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Lorusso D, Xiang Y, Hasegawa K, Scambia G, Leiva M, Ramos-Elias P, Acevedo A, Sukhin V, Cloven N, Pereira de Santana Gomes AJ, Contreras Mejía F, Reiss A, Ayhan A, Lee JY, Saevets V, Zagouri F, Gilbert L, Sehouli J, Tharavichitkul E, Lindemann K, Lazzari R, Chang CL, Lampé R, Zhu H, Oaknin A, Christiaens M, Polterauer S, Usami T, Li K, Yamada K, Toker S, Keefe SM, Pignata S, Duska LR. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): a randomised, double-blind, phase 3 clinical trial. Lancet 2024; 403:1341-1350. [PMID: 38521086 DOI: 10.1016/s0140-6736(24)00317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Pembrolizumab has shown efficacy in persistent, recurrent, or metastatic cervical cancer. The effect of chemoradiotherapy might be enhanced by immunotherapy. In this phase 3 trial, we assessed the efficacy and safety of adding pembrolizumab to chemoradiotherapy in locally advanced cervical cancer. METHODS In this randomised, double-blind, placebo-controlled, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 clinical trial, adults (age ≥18 years) at 176 medical centres in 30 countries with newly diagnosed, high-risk, locally advanced cervical cancer were randomly assigned (1:1) using an interactive voice-response system with integrated web response to receive 5 cycles of pembrolizumab (200 mg) or placebo every 3 weeks plus chemoradiotherapy, followed by 15 cycles of pembrolizumab (400 mg) or placebo every 6 weeks. Randomisation was stratified by planned external beam radiotherapy type (intensity-modulated radiotherapy or volumetric-modulated arc therapy vs non-intensity-modulated radiotherapy or non-volumetric-modulated arc therapy), cervical cancer stage at screening (International Federation of Gynecology and Obstetrics 2014 stage IB2-IIB node positive vs stage III-IVA), and planned total radiotherapy (external beam radiotherapy plus brachytherapy) dose (<70 Gy vs ≥70 Gy equivalent dose in 2 Gy fractions). Primary endpoints were progression-free survival per Response Evaluation Criteria in Solid Tumours version 1.1-by investigator or by histopathologic confirmation of suspected disease progression-and overall survival. Primary analysis was conducted in the intention-to-treat population, which included all randomly allocated participants. Safety was assessed in the as-treated population, which included all randomly allocated patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT04221945, and is closed to new participants. FINDINGS Between June 9, 2020, and Dec 15, 2022, 1060 participants were randomly assigned to treatment, with 529 assigned to the pembrolizumab-chemoradiotherapy group and 531 to the placebo-chemoradiotherapy group. At data cutoff (Jan 9, 2023), median follow-up was 17·9 months (IQR 11·3-22·3) in both treatment groups. Median progression-free survival was not reached in either group; rates at 24 months were 68% in the pembrolizumab-chemoradiotherapy group versus 57% in the placebo-chemoradiotherapy group. The hazard ratio (HR) for disease progression or death was 0·70 (95% CI 0·55-0·89, p=0·0020), meeting the protocol-specified primary objective. Overall survival at 24 months was 87% in the pembrolizumab-chemoradiotherapy group and 81% in the placebo-chemoradiotherapy group (information fraction 42·9%). The HR for death was 0·73 (0·49-1·07); these data have not crossed the boundary of statistical significance. Grade 3 or higher adverse event rates were 75% in the pembrolizumab-chemoradiotherapy group and 69% in the placebo-chemoradiotherapy group. INTERPRETATION Pembrolizumab plus chemoradiotherapy significantly improved progression-free survival in patients with newly diagnosed, high-risk, locally advanced cervical cancer. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co (MSD).
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Affiliation(s)
- Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy.
| | - Yang Xiang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Kosei Hasegawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Manuel Leiva
- Instituto de Oncologia y Radioterapia Clinica Ricardo Palma, Lima, Peru
| | - Pier Ramos-Elias
- Integra Cancer Institute, Edificio Integra Medical Center, Guatemala City, Guatemala
| | | | - Vladyslav Sukhin
- Grigoriev Institute for Medical Radiology and Oncology NAMS Ukraine, Kharkiv, Ukraine
| | - Noelle Cloven
- Texas Oncology-Fort Worth Cancer Center, Fort Worth, TX, USA
| | | | | | - Ari Reiss
- Rambam Medical Center, Gyneco-oncology Unit, Haifa, Israel
| | - Ali Ayhan
- Turkish Society of Gynecologic Oncology, Başkent University, Ankara, Türkiye
| | - Jung-Yun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Valeriya Saevets
- Chelyabinsk Regional Clinical Center for Oncology and Nuclear Medicine, Chelyabinsk, Russia
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Jalid Sehouli
- Charité Universitätsmedizin, Berlin, Germany; North-Eastern German Society of Gynecological Oncology, Berlin, Germany
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Nordic Society of Gynaecological Oncology Clinical Trial Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Roberta Lazzari
- Division of Radiotherapy, European Institute of Oncology IRCCS, Milan, Italy
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Hunan, China
| | - Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Melissa Christiaens
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; AGO Austria, Austria
| | | | - Kan Li
- Merck & Co, Rahway, NJ, USA
| | | | | | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Naples, Italy
| | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, USA
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Jusztus V, Medyouni G, Bagosi A, Lampé R, Panyi G, Matolay O, Maka E, Krasznai ZT, Vörös O, Hajdu P. Activity of Potassium Channels in CD8 + T Lymphocytes: Diagnostic and Prognostic Biomarker in Ovarian Cancer? Int J Mol Sci 2024; 25:1949. [PMID: 38396628 PMCID: PMC10888402 DOI: 10.3390/ijms25041949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
CD8+ T cells play a role in the suppression of tumor growth and immunotherapy. Ion channels control the Ca2+-dependent function of CD8+ lymphocytes such as cytokine/granzyme production and tumor killing. Kv1.3 and KCa3.1 K+ channels stabilize the negative membrane potential of T cells to maintain Ca2+ influx through CRAC channels. We assessed the expression of Kv1.3, KCa3.1 and CRAC in CD8+ cells from ovarian cancer (OC) patients (n = 7). We found that the expression level of Kv1.3 was higher in patients with malignant tumors than in control or benign tumor groups while the KCa3.1 activity was lower in the malignant tumor group as compared to the others. We demonstrated that the Ca2+ response in malignant tumor patients is higher compared to control groups. We propose that altered Kv1.3 and KCa3.1 expression in CD8+ cells in OC could be a reporter and may serve as a biomarker in diagnostics and that increased Ca2+ response through CRAC may contribute to the impaired CD8+ function.
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Affiliation(s)
- Vivien Jusztus
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (V.J.); (G.M.); (A.B.); (G.P.); (O.V.)
| | - Ghofrane Medyouni
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (V.J.); (G.M.); (A.B.); (G.P.); (O.V.)
| | - Adrienn Bagosi
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (V.J.); (G.M.); (A.B.); (G.P.); (O.V.)
| | - Rudolf Lampé
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (R.L.); (O.M.); (E.M.); (Z.T.K.)
| | - György Panyi
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (V.J.); (G.M.); (A.B.); (G.P.); (O.V.)
| | - Orsolya Matolay
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (R.L.); (O.M.); (E.M.); (Z.T.K.)
| | - Eszter Maka
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (R.L.); (O.M.); (E.M.); (Z.T.K.)
| | - Zoárd Tibor Krasznai
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (R.L.); (O.M.); (E.M.); (Z.T.K.)
| | - Orsolya Vörös
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (V.J.); (G.M.); (A.B.); (G.P.); (O.V.)
| | - Péter Hajdu
- Department of Biophysics and Cell Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary; (V.J.); (G.M.); (A.B.); (G.P.); (O.V.)
