123 results on '"Hüttl K"'
Search Results
2. Safety, Clinical Outcome, and Fracture Rate of Femoropopliteal Stenting Using a 4F Compatible Delivery System
- Author
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Sarkadi, H., Bérczi, V., Kollár, A., Kiss, D., Jakabfi, P., Végh, E.M., Nemes, B., Merkely, B., Hüttl, K., and Dósa, E.
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- 2015
- Full Text
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3. Percutaneous Endovascular Treatment of Innominate Artery Lesions: A Single-centre Experience on 77 Lesions
- Author
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Paukovits, T.M., Lukács, L., Bérczi, V., Hirschberg, K., Nemes, B., and Hüttl, K.
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- 2010
- Full Text
- View/download PDF
4. Changes in the plasma concentration of soluble thrombomodulin in patients with severe carotid artery stenosis after eversion endarterectomy
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Dósa, E., Szabó, A., Prohászka, Z., Karádi, I., Rugonfalvi-Kiss, S., Apor, A., Járányi, Z., Hüttl, K., Selmeci, L., Acsády, G., Füst, G., and Entz, L.
- Published
- 2005
- Full Text
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5. Pulmonale Infiltrate und noduläre Veränderungen der Trachealschleimhaut
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Merk, T., Akinli, A., Ott, G., and Hüttl, K.
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- 2013
- Full Text
- View/download PDF
6. Endovascular Treatment of Peripheral Artery Disease with Expanded PTFE-Covered Nitinol Stents: Interim Analysis from a Prospective Controlled Study
- Author
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Duda, S.H., Bosiers, M., Pusich, B., Hüttl, K., Oliva, V., Müller-Hülsbeck, S., Bray, A., Luz, O., Remy, C., Hak, J.B., and Beregi, J.-P.
- Published
- 2002
- Full Text
- View/download PDF
7. Endovascular Treatment of Peripheral Arterial Disease With ePTFE-Covered Nitinol Stents
- Author
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Bosiers, M, Duda, S H, Pusich, B, Hüttl, K, Oliva, V, Müller-Hülsbeck, S, Bray, A, Luz, O, Remy, C, Hak, J B, and Beregi, J P
- Published
- 2002
8. PO289 Clinical Outcome of Endovascular Treatment For Infrarenal Aortic Stenosis
- Author
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Dósa, E., primary, Vértes, M., additional, Berencsi, A., additional, Nemes, B., additional, Merkely, B., additional, and Hüttl, K., additional
- Published
- 2018
- Full Text
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9. PO285 Clinical Outcome of Kissing Stenting For Aortoiliac Steno-Occlusive Disease
- Author
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Dósa, E., primary, Berencsi, A., additional, Vértes, M., additional, Nemes, B., additional, Merkely, B., additional, and Hüttl, K., additional
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- 2018
- Full Text
- View/download PDF
10. Proximal bleeding control obtained by a balloon catheter in the surgical repair of a left supraclavicular traumatic arteriovenous fistula
- Author
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Nemes, A., Pintér, L., Hüttl, K., Biró, G., and Acsády, Gy.
- Published
- 1997
11. Occurrence of Metachronous Multiple Malignancies. Review of the Literature: Case of Three Patients
- Author
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M Wohlleber, A. Grabner, M. Kimmich, Godehard Friedel, Hüttl K, German Ott, Bode-Erdmann S, M Kohlhäufl, and Falkenstern Ge Rf
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Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,non-small cell lung cancer (NSCLC) ,Family history ,medicine.disease ,Bioinformatics ,business - Abstract
We report the rare occurrence of multiple metachronous malignancies in three patients within different time frames from 18 months, 7 years and up to 25 years, respectively. Multiple primary malignant neoplasias (MPMN) are extremely rare. The key risk factors may be smoking and family history. While numerous studies have been published on the development of secondary malignancies following a first primary, the literature contains only few reports of patients with multiple metachrounous malignancies.
- Published
- 2016
12. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial
- Author
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Halliday, A, Harrison, M, Hayter, E, Kong, X, Mansfield, A, Marro, J, Pan, H, Peto, R, Potter, J, Rahimi, K, Rau, A, Robertson, S, Streifler, J, Thomas, D, Fraedrich G, Asymptomatic Carotid Surgery Trial Collaborative G. r. o. u. p., Schmidauer, C, Hölzenbein, Th, Huk, I, Haumer, M, Kretschmer, G, Metz, V, Polterauer, P, Teufelsbauer, H, Cras, P, Hendriks, J, Lauwers, P, Van Schil, P, de Souza EB, Dourado, Me, Gurgel, G, Rocha, Gm, Petrov, V, Slabakov, G, Cooper, Me, Gubitz, G, Holness, R, Howes, W, Langille, R, Legg, K, Nearing, S, Mackean, G, Mackay, M, Phillips, Sj, Sullivan, J, Wood, J, Erdelez, L, Sosa, T, Angelides, Ns, Christopoulos, G, Malikidou, A, Pesta, A, Ambler, Z, Mracek, J, Polivka, J, Rohan, V, Sevcik, P, Simaná, J, Benes, V, Kramár, F, Kaste, M, Lepäntalo, M, Soinne, L, Cardon, Jm, Legalou, A, Gengenbach, B, Pfadenhauer, K, Wölfl, Kd, Flessenkämper, I, Klumpp, Bf, Marsch, J, Kolvenbach, R, Pfeiff, T, Sandmann, W, Beyersdorf, F, Hetzel, A, Sarai, K, Schöllhorn, J, Spillner, G, Lutz, Hj, Böckler, D, Maeder, N, Busse, O, Grönniger, J, Haukamp, F, Balzer, K, Knoob, Hg, Roedig, G, Virreira, L, Franke, S, Moll, R, Schneider, J, Dayantas, J, Sechas, Mn, Tsiaza, S, Kiskinis, D, Apor, A, Dzinich, C, Entz, L, Hüttl, K, Jàrànyi, Z, Mogan, I, Nagy, Z, Szabo, A, Varga, D, Juhász, G, Mátyás, L, Hutchinson, M, Mehigan, D, Aladjem, Z, Harah, E, Elmakias, S, Gurvich, D, Yoffe, B, Ben Meir, H, Dagan, L, Karmeli, R, Keren, G, Shimony, A, Weller, B, Avrahami, R, Koren, R, Streifler, Jy, Tabachnik, S, Zelikovski, A, Angiletta, D, Federico, F, Impedovo, G, Marotta, V, Pascazio, L, Regina, G, Andreoli, A, Pozzati, E, Bonardelli, S, Giulini, Sm, Guarneri, B, Caiazzo, P, Mascoli, F, Becchi, G, Masini, R, Santoro, E, Simoni, G, Ventura, M, Scarpelli, P, Spartera, C, Arena, O, Collice, M, Puttini, M, Romani, F, Santilli, I, Segramora, V, Sterzi, R, Deriu, G, Verlato, F, Cao, Pg, Cieri, Enrico, De Rango, P, Moggi, L, Ricci, S, Antico, A, Spigonardo, F, Malferrari, G, Tusini, N, Vecchiati, E, Cavallaro, A, Kasemi, H, Marino, M, Sbarigia, E, Speziale, F, Zinicola, N, Alò, Fp, Bartolini, M, Carbonari, L, Caporelli, S, Grili Cicilioni, C, Lagalla, G, Ioannidis, G, Pagliariccio, G, Silvestrini, M, Palombo, D, Peinetti, F, Adovasio, R, Chiodo Grandi, F, Mase, G, Zamolo, F, Fregonese, V, Gonano, N, Mozzon, L, Blair, R, Chuen, J, Ferrar, D, Garbowski, M, Hamilton, Mj, Holdaway, C, Muthu, S, Shakibaie, F, Vasudevan, Tm, Kroese, A, Slagsvold, Ce, Dahl, T, Johnsen, Hj, Lange, C, Myhre, Ho, Gniadek, J, Andziak, P, Elwertowski, M, Leszczynski, J, Malek, Ak, Mieszkowski, J, Noszczyk, W, Szostek, M, Toutounchi, S, Correia, C, Pereira, Mc, Akchurin, Rs, Flis, V, Miksic, K, Stirn, B, Tetickovic, E, Cairols, M, Capdevila, Jm, Iborra Ortega, E, Obach, V, Riambau, V, Vidal Barraquer, F, Vila Coll, R, Diaz Vidal, E, Iglesias Negreia JI, Tovar Pardo, A, Iglesias, Rj, Alfageme, Af, Barba Velez, A, Estallo Laliena, L, Garcia Monco JC, Gonzalez, Lr, Corominas, C, Julia, J, Lozano, P, Marti Masso JF, Porta, Rm, Carrera, Ar, Gomez, J, Blomstrand, C, Gelin, J, Holm, J, Karlström, L, Mattsson, E, Bornhov, S, Dahlstrom, J, De Pedis, G, Jensen, Sm, Pärsson, H, Plate, G, Qvarfordt, P, Arvidsson, B, Brattström, L, Forssell, C, Potemkowski, A, Skiöldebrand, C, Stoor, P, Blomqvist, M, Calander, M, Lundgren, F, Almqvist, H, Norgren, L, Norrving, B, Ribbe, E, Thörne, J, Gottsäter, A, Mätzsch, T, Nilsson, Me, Lonsson, M, Stahre, B, Stenberg, B, Konrad, P, Jarl, L, Lundqvist, L, Olofsson, P, Rosfors, S, Swedenborg, J, Takolander, R, Bergqvist, D, Ljungman, C, Kniemeyer, Hw, Widmer, Mk, Kuster, R, Kaiser, R, Nagel, W, Sege, D, Weder, B, De