Zsolt Cselik

Kaposvar University, Toponár, Somogy, Hungary

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Publications (9)10.76 Total impact

  • Zsolt Cselik
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    ABSTRACT: Introduction: Nearly 65-70% of the population over the age of 40 years may be affected by lumbar pain. Aim: The aim of the author was to detect the impact of percutaneous laser disc decompression in intervertebral discs. Method: For the model 27 ex vivo lumbar intervertebral discs were used. Constant laser light energy to the nucleus pulposus was delivered using diode laser. Computed tomography and fluoroscopy were performed to compare the accuracy of the procedure. For the detection of the physical effect of the laser procedure, magnetic resinance imaging was performed after the laser procedure. To demonstrate morphological tissue changes, histopathological studies were conducted. Results: 2 mm accuracy was reached by cross-sectional imaging aided surgical navigation. The radiation exposure time to the staff was reduced. Measurable tissue changes were detected and different physical effects were verified in the nucleus pulposus after the laser procedure magnetic resonance imaging. Conclusions: The applied study is feasible for modeling percutaneous laser disk decompression PLDD with cross sectional imaging aided surgical navigation. The physical effect was detectable by magnetic resonance measurements which could be used to control in vivo human applications in the future. Orv. Hetil., 2013, 154, 1389-1396.
    Orvosi Hetilap 09/2013; 154(35):1389-96. DOI:10.1556/OH.2013.29695
  • The Spine Journal 09/2012; 12(9):S77. DOI:10.1016/j.spinee.2012.08.219 · 2.80 Impact Factor
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    ABSTRACT: Percutaneous laser disc decompression is commonly used to lower high pressure in the nucleus pulposus in degenerative disc diseases. The aim of this study was to investigate the impact of diode laser disc decompression at different wavelengths (980-nm vs. 1,470-nm, i.e., different water absorption characteristics). To model decompression, a flexible laser quartz fiber inserted into the nucleus pulposus of ex vivo bovine spines using computer-assisted surgical navigation was utilized to vaporize tissue. The same energy (500 J) was delivered using both 980-nm and 1,470-nm wavelength lasers. To determine the different impact of the wavelengths before and after the procedure we evaluated the discs with MRI (T(1), T(2), diffusion maps) and with histopathology. There were no visible changes on T(1) and T(2) maps after 1,470-nm wavelength laser irradiation; however, the 980-nm wavelength caused significant changes on T(1) (decrease) and T(2) (increase) in the vaporization zone at the site of the quartz fiber. Pathological findings showed carbonization and steam-bubble formation in addition to the T(1) and T(2) changes. No significant changes were detected in the value of apparent diffusion coefficient (ADC) measurements in intervertebral disc with the 980-nm wavelength, but significant ADC and T(1) signal increase was detected with the 1,470-nm wavelength when the whole nucleus pulposus was considered. The 1,470-nm laser light had an effect in the whole nucleus pulposus and not only at the site of the quartz fiber, whereas with the 980-nm laser irradiation, significant changes were demonstrated only at the application site.
    Lasers in Surgery and Medicine 07/2012; 44(5):406-12. DOI:10.1002/lsm.22034 · 2.61 Impact Factor
  • Ronald A von Jako, Zsolt Cselik
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    ABSTRACT: Percutaneous laser discectomy at various wavelengths has been used for minimally invasive surgery of herniated intervertebral discs. Using a high-intensity diode laser at 980-nm wavelength, we aimed to improve the safe insertion of the laser trocar with the aid of a stereotactic computer-assisted surgical navigation system. The experiments were performed on ex vivo porcine spines with intact soft tissue. Before laser irradiation, each specimen was imaged by computed tomography (CT) with fiduciary markers. The Digital Imaging and Communications in Medicine (DICOM standard) data sets were retrieved into the GE Healthcare Surgery InstaTRAK3500 Plus computer-assisted surgical navigation platform via the hospital Ethernet using a picture archiving and communication system. A special trocar with quartz waveguide connected to the navigation system was inserted into a total of 12 lumbar discs of two fresh intact porcine specimens. Various laser energies (200-700 J) with different exposure times were delivered. Pre- and post-irradiation magnetic resonance (MR) imaging and postoperative macroscopic and histologic studies were carried out. A navigation system accuracy of better than 2 mm was achieved. Tracking of the instrument from pre-acquired formatted CT reconstructed images reduced overall radiation exposure by limiting the need for continuous intraoperative C-arm fluoroscopy. The use of surgical navigation by CT images enhanced the precision insertion of the laser trocar. Irradiation with the 980-nm wavelength diode laser resulted in tissue evaporation changes of the intervertebral disc material as demonstrated by comparing pre- and post-irradiation changes of MR images and macro- and microscopic changes of the dissected disc material. This preclinical study demonstrates the clinical utility of a 980-nm diode laser delivered through a fiber-optic waveguide trocar in which precise insertion was enabled by the use of surgical navigation. This in turn decreases the exposure to ionizing radiation during the procedure.
    Lasers in Surgery and Medicine 01/2009; 41(1):42-51. DOI:10.1002/lsm.20728 · 2.61 Impact Factor
  • IPOS 10th World Congress, Spain, Madrid; 01/2008