- Division of Dental Biochemistry, Department of Basic Medical Sciences, Faculty of Dentistry, University of Debrecen, Egyetem tér 1., H-4032 Debrecen, Hungary
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Kovács AR, Lukács L, Pál L, Szűcs S, Kovács KS, Lampé R. Recovery of the Decreased Phagocytic Function of Peripheral Monocytes and Neutrophil Granulocytes following Cytoreductive Surgery in Advanced Stage Epithelial Ovarian Cancer. Medicina (Kaunas) 2023; 59:1602. [PMID: 37763721 PMCID: PMC10533144 DOI: 10.3390/medicina59091602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/13/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
(1) Monocytes and neutrophil granulocytes are the phagocytic cells of the innate immune system, playing a crucial role in recognizing and eliminating tumor-transformed cells. Our objective was to assess the impact of advanced-stage epithelial ovarian cancer (EOC) and cytoreductive surgery on the phagocytic function of peripheral monocytes and neutrophil granulocytes. We aimed to compare the pre- and postoperative phagocytic function of these immune cells in EOC patients with healthy control women. Additionally, we aimed to examine the influence of surgery on phagocytic function by comparing pre- and postoperative samples from patients with benign gynecological tumors. (2) We examined peripheral blood samples from 20 patients with FIGO IIIC stage high-grade serous EOC and 16 patients with benign gynecological tumors as surgical controls, collected before and seven days after tumor removal surgery, and from 14 healthy women. After separation, the cells were incubated with Zymosan-A particles, and the phagocytic index (PI) was assessed using immunofluorescence microscopy. One-way ANOVA, the Kruskal-Wallis H-test, and the paired samples t-test were used for the statistical analysis of the data. A significance level of p < 0.05 was applied. (3) Peripheral monocytes and neutrophils from EOC patients exhibited significantly lower preoperative PI values compared to healthy controls (p < 0.001; p < 0.001, respectively). Following cytoreductive surgery, the PI values of immune cells in EOC patients significantly increased by the 7th postoperative day (p < 0.001; p < 0.001), reaching levels comparable to those of healthy controls (p = 0.700 and p = 0.991). In contrast, there was no significant disparity in the PI values of cells obtained from pre- and postoperative blood samples of surgical controls when compared to healthy women (monocytes: p = 0.361 and p = 0.303; neutrophils: p = 0.150 and p = 0.235). (4) EOC and/or its microenvironment may produce factors that reduce the phagocytic function of monocytes and neutrophils, and the production of these factors may be reduced or eliminated after tumor removal.
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Affiliation(s)
- Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26. Kassai út, 4028 Debrecen, Hungary
| | - Sándor Szűcs
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26. Kassai út, 4028 Debrecen, Hungary
| | - Kincső Sára Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
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Kovács AR, Sulina A, Kovács KS, Lukács L, Török P, Lampé R. Prognostic Significance of Preoperative NLR, MLR, and PLR Values in Predicting the Outcome of Primary Cytoreductive Surgery in Serous Epithelial Ovarian Cancer. Diagnostics (Basel) 2023; 13:2268. [PMID: 37443662 DOI: 10.3390/diagnostics13132268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
(1) The degree of cytoreduction achieved during primary debulking surgery (PDS) is an important prognostic factor for the survival of patients with epithelial ovarian cancer (EOC). Our aim was to investigate the prognostic value of preoperative laboratory parameters for the outcome of PDS. (2) We analyzed the preoperative laboratory parameters of 150 serous EOC patients who underwent PDS between 2006 and 2013. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values of the variables for predicting the PDS outcome. We used binary logistic regression to examine the independent predictive value of the factors for incomplete cytoreduction. (3) Among the parameters, we established optimal cut-off values for cancer antigen (Ca)-125, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) to predict the outcome of PDS. The results of binary logistic regression showed that stage (FIGO III-IV), MLR (>0.305), and Ca-125 (>169.15 kU/L) were independent significant predictors of the degree of tumor reduction achieved during PDS. (4) In the future, MLR, especially in combination with other parameters, may be useful in determining prognosis and selecting the best treatment option (PDS or neoadjuvant chemotherapy + interval debulking surgery) for ovarian cancer patients.
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Affiliation(s)
- Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Anita Sulina
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Kincső Sára Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98. Nagyerdei krt., 4032 Debrecen, Hungary
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Lukács L, Kovács AR, Pál L, Szűcs S, Lampé R. Evaluating the Phagocytic Index of Peripheral Leukocytes in Endometriosis by Plasma Experiments. Medicina (B Aires) 2022; 58:medicina58070925. [PMID: 35888644 PMCID: PMC9316155 DOI: 10.3390/medicina58070925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Endometriosis is a benign, chronic disease, that negatively influences the quality of life of affected women and is responsible for a remarkable amount of infertility. The pathophysiology of the disease is still not clarified, but the insufficient immune surveillance plays a significant role in it. The phagocyte function of innate immune cells may play a role in the elimination of ectopic endometrium. The purpose of this study is to examine the phagocyte function of neutrophil granulocytes and monocytes, incubated in heat-inactivated and not-inactivated plasma samples from healthy women and from women with endometriosis before and after the surgical treatment. Materials and Methods: Blood samples were collected from eight preoperative and eight postoperative patients with endometriosis before and after the surgical treatment, and from 16 healthy patients as controls. Neutrophil granulocytes, monocytes and blood plasma samples were isolated. Cells were incubated in different plasma samples, and the phagocytic index was determined with a fluorescence microscope. Results: The phagocytic index of granulocytes and monocytes isolated from patients with endometriosis was significantly decreased compared to healthy women after the cells were incubated in their own plasma. Preoperatively isolated cells from patients with endometriosis demonstrated an improved phagocyte function after incubating them in plasma samples from healthy controls. In contrast, the phagocytic activity of cells from healthy women significantly reduced after being incubated in the plasma of preoperative endometriosis patients. The heat-inactivation of plasma samples did not affect the results. Conclusions: Active endometriosis lesions may produce heat-stable systemic immunomodulatory factors, which reduced the phagocyte function of peripheral monocytes and neutrophil granulocytes. The phagocyte function of these cells can be normalized after the complete surgical removal of endometriosis, which then demonstrates similar values as in healthy women.
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Affiliation(s)
- Luca Lukács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
| | - Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (L.P.); (S.S.)
| | - Sándor Szűcs
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 4028 Debrecen, Hungary; (L.P.); (S.S.)
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 4031 Debrecen, Hungary; (L.L.); (A.R.K.)
- Correspondence:
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Deli T, Tóth J, Csépes-Ruzicska L, Török O, Krasznai ZT, Mosolygó-Lukács Á, Kappelmayer J, Lampé R. Az epesavmérés szerepe a súlyos terhességi cholestasis szülészeti ellátásában. Orv Hetil 2022; 163:797-805. [DOI: 10.1556/650.2022.32474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
Abstract
Bevezetés: A terhességi cholestasis a terhességek 1%-ában
előforduló kórkép. Fennállása nagymértékben növeli a súlyos magzati szövődmények
kialakulásának, így a koraszülésnek és a terminusközelben váratlanul
bekövetkező, méhen belüli magzati elhalásnak a rizikóját.