Nie, J, Doelman, J, Yilmaz, N, Buth, J, Stultiens, G, Boiten, J, Boon, A, van der Linden, F, Busman, Dc, Sinnige, Ha, Yo, Ti, de Borst GJ, Eikelboom, Bc, Kappelle, Lj, Moll, F, Dortland, Rw, Westra, Te, Jaber, H, Manaa, J, Meftah, Rb, Nabil, Br, Sraieb, T, Bateman, D, Budd, J, Horrocks, M, Kivela, M, Shaw, L, Walker, R, D'Sa, Aa, Fullerton, K, Hannon, R, Hood, Jm, Lee, B, Mcguigan, K, Morrow, J, Reid, J, Soong, Cv, Simms, M, Baird, R, Campbell, M, Cole, S, Ferguson, It, Lamont, P, Mitchell, D, Sassano, A, Smith, Fc, Blake, K, Kirkpatrick, Pj, Martin, P, Turner, C, Clegg, Jf, Crosley, M, Hall, J, De Cossart, L, Edwards, P, Fletcher, D, Rosser, S, Mccollum, Pt, Davidson, D, Levison, R, Bradbury, Aw, Chalmers, Rt, Dennis, M, Murie, J, Ruckley, Cv, Sandercock, P, Campbell, Wb, Frankel, T, Gardner Thorpe, C, Gutowski, N, Hardie, R, Honan, W, Niblett, P, Peters, A, Ridler, B, Thompson, Jf, Bone, I, Welch, G, Grocott, Ec, Overstall, P, Aldoori, Mi, Dafalla, Be, Bryce, J, Clarke, C, Ming, A, Wilkinson, Ar, Bamford, J, Berridge, D, Scott, J, Abbott, Rj, Naylor, R, Harris, P, Humphrey, P, Adiseshiah, M, Aukett, M, Baker, D, Bishop, Cc, Boutin, A, Brown, M, Burke, P, Burnand, Kg, Colchester, A, Coward, L, Davies, Ah, Espasandin, M, Giddings, Ae, Hamilton, G, Judge, C, Kakkos, S, Mcguiness, C, Morris Vincent, P, Nicolaides, A, Padayachee, Ts, Riordan, H, Sullivan, E, Taylor, P, Thompson, M, Wolfe, Jh, Mccollum, Cn, O'Neill, Pa, Welsh, S, Barnes, J, Cleland, P, Davis, M, Gholkar, A, Jones, R, Jaykishnam, V, Mendelow, Ad, O'Connell, Je, Siddique, Ms, Stansby, G, Vivar, R, Ashley, S, Cosgrove, C, Gibson, J, Wilkins, Dc, Chant, Ad, Frankel, J, Shearman, Cp, Williams, J, Hall, G, Holdsworth, R, Davies, Jn, Mclean, B, Woodburn, Kr, Brown, G, Curley, P, Loizou, L, Chaturvedi, S, Diaz, F, Radak, D, Todorovic, Pr, Kamugasha, D, Baxter, A, Berry, C, Burrett, J, Collins, R, Crowther, J, Davies, C, Farrell, B, Godwin, J, Gray, R, Harwood, C, Hirt, L, Hope, C, Knight, S, Lay, M, Munday, A, Murawska, A, Peto, Cg, Radley, A, Richards, S., Cras, Patrick, van Schil, Paul, et al., Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group, Halliday, A, Harrison, M, Hayter, E, Kong, X, Mansfield, A, Marro, J, Pan, H, Peto, R, Potter, J, Rahimi, K, Rau, A, Robertson, S, Streifler, J, Thomas, D, Adovasio, Roberto, and Asymptomatic Carotid Surgery Trial Collaborative, Group
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Carotid endarterectomy ,Aged ,80 and over ,Carotid Stenosis ,Endarterectomy ,Carotid ,Female ,Humans ,Incidence ,Middle Aged ,Primary Prevention ,Stroke ,Treatment Outcome ,Stroke/epidemiology ,law.invention ,Randomized controlled trial ,law ,Aged, 80 and over ,Endarterectomy, Carotid ,endarterectomy ,Carotid Stenosis/mortality ,Incidence (epidemiology) ,Carotid*/mortality ,General Medicine ,Carotid Stenosis | Internal Carotid Artery | Endarterectomy ,medicine.symptom ,medicine.medical_specialty ,Asymptomatic ,Internal medicine ,asymptomatic carotid artery stenosi ,medicine ,asymptomatic carotid artery stenosis ,business.industry ,Carotid Stenosis/complications ,Stroke/prevention & control ,Perioperative ,medicine.disease ,Surgery ,Stenosis ,Human medicine ,business - Abstract
SummaryBackgroundIf carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA.MethodsBetween 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3–2·5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6–11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392.Findings1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1% vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4–3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0–7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7–9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43–0·68, p
- Published
- 2010
13. In-vitro-Untersuchungen zum Einfluss des Tyrosinkinase-Inhibitors Pazopanib auf das Bindungsverhalten eines gegen CEA-gerichteten Antikörpers in Zelllinien des kolorektalen Karzinoms
- Author
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Hüttl, K, primary, Breunig, C, additional, Bähre, M, additional, and Meller, B, additional
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- 2016
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14. Transradial and transulnar access for iliac artery interventions using sheathless guiding systems: A feasibility study
- Author
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Ruzsa, Z., primary, Tóth, K., additional, Nemes, B., additional, Édes, I.F., additional, Nardai, S., additional, Berta, B., additional, Kovács, N., additional, Hüttl, K., additional, and Merkely, B., additional
- Published
- 2016
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15. PS317 Incidence and Risk Factors for Subclavian Artery Stent Fracture
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Dósa, E., primary, Hüttl, A.G., additional, Hüttl, A., additional, Végh, E.M., additional, Nemes, B., additional, and Hüttl, K., additional
- Published
- 2016
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16. Transradial Intravascular Ultrasound Guided Culotte Stenting with Zotarolimus Eluting Coronary Stents in Renal Artery Bifurcation Stenosis
- Author
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Ruzsa, Z., primary, Hüttl, K., additional, and Merkely, B., additional
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- 2015
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17. The Importance of Intraoperative Transesophageal Echocardiography for Endovascular Repair of Thoracic Aortic Dissection and Pulmonary Vein Stenosis: Twenty-One Case Reviews, Single-Centre Experience
- Author
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Kudrnova, S., primary, Doros, A., additional, Apor, A., additional, Gellér, L., additional, and Hüttl, K., additional
- Published
- 2011
- Full Text
- View/download PDF
18. Rotational atherectomy of a severely calcified superficial femoral artery stenosis after failed balloon passage — Case report
- Author
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Ruzsa, Z., primary, HÜttl, K., additional, Tóth, K., additional, and Merkely, B., additional
- Published
- 2010
- Full Text
- View/download PDF
19. Statement on ethical publishing and scientific authorship
- Author
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Szél, Á., primary, Merkely, B., additional, Hüttl, K., additional, Gál, J., additional, Nemes, B., additional, and Komócsi, A., additional
- Published
- 2010
- Full Text
- View/download PDF
20. Percutaneous Endovascular Treatment of Innominate Artery Lesions: A Single-centre Experience on 77 lesions
- Author
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Paukovits, T.M., primary, Lukács, L., additional, Bérczi, V., additional, Hirschberg, K., additional, Nemes, B., additional, and Hüttl, K., additional
- Published
- 2010
- Full Text
- View/download PDF
21. Stent-graft Treatment of Carotid Pseudoaneurysms: Case Report and Review of the Literature
- Author
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Nemes, B., primary, Járányi, Z., additional, Bérczi, V., additional, Hüttl, K., additional, and Acsády, G., additional
- Published
- 2005
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- View/download PDF
22. Stent-graft Treatment of Carotid Pseudoaneurysms: Case Report and Review of the Literature
- Author
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Nemes, B., Járányi, Z., Bérczi, V., Hüttl, K., and Acsády, G.
- Published
- 2005
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23. The role of atheromatous plaque of the internal carotid artery in carotid sinus hypersensitivity
- Author
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Bérczi, V., primary, Solti, F., additional, Entz, L., additional, Hüttl, K., additional, Járányi, Zs., additional, and Szántó§, J., additional
- Published
- 1998
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24. High-resolution CT and angiographic evaluation of NexStent wall adaptation.
