Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition characterized by inflammation of the airways and lung parenchyma, manifested by persistent respiratory symptoms such as dyspnoe and cough. As a global pandemic, it affects approximately 10.3% of the population over the age of 40 and remains among the leading causes of death with an increasing mortality trend. In Hungary, the estimated actual prevalence is approximately three times higher than the number of officially registered cases. COPD imposes a significant economic burden, primarily driven by the hospital care required for acute exacerbations. The systemic consequences of chronic inflammation contribute to the development of frequent comorbidities, such as atherosclerosis and heart failure. The primary objectives in managing stable COPD are symptom reduction, improvement of quality of life, and the prevention of disease progression. The cornerstones of therapy include smoking cessation, maintenance inhalation pharmacotherapy, and various non-pharmacological interventions. The latter encompasses appropriately indicated pulmonary rehabilitation, long-term oxygen therapy, and non-invasive ventilation, as well as lung volume reduction interventions and lung transplantation in selected cases. The selection of optimal, individualized therapy combined with high patient adherence significantly improves survival rates. Orv Hetil. 2026; 167(41): 1639-1645.

Age-related muscle loss (sarcopenia) represents one of the most significant health burdens in a globally ageing population. The relationship between the gut microbiome and skeletal muscle, referred to as the gut-muscle axis, is the subject of increasing research, yet the identification of specific responsible microbial species and mechanisms has remained limited. This review aims to summarize the current evidence on the gut-muscle axis, with particular focus on the association between the intestinal bacterium Roseburia inulinivorans and muscle performance reported in a 2026 Gut publication, and to evaluate its clinical and therapeutic relevance. Narrative review based primarily on the study by Martinez-Tellez et al. (2026), supplemented by relevant literature on the gut-muscle axis, sarcopenia, and the ageing microbiome. The relative abundance of R. inulinivorans positively correlated with handgrip strength, leg press and bench press performance. Older adults with detectable R. inulinivorans showed 29% higher handgrip strength without a concomitant increase in cardiorespiratory capacity. In a murine model, oral supplementation produced approximately 30% increase in forelimb grip strength. The mechanism may operate not via butyrate but through activation of the purine and pentose phosphate pathways in muscle tissue. R. inulinivorans shows a species-specific association with muscle strength and represents a candidate target for nutraceutical interventions against sarcopenia and cachexia. Human randomized clinical trials and longitudinal studies accounting for sex differences are required to confirm these findings. Orv Hetil. 2026; 167(41): 1646-1654.

Severe hypokalemia is a rare but potentially reversible cause of malignant arrhythmias and cardiac arrest. Early recognition of significant fluid, electrolyte, and acid-base disturbances in patients with intestinal urinary diversion may be life-saving. We present the clinical course of a 55-year-old woman who developed severe hyperchloremic metabolic acidosis and extreme hypokalemia following prolonged vomiting and high-output fluid loss through a Bricker ureteroileocutaneostomy. The patient was admitted to the intensive care unit in a peri-arrest condition, where cardiac arrest occurred shortly thereafter. The monitored rhythm was ventricular fibrillation alternating with "torsade de pointes" ventricular fibrillation. During advanced life support, targeted high-dose intravenous potassium replacement, magnesium sulfate administration, and bicarbonate substitution were performed. A total of 120 mL of 7.4% potassium chloride was administered during resuscitation, resulting in return of spontaneous circulation after approximately 18 minutes. During the first 24 hours, a total of 460 mmol potassium chloride replacement was required. Following the return of spontaneous circulation, intermittent hemodialysis was performed to correct severe metabolic acidosis. During subsequent intensive care treatment, sepsis and bilateral pneumonia developed; however, with targeted antimicrobial therapy, organ support, and continuous electrolyte correction, the patient's condition gradually improved. Successful extubation was performed on day 7, and the patient was transferred back to the nephrology ward with favourable neurological outcome. This case highlights that rapidly developing severe hypokalaemia and metabolic acidosis in patients with Bricker urinary diversion may lead to malignant arrhythmias and cardiac arrest; however, prompt recognition of reversible metabolic abnormalities and aggressive targeted potassium replacement can be life-saving. Orv Hetil. 2026; 167(41): 1664-1668.

The most well-known skin manifestation of human parvovirus B19 infection is erythema infectiosum, also known as fifth disease. In atypical cases, particularly among young adults, purpuric-petechial glove-and-sock syndrome (PPGSS) is observed, which is a condition characterized by a symmetrical distribution in the acral areas. Its onset is attributed to the active viremia phase; therefore, patients exhibiting symptoms are contagious, which is of particular importance in the case of immunocompromised individuals and pregnant women. In our report, we present three cases: in two patients, the skin manifestations appeared as an atypical petechial-purpuric exanthem, while in the third child, they manifested as pityriasis rosea; to our knowledge, the parvovirus-associated form of this condition has not been described in the literature to date. During laboratory testing, in addition to typical abnormalities, we observed monocytosis in the blood counts of all three patients. Detecting the virus or the virus-specific antibody response is a highly challenging, comprehensive microbiological task in which molecular tests play a key role alongside serological tests. With our cases, we wish to draw attention to the rising prevalence of diseases caused by parvovirus B19, the periodic clusters and small outbreaks, the appearance of unusual skin symptoms, and the difficulties in detecting the virus. Orv Hetil. 2026; 167(41): 1669-1675.