Célkitűzés: A hazánkban a klinikum számára a közelmúltban
elérhetővé vált szérumösszepesavszint-méréssel kapcsolatos eddigi
tapasztalataink összegzése és a terhességi cholestasis ellátása debreceni
gyakorlatának bemutatása. Betegek és módszer: Retrospektív
esetsorozatban vizsgáltuk a debreceni Szülészeti és Nőgyógyászati Klinikán 2020.
szeptember és 2021. szeptember között kezelt súlyos cholestasisos várandósok
adatait. Meghatároztuk az epesav-, a májenzim- és a bilirubinszintek
statisztikai korrelációját is. Eredmények: 758 várandós 1258
szérummintájából történt epesav-meghatározás. 5 esetben (az összes eset 0,7%-a,
a cholestasisos esetek 6,4%-a) súlyos (epesav 40–99 μmol/l), 7 esetben (0,9%,
illetve 9,0%) igen súlyos (epesav ≥100 μmol/l) epepangás volt igazolható. A 12
súlyos cholestasisos várandós átlagéletkora 30,6 (21–43) év volt, közülük 7 volt
primigravida. A betegek közül 5-nél állt fenn cholestasisra hajlamosító
előzményi betegség. 6 beteg részesült urzodezoxikólsav-kezelésben, amely az
epesavszintek jelentős csökkenését eredményezte. Súlyos cholestasisban az
epesav–GOT (R2 = 0,14) és az epesav–GPT (R2 = 0,17)
korreláció gyengének bizonyult (n = 45). Az epesavszintek postpartum hamar
szignifikánsan javultak. A 12 beteg közül eddig 11 szült meg, és 13 újszülött
született, 2/12 volt ikerterhesség. Az átlagos gestatiós kor a szüléskor 37
(33–40) hét volt. 3/11 koraszülés történt (27%). A terminusközeli szülések közül
7/8 (88%) szülésindukciót követően zajlott. Egyszer sem volt szükség elektív
császármetszésre, és a vajúdás során mindössze 2/11 esetben kellett
császármetszést végezni (18%). Intrauterin magzati elhalás nem következett be.
Következtetés: A szérumepesav-mérés hatékony eszköz a
terhességi cholestasis diagnosztikájában és követésében, a protokollalapú
szülészeti ellátáshoz pedig nélkülözhetetlen. A közleményben bemutatjuk
klinikánk epesavszinten alapuló terhességi cholestasis ellátásának gyakorlatát
is. Orv Hetil. 2022; 163(20): 797–805.
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Affiliation(s)
- Tamás Deli
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Judit Tóth
- Debreceni Egyetem, Általános Orvostudományi Kar, Laboratóriumi Medicina Intézet Debrecen Magyarország
| | - Lea Csépes-Ruzicska
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Olga Török
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Zoárd Tibor Krasznai
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Ágnes Mosolygó-Lukács
- Debreceni Egyetem, Általános Orvostudományi Kar, Laboratóriumi Medicina Intézet Debrecen Magyarország
| | - János Kappelmayer
- Debreceni Egyetem, Általános Orvostudományi Kar, Laboratóriumi Medicina Intézet Debrecen Magyarország
| | - Rudolf Lampé
- Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet Debrecen, Nagyerdei krt. 98., 4032 Magyarország
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Csikós A, Kozma B, Pór Á, Kovács I, Lampé R, Miklós I, Takacs P. Zinc Transporter 9 (SLC30A9) Expression Is Decreased in the Vaginal Tissues of Menopausal Women. Biol Trace Elem Res 2021; 199:4011-4019. [PMID: 33409913 DOI: 10.1007/s12011-020-02525-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/29/2020] [Indexed: 12/11/2022]
Abstract
Our aim was to compare zinc transporter (ZnT/SLC30A, and ZIP/SLC39A) expression between pre- and postmenopausal women in human vaginal tissues. Zinc transporter families are responsible for the maintenance of intracellular zinc concentrations. Zinc has significant effects on the extracellular matrix composition. Vaginal wall biopsies were obtained from seven premenopausal and seven postmenopausal women. mRNA expression of twenty-four zinc transporters was determined by quantitative real-time PCR. Zinc transporter expression at the protein level was assessed by immunohistochemistry. Student's t test and Mann-Whitney U test were used to compare data. ZnT4 and ZnT9 mRNA expression were significantly lower in postmenopausal women compared with premenopausal women (mean ± SD mRNA expression in relative units, 96.43 ± 140.61 vs. 410.59 ± 304.34, p = 0.03 and 0.62 ± 0.39 vs. 1.13 ± 0.31, p = 0.02). In addition, ZIP2, ZIP3, and ZIP6 mRNA expressions were significantly lower in postmenopausal women compared with premenopausal women (mean ± SD mRNA expression in relative units, 1.11 ± 0.61 vs. 2.29 ± 1.20, p = 0.04; 2.32 ± 1.90 vs. 15.82 ± 12.97, p = 0.02 and 1.10 ± 0.80 vs. 5.73 ± 4.72, p = 0.03). ZnT9 protein expression in the stratum spinosum was significantly lower in postmenopausal women (p = 0.012). Zinc transporters were expressed differentially in the vaginal tissues. ZnT9 expression was significantly lower in postmenopausal women compared with premenopausal women.
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Affiliation(s)
- Anett Csikós
- Molecular Biology Group, FemPharma, LLC, Vígkedvű Mihály utca 21. II/5, Debrecen, 4024, Hungary.
| | - Bence Kozma
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Ágnes Pór
- Department of Pathology, Gyula Kenézy County Hospital, University of Debrecen, Debrecen, Hungary
| | - Ilona Kovács
- Department of Pathology, Gyula Kenézy County Hospital, University of Debrecen, Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Ida Miklós
- Department of Genetics and Applied Microbiology, University of Debrecen, Debrecen, Hungary
| | - Peter Takacs
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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Lörincz J, Vitale SG, Barna SK, Dinkó F, Riemma G, Tünde H, Nagyházi O, Lampé R, De Franciscis P, Török P. Hystero-salpingo scintigraphy for fallopian tubal patency assessment: results from a prospective study. MINIM INVASIV THER 2021; 31:797-802. [PMID: 34636280 DOI: 10.1080/13645706.2021.1986845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of a bygone method, hystero-salpingo-scintigraphy (HSSG), for tubal patency assessment of infertile women. MATERIAL AND METHODS Prospective cohort study involving women in the infertility workup at the University of Debrecen, Hungary. Seventy infertile patients were scheduled to either basic dynamic HSSG, post-purge dynamic HSSG, or post-purge dynamic HSSG followed by SPECT/CT for reducing tracer contamination. The primary endpoint was the evaluation of the diagnostic accuracy of HSSG for the three methods. RESULTS During the basic dynamic group, the examination yielded a sensitivity of 87.5%, with a specificity of 71.7%, while positive and negative predictive values were 31.8%, and 97.4% respectively. Using post purge dynamic HSSG, it resulted in a sensitivity of 87.5%, a specificity of 88.7%, a positive predictive value of 53.8%, and a negative predictive value of 97.9%. Adding SPECT/CT to post-purge dynamic HSSG increased diagnostic accuracy with 100% sensitivity and 88.7% specificity, while positive and negative predictive values were 57.1% and 100%, respectively. CONCLUSION HSSG is a non-invasive and well-tolerated technique for tubal patency. It could be used initially to predict tubal patency in case of infertility. Its diagnostic accuracy is higher when it is carried out by adding SPECT/CT to the post-purge dynamic method.