- Author
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Nemes B, Lukács L, Balázs G, Dósa E, Bérczi V, Hüttl K, Nemes, Balázs, Lukács, Levente, Balázs, György, Dósa, Edit, Bérczi, Viktor, and Hüttl, Kálmán
- Abstract
Carotid stenting is a minimally invasive treatment for extracranial carotid artery stenosis. Stent design may affect technical success and complications in a certain subgroup of patients. We examined the wall adaptability of a new closed-cell carotid stent (NexStent), which has a unique rolled sheet design. Forty-one patients had 42 carotid arteries treated with angioplasty and stenting for internal carotid artery stenosis. The mean patient age was 65 +/- 10 years. All patients underwent high-resolution computed tomographic angiography after the stent implantation. Data analysis included pre- and postprocedural stenosis, procedure complications, plaque calcification, and stent apposition. We reviewed the angiographic and computed tomographic images for plaque coverage and stent expansion. All procedures were technically successful. Mean stenosis was reduced from 84 +/- 8% before the procedure to 15.7 +/- 7% after stenting. Two patients experienced transient ischemic attack; one patient had bradycardia and hypotension. Stent induced kinking was observed in one case. Good plaque coverage and proper overlapping of the rolled sheet was achieved in all cases. There was weak correlation between the residual stenosis and the amount of calcification. The stent provides adequate expansion and adaptation to the tapering anatomy of the bifurcation. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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25. Allen’s test in patients with peripheral artery disease
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Ruzsa Zoltán, Tóth Károly, Berta Balázs, Koncz István, Szabó György, Jambrik Zoltán, Varga István, Hüttl Kálmán, Merkely Béla, and Nemes Attila
- Subjects
allen’s test ,ishaemia ,transradial access ,Medicine - Published
- 2014
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- View/download PDF
26. INTRAOPERATIVE PARATHYROID ASPIRATION AND HORMONE ASSAY.
- Author
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Duffek, L., Horányi, J., Györke, T., and Hüttl, K.
- Abstract
Aim: Conventional parathyroidectomy is a difficult operation and the unsuccessful rate is 5% to 10% . In order to improve the efficiency intraopertative quick aspiration parathyroid hormon assay were used. Material and methods: Intraoperative aspiration PTH concentration was determined by 82 patients. They under went parathyroiectomy from March 2006 to January 2007 with diagnosis of primery hyperparathyroidism. Each specimen was divided into tubes and was stored in four Celsius until the quick PTH assay start. The aspiration tissue parathyroid hormone concentration was measured by cisbio quick IRMA method. Results: Ex vivo parathyroid adenoma sample PTH concentration was always between 3500–9800 pg/ml obtaining by the semi-quantitative tissue hormone determination. PTH concentration of the aspiration thyroid tissue was beetwen 0.1–5.0 pg/ml. Conclusion: PTH measurement from intraoperative aspiration of suspected parathyroid adenomas is clinically useful for patients. In case of hyperparathyroidism, the combined use of intraoperative aspiration hormone assay, gamma probe measurements and quick PTH examination improve the success rate and decrease the duration of parathyroidectomy as well as give a chance to apply minimal invazive parathyroidectomy [ABSTRACT FROM AUTHOR]
- Published
- 2007
27. PTFE interposition graft in carotid surgery: Late results
- Author
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Mogan, I., Entz, L., Hüttl, K., Járányl, Zs., and Nemes, A.
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- 1995
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28. 17.7 Revascularization of branches of the aortic arch
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Dzsinich, C., Nemes, A., Acsády, G., Entz, L., Szlávy, L., and Hüttl, K.
- Published
- 1997
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29. [Genetic evolution of in situ follicular neoplasia to t(14;18)-positive aggressive B-cell lymphoma].
- Author
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Vogelsberg A, Steinhilber J, Mankel B, Federmann B, Schmidt J, Montes-Mojarro IA, Hüttl K, Rodriguez-Pinilla M, Baskaran P, Nahnsen S, Piris MA, Ott G, Quintanilla-Martinez L, Bonzheim I, and Fend F
- Subjects
- Evolution, Molecular, Humans, In Situ Hybridization, Fluorescence, Translocation, Genetic genetics, Lymphoma, Follicular genetics, Lymphoma, Large B-Cell, Diffuse genetics
- Abstract
Background: In situ follicular neoplasia (ISFN) is a t(14;18)(q32;q21)
+ precursor lesion of follicular lymphoma (FL), which in turn can transform into diffuse large B‑cell lymphoma (DLBCL). For DLBCL that arise de novo, no precursor lesion is known. Given the high frequency of the t(14;18) translocation in de novo DLBCL as well, we investigated whether they can also arise from ISFN without FL as an intermediate step., Objectives: To investigate the clonal evolution of ISFN to DLBCL - transformed from FL and de novo., Materials and Methods: Identification of ISFN lesions in patients with DLBCL was performed by BCL2 staining of reactive lymphoid tissues. ISFN and DLBCL were subsequently analyzed by fluorescence in situ hybridization, clonality analyses, sequencing of the t(14;18) breakpoint, and targeted next-generation sequencing., Results: 10 cases with paired ISFN and DLBCL samples were identified, 6 of which were de novo DLBCL and 4 transformed from FL. 3 DLBCL carried MYC-rearrangements in addition to the t(14;18) and were classified as high-grade B‑cell lymphoma (HGBL). The clonal relationship of ISFN and DLBCL/HGBL was confirmed for all cases. CREBBP, KMT2D, EZH2, TNFRSF14, and BCL2 were the genes most frequently mutated, with the distribution of private and shared mutations pointing to 2 different scenarios of clonal evolution. In most cases, DLBCL/HGBL, ISFN, and, if also present, FL had evolved divergently from a common progenitor, whereas linear evolution was less frequent., Conclusion: We show for the first time that t(14;18)+ DLBCL/HGBL can arise directly from ISFN without FL as an intermediate step and that during this progression, divergent evolution is common., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)- Published
- 2021
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30. Genetic evolution of in situ follicular neoplasia to aggressive B-cell lymphoma of germinal center subtype.
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Vogelsberg A, Steinhilber J, Mankel B, Federmann B, Schmidt J, Montes-Mojarro IA, Hüttl K, Rodriguez-Pinilla M, Baskaran P, Nahnsen S, Piris MA, Ott G, Quintanilla-Martinez L, Bonzheim I, and Fend F
- Subjects
- Evolution, Molecular, Germinal Center, Humans, Translocation, Genetic, Lymphoma, Follicular genetics, Lymphoma, Large B-Cell, Diffuse
- Abstract
In situ follicular neoplasia (ISFN) is the earliest morphologically identifiable precursor of follicular lymphoma (FL). Although it is genetically less complex than FL and has low risk for progression, ISFN already harbors secondary genetic alterations, in addition to the defining t(14;18)(q32;q21) translocation. FL, in turn, frequently progresses to diffuse large B-cell lymphoma (DLBCL) or high-grade B-cell lymphoma (HGBL). By BCL2 staining of available reactive lymphoid tissue obtained at any time point in patients with aggressive B-cell lymphoma (BCL), we identified ten paired cases of ISFN and DLBCL/HGBL, including six de novo tumors and four tumors transformed from FL as an intermediate step, and investigated their clonal evolution using microdissection and next-generation sequencing. A clonal relationship between ISFN and aggressive BCL was established by immunoglobulin and/or BCL2 rearrangements and/or the demonstration of shared somatic mutations for all ten cases. Targeted sequencing revealed CREBBP, KMT2D, EZH2, TNFRSF14 and BCL2 as the genes most frequently mutated already in ISFN. Based on the distribution of private and shared mutations, two patterns of clonal evolution were evident. In most cases, the aggressive lymphoma, ISFN and, when present, FL revealed divergent evolution from a common progenitor, whereas linear evolution with sequential accumulation of mutations was less frequent. In conclusion, we demonstrate for the first time that t(14;18)+ aggressive BCL can arise from ISFN without clinically evident FL as an intermediate step and that during this progression, branched evolution is common.
- Published
- 2021
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31. A Diagnostic Approach to the Identification of Burkitt-like Lymphoma With 11q Aberration in Aggressive B-Cell Lymphomas.
