HEV) one of the most common cause of hepatitis in endemic areas. However recently demonstrated that human infection may occur in developed countries without any travel history and that swine may act as a reservoir., Aims: The objective of this study was to identified hepatitis E virus by molecular methods in patient with acute non-A-C hepatitis infection with no recent travel history in Hungary and to determine the viral genetic relationship to known HEV strains., Materials: Laboratory diagnosis of hepatitis E virus infection was performed in patient sera by HEV IgM and IgG ELISA, IgM and IgG immunoblot and reverse transcription polymerase chain reaction using primers for partial viral capsid region., Results: Patient with acute hepatitis with unknown origin was treated in Hospital of Szeged in June 2004. The acute patient's sera was positive by HEV IgM and IgG confirmed by immunoblot. Viral genome was successfully amplified in sera by RT-PCR. By sequence- and phylogenetic analysis the virus, designated Hungary-1, showed 95% nucleotide identity to genotype 3 hepatitis E viruses related to highest identity to swine HEV strain (Sp354-1-02) and having 90% nucleic acid identity to human strain (Greece2)., Discussion: Hepatitis E virus infection is present in Hungary without travelling to known endemic regions. The first identified HEV in Hungary, which is represent a new human genetic lineage, support the possibility of the endemic infections caused by genotype 3 strains in developed countries and that swine may act as reservoir of human HEV.

There are several new data on the acute viral hepatitis particularly on infectious non-A-non-C hepatitis viruses. The hepatitis E virus infection was originally thought to be limited only for certain geographic areas and humans. Recently, it has been demonstrated the genetic diversity and worldwide distribution of hepatitis E virus in human population, as well as, the circulation of the virus in many species of animals. It is evident, that hepatitis E virus can spread by fecally contaminated water (waterborne transmission), by meat of infected animals (food-borne transmission), by animal-human contact (zoonotic transmission), and even by transfusion (blood-borne transmission). The frequency of hepatitis E virus infections among the acute hepatitis cases with unknown origin is supposed to be more than 10%. In the differential diagnosis of hepatitis, possible hepatitis E virus infection must be now taken into account even in those areas and countries, like in Hungary, where the infection was previously thought to be non-endemic. To confirm the clinical diagnosis of hepatitis E virus infection, virus specific ELISA and molecular methods are now available. In the near future, a molecular epidemiological study will be organized for the detection of hepatitis E virus in Hungary in collaboration with 9 European countries.--This review covers all aspects of the hepatitis E virus infection including the characteristics and transmission of the etiological agent, the clinical symptoms, its epidemiology, laboratory diagnosis, and some possible control measures.

Patients with diffuse lung disease need lung biopsy for accurate diagnosis and treatment. Both traditional open lung biopsy through a thoracotomy and video assisted thoracoscopic lung biopsy are effective methods for obtaining parenchymal samples. The authors present their surgical method and experience. Thirty patients were operated on for lung biopsy using mediastinoscope between 1999-2003. Lung parenchymal samples were eligible for histological examination. No serious postoperative complications developed. The method is simple, safe and low-cost.

The role of bronchoscopy in examination and treatment of esophageal tumours. The esophageal tumours are diagnosed in many cases in inoperable stage, and if a surgical resolution is possible, it's a heroic, great operation with high mortality rates and poor results. The involvement of great airways should be explored preoperatively by imaging methods, but bronchoscopy is also mandatory. The authors report their one year's experience of 121 bronchoscopic examinations in esophageal cancer patients. The finding was negative in 40.5% of all examinations, and 29.7% was concerned the cancer propagation to bronchial system. 29.8% of all examinations resulted a suspicion of propagation. The opinion of bronchologist can be decisive postoperatively if a fistula is suspected, or after an esophageal stent implantation airway symptoms occur. Bronchoscopy is a standard method for removal of airway excretion. The author's overview is comparing their fifteen years experience with international literature.

We performed 346 operations for oesophageal cancer between 1 June 1991 and 31 May 2001. 168 of them were resections. The resection rate was 48.5 percent. The most frequently performed operation was subtotal resection of the oesophagus with the removal of paraesophageal lymph nodes. Reconstruction was usually performed with gastric tube pulled up retrosternally according to Akiyama with cervical oesophago-gastrostomy (135/168). In 24 patients intrathoracic oesophago-gastrostomy and in 9 patients other type of reconstruction was performed. Considerable co-morbidity was present in 88 percent of our patients (148/168). Alcohol dependency was noted in 88 patients however we suspect there were patients who did not admit alcohol abuse. Extended resection i.e. other organs' resection together with the oesophagus was performed in 59 patients. Postoperative recovery was uneventful in 49.4 percent (83/168) of our patients. Surgical complications occurred in 28.6 percent. Anastomotic leak was observed in 21 cases (12.5 percent). The most severe complication was necrosis of an organ used in reconstruction (7 patients, 4.2 percent). 23 patients (13.7 percent) died in the postoperative period, 7 of them (4.2 percent) because of surgical complication. Statistical analysis proved that the R status and the extension of resection had no influence on the frequency of complications and mortality rate except for when the removal of the entire stomach or gastric stump was performed in one sitting with the oesophageal resection. The frequency of anastomotic leakage is grossly affected by the anastomosis technique and whether it was in cervical or in thoracic position.