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Affiliation(s)
- Judit Lörincz
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Sándor Kristóf Barna
- Faculty of Medicine, Medical Imaging Clinic - Nuclear Medicine, University of Debrecen, Debrecen, Hungary
| | - Fanni Dinkó
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Herman Tünde
- Center of Assisted Reproduction, University of Debrecen, Debrecen, Hungary
| | - Orsolya Nagyházi
- Department of Obstetrics and Gynecology, Saint Margaret Hospital, Budapest, Hungary
| | - Rudolf Lampé
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Péter Török
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
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Abstract
Endometrial cancer is the most common gynecological malignancy with a relatively good overall prognosis. It traditionally has two subtypes: type 1 (endometrioid carcinoma) and type 2 (non-endometrioid carcinoma). The prognosis is excellent for stage I endometrioid cancer, with a 5-year survival rate of 96%. However, the prognosis is much worse for women with high-risk endometrial cancer. Effective preoperative staging is important in order to tailor treatment and achieve optimal long-term survival. The majority of asymptomatic polyps detected by ultrasound are treated surgically. Conventionally, dilatation and curettage was performed to obtain a histological diagnosis, but nowadays hysteroscopy with biopsy is starting to be considered as the gold standard. Hysteroscopic resection seems to reduce the risk of underdiagnosed (atypical endometrial hyperplasia) endometrial cancer. To avoid the spread of malignant cells, hysteroscopy should be performed with concern to keep intrauterine pressure low. In comparison with cervical injection, the hysteroscopic method has a better detection rate in the para-aortic area during sentinel lymph node mapping. In the assessment of cervical involvement, the accuracy of magnetic resonance imaging is significantly higher than the accuracy of hysteroscopy. In fertility-sparing cases, hysteroscopic endometrium resection with progesterone therapy is an acceptable option.
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Affiliation(s)
- P Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - S Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Abstract
Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.
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Affiliation(s)
- S Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Z Farkas
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - R Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - P Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Abstract
The extent of the 2020 pandemic not only extends to the infected patients but also to patients who have been waiting for medical procedures. Reevaluation of the healthcare system is important in order to help assist the needs of intensive care units. The urgency of the gynaecological cases should be aligned based on surgical interventions and minimally invasive methods should be preferred. This will not endanger professional and other resource demands of ICUs. In acute cases, laparoscopy or hysteroscopy (preferring office hysteroscopy) should be chosen, that require no or only short period of hospitalization. Postponing non-acute surgeries is recommended to the post-pandemic period. Abbreviations: ICU: intensive care unit; COVID-19: coronavirus disease; SARS-CoV-2: severe acute respiratory syndrome Coronaviruses; IgM-IgG: immunoglobulin M; GAGP: aerosol generating procedures; PPE: personal protective equipment; ERAS: early recovery after surgery; mESAS: modified elective surgery acuity scale; RPOC: retained product of concept; PMB: postmenopausal bleeding.
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Affiliation(s)
- Zsolt Farkas
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Zoárd T Krasznai
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Rudolf Lampé
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
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Deli T, Lampé R, Juhász AG, Kovács T, Daragó P, Bacskó G, Török O. How the cesarean delivery rate decreased at the Department of Obstetrics and Gynecology, University of Debrecen during the COVID-19 pandemic. Orv Hetil 2021; 162:811-823. [PMID: 34023814 DOI: 10.1556/650.2021.32241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Az új koronavírus (SARS-CoV-2) okozta pandémia számos változást eredményezett életünk minden területén, így a debreceni Szülészeti és Nőgyógyászati Klinikán is. Célkitűzések: A koronavírus-járvány többek között a terminus körüli elektív szülésindukciók gyakorlatának megváltoztatását igényelte. A bevezetett új szakmai eljárásrendeknek, járványügyi intézkedéseknek, a megyei kórházi funkciót ellátó debreceni Kenézy Kórház Szülészeti Osztálya és a Szülészeti Klinika összevonásának, illetve a megváltozott jogi környezetnek a szülészeti ellátásra kifejtett együttes hatásait elemezzük. Módszerek: Helyi protokollokat és részletes eljárásrendeket készítettünk és vezettünk be. 1. Szülésindukció. 2. Szülésindukció cervixérlelést igénylő esetekben. 3. A szülés módjának megválasztása előzményi császármetszés után. 4. A császármetszés utáni hüvelyi szülést támogató, terminus körüli gondozási protokoll. A protokollok bevezetését követő első 9 hónap szülészeti mutatóit (szülésszám, császármetszések aránya, perinatalis kimenetel, szülésindukciók aránya és sikeressége) vizsgáltuk és hasonlítottuk össze a megelőző időszak debreceni adataival, illetve az országos szülészeti mutatókkal. Eredmények: Klinikánkon a császármetszés aránya 2020-ban 33,5%-ra csökkent, a protokollok bevezetése óta pedig 30,7%, miközben a 2020. évi magyarországi arány 40,3%. Az összes szülés 20%-a volt 2020-ban szülésindukció, melyek közül 74% végződött hüvelyi szüléssel, míg ugyanez 2019-ben 11% indukcióból 47%-nak adódott. A havi szülésszám 2020. január és 2021. január között folyamatosan emelkedett (250-ről 450-re), a havi császármetszési arány pedig 41%-ról 25%-ra csökkent. Mindezen változások mellett 2019-ről 2020-ra csökkent mind a perinatalis mortalitás (6,3‰-ről 4,2‰-re), mind a szülés után a Neonatalis Intenzív Centrumba történő felvételek aránya (14,8%-ról 13,5%-ra). Következtetések: A bemutatott tényezők együttes hatásaként - elsődlegesen a megfelelő és következetesen betartott protokolloknak köszönhetően - a szülésindukciók aránya és sikeressége jelentősen növekedett, a császármetszések aránya szignifikánsan csökkent, javuló perinatalis morbiditási és mortalitási mutatók mellett. Orv Hetil. 2021; 162(21): 811-823. SUMMARY INTRODUCTION The pandemic caused by the new coronavirus (SARS-CoV-2) has catalized several changes in many fields of our lives, and also at the Department of Obstetrics and Gynecology of the University of Debrecen, Hungary. OBJECTIVES We wanted to analyse the compound effect of our new local protocols regarding elective labour inductions at term, the coronavirus pandemic and the resulting infection control measures, the merging of the Obstetrics and Gynecology Ward of the Kenézy County Hospital of Debrecen and the University Department of Obstetrics and Gynecology, and also the change of the legal environment. METHODS Local protocols were introduced: 1. Labour induction. 2. Cervical ripening in labour induction. 3. Choosing the route of delivery after cesarean. 4. Management of pregnancy around term in the case of planned trial of labour after cesarean. We compared the obstetrical data (number of deliveries, cesarean section rate, perinatal outcome and the rate and success rate of labour inductions) before and after the implementation of the protocols. The results were also compared to the Hungarian national database. RESULTS The annual cesarean rate at our department dropped to 33.5% in 2020. In the first 9-month period, after the introduction of the new reforms, the cesarean rate decreased to 30.7%, whereas the Hungarian national rate was 40.3% in 2020. At our department, 20% of all the deliveries were induced and 74% of them led to vaginal deliveries in 2020, while in 2019 only 11% of deliveries were labour inductions, and 47% of these cases were vaginal deliveries. The monthly number of deliveries was rising constantly between January 2020 (250 deliveries) and January 2021 (450 deliveries), and the monthly cesarean rate decreased from 41% to 25%. Comparing the data of 2019 and 2020, the annual perinatal mortality rate dropped from 6.3‰ in 2019 to 4.2‰ in 2020. Neonatal morbidity, as measured by admissions to the neonatal intensive care unit, also decreased (14.8% in 2019 and 13.5% in 2020). CONCLUSIONS As a compound result of the described factors, but mainly due to the new protocols, both the rate and the success rate of labour inductions increased significantly, while the cesarean rate decreased with improving perinatal mortality and morbidity. Orv Hetil. 2021; 162(21): 811-823.