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Horn H, Kalmbach S, Wagener R, Staiger AM, Hüttl K, Mottok A, Bens S, Traverse-Glehen A, Fontaine J, Siebert R, Rosenwald A, and Ott G
- Subjects
- Apoptosis, Burkitt Lymphoma classification, Burkitt Lymphoma pathology, Genetic Predisposition to Disease, Humans, Immunohistochemistry, In Situ Hybridization, Fluorescence, Lymphoma, Large B-Cell, Diffuse classification, Lymphoma, Large B-Cell, Diffuse pathology, Neoplasm Grading, Phenotype, Predictive Value of Tests, Retrospective Studies, Terminology as Topic, Tumor-Associated Macrophages, Burkitt Lymphoma genetics, Chromosome Aberrations, Chromosomes, Human, Pair 11, Lymphoma, Large B-Cell, Diffuse genetics, Molecular Diagnostic Techniques
- Abstract
Rare cases of aggressive B-cell lymphomas with a morphology similar to Burkitt lymphoma (BL) present with the BL-typical immunophenotype, but lacked MYC translocation (MYC-negative Burkitt-like lymphoma: mnBLL). A proportion of those with an imbalance pattern in chromosome 11q has been designated Burkitt-like lymphoma with 11q aberration in the recent update of the World Health Organization (WHO) classification. Because of the problems in the identification of Burkitt-like lymphoma with 11q aberration, our goal was to retrospectively analyze their frequency in a cohort of "candidate" aggressive lymphomas (cohort 1, n=35) such as mnBLL (n=16), diffuse large B-cell lymphoma with similarities to Burkitt lymphoma (DLBCL-BL; n=3), high-grade B-cell lymphomas, not otherwise specified (NOS) (n=16), as well as in a cohort of MYC-negative diffuse large B-cell lymphoma NOS (cohort 2, n=62). In total, 17/33 cohort 1 cases (52%) harbored the typical 11q aberration pattern, predominantly those that had been classified as mnBLL (12/16, 75%), but also as DLBCL-BL (2/3, 67%) and high-grade B-cell lymphomas, NOS (3/14; 21%). The specimens with this typical 11q aberration pattern were usually negative for the BCL2 protein. Of interest and as a new finding, samples harboring the 11q aberration pattern were often characterized by strikingly coarse apoptotic debris within starry sky macrophages facilitating their recognition. In contrast, only 1 of 62 garden variety DLBCL, NOS was positive for the 11q aberration pattern. In 2 DLBCL-BL, a dual MYC translocation/11q aberration pattern was detected. As a diagnostic algorithm, we, therefore, propose analysis of 11q status in MYC-negative high-grade lymphomas with features of BL, especially showing BCL2 negativity and a conspicuous coarse apoptotic debris in starry sky macrophages., Competing Interests: Conflicts of Interest and Source of Funding: Supported by the German José Carreras Leukämie-Stiftung (DJCLS R 10/28) and the Robert Bosch-Stiftung (Project O3), Stuttgart, Germany. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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32. Early and long-term results of the endovascular treatment of patients with isolated infrarenal aortic stenosis.
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Bérczi Á, Vértes M, Nguyen TD, Bérczi V, Nemes B, Hüttl K, and Dósa E
- Subjects
- Aged, Aorta, Abdominal diagnostic imaging, Aorta, Abdominal physiopathology, Aortic Diseases diagnostic imaging, Aortic Diseases physiopathology, Atherosclerosis diagnostic imaging, Atherosclerosis physiopathology, Constriction, Pathologic, Female, Humans, Male, Middle Aged, Recurrence, Retreatment, Retrospective Studies, Risk Assessment, Risk Factors, Stents, Time Factors, Treatment Outcome, Vascular Patency, Angioplasty, Balloon adverse effects, Angioplasty, Balloon instrumentation, Aortic Diseases therapy, Atherosclerosis therapy
- Abstract
Objective: The purpose of this study was to report our results of patients' characteristics, procedural complications, and long-term patency in treatment of isolated infrarenal aortic stenosis (IIAS)., Methods: Forty symptomatic patients (28 female, 12 male; median age, 60 years [54.8-68 years]) with IIAS who underwent endovascular intervention between 2001 and 2017 were retrospectively analyzed. Patient, lesion, procedure, and balloon/stent characteristics were assessed. Follow-up included clinical status evaluation and color Doppler ultrasound examination., Results: The cause of IIAS was atherosclerosis in all patients. Twenty percent of the patients were younger than 50 years; 85% had hypertension, 80% were smokers, 38% had hyperlipidemia, 23% had diabetes mellitus, 15% were obese (body mass index ≥30 kg/m
2 ), and 8% had chronic kidney disease. The median stenosis grade was 80% (70%-80%), and the median lesion length was 19.9 mm (13-29.4 mm). Severe calcification was present in 8% of the patients. Percutaneous transluminal angioplasty was performed in four cases (10%), whereas stenting was performed in 36 (90%). One complication, an aortic rupture requiring surgical repair, occurred. The median follow-up was 61 months (17-101 months). The primary patency rate was 100% at 6 months, 97% at 12 and 24 months, and 88% at 60 and 96 months. Restenosis developed in three patients (8%); reintervention was carried out in two cases (5%)., Conclusions: Endovascular therapy for IIAS provides a safe and effective long-term treatment strategy., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)- Published
- 2021
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33. The impact of SAMHD1 expression and mutation status in mantle cell lymphoma: An analysis of the MCL Younger and Elderly trial.
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Roider T, Wang X, Hüttl K, Müller-Tidow C, Klapper W, Rosenwald A, Stewart JP, de Castro DG, Dreger P, Hermine O, Kluin-Nelemans HC, Grabe N, Dreyling M, Pott C, Ott G, Hoster E, and Dietrich S
- Subjects
- Adult, Age Factors, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cell Line, Tumor, Cyclophosphamide pharmacology, Cyclophosphamide therapeutic use, Cytarabine pharmacology, Cytarabine therapeutic use, DNA Mutational Analysis, Disease-Free Survival, Dose-Response Relationship, Drug, Doxorubicin pharmacology, Doxorubicin therapeutic use, Drug Resistance, Neoplasm drug effects, Female, Gene Expression Profiling, Gene Expression Regulation, Neoplastic, Humans, Kaplan-Meier Estimate, Lymphoma, B-Cell genetics, Lymphoma, B-Cell pathology, Lymphoma, Mantle-Cell genetics, Lymphoma, Mantle-Cell mortality, Male, Middle Aged, Mutation, Oxaliplatin pharmacology, Oxaliplatin therapeutic use, Prednisone pharmacology, Prednisone therapeutic use, Primary Cell Culture, Rituximab pharmacology, Rituximab therapeutic use, Tissue Array Analysis, Vidarabine analogs & derivatives, Vidarabine pharmacology, Vidarabine therapeutic use, Vincristine pharmacology, Vincristine therapeutic use, Antineoplastic Combined Chemotherapy Protocols pharmacology, Biomarkers, Tumor genetics, Drug Resistance, Neoplasm genetics, Lymphoma, B-Cell drug therapy, Lymphoma, Mantle-Cell drug therapy, SAM Domain and HD Domain-Containing Protein 1 genetics
- Abstract
The sterile alpha motif and histidine-aspartic domain-containing protein 1 (SAMHD1) has been demonstrated to predict the response to high-dose cytarabine consolidation treatment in acute myeloid leukemia patients. Here, we evaluated SAMHD1 as potential biomarker for the response to high-dose cytarabine in mantle cell lymphoma (MCL) patients. We quantified SAMHD1 protein expression and determined the mutation status in patients of the MCL Younger and Elderly trials (n = 189), who had received high-dose cytarabine- or fludarabine-based polychemotherapy. Additionally, we quantified SAMHD1 expression in B cell lymphoma cell lines and exposed them to cytarabine, fludarabine, and clinically relevant combinations. Across both trials investigated, SAMHD1 mutations had a frequency of 7.1% (n = 13) and did not significantly affect the failure-free survival (FFS, P = .47). In patients treated with high-dose cytarabine- or fludarabine-containing regimes, SAMHD1 expression was not significantly associated with FFS or complete remission rate. SAMHD1 expression in B cell lymphoma cell lines, however, inversely correlated with their in vitro response to cytarabine as single agent (R = .65, P = .0065). This correlation could be reversed by combining cytarabine with other chemotherapeutics, such as oxaliplatin and vincristine, similar to the treatment regime of the MCL Younger trial. We conclude that this might explain why we did not observe a significant association between SAMHD1 protein expression and the outcome of MCL patients upon cytarabine-based treatment., (© 2020 UICC.)
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- 2021
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34. Feasibility of distal radial access for carotid interventions: the RADCAR-DISTAL pilot study.
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Nardai S, Végh E, Óriás V, Nemes B, Tóth J, Hüttl A, Hüttl K, Avantadil B, Bertrand OF, Merkely B, and Ruzsa Z
- Subjects
- Coronary Angiography, Pilot Projects, Radial Artery, Feasibility Studies
- Published
- 2020
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35. The presence of long and heavily calcified lesions predisposes for fracture in patients undergoing stenting of the first part of the subclavian artery.
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Hüttl AB, Hüttl A, Vértes M, Nguyen DT, Bérczi Á, Hüttl K, and Dósa E
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- Aged, Angioplasty, Balloon adverse effects, Female, Humans, Male, Middle Aged, Prospective Studies, Prosthesis Design, Recurrence, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Subclavian Steal Syndrome diagnostic imaging, Subclavian Steal Syndrome physiopathology, Time Factors, Treatment Outcome, Vascular Calcification diagnostic imaging, Vascular Calcification physiopathology, Vascular Patency, Angioplasty, Balloon instrumentation, Prosthesis Failure, Stents, Subclavian Steal Syndrome therapy, Vascular Calcification therapy
- Abstract
Objective: To determine the prevalence and risk factors of subclavian artery stent fractures and to investigate their impact on in-stent restenosis development., Methods: One hundred eight patients (65 females; median age, 58.3 years [interquartile range, 53.4-65.5 years]) with steno-occlusive disease of the first part of the subclavian artery who underwent stenting (N = 108 stents; balloon-expandable, 83.3%; self-expandable, 16.7%) between 2005 and 2015 and returned for a fluoroscopic examination of the implanted stents in 2017 were included in our study. Fractures were type I (single strut fracture), type II (multiple strut fractures without deformation), type III (multiple strut fractures with deformation), type IV (multiple strut fractures with acquired transection but without gap), or type V (multiple strut fractures with acquired transection with gap in the stent body). Stent patency was monitored by duplex ultrasound imaging. The Mann-Whitney U and Fisher's exact tests; Kaplan-Meier, receiver operating characteristic, and logistic regression analyses; as well as a log-rank test were used as statistical methods., Results: The median follow-up was 73.8 months (interquartile range, 35.6-104.2 months). Thirty-eight fractures (35.2%) were detected; fractures were type I in 13, type II in 12, type III in 6, type IV in 4, and type V in 3 cases. Multivariable logistic regression analysis revealed the presence of long (≥20 mm) lesions (odds ratio, 3.3; 95% confidence interval, 1.3-8.4; P = .012) and heavy calcification (odds ratio, 4.7; 95% confidence interval, 1.7-12.7; P = .002) to be significant independent predictors of stent fracture. The primary patency rates were significantly worse (P = .035) in patients with stent fracture compared with those without stent fracture., Conclusions: Stent fractures frequently occur. Patients with long and/or heavily calcified lesions require closer follow-up., (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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36. Multidetector CT angiography of the Circle of Willis: association of its variants with carotid artery disease and brain ischemia.