One of the most widely used plastic surgery procedures is breast augmentation, which may have short-term psychological benefits but long-term complex biopsychosocial repercussions. In recent years, increased attention has been given to the symptoms associated with breast implants (breast implant illness - BII), as well as to the malignancies associated with implants (breast implant-associated anaplastic large cell lymphoma - BIA-ALCL; breast implant-associated squamous cell carcinoma - BIA-SCC). The objective of our study was to provide a comprehensive examination of the psychological characteristics of patients with breast implants, the role of preoperative psychological vulnerability, and the psychological aspects of BII and malignancies associated with breast implants, including BIA-ALCL and BIA-SCC. Our method was a narrative literature review based on the relevant international literature. The results show that the prevalence of mental health disorders in the population choosing aesthetic breast surgery exceeds the average population values. The preoperative mental state largely determines the postoperative psychological outcomes. BII is an ill-defined, heterogeneous symptom complex whose development and persistence may be influenced by psychological factors, particularly health anxiety, cognitive distortions, and nocebo effects. In the case of BII, implant removal does not always result in clinical improvement, which supports the multifactorial nature of the phenomenon. Implant-associated malignancies, such as BIA-ALCL and BIA-SCC, are rare and not psychogenic, but they can cause significant psychological distress, including anxiety, a sense of loss of control and repeated body image disturbance. Consequently, conditions associated with breast implants are complex biopsychosocial phenomena that require an integrated approach for interpretation and treatment. Preoperative psychological screening and the identification of comorbid mental health conditions are crucial for the management of these complex biopsychosocial phenomena. Orv Hetil. 2026; 167(40): 1616-1623.

Numerous clinical studies and experimental findings have confirmed that breast implants with different textures and fillings can promote structural changes in cells and tissues within the implant capsule, which may induce tumorigenesis in the long term. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and squamous cell carcinoma (BIA-SCC) are two distinct malignant conditions that develop within the implant capsule and are clearly distinct from breast cancer; their estimated incidence and prevalence are low. Recognized by the WHO since 2023, BIA-SCC is an immunological inflammatory process associated with chronic antigen stimulation, where the actual risk of tumor development and its triggering factors remain unclear, but the investigation of tumor-associated genetic mutations and environmental influences remains at the center of scientific interest. Systemic symptoms of immunodeficiency (fever, chronic fatigue, weakness) are less prominent in the presence of CK5/6 and p40/p63 positivity. Local symptoms (late seroma, painful breast swelling, asymmetry, capsule thickening, skin symptoms) dominate and typically appear 15-20 years after implantation. Positive cytology and immunohistochemistry results following imaging studies (ultrasound, MRI, fine-needle aspiration biopsy, CT, PET/CT) indicate a good prognosis in localized cases. In 80% of patients diagnosed with BIA-SCC, extracapsular tumor invasion is already evident at the time of diagnosis. The aggressiveness of BIA-SCC is demonstrated by the fact that the 6-month mortality rate in registered cases was very high, at 43.8%. Care must be provided with mandatory multidisciplinary professional involvement, and data recording is mandatory in every country; in Hungary, there is a reporting obligation to the Implant Registry of the National Health Insurance Fund Administration. Beyond plastic surgery and oncology research, all physicians must be aware of the importance of monitoring the signs and symptoms of patients with breast implants and, in cases of clinical suspicion, referring patients for appropriate diagnostic testing. This study summarizes our current knowledge regarding the epidemiological factors of BIA-SCC, its pathogenesis, genetic and clinical aspects, treatment, and prognosis. Orv Hetil. 2026; 167(40): 1585-1592.

The modern development of plastic surgery has significantly contributed to the positive change in body image and self-esteem. For the past few decades, the use of plastic surgical implants has been a fundamental tool in reconstructive and aesthetic surgery. At the same time, over the past two decades, in addition to scientific medical literature, the following implant-related conditions have gained increasing attention in public discourse, the press, and tabloid media: breast implant illness (BII), breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), and breast implant-associated squamous cell carcinoma (BIA-SCC). So, these clinical entities not only cause medical problems, but they also cause psychological, ethical, and social problems. Breast implant illness is a heterogeneous syndrome in which patients report various systemic complaints (such as chronic fatigue, joint and muscle pain, mood disorders, hair loss, etc.) to their breast implants, without any clear correlation being demonstrable or any objectively detectable clinical parameters being present. In cases of breast implant illness symptoms, based on appropriate diagnostic and differential diagnostic findings and indications, currently one of the primary and most important treatment strategies is the removal of the implant and surrounding connective tissue (explantation + total capsulectomy). 60-80% of patients report that their symptoms have been partially or completely resolved following surgery. This review article presents the immunological and pathological processes associated with breast implant illness, as well as its epidemiological and clinical aspects, offers recommendations for modernizing surgical practice and communication strategies in light of the international literature and guidelines. Orv Hetil. 2026; 167(40): 1593-1604.