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Affiliation(s)
- Tamás Deli
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Rudolf Lampé
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Alpár Gábor Juhász
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Tamás Kovács
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Péter Daragó
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - György Bacskó
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Olga Török
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
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Krasznai ZT, Bagoly Z, Nagy E, Farkas Z, Póka R, Török P, Lampé R, Hernádi Z. Multimodal hyperspectroscopy – the use of digital technology in cervical cancer screening. Orv Hetil 2021; 162:790-799. [PMID: 33999853 DOI: 10.1556/650.2021.32096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/05/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Bevezetés: A citológiai alapú méhnyakrákszűrés átmeneti kategóriáinak optimális menedzselése a humán papillomavírus (HPV) szűrése és tipizálása ellenére jelenleg is kihívás. Vizsgálatunk célja a modern cervixspektroszkópiának (multimodális hiperspektroszkópia - MHS), egy azonnali eredményt nyújtó, digitális technológiára épülő módszernek a vizsgálata volt a citológiai alapú méhnyakszűrés találati biztonságának javítására. Betegek és módszer: Vizsgálatainkat 208, 18 és 75 év közötti nőbeteg bevonásával végeztük, akiknél már indikálásra került valamely, a méhnyakon végzendő műtét, citológiai eredményük rendelkezésre állt (a HPV-tesztet, amennyiben nem történt meg, elvégeztük), valamint valamennyi betegnél elvégeztük a műtét előtt az MHS-vizsgálatot. A szövettani mintavétel 166 betegnél történt meg. Eredmények: A citológiai vizsgálatot (az összes betegre tekintve) magas álpozitív arány jellemezte (69,28%), amely megfigyelések mindenképpen utalnak az újabb komponens alkalmazásának igényére a triázsban. Az összes citológiai kategóriára nézve az MHS-eredmények közül kiemelendő az álnegatív leletek rendkívül alacsony aránya (3/166 = 1,8%), mely a HPV-teszt esetén ennél magasabb volt (11/165 = 6,66%). A spektroszkópiás vizsgálat álpozitív aránya ugyanakkor kedvezőtlenebbnek bizonyult (91/166 = 54,81%) a HPV-vizsgálat álpozitív arányánál (40/165 = 24,24%). Az atípusos laphámsejt (ASC-US/ASC-H) citológiai kategória esetén a spektroszkópia álnegatív eredményeinek aránya (3/126 = 2,38%) szintén kedvezőbb volt, mint a HPV-vizsgálaté (9/126 = 7,14%). A cervicalis intraepithelialis neoplasia-2 vagy súlyosabb fokozatú hámelváltozások azonosításában a spektroszkópia szenzitivitása 94% (95% CI = 0,84-0,99), specificitása 22% (95% CI = 0,15-0,31), negatív prediktív értéke 90% (95% CI = 0,73-0,98), pozitív prediktív értéke 34% (95% CI = 0,26-0,43) volt (p = 0,00130). Következtetés: Az MHS fejlett innovatív technológián alapuló, azonnali eredményt adó vizsgálóeljárás, amely kiemelkedően alacsony álnegatív eredménye miatt nagy segítséget nyújt a citológiai eltéréssel rendelkező betegek további vizsgálatában. Orv Hetil. 2021; 162(20): 790-799. SUMMARY INTRODUCTION Despite the use of human papillomavirus (HPV) testing, the management of the transitional categories of cytology-based screening still remains a challenge. The modern multimodal hyperspectroscopy (MHS) of the cervix is a novel digital technology based on artificial intelligence, providing an instant result in the assessment of cytology-based screening abnormalities. PATIENTS AND METHODS 208 women (age 18-75) were enrolled. The patients already had cytology results and an operation on the cervix indicated at the time of inclusion. HPV and the hyperspectroscopy examination was performed pre-operatively. The pre-indicated operation was performed on 166 patients. RESULTS Cytology-based screening alone (in the category of all patients) resulted in a high false-positive rate (69.28%). In this category, the MHS had an outstanding false-negative rate (3/166 = 1.80%) compared to the HPV (11/165 = 6.66%). The false-positive rate of the spectroscopy examination (91/166 = 54.81%) was higher than that of the HPV testing (40/165 = 24.24%). In the atypical squamous cell (ASC-US/ASC-H) category, the false-negative rate of the spectroscopy (3/126 = 2.38%) was also lower than that of the HPV test (9/126 = 7.14%). In the detection of high-grade abnormalities (cervical intraepithelial neoplasia 2 and worse), the spectroscopy had a 94% sensitivity (95% CI = 0.84-0.99), with a 22% specificity (95% CI = 0.15-0.31), an 90% negative predictive value (95% CI = 0.73-0.98), and a 34% positive predictive value (95% CI = 0.26-0.43) (p = 0.00130). CONCLUSION In the case of cytological abnormality, the MHS provides an immediate result based on advanced digital technology, and because of its outstanding false negative rate it is a great aid and should be considered in the triage of such patients. Orv Hetil. 2021; 162(20): 790-799.
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Affiliation(s)
- Zoárd Tibor Krasznai
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Zsuzsa Bagoly
- 2 Debreceni Egyetem, Laboratóriumi Medicina Intézet, Klinikai Laboratóriumi Kutató Tanszék, Debrecen
| | - Eszter Nagy
- 3 Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest
| | - Zsolt Farkas
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Róbert Póka
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Péter Török
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Rudolf Lampé
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Zoltán Hernádi
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
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Kozma B, Pákozdy K, Lampé R, Berényi E, Takács P. Application of ultrasound elastography in obstetrics and gynecology. Orv Hetil 2021; 162:690-695. [PMID: 33934083 DOI: 10.1556/650.2021.32094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Az ultrahang-elasztográfia az elmúlt évek során egyre növekvő figyelmet kapott a lágyszövetek elaszticitásának vizsgálatában. A módszer használatát az teszi szükségessé, hogy egyes, a mechanikai tulajdonságaikban különböző szövetek hasonló echogenitásúak lehetnek, valamint hogy egy adott szövet megváltozott struktúrája vagy mechanikai tulajdonsága nem minden esetben jár együtt a szövet hagyományos ultrahangképének megváltozásával. Az elmúlt évtizedben a deformációs és a nyírási ultrahang-elasztográfia vált széles körben elérhetővé. Ezen új képalkotási technika egyre nagyobb szerepet tölt be a szülészeti-nőgyógyászati ultrahang-diagnosztikában is. A nőgyógyászatban szerephez juthat az endometriosis és az adenomyosis kimutatásában, valamint a benignus és a malignus cervicalis és ovarialis képletek elkülönítésében. A nőgyógyászathoz hasonlóan a szülészetben is jelentős változást hozhat az ultrahang-elasztográfia: alkalmas lehet a szülésindukció sikerességének, a koraszülés bekövetkezésének és a praeeclampsia kialakulásának előrejelzésére. Orv Hetil. 2021; 162(18): 690-695. Summary. Ultrasound elastography has received significant attention for the assessment and measurement of soft tissue elastic properties in recent years. The advantage of ultrasound elastography lies in the fact that two different tissues can share similar echogenicities but may have other mechanical properties or, on the contrary, mechanical abnormalities of a designated tissue do not necessarily go hand in hand with an altered appearance on a conventional ultrasound image. In the last decade, strain and shear-wave elasticity imaging methods have become the most widely available among commercial ultrasound equipments. The importance of this new method expands rapidly also in the field of obstetrics and gynecology. Ultrasound elastography has a promising role in the diagnosis of endometriosis and adenomyosis and helps to differentiate benign and malignant cervical and ovarian lesions. The use in the prediction of the outcome of labor induction and preterm birth, and in the evaluation of preeclampsia are emerging. Orv Hetil. 2021; 162(18): 690-695.