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Varga A, Di Leo G, Banga PV, Csobay-Novák C, Kolossváry M, Maurovich-Horvat P, and Hüttl K
- Subjects
- Adult, Aged, Aged, 80 and over, Brain Ischemia etiology, Carotid Stenosis complications, Female, Humans, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Brain Ischemia diagnosis, Carotid Stenosis diagnosis, Circle of Willis diagnostic imaging, Computed Tomography Angiography methods, Multidetector Computed Tomography methods
- Abstract
Purpose: (1) to estimate the prevalence of Circle of Willis (CoW) variants in patients undergoing carotid endarterectomy, (2) to correlate these variants to controls and (3) cerebral ischemia depicted by computed tomography (CT)., Materials and Methods: After Institutional Review Board approval, data of 544 carotid endarterectomy patients (331 males, mean age 69±8 years) and 196 controls (117 males, mean age 66±11 years) who underwent brain CT and carotid CT angiography (CTA) were retrospectively analysed. Two observers independently classified each CoW segment as normal, hypoplastic (diameter <0.8 mm) or non-visualized. Four groups of CoW variants based on the number of hypoplastic/non-visualized segments were correlated with clinical data (ANOVA, χ
2 and multivariate logistic regression analysis). Intra- and inter-observer agreement was estimated using Cohen κ statistics., Results: High prevalence of CoW variants (97%) and compromised CoW (81%) was observed in the study group and significant difference was found in the distribution of CoW variants compared to controls (p<0.001), internal carotid artery (ICA) stenosis being the only independent predictor of CoW morphology (p<0.001). Significant correlation was found between CoW configuration and brain ischemia in the study group (p=0.002). ICA stenosis of ≥90% was associated to higher rate of ipsilateral A1 hypoplasia/non-visualization (p<0.001). Intra- and inter-observer agreement was from substantial to almost perfect (Cohen κ=0.75-1.0)., Conclusion: Highly variable CoW morphology was demonstrated in patients undergoing endarterectomy compared to controls. Likely compromised CoW in relation to cerebral ischemia was observed in a large cohort of carotid endarterectomy subjects., Key Points: • CoW variant distribution significantly differed in the study and control groups (p<0.001). • ICA stenosis was the only independent predictor of CoW morphology (p<0.001). • Severely compromised CoW configuration showed significant association with brain ischemia (p=0.002).- Published
- 2019
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37. Stent Protrusion >20 mm Into the Aorta: A New Predictor for Restenosis After Kissing Stent Reconstruction of the Aortoiliac Bifurcation.
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Vértes M, Juhász IZ, Nguyen TD, Veres DS, Hüttl A, Nemes B, Hüttl K, and Dósa E
- Subjects
- Aged, Aortic Diseases diagnostic imaging, Aortic Diseases physiopathology, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases physiopathology, Critical Illness, Female, Humans, Intermittent Claudication diagnostic imaging, Intermittent Claudication physiopathology, Ischemia diagnostic imaging, Ischemia physiopathology, Male, Middle Aged, Prosthesis Design, Retrospective Studies, Time Factors, Treatment Outcome, Vascular Patency, Angioplasty, Balloon adverse effects, Angioplasty, Balloon instrumentation, Aortic Diseases therapy, Arterial Occlusive Diseases therapy, Iliac Artery diagnostic imaging, Iliac Artery physiopathology, Intermittent Claudication therapy, Ischemia therapy, Stents
- Abstract
Purpose: To determine the long-term patency of aortoiliac kissing stents and to identify predisposing factors for the development of in-stent restenosis (ISR)., Methods: A retrospective analysis was conducted of 105 patients (median age 60.9 years; 64 women) with symptomatic aortoiliac occlusive disease who had kissing stents implanted between 2001 and 2015. The indication for kissing stents was severe claudication in 91 (86.7%) patients and critical limb ischemia in 14 (13.3%). Lesions were TASC A in 52 (49.5%), B in 29 (27.6%), C in 4 (3.8%), and D in 20 (19%) patients. Twenty-five (23.8%) patients had heavily calcified lesions. In all, 210 stents were deployed [180 (85.7%) self-expanding and 30 (14.3%) balloon-expandable]. Follow-up included clinical evaluation, ankle-brachial index measurement, and duplex ultrasonography., Results: The median follow-up was 45 months. The primary patency rates were 93%, 86%, and 77% at 12, 24, and 60 months, respectively. Significant ISR developed in 23 (21.9%) patients (12 unilateral and 11 bilateral). Univariate Cox regression analysis revealed older age [hazard ratio (HR) 0.5, 95% confidence interval (CI) 0.31 to 0.81, p=0.004] and larger aortic diameter (HR 0.42, 95% CI 0.25 to 0.7, p<0.001) to be variables favoring long-term patency, while a longer aortic stent segment (HR 1.56, 95% CI 1.16 to 2.09, p=0.003) and a larger discrepancy between the summed stent diameters and the aortic diameter (HR 1.64, 95% CI 1.01 to 2.65, p=0.043) were associated with ISR development. Multivariate analysis showed a longer aortic stent segment to be the only significant determinant of ISR (HR 1.44, 95% CI 1.02 to 2.01, p=0.035)., Conclusion: The kissing stent technique can be performed with good long-term patency. Patients whose iliac stents protrude too far into the aorta need closer follow-up.
- Published
- 2018
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38. Round-robin test for the cell-of-origin classification of diffuse large B-cell lymphoma-a feasibility study using full slide staining.
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Reinke S, Richter J, Fend F, Feller A, Hansmann ML, Hüttl K, Oschlies I, Ott G, Möller P, Rosenwald A, Stein H, Altenbuchinger M, Spang R, and Klapper W
- Subjects
- Humans, Interferon Regulatory Factors analysis, Lymphoma, Large B-Cell, Diffuse chemistry, Lymphoma, Large B-Cell, Diffuse classification, Neprilysin analysis, Proto-Oncogene Proteins c-bcl-6 analysis, Staining and Labeling, Lymphoma, Large B-Cell, Diffuse pathology
- Abstract
Diffuse large B-cell lymphoma (DLBCL) is subdivided by gene expression analysis (GEP) into two molecular subtypes named germinal center B-cell-like (GCB) and activated B-cell-like (ABC) after their putative cell-of-origin (COO). Determination of the COO is considered mandatory in any new-diagnosed DLBCL, not otherwise specified according to the updated WHO classification. Despite the fact that pathologists are free to choose the method for COO classification, immunohistochemical (IHC) assays are most widely used. However, to the best of our knowledge, no round-robin test to evaluate the interlaboratory variability has been published so far. Eight hematopathology laboratories participated in an interlaboratory test for COO classification of 10 DLBCL tumors using the IHC classifier comprising the expression of CD10, BCL6, and MUM1 (so-called Hans classifier). The results were compared with GEP for COO signature and, in a subset, with results obtained by image analysis. In 7/10 cases (70%), at least seven laboratories assigned a given case to the same COO subtype (one center assessed one sample as not analyzable), which was in agreement with the COO subtype determined by GEP. The results in 3/10 cases (30%) revealed discrepancies between centers and/or between IHC and GEP subtype. Whereas the CD10 staining results were highly reproducible, staining for MUM1 was inconsistent in 50% and for BCL6 in 40% of cases. Image analysis of 16 slides stained for BCL6 (N = 8) and MUM1 (N = 8) of the two cases with the highest disagreement in COO classification were in line with the score of the pathologists in 14/16 stainings analyzed (87.5%). This study describes the first round-robin test for COO subtyping in DLBCL using IHC and demonstrates that COO classification using the Hans classifier yields consistent results among experienced hematopathologists, even when variable staining protocols are used. Data from this small feasibility study need to be validated in larger cohorts.
- Published
- 2018
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39. Combined Transradial and Transpedal Approach for Femoral Artery Interventions.