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    ABSTRACT: Several methods have been developed to reduce tumor motions and patient movements during radiotherapy of lung cancer. In this study, a multislice CT-based analysis was performed to examine the effect of a thermoplastic patient immobilization system on the chest wall and tumor motions. Ten patients with stage II-IV lung cancer were enrolled into the study. According to tumor localization, five patients had peripheral, and five patients central lung cancer (T2-T4). In total, six series of measurements were made with a multislice CT scanner, both with and without mask fixation, in normal breathing, at maximal tidal volume inhalation, and at maximal tidal volume exhalation. Movements of chest wall, diaphragm and tumor, with and without mask, under different breathing conditions were registered. With the use of the immobilization system, no significant difference was found in diaphragmatic movements (mean deviation of diaphragm: 41.7-40.5 mm to the right, and 40.5-36.8 mm to the left side) and in tumor motions (mean deviation of tumor: 15.3-12.4 mm in craniocaudal, and 11.5-8.8 mm in posterolateral direction, mean medial deviation: 4.6-4.1 mm, mean lateral deviation: 7.2-5 mm). Significant differences were observed concerning tumor motions in anteroposterior direction (mean: 8.9-6.3 mm) and transverse chest movements in anteroposterior direction. Besides the advantage of optimal patient positioning, the movements of the bony chest wall can be considerably reduced by using the immobilization system. However, this fixation system has limitations concerning its suitability for minimizing tumor motions.
    Strahlentherapie und Onkologie 06/2007; 183(5):271-8. DOI:10.1007/s00066-007-1681-6 · 2.73 Impact Factor
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    ABSTRACT: Background: The aim of this study was to analyze the use of magnetic resonance imaging (MRI) as a modern medical imaging technique in radiotherapy with special emphasis on the integration of MRI and a novel technique in brachytherapy to optimize treatment outcome in cervical cancer. Methods: In addition to the CT based shrinking volume conformal teletherapy in 31 patients with locally advanced cervical cancer, MRI examination with a special adjustable applicator at the treatment site was performed for the brachytherapy planning. To avoid excessive doses to the healthy structures during complex cervical radiotherapy isodose curves were calculated upon the information of the MR image and dose distribution was evaluated. Results: The consecutive application of CT and MRI limited the possibility for overdosage of the critical organs and undertreatment of the advanced tumor spread in all cases. The overall response rate for the complex treatment was 74.2% with complete regression in 25.8% of the cases. Based on the exact information of the three dimensional digital data radiation doses could be optimized without increasing the possibility of acute complications rate. Conclusion: The introduction of 3D treatment planning for teletherapy pelvic and boost irradiation of cervical carcinoma as well as for the brachytherapy part of the complex treatment is to be recommended. .
    Archive of oncology 01/2006; DOI:10.2298/AOO0604095H
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    ABSTRACT: Betegek 1. Bőr-biopsiás mintákból nyert fibroblast (Fb)-kultúrákban a survival fraction at 2 Gy (SF2)-értékek meghatározása 93 betegben. A radiogén második tumor relatív kockázatának (RR) becslése 6, 0-IA stádiumú, méhnyakrákos betegben. 2. A génexpresszió vizsgálata 7 normális, illetve 3 fokozottan sugárérzékeny sejtvonalban. 3. Multisegmentális (MS) besugárzás tanulmányozása 436 emlőrákbetegnél. Eredmények 1. Az akut dermatitis/mucositis 8/14 (57%), a reirradiáció 1/6, a késői idegrendszeri károsodás 4/11 (36%), a késői kötőszöveti/bőr toxicitás 9/50 (18%) beteg esetében járt együtt fokozott Fb-sugárérzékenységgel. A sugárkezelt, korai méhnyakrákos betegek RR-je rectumtumorra 9, anusrákra 23. 2. A normális sugárérzékenységű Fb-kből származó RNS-ekben a besugárzás hatására 109 gén expressziója növekedett, és 115 gén működése csökkent; fokozott sugárérzékenység esetén a hasonló adatok 142, illetve 56. 3. MS tervezéssel a tervezési céltérfogat (TCT) 90,9%-a esett a kívánatos dózisértékek közé (hagyományos tervezéssel: 82,8%), s a normális szervek dózisterhelése nem növekedett. Konklúziók 1. Nagyobb gyakorisággal alakulnak ki radiogén sérülések olyan betegekben, akik Fb-jének fokozott a sugárérzékenysége. 2. A sugárérzékenység sugárterápia előtti meghatározása elősegíthetné az egyénre szabott terápiás protokollok kialakítását. 3. Az MS sugárkezelés a normális szövetek dózis-terhelésének növekedése nélkül javítja a TCT dózisellátottságát. | Patients 1. Survival fractions at 2 Gy (SF2s) were determined using skin biopsy-based fibroblast (Fb) cultures in 93 pts. The relative risks (RRs) of radiogenic, secondary cancer were determined for 6, stage 0-IA, radiotherapy?treated cervix cancer pts. 2. Gene expressions were analyzed for 7 normal and 3 radiosensitive Fb cell lines. 3. Multisegmental (MS) radiotherapy was investigated in 436 breast cancer pts. Results 1. Inreased radiosensitivity was detected in 8/14 (57%) pts with acute dermatitis/mucositis, in 1/6 pts before reirradiation, in 4/11 (36%) pts with late neurological sequelae, and 9/50 (18%) pts with late subcutaneus/cutaneous toxicity. For radiotherapy-treated, early cervical cancer pts, the RRs are 9 and 23 to develope rectal and anal cancer, respectively. 2. Expressions of 109 genes were increased and 115 of them were decreased following irradiation of normal Fbs, while the comparative results for radiation-sensitive Fbs were 142 and 56, respectively. 3. Using MS radiotherapy, 90,9% of the planning target volme (PTV) was covered by the prescribed dose without an increase of radiation burden on normal tissues. Conclusions 1. The probability of radiation sequelae is higher among pts with radiosensitive Fbs. 2. Identification of radiosensitivity would help to determine individualized therapy protocols. 3. Introduction of MS radiotherapy would improve the PTV coverage without increasing the radiation burden on normal tissues.