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Affiliation(s)
- Bence Kozma
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Krisztina Pákozdy
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Rudolf Lampé
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debrecen, Nagyerdei krt. 98., 4032
| | - Ervin Berényi
- 2 Debreceni Egyetem, Általános Orvostudományi Kar, Orvosi Képalkotó Intézet, Debrecen
| | - Péter Takács
- 3 Eastern Virginia Medical School, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Norfolk, VA, United States of America
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Török P, Krasznai Z, Molnár S, Lampé R, Jakab A. Preoperative assessment of endometrial cancer. Transl Cancer Res 2020; 9:7746-7758. [PMID: 35117377 PMCID: PMC8797972 DOI: 10.21037/tcr-20-2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
Endometrial cancer (EC), the most common among gynaecological malignancies occurs predominantly after the menopause. The diagnosis is most commonly (in about 75-80%) set up at early stage when surgical therapy and if necessary postoperative radiotherapy results in an excellent prognosis, with a 90-95% 5-year overall survival (OS) and a locoregional recurrence rates of 4-8%. Accurate preoperative assessment of the lymph nodes would ideally identify those patients with advanced stage disease, who might benefit from more extensive surgical procedures and adjuvant therapies. magnetic resonance imaging (MRI), hysteroscopic excisional biopsy (HEB) and high resolution 2D or 3D ultrasound performed by expert operator are considered to add valuable information for preoperative staging of EC. The use of biomarkers could be beneficial in decreasing inter-observer variability between the histology of the diagnostic specimen and the final operative sample, as well as to avoid overtreatment in a part of the high-grade tumors with excellent prognosis. The goal of surgical management of EC is to remove the primary tumor and to identify definite prognostic factors to determine whether adjuvant therapy is required. Extended surgery, including para-aortic lymphadenectomy has a significant morbidity, and with the future selection of cases it can be safely avoided, we can decrease complications without compromising oncological safety. In the future, the importance of hysteroscopy guided sampling may increase to gain a representative sample for biomarker detection.
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Affiliation(s)
- Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoárd Krasznai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Kovács KS, Kovács AR, Harangi B, Lampé R, Török P. Standardized measurement in uterine ultrasonography. Orv Hetil 2020; 161:2029-2036. [PMID: 33249410 DOI: 10.1556/650.2020.31929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: Jelenleg a méh méretének pontos megítélése meglehetősen szubjektív, az azt leíró ultrahangleletek igen nagy eltérést mutatnak. Számos klinikai szituációban azonban nagyon fontos az eltérések méretének, elhelyezkedésének, meghatározott anatómiai pontokhoz való viszonyának pontos leírása. Célkitűzés: Célunk egy egységes mérési módszer kifejlesztése, mellyel sorvezetőt adunk a vizsgálók kezébe, így csökkentve az egyéni variabilitásból adódó eltéréseket. A standardizált adatok lehetőséget adnak a szisztematikus gyűjtésre, azok egységes feldolgozására, rendszerbe foglalására, tudományos értékelésére, segítséget nyújtva a mindennapi klinikai gyakorlatban és kutatásokban. Módszer: A méh általunk végzett ultrahangvizsgálatait, valamint a nemzetközi tanulmányokat alapul véve kívánunk javaslatot tenni egy egységes mérési módszer kialakítására, mellyel egyértelmű, pontos, reprodukálható adatokat kaphatunk a méhről. Eredmények: Létrehoztunk egy standardizált paraméterekkel rendelkező mérési eljárást Uteromap néven, melyet alkalmazva objektív méretadatokat kaphatunk a méh ultrahangvizsgálata során. Külön figyelmet fordítottunk arra, hogy az általunk létrehozni kívánt standardizált mérési eljárás alkalmas legyen minden általános, valamint speciális esetben is. A kipróbálás során a legelső 253 páciens adatait elemeztük retrospektív módon. Eredményeink szerint az idősebb életkor megnövekedett méhmagassággal és nagyobb hátsó falvastagsággal korrelált. Következtetés: Arra a következtetésre jutottunk, hogy standardizált mérési módszerünk alkalmazásával a méhről és elváltozásairól sokkal pontosabb, objektívebb és egységesebb adatokat nyerhetünk anélkül, hogy a vizsgálathoz szükséges idő szignifikánsan hosszabb lenne. Munkánk folytatásaként minél több vizsgáló bevonásával szeretnénk a standardizált módszert a mindennapi gyakorlatra kiterjeszteni, a felmerülő igények, javaslatok alapján fejleszteni és létrehozni egy nemzetközileg elfogadott, standardizált mérési eljárást, mellyel az ultrahangvizsgálatok minőségét növelhetnénk, azzal a végső céllal, hogy javítsuk a betegek biztonságát és az ellátás eredményességét. Orv Hetil. 2020; 161(48): 2029-2036. SUMMARY INTRODUCTION Currently, the accurate assessment of the size of the uterus is rather subjective as the related ultrasound findings show an immense difference. However, in several clinical situations it is crucial to accurately describe the size and location of abnormalities and their relationship to specific anatomical positions. OBJECTIVE We aim to develop a unified measurement method that can serve as a guide for the examiners, thus reducing variances due to individual variability. Standardized data provide an opportunity for systematic collection, unified processing, systematization, and scientific evaluation, assisting in everyday clinical practice and research. METHOD Based on our ultrasound examinations and the international studies, we propose a unified measurement method that can provide precise, accurate and reproducible data on the uterus. RESULTS We have established a measurement procedure with standardized parameters called Uteromap, which obtained objective size data during the ultrasound examination of the uterus. Special attention was given to creating a standardized measurement procedure suitable for general and special cases, too. According to our results, older age was correlated with increased uterine height and greater posterior wall thickness. During the trial, the data of the first 253 patients were analyzed retrospectively. CONCLUSION We concluded that our standardized measurement method could obtain more accurate, objective, and consistent data about the uterus and its lesions without significantly increasing the time of the examination. Continuing our work, we would like to extend the standardized method to everyday practice, develop and create an internationally accepted standardized measurement procedure based on the emerging needs and recommendations, with the ultimate aim of improving patient safety and effectiveness of care. Orv Hetil. 2020; 161(48): 2029-2036.