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Ruzsa Z, Bellavics R, Nemes B, Hüttl A, Nyerges A, Sótonyi P, Bertrand OF, Hüttl K, and Merkely B
- Subjects
- Aged, Constriction, Pathologic, Female, Humans, Male, Middle Aged, Peripheral Arterial Disease diagnostic imaging, Peripheral Arterial Disease mortality, Peripheral Arterial Disease physiopathology, Pilot Projects, Prospective Studies, Risk Factors, Stents, Time Factors, Treatment Outcome, Angioplasty, Balloon adverse effects, Angioplasty, Balloon instrumentation, Angioplasty, Balloon mortality, Catheterization, Peripheral adverse effects, Catheterization, Peripheral mortality, Femoral Artery diagnostic imaging, Femoral Artery physiopathology, Foot blood supply, Peripheral Arterial Disease therapy, Radial Artery diagnostic imaging
- Abstract
Objectives: The purpose of this prospective study was to evaluate the acute success and complication rates of combined transradial and transpedal access for femoral artery intervention., Background: Improved equipment and techniques have resulted in transition from transfemoral to transradial access for intervention of superficial femoral artery., Methods: Between 2014 and 2016, clinical and angiographic data from 145 consecutive patients with symptomatic superficial femoral stenosis, treated via primary radial access using the 6-F SheathLess Eaucath PV guiding catheter were evaluated in a pilot study. Secondary access was achieved through the pedal or popliteal artery. The primary endpoints were major adverse events, target lesion revascularization, and rates of major and minor access-site complications. Secondary endpoints included angiographic outcome, procedural factors, crossover rate to femoral access site, and duration of hospitalization., Results: Technical success was achieved in 138 patients (95.2%). Combined radial and pedal access was obtained in 22 patients (15.1%). The crossover rate to a femoral access site was 2%. Stent implantation was necessary in 23.4% of patients. Chronic total occlusion recanalization was performed in 63 patients, with a 90.4% technical success rate. The mean contrast consumption, radiation dose, and procedure time were 112.9 ml (101.8 to 123.9 ml), 21.84 Gy/cm
2 (9.95 to 33.72 Gy/cm2 ), and 34.9 min (31.02 to 38.77 min), respectively. The cumulative rate of access-site complications was 4.8% (0% major, 4.8% minor). The cumulative incidence rates of major adverse events at 3 and 12 months follow-up was 8.3% and 19.2%. The cumulative incidence rates of death at 3- and 12-month follow-up were 2.8% and 5.6%., Conclusions: Femoral artery intervention can be safely and effectively performed using radial and pedal access with acceptable morbidity and a high technical success rate., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2018
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40. Intraosseous venous malformation of the zygomatico-orbital complex. Case report and literature review with focus on confusions in vascular lesion terms.
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Fábián Z, Szabó G, Petrovan C, Horváth KU, Babicsák B, Hüttl K, Németh Z, and Bogdán S
- Subjects
- Adolescent, Dental Implants, Humans, Imaging, Three-Dimensional, Male, Titanium, Tomography, X-Ray Computed, Vascular Malformations diagnostic imaging, Embolization, Therapeutic methods, Skull surgery, Vascular Malformations surgery
- Abstract
Intraosseous vascular malformations (VascM) of the facial skeleton are rare entities, raising difficulties even today in their treatment. We present a case for zygomatic intraosseous venous malformation of traumatic etiology with growth dynamics presentation and a multidisciplinary treatment approach, with intravascular embolization surgical ablation and primary reconstructruction using a titanium patient-specific implant (PSI), and a review of the literature for intraosseous vascular lesions of the facial skeleton focusing on the diagnostic syntagms used by the involved medical personnel, to shed light on the confusions over these terms.
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- 2018
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41. Fractional flow reserve in below the knee arteries with critical limb ischemia and validation against gold-standard morphologic, functional measures and long term clinical outcomes.
- Author
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Ruzsa Z, Róna S, Tóth GG, Sótonyi P, Bertrand OF, Nemes B, Merkely B, and Hüttl K
- Subjects
- Aged, Angiography, Angioplasty, Balloon instrumentation, Critical Illness, Drug-Eluting Stents, Feasibility Studies, Female, Humans, Hyperemia physiopathology, Ischemia physiopathology, Ischemia therapy, Laser-Doppler Flowmetry, Male, Papaverine administration & dosage, Peripheral Arterial Disease physiopathology, Peripheral Arterial Disease therapy, Predictive Value of Tests, Proof of Concept Study, Prospective Studies, Regional Blood Flow, Reproducibility of Results, Severity of Illness Index, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Duplex, Vasodilator Agents administration & dosage, Blood Pressure, Blood Pressure Determination methods, Ischemia diagnosis, Leg blood supply, Peripheral Arterial Disease diagnosis
- Abstract
Introduction: The aim of this study was to assess the applicability of fractional flow reserve measurement (FFR) in below-the-knee (BTK) arteries and to evaluate its correlation with non-invasive functional parameters before and after angioplasty., Methods: We enrolled 39 patients with severe BTK arterial lesions. Inclusion criteria were critical limb ischemia (Rutherford 4-6) and angiographically proven arterial stenosis of the distal lower limb (percent diameter stenosis ≥70%). Exclusion criteria were chronic total occlusion, diabetic foot syndrome and non-viable distal lower limb. The transstenotic distal/proximal pressure ratio was measured under resting (Pd/Pa) and hyperemic (FFR) conditions induced by 40mg intra-arterial Papaverin and was compared with quantitative angiography-, laser Doppler- and duplex ultrasound-derived measurements before and after percutaneous angioplasty (PTA)., Results: Comparing measurements before and after PTA, we found significant improvements in the resting Pd/Pa values (0.79 [0.67-0.90] vs 0.90 [0.85-0.97]; p<0.001) and FFR values (0.60±0.19 vs 0.76±0.15; p<0.001), respectively. At baseline, Pd/Pa ratio and FFR were significantly albeit weakly correlated with % area stenosis (r:-0.31, p=0.05 and r:-0.31, p=0.05, respectively). After PTA, neither Pd/Pa nor FFR remained correlated with % area stenosis. Similarly, prior PTA, Pd/Pa ratio and FFR were significantly correlated with TcO2% and perfusion unit change (r:0.48, p<0.01 and r:0.34, p<0.05, respectively), but after intervention, these significant correlations vanished. Pd/Pa and FFR values did not show correlation with duplex ultrasound-derived measurements. At 1year, major adverse events (MAEs) and major adverse cardiovascular and cerebrovascular (MACCEs) were observed in 7 (17.9%) and in 9 (23.1%) patients, respectively., Conclusion: CLI due to severe BTK arterial disease was associated with several impediments of baseline pressure measurements which were significantly improved after successful PTA and stenting. Significant relationships between pressure data and functional and imaging parameters existed prior intervention but vanished after. Further studies are required to determine the clinical value of pre- and post-PTA pressure measurements in BTK arterial disease., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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42. [Endovascular treatment of acute iliofemoral deep venous thrombosis - our results with catheter-directed thrombolysis and AngioJet].
- Author
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Berencsi A, Dósa E, Nemes B, Hüttl K, Legeza P, Oláh Z, Kristóf V, Acsády G, and Sótonyi P
- Subjects
- Female, Femoral Vein diagnostic imaging, Femoral Vein physiopathology, Fibrinolytic Agents adverse effects, Fibrinolytic Agents therapeutic use, Humans, Iliac Vein diagnostic imaging, Iliac Vein physiopathology, Male, Postthrombotic Syndrome prevention & control, Quality of Life, Thrombectomy, Thrombolytic Therapy methods, Treatment Outcome, Vascular Patency drug effects, Venous Thrombosis diagnosis, Venous Thrombosis physiopathology, Catheterization, Peripheral, Endovascular Procedures methods, Femoral Vein surgery, Fibrinolytic Agents administration & dosage, Iliac Vein surgery, Stents, Thrombolytic Therapy adverse effects, Ultrasonography, Interventional methods, Venous Thrombosis therapy
- Abstract
Introduction: Most of the patients with iliofemoral thrombosis treated with anticoagulants only are affected with postthrombotic syndrome (PTS) that worsens the patients' quality of life. In the acute phase of proximal deep venous thrombosis (DVT) catheter-directed (CDT) and pharmacomechanical thrombolysis may be a reasonable alternative therapeutic method. Our aim was to summarize our results using these methods., Methods: Since 2009 twenty-four patients with iliofemoral DVT were treated with these endovascular procedures and with stenting at our Institution., Results: The median age of the patients was 35.83 ± 15.9 years, the female: male ratio was approximately 2:1. The mean time between the onset of the symptoms and the procedures was eleven days. CDT alone was performed in 8 patients, thrombus aspiration in addition to CDT using AngioJet device in 16 patients; in 19 cases the procedure was completed with venous stenting. During the follow-up we performed US examinations and estimated the severity of PTS by Villalta-scale. The total recanalization-rate was more than 50%, which even improved during the follow-up. The total lysis time and the amount of used recombinant tissue plasminogen activator decreased significantly by applying the AngioJet. We did not find any severe PTS among our patients during the follow-up visits., Conclusion: Our data suggests that these methods can be used efficiently and safely in the treatment of acute iliofemoral DVT.