In modern plastic surgery, breast implants are an indispensable surgical tool in both reconstructive and cosmetic procedures. The clear positive effect of implantation is that it improves body image and thus self-esteem, but over the past twenty years, alongside its successful use, a downside to implants has emerged, known in medical literature as implant diseases. These are autoimmune breast implant illness (BII), breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-associated squamous cell carcinoma (BIA-SCC). BIA-ALCL is a rare but well-defined syndrome, an anaplastic, CD30+ T-cell non-Hodgkin lymphoma, primarily associated with textured surface implants. The disease usually develops later, 8-12 years after implantation, and local symptoms (late seroma, breast shape change, asymmetry, etc.) are dominant. In advanced stage III and IV cases, systemic symptoms such as chronic fatigue, fever, night sweats, and regional lymph node or distant metastases (e.g., chest wall, liver, small intestine, bone marrow) may also develop. In localized BIA-ALCL, en bloc explantation and capsulectomy are often curative and no further adjuvant treatment is necessary. In stages II-IV, postoperative adjuvant chemo-radiotherapy and biological treatment are also necessary. Treatment protocols for the disease emphasize a multidisciplinary approach, with plastic surgeons, oncologists, radiologists, pathologists, and psychologists all participating in patient care. This holistic approach improves long-term therapeutic outcomes and patients' quality of life. This study, which reviews international literature and considers local practical data, presents the immunological processes, epidemiological, clinical, and surgical factors underlying these processes. Orv Hetil. 2026; 167(40): 1605-1615.

TORCH infections (toxoplasmosis, other [syphilis, varicella-zoster, parvovirus B19], rubella, cytomegalovirus, herpes) constitute the classic group of congenital infections that may result in severe fetal and neonatal consequences. Transplacentally transmitted infections have been a critical component of prenatal care for decades. Although screening for this group of infections has been performed in Hungary since 1971, diagnostic approaches and screening strategies have undergone significant transformation. Current international recommendations, as well as national professional guidelines, no longer support the routine use of non-indicated TORCH panels in the presence of non-specific ultrasound findings, as their diagnostic value is extremely limited. The aim of this paper is to present the clinical significance of TORCH infections, the most recent evidence-based diagnostic algorithms (including serology, avidity testing, and polymerase chain reaction), and emerging therapeutic options (e.g., valacyclovir in cytomegalovirus infection), while emphasizing the importance of targeted diagnostic evaluation and prevention. The manuscript provides an overview of the Hungarian aspects of the diagnosis and management of TORCH infections during pregnancy, including current national screening recommendations, practices and the organization of reference care pathways. The diagnostic approach to TORCH infections has undergone a paradigm shift; therefore, routine TORCH panel testing is no longer recommended. The use of a targeted diagnostic strategy improves diagnostic efficiency and reduces unnecessary interventions. Orv Hetil. 2026; 167(39): 1535-1551.

Gastroschisis is a congenital abdominal wall defect associated with extraabdominal herniation of the bowels and, rarely, other abdominal organs. In cases of severe visceroabdominal disproportion, primary abdominal wall closure may not be feasible, therefore staged reduction using silo systems is required. The use of the Alexis wound protector/retractor as an alternative silo system in gastroschisis was first described by Kusafuka et al. in 2005. We present the case of a restricted neonate born at 38 weeks of gestation with prenatally diagnosed gastroschisis. Due to the hypoplastic abdominal cavity and the condition of the eventerated bowel loops, primary closure could not be performed. Following abdominal wall defect enlargement, an XS-sized Alexis O wound protector/retractor ring was applied as a suspended alternative silo system. Gradual reduction of the herniated organs was achieved during daily surgical care and regular silo narrowing. Definitive abdominal wall closure was performed on postoperative day 10 under continuous intraabdominal pressure monitoring at 10-11 cmH2O. Alexis O wound retractor proved to be a safe, tissue-friendly and cost effective alternative to conventional silo systems in the staged treatment of gastroschisis. Its structural properties, wide size range and the possibility of suspended fixation make it suitable for neonatal surgical and intensive care use. In our case, the device provided effective temporary abdominal coverage, allowed gradual reduction of the herniated organs, supported infection control and contributed to successful delayed abdominal wall closure. Orv Hetil. 2026; 167(39): 1574-1577.