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Affiliation(s)
- Kincső Sára Kovács
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
| | - Anna Rebeka Kovács
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
| | - Balázs Harangi
- 2 Informatikai Kar, Komputergrafika és Képfeldolgozás Tanszék, Debreceni Egyetem, Debrecen
| | - Rudolf Lampé
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
| | - Péter Török
- 1 Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Debrecen, Nagyerdei krt. 98., 4032
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Lörincz J, Molnár S, Herman T, Vitale SG, Jashanjeet S, Lampé R, Kardos L, Török P. Predictive value of bubble sign for tubal patency during office hysteroscopy. Eur J Obstet Gynecol Reprod Biol 2020; 253:58-60. [PMID: 32777542 DOI: 10.1016/j.ejogrb.2020.07.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our purpose was to investigate the predictive value of visible air bubble sign for real tubal patency during hysteroscopic procedures. METHODS In this cross-sectional study, clinical data of 61 infertile women who underwent diagnostic hysteroscopy and laparoscopy have been analysed. RESULTS Mean age of patients was 33.45 ± 3.25 years. Bubble sign for the detection of patency demonstrated 73 % (95 % CI: 57-86 %) sensitivity, 70 % (95 % CI: 46-88 %) specificity, a positive predictive value of 83 % (95 % CI: 67-94 %), and a negative predictive value of 56 % (95 % CI: 35-76 %). CONCLUSIONS A visible tubal "flow" of air bubbles during hysteroscopy was not accurate in the prediction of tubal patency.
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Affiliation(s)
- Judit Lörincz
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Hungary.
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Italy
| | - Singh Jashanjeet
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
| | - László Kardos
- University of Debrecen, Kenézy Gyula Teaching Hospital, Department of Clinical Pharmacology, Infectology and Allergology, Hungary.
| | - Péter Török
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, Hungary.
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18
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Vitale SG, Carugno J, Riemma G, Farkas Z, Krasznai Z, Bacskó G, Lampé R, Török P. The role of hysteroscopy during COVID‐19 outbreak: Safeguarding lives and saving resources. Int J Gynaecol Obstet 2020; 150:256-258. [PMID: 32533848 PMCID: PMC9087704 DOI: 10.1002/ijgo.13269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 01/15/2023]
Abstract
During the COVID‐19 pandemic, the use of hysteroscopy should be limited to specific, urgent pathologies in order to avoid a deleterious impact on healthcare services.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit Department of General Surgery and Medical Surgical Specialties University of Catania Catania Italy
| | - Jose Carugno
- Obstetrics and Gynecology Department Miller School of Medicine University of Miami Miami FL USA
| | - Gaetano Riemma
- Department of Woman Child and General and Specialized Surgery University of Campania "Luigi Vanvitelli" Naples Italy
| | - Zsolt Farkas
- Department of Obstetrics and Gynecology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Zoárd Krasznai
- Department of Obstetrics and Gynecology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - György Bacskó
- Department of Obstetrics and Gynecology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Péter Török
- Department of Obstetrics and Gynecology Faculty of Medicine University of Debrecen Debrecen Hungary
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Lukács L, Kovács AR, Pál L, Szűcs S, Kövér Á, Lampé R. Phagocyte function of peripheral neutrophil granulocytes and monocytes in endometriosis before and after surgery. J Gynecol Obstet Hum Reprod 2020; 50:101796. [PMID: 32413524 DOI: 10.1016/j.jogoh.2020.101796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Endometriosis is a chronic systemic disease, which influence negatively the quality of life of affected women and responsible for infertility and chronic pelvic pain. Pathophysiology of the disease is still enigmatic, but insufficient immune surveillance may play a role in it. Peripheral natural immune cell function is rarely examined. The aim of the study was to examine phagocyte function of peripheral neutrophil granulocytes and monocytes, whether this phagocytic activity is affected by the presence or removal of endometriotic lesions in women with endometriosis. MATERIAL AND METHODS Twenty-six preoperative, 13 postoperative samples from women with endometriosis, 23 samples from healthy women, 14 pre- and postoperative samples from the surgical control group were enrolled. Cells were isolated from peripheral blood samples, marked and evaluated for the phagocytosis index with immunofluorescent microscope after phagocyting the zymosane molecules. RESULTS Phagocyte function of monocytes and neutrophil granulocytes decreased significantly women with endometriosis before surgery compared to healthy controls. However, 7 days after surgery the postoperative values showed significant improvement compared to the preoperative results of women with endometriosis. This increment reached the values of the healthy women. In the surgical control group no difference was detected between the pre- and postoperative outcomes. DISCUSSION Decreased phagocyte function of the examined cells, which can be the result of the circulating immunosuppressive factors, may play a role in the deficient clearance of ectopic endometrial tissue. Based on the postoperative results, these immunosuppressive factors may be reduced or eliminated 7 days after surgery in women with endometriosis.
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Affiliation(s)
- Luca Lukács
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary
| | - Anna Rebeka Kovács
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary
| | - László Pál
- University of Debrecen, Faculty of Public Health, Department of Preventive Medicine, Hungary
| | - Sándor Szűcs
- University of Debrecen, Faculty of Public Health, Department of Preventive Medicine, Hungary
| | - Ágnes Kövér
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Univesity of Debrecen, Faculty of Medicine, 98. Nagyerdei krt., Debrecen 4012, Hungary.
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Török P, Molnár S, Herman T, Jashanjeet S, Lampé R, Riemma G, Vitale SG. Fallopian tubal obstruction is associated with increased pain experienced during office hysteroscopy: a retrospective study. Updates Surg 2020; 72:213-218. [PMID: 31993995 DOI: 10.1007/s13304-020-00712-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/22/2020] [Indexed: 01/30/2023]
Abstract
This study aimed at evaluating the pain experienced during office hysteroscopy, with selective tubal cannulation and chromopertubation, by women with and without tubal obstruction in order to determine if such condition would be associated with increased pain during the examination. Women with a history of infertility underwent in-office hysteroscopy with selective chromopertubation using a continuous flow office hysteroscope with a 5 Fr operating channel fitted with a 4 Fr catheter for the injection of methylene blue dye. Experienced pain was recorded on a Visual Analog Scale (VAS) during diagnostic hysteroscopy after access to the uterine cavity. Of 90 women, 58 (66.4%) were found with at least one patent fallopian tube and inserted in the group "any", meanwhile 32 (33.6%) were categorized into group "none" as both tubes were judged obstructed. There was no significant difference between groups in BMI and primary infertility rate, but the difference was significant concerning mean age (32.6 vs. 35.8; p < 0.001). The mean VAS score was 3.34 (± 1.07) in the group "any" and 4.25 (± 1.11) in "none". Comparing the VAS score of the two groups, the difference was significant (p < 0.001). Tubal occlusion may have a potential role in the pain experienced by women undergoing in-office hysteroscopy. Women with bilateral tubal occlusion experienced a higher level of pain compared with patients with at least one patent fallopian tube. Operators may use milder intrauterine pressure of fluid distension medium when these patients are undergoing in-office hysteroscopy to reduce discomfort.