- Published
- 2017
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43. [Long term results after invasive treatment of critical limb ischemia].
- Author
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Ruzsa Z, Kuti F, Berta B, Tóth K, Bánsághi Z, Vámosi Z, and Hüttl K
- Subjects
- Aged, Angioplasty, Balloon, Female, Follow-Up Studies, Humans, Ischemia physiopathology, Male, Middle Aged, Stents, Treatment Outcome, Angioplasty methods, Ischemia therapy, Leg blood supply
- Abstract
Introduction and Aim: Surgical tibial bypass for critical limb ischemia is associated with significant morbidity, mortality, and graft failure, whereas percutaneous angioplasty and stenting has promising results. The objective of this study was the investigation of the long term results of below-knee percutaneous angioplasty for restoring straight inline arterial flow in patients with critical limb ischemia., Method: The clinical and angiographic data of 281 consecutive patients with critical limb ischemia treated by PTA between 2008 and 2011 was evaluated in a prospective register. The aim of the revascularization was to achieve a straight inline flow to the wound with balloon angioplasty. Stent implantation was done in the case of recoil and flow limiting dissection. Primary end points were clinical success (relief of resting pain, healing of ulceration, limb survival) and major adverse events (death, myocardial infarction, major unplanned amputation, need for surgical revascularization, or major bleeding). Secondary end points were the angiographic result of the intervention, procedural data and consumption of angioplasty equipment. The impact of diabetic leg syndrome and the result of the angioplasty on the limb salvage was also investigated. We have analysed the impact of major amputation on long term mortality., Results: Mean age of patients was 72.5 ± 10.6 years and the follow-up period was 40.8 ± 9.7 months. Technical success was reached in 255 (90.7%) of the patient's: 255 limbs straight inline flow with good angiographic result was restored to at least one tibial vessel. Balloon angioplasty, stent implantation and rotational atherectomy was performed in 278 (98.9%), 74 (26.3%) and 2 patients (0.7%). From clinical end points the rest pain was ceased in 56.6%, the ulcer and the gangrena was healed in 73.5% and 46.5%. The long term limb survival was 73.5%; 65.8% in diabetic and 89.6% in non-diabetic leg syndrome (p = 0.001). The major adverse events at long-term follow-up occured in 122 (43.8%) patients. Death occured in 57 (20.3%) of the patients during the long-term follow-up: 38 (13.5%) vs. 19 (6.8%) in diabetic vs. non-diabetic leg subgroup, respectively (p = 0.932). Long-term limb saving occured in 72.3% vs. 84.6% of the patients dependening the procedure was successful or unsuccessful (p = 0.225)., Conclusion: Below-knee stent angioplasty for critical limb ischemia results in good clinical outcome, but the major adverse event rate is high. Diabetes mellitus is associated with a high rate of mortality and amputation. Orv. Hetil., 2017, 158(11), 418-425.
- Published
- 2017
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44. Thoracic Aortic Strain is Irrelevant Regarding Endograft Sizing in Most Young Patients.
- Author
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Csobay-Novák C, Fontanini DM, Szilágyi B, Szeberin Z, Kolossváry M, Maurovich-Horvat P, Hüttl K, and Sótonyi P
- Subjects
- Adult, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic physiopathology, Aortic Diseases diagnostic imaging, Aortic Diseases physiopathology, Aortography methods, Cardiac-Gated Imaging Techniques, Computed Tomography Angiography, Coronary Angiography methods, Female, Humans, Male, Middle Aged, Multidetector Computed Tomography, Observer Variation, Predictive Value of Tests, Pulsatile Flow, Radiographic Image Interpretation, Computer-Assisted, Reproducibility of Results, Stress, Mechanical, Aorta, Thoracic surgery, Aortic Diseases surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Hemodynamics, Prosthesis Design
- Abstract
Background: The introduction of electrocardiogram gating in computed tomography (CT) angiography imaging of aortic disease raised questions whether diameters measured on diastolic images can lead to the undersizing of aortic endografts. As previous studies suggested that young patients may have the highest risk of an unintended undersize, the aim of our study was to analyze the strain of the thoracic aorta in a young patient cohort., Methods: We assessed the descending aorta of 52 patients (35 men, mean age 41.1 ± 7.3 years) who underwent coronary CT angiography (CCTA) with suspected coronary artery disease. To reduce radiation dose, native calcium score scans triggered on late systole were compared with diastolic phase CCTA images. Cross-section areas were measured, and effective diameters were derived at 3 levels of the visible segment of the descending aorta (P1, P2, and P3) in systole and diastole. Aortic pulsatility (mm, d
systolic -ddiastolic ) and strain (%, [dsystolic -ddiastolic ]/ddiastolic ) were calculated at each level. All measurements were performed 3 times by 2 independent readers to evaluate interreader and intrareader reproducibility., Results: A total of 936 measurements were performed. Significant differences were found between systolic and diastolic diameters at each location (all P < 0.001). Average aortic pulsatility was 1.5 ± 0.6 mm at P1, 1.6 ± 0.7 mm at P2, and 1.7 ± 0.7 mm at P3, with a corresponding aortic strain of 6.7 ± 3.1% at P1, 7.4 ± 3.5% at P2, and 8.1 ± 3.6% at P3. The differences between the strain of the measurement levels were not significant (P = 0.344). Aortic strain and pulsatility did not show significant correlation with pulse pressure (P = 0.693), patient age (P = 0.649), or other anamnestic data. Intraclass correlation coefficient was in the range of 0.95-0.96 for interobserver and in the range of 0.95-0.97 for intraobserver analysis., Conclusions: This study shows that descending aortic strain can be measured precisely and reliably on images of routine CCTA examinations with native scans acquired during systole. We demonstrated that young adults have an aortic strain of 6.7-8.1%. As the average thoracic aortic strain was still lower than the recommended prosthesis oversize of 10%, routine use of systolic phase imaging cannot be recommended: it has no clinical benefit for the vast majority of the patients but increases the risk of motion artefacts. We also demonstrated that large interindividual differences are present in the scale of thoracic aortic strain, a phenomenon that needs further investigations to be fully understood., (Copyright © 2016 Elsevier Inc. All rights reserved.)- Published
- 2017
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- View/download PDF
45. Fracture and Lung Penetration of a Left Ventricular Lead Stabilized by Retained Stylet.
- Author
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Osztheimer I, Duray G, Hüttl K, and Merkely B
- Subjects
- Equipment Failure Analysis, Female, Heart Ventricles physiopathology, Humans, Middle Aged, Prosthesis Failure, Prosthesis Fitting adverse effects, Prosthesis Fitting methods, Cardiac Resynchronization Therapy adverse effects, Cardiac Resynchronization Therapy methods, Electrodes, Implanted adverse effects, Heart Failure therapy, Lung Injury etiology, Lung Injury prevention & control
- Abstract
During cardiac resynchronization therapy (CRT) pacemaker implantation in a 54-year-old female patient, removing the stylet resulted in repeated left ventricular (LV) lead dislodgment. Lead stability was achieved by retaining the stylet within the lead lumen. Two years after cardiac resynchronization therapy, a LV lead fracture near the connector pin occurred. The proximal lead segment was removed, and a new connector pin was attached. Two years after that, the same lead fractured in the right atrium with the stylet penetrating the lung. The LV lead and retained stylet were successfully extracted. LV lead dislodgment is a limitation of CRT, but using the retained stylet technique to achieve lead stability is potentially dangerous and is not recommended., (Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
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46. Thoracic aortic strain can affect endograft sizing in young patients.
- Author
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Csobay-Novák C, Fontanini DM, Szilágyi BR, Szeberin Z, Szilveszter BA, Maurovich-Horvat P, Hüttl K, and Sótonyi P
- Subjects
- Aged, Aged, 80 and over, Blood Vessel Prosthesis, Electrocardiography, Female, Hemodynamics, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Radiographic Image Interpretation, Computer-Assisted methods, Tomography, X-Ray Computed, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic physiopathology, Prosthesis Fitting
- Abstract
Objective: Aortic computed tomography angiography (CTA) examination with electrocardiography gating is becoming the clinical routine image acquisition protocol for diagnosis and intervention planning. To minimize motion artifact, the images are reconstructed in the diastolic phase of the cardiac cycle. The aim of our study was to quantify aortic strain in an elderly nonaneurysmatic patient cohort and to identify the phases of the R-R cycle that correspond to the minimal and maximal aortic diameters. The quantification of aortic strain may enable the improvement of intervention planning and the introduction of more effective dose-saving protocols for CTA scans., Methods: We assessed CTA images of 28 patients (14 men; mean age, 74 years). Aortic calcium score was calculated on native images. Angiography images were reconstructed in equally spaced 10 phases of the R-R cycle. After semiautomatic centerline analysis, we measured the cross-sectional areas in each of the 10 phases at 9 specific segments between the ascending aorta and the common iliac bifurcation representing the attachment sites of thoracic and abdominal stent grafts. Area-derived effective diameter, pulsatility (Amax - Amin), and strain [(Amax - Amin)/Amin] were calculated. Repeated measurements were taken to evaluate inter-reader and intrareader reproducibility (10-10 patients each)., Results: A total of 4320 measurements were performed. We found significant difference between diastolic and systolic diameters (DD,Z0 = 33.2, DS,Z0 = 34.4; P < .001). Pulsatility values of the vessel diameters were 1.0 to 1.1 mm in the thoracic aorta, 0.7 to 0.9 mm in the abdominal aorta, and 0.5 to 0.6 mm in the common iliac arteries. Negative, moderate correlations were found between aortic strain and age (r = -0.586; P = .001), aortic strain and plaque area (r = -0.429; P = .026), and age and body mass index (r = -0.412; P = .029). We found positive, moderate correlation between age and plaque area (r = 0.594; P = .001). The aortic pulsatility curve has a positive extreme at 30% and a negative extreme at 90% of the R-R cycle throughout the aorta. Lin concordance coefficients were 0.987 for inter-reader and 0.994 for intrareader correlations., Conclusions: Aortic strain can be reliably quantified on electrocardiography-gated CTA images. Pulsatility of the aorta can be substantial in the thoracic aortic segments of young patients; therefore, the routine use of systolic images is not recommended. In addition, we demonstrated that images at 30% of the heart cycle correspond to the largest diameter of the aorta., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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47. [In Process Citation].
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Entz L, Nemes B, Szeberin Z, Szabó GV, Sótonyi P, Banga P, Csobay-Novák C, Széphelyi K, and Hüttl K
- Abstract
Case Report: The first case was a 77-year-old man with 5.6 cm juxtarenal abdominal aortic aneurysm who presented with multiple comorbidities. The patient had a single left kidney. A custom-made, single fenestrated stent graft was implanted successfully. The one-month follow-up showed a patent left renal fenestration without evidence of any endoleaks. Four months after the operation the patient was admitted with acute uremia. Imaging studies revealed an occluded left renal stent, which was successfully reopened. The second case was a 71-year-old man with 8.0 cm juxtarenal aneurysm. He presented with severe coronary artery disease among other multiple comorbidities in his medical history. He was successfully treated with a 3-vessel custom-made fenestrated stent graft to the renal and the superior mesenteric arteries. The one-month CT imaging revealed patent fenestrations without endoleaks., Discussion: With the development of fenestrated endograft technology, complex aneurysms with visceral artery involvement can be treated with complete endovascular approaches. The first fenestrated endovascular case in Hungary was treated in the Heart and Vascular Center of Semmelweis University, Budapest. The short and middle-term results are offering improved clinical results when compared with conventional surgery, but the long-term outcomes are difficult to ascertain from the current published series.
- Published
- 2015
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48. [Editorial comment: Interventional radiology, radiologic intervention].
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Doros A, Horváth L, and Hüttl K
- Subjects
- Cardiovascular Diseases diagnostic imaging, Cardiovascular Diseases radiotherapy, Decision Making, History, 20th Century, History, 21st Century, Humans, Hungary, International Cooperation, Radiography, Interventional history, Radiography, Interventional methods, Radiography, Interventional trends, Radiology, Interventional history, Radiology, Interventional methods, Radiology, Interventional trends
- Published
- 2015
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49. Esmolol is noninferior to metoprolol in achieving a target heart rate of 65 beats/min in patients referred to coronary CT angiography: a randomized controlled clinical trial.
- Author
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Maurovich-Horvat P, Károlyi M, Horváth T, Szilveszter B, Bartykowszki A, Jermendy ÁL, Panajotu A, Celeng C, Suhai FI, Major GP, Csobay-Novák C, Hüttl K, and Merkely B
- Subjects
- Aged, Chi-Square Distribution, Coronary Stenosis diagnostic imaging, Female, Heart Rate physiology, Humans, Infusions, Intravenous, Male, Middle Aged, Premedication methods, Sensitivity and Specificity, Coronary Angiography methods, Heart Rate drug effects, Metoprolol administration & dosage, Propanolamines administration & dosage, Tomography, X-Ray Computed methods
- Abstract
Background: Coronary CT angiography (CTA) is an established tool to rule out coronary artery disease. Performance of coronary CTA is highly dependent on patients' heart rates (HRs). Despite widespread use of β-blockers for coronary CTA, few studies have compared various agents used to achieve adequate HR control., Objective: We sought to assess if the ultrashort-acting β-blocker intravenous esmolol is at least as efficacious as the standard of care intravenous metoprolol for HR control during coronary CTA., Methods: Patients referred to coronary CTA with a HR >65 beats/min despite oral metoprolol premedication were enrolled in the study. We studied 412 patients (211 male; mean age, 57 ± 12 years). Two hundred four patients received intravenous esmolol, and 208 received intravenous metoprolol with a stepwise bolus administration protocol. HR and blood pressure were recorded at arrival, before, during, immediately after, and 30 minutes after the coronary CTA scan., Results: Mean HRs of the esmolol and metoprolol groups were similar at arrival (78 ± 13 beats/min vs 77 ± 12 beats/min; P = .65) and before scan (68 ± 7 beats/min vs 69 ± 7 beats/min; P = .60). However, HR during scan was lower in the esmolol group vs the metoprolol group (58 ± 6 beats/min vs 61 ± 7 beats/min; P < .0001), whereas HRs immediately and 30 minutes after the scan were higher in the esmolol group vs the metoprolol group (68 ± 7 beats/min vs 66 ± 7 beats/min; P = .01 and 65 ± 8 beats/min vs 63 ± 8 beats/min; P < .0001; respectively). HR ≤ 65 beats/min was reached in 182 of 204 patients (89%) who received intravenous esmolol vs 162 of 208 of the patients (78%) who received intravenous metoprolol (P < .05). Of note, hypotension (systolic BP <100 mm Hg) was observed right after the scan in 19 patients (9.3%) in the esmolol group and in 8 patients (3.8%) in the metoprolol group (P < .05), whereas only 5 patients (2.5%) had hypotension 30 minutes after the scan in the esmolol group compared to 8 patients (3.8%) in the metoprolol group (P = .418)., Conclusion: Intravenous esmolol with a stepwise bolus administration protocol is at least as efficacious as the standard of care intravenous metoprolol for HR control in patients who undergo coronary CTA., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
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50. Role of stent selection in the incidence of persisting hemodynamic depression after carotid artery stenting.
- Author
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Csobay-Novák C, Bárány T, Zima E, Nemes B, Sótonyi P, Merkely B, and Hüttl K
- Subjects
- Aged, Alloys, Body Mass Index, Bradycardia etiology, Carotid Artery, Internal pathology, Carotid Stenosis epidemiology, Carotid Stenosis physiopathology, Female, Humans, Hypertension etiology, Incidence, Male, Middle Aged, Platelet Aggregation Inhibitors administration & dosage, Postoperative Care, Preoperative Care, Retrospective Studies, Risk Assessment, Risk Factors, Treatment Outcome, Angioplasty, Balloon adverse effects, Carotid Artery, Common pathology, Carotid Stenosis pathology, Carotid Stenosis therapy, Hemodynamics, Stents adverse effects
- Abstract
Purpose: To investigate the possible role of stent selection and procedure-related vessel diameter changes in the development of persisting hemodynamic depression (PHD) and to demonstrate the effectiveness and safety of permanent pacemaker implantation in patients with refractory PHD., Methods: Data from 584 procedures performed in 542 patients (398 men; mean age 67.3 years) between 2008 and 2011 using Wallstent, Precise, and Xact stents in a nonrandomized fashion were analyzed retrospectively. Cardiovascular risk factors and lesion, stent, and balloon characteristics were collected, and the pre- and postprocedure diameters of the common carotid artery (CCA) and internal carotid artery were measured. PHD was defined as any episode of hypotension (systolic blood pressure <90 mm Hg) and/or bradycardia (heart rate <60/min) lasting >6 hours. Risk factors for PHD were sought using logistic regression analyses; the results are presented as the odds ratio (OR) and 95% confidence interval (CI)., Results: The incidence of PHD was 37.0% (216/584). Refractory PHD was encountered in 9 patients; among these, 6 were successfully treated with pacemaker implantation. A history of prior ipsilateral carotid endarterectomy (OR 0.44, 95% CI 0.22 to 0.87, p=0.019) and the presence of a contralateral high-grade stenosis (OR 0.12, 95% CI 0.02 to 0.95, p=0.045) were independent protective factors, while calcification (OR 1.5, 95% CI 1.03 to 2.18, p=0.034), involvement of the carotid bulb (OR 2.56, 95% 1.62 to 4.03, p<0.001), and implantation of a nitinol stent (adjusted OR 1.62, 95% CI 1.12 to 2.34, p=0.011) were independent risk factors for developing PHD after carotid artery stenting. The ratio of the post-/preprocedure CCA diameter (p=0.002), the stent to CCA diameter ratio (p=0.009), and the presence of residual stenosis (p=0.009) were significantly higher in the PHD group., Conclusion: Stent selection and procedure-related changes in vessel diameter may have an influence on the development of PHD. Permanent pacemaker implantation is an effective treatment option in patients with refractory PHD., (© The Author(s) 2015.)
- Published
- 2015
- Full Text
- View/download PDF
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