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Affiliation(s)
- Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Molnár
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Singh Jashanjeet
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Rudolf Lampé
- Faculty of Medicine, Institute of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
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Takacs P, Sipos AG, Kozma B, Cunningham TD, Larson K, Lampé R, Poka R. The Effect of Vaginal Microablative Fractional CO
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Laser Treatment on Vaginal Cytology. Lasers Surg Med 2020; 52:708-712. [DOI: 10.1002/lsm.23211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery Eastern Virginia Medical School 825 Fairfax Avenue, Suite 526 Norfolk Virginia 23507‐2007
| | - Attila Gergely Sipos
- Department of Obstetrics and Gynecology University of Debrecen Faculty of Medicine Pf. 400 H‐4002 Debrecen Hungary
| | - Bence Kozma
- Department of Obstetrics and Gynecology University of Debrecen Faculty of Medicine Pf. 400 H‐4002 Debrecen Hungary
| | - Tina D. Cunningham
- The Center for Health Analytics and Discovery 825 Fairfax Avenue Suite 526 Norfolk Virginia 23507‐2007
| | - Kindra Larson
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery Eastern Virginia Medical School 825 Fairfax Avenue, Suite 526 Norfolk Virginia 23507‐2007
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology University of Debrecen Faculty of Medicine Pf. 400 H‐4002 Debrecen Hungary
| | - Robert Poka
- Department of Obstetrics and Gynecology University of Debrecen Faculty of Medicine Pf. 400 H‐4002 Debrecen Hungary
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Kovács AR, Póka R, Szücs S, Pál L, Lampé R. Phagocytic function of peripheral monocytes and neutrophils in ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2019. [DOI: 10.1016/j.ejogrb.2018.08.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Török P, Herman T, Lőrincz J, Molnár S, Lampé R, Póka R. Suprapubic pressure facilitates the procedure of office hysteroscopy: A randomized controlled trial. J Obstet Gynaecol Res 2018; 45:640-644. [PMID: 30362211 DOI: 10.1111/jog.13848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 10/02/2018] [Indexed: 11/28/2022]
Abstract
AIM To minimize the experienced pain during office hysteroscopy, a number of technical approaches and maneuvers are used. The aim of the study was to assess the effect of suprapubic pressure (SuPuP) applied during hysteroscopy. The impact of this maneuver on experienced pain (assessed by visual analog scale [VAS]) and duration of passage through the cervical canal was measured and compared to a reference group with no SuPuP. METHODS Hysteroscopy was performed in study subjects as part of their infertility work-up. Patients were randomized into two groups as part of a controlled trial. In group 1, SuPuP was applied while inserting the scope; in group 2, SuPuP was not applied. Pain experienced during the procedure was measured on a 0-10 VAS. Duration of passage through the cervical canal was measured by analyzing the video of the procedure. The effect of SuPuP was estimated by testing for between-groups differences in these outcomes. RESULTS The number of patients included the study was 60. Mean (SD) VAS score was 3.40 (1.276) in group 1 compared to 3.33 (0.802) in group 2 (P = 0.809). Mean (SD) time of passage through the cervical canal in group 1 was 30.5 (18.37) seconds compared to 43.0 (24.51) seconds in group 2 (P = 0.029). CONCLUSION Applying suprapubic pressure could facilitate the procedure by significantly shortening the duration of the passage through the cervical canal, but significantly not reduces the pain experienced during hysteroscopy. Further studies are to be undertaken to investigate the advantages of suprapubic pressure during office hysteroscopy.
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Affiliation(s)
- Péter Török
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Tünde Herman
- Center for Assisted Reproduction, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Judit Lőrincz
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
| | - Róbert Póka
- Department of Obstetrics and Gynecology, University of Debrecen Clinical Center, Debrecen, Hungary
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Abstract
INTRODUCTION Recently, tumor-infiltrating immune cells have been studied in various cancers. However, fewer studies address the role of peripheral immune cells in the pathogenesis of cancer. AIM Our aim was to investigate whether the phagocytic activity of peripheral monocytes and neutrophil granulocytes is affected by the removal of tumor in advanced ovarian cancer. METHOD We investigated peripheral blood samples from 12 patients with advanced stage of serous epithelial ovarian cancer - which were collected before the optimal tumor reduction surgery and on the 7th postoperative day - and from 8 healthy women. After separation of monocytes and neutrophils, the cells were incubated with opsonized fluorescein isothiocyanate-labeled zymosan A particles as the target of phagocytosis. By using fluorescence microscope we counted the number of particles phagocytized by the cells and calculated the phagocytic index. Statistical analysis of the data was performed using analysis of variances method. RESULTS Preoperative phagocytic indexes of monocytes and neutrophils from patients were significantly lower than phagocytic indexes of the corresponding cells from healthy women. The phagocytic function of monocytes and granulocytes isolated from postoperative samples of patients significantly increased compared to preoperative values and reached the phagocytic indexes of monocytes and neutrophils from healthy controls. CONCLUSION Based on our results we assume that the tumor and/or its microenvironment in ovarian cancer may produce factors that can depress the phagocytic function of monocytes and granulocytes. Since the phagocytic indexes increased following the cytoreductive surgery, it can be assumed that after the removal of the tumor, the production of these factors is reduced or eliminated. Orv Hetil. 2018; 159(33): 1353-1359.
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Affiliation(s)
- Anna Rebeka Kovács
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
| | - László Pál
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen
| | - Sándor Szűcs
- Népegészségügyi Kar, Megelőző Orvostani Intézet, Debreceni Egyetem Debrecen
| | - Luca Lukács
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
| | - Róbert Póka
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
| | - Rudolf Lampé
- Általános Orvostudományi Kar, Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem Debrecen, Nagyerdei krt. 98., 4032
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Abstract
INTRODUCTION Cervical cancer is one of the most common causes of death among women with malignant tumours. The two most common ways of surgical technique of early stage cervical cancer is the laparoscopy and the laparotomy. AIM Our aim was to compare the intra- and postoperative results of total laparoscopic radical hysterectomy and abdominal radical hysterectomy. METHOD Ten nerve sparing laparoscopic and 11 abdominal radical hysterectomies were performed from June 2016 until June 2017 because of early stage cervical cancer. Results were analysed retrospectively. RESULTS There was no significant difference between the two groups in the length of the operation, in blood loss and in intra- and postoperative complications. Significantly more lymph nodes were harvested by abdominal surgery and the length of hospitalisation was significantly shorter in the laparoscopy group. CONCLUSION Results of total laparoscopic radical hysterectomy are comparable and not worse than abdominal radical hysterectomy. Laparoscopic way may have a priority because of the general advantages of laparoscopic surgery in the surgical treatment of early stage cervical cancer. Orv Hetil. 2017; 158(36): 1403-1409.
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Affiliation(s)
- Rudolf Lampé
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Róbert Póka
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
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Lampé R, Móré C, Fazekas I, Póka R. [Total laparoscopic hysterectomy with the coagulation of the uterine arteries at their origin]. Orv Hetil 2017; 158:298-303. [PMID: 28218565 DOI: 10.1556/650.2017.30672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hysterectomy is one of the most frequently performed gynecological operations worldwide. Due to patient perceived advantages of technical development laparoscopic hysterectomy has become a widely used method. The attitude of patients, surgeons and service providers to laparoscopic procedures is not uniform, but total laparoscopic hysterectomy has prevailed due to its advantages from other types of laparoscopic hysterectomies. Coagulation of the uterine arteries at their origin during the standardized method of total laparoscopic hysterectomy provides further benefits for this procedure. AIM Our aim was the presentation of our experience together with a review of the relevant literature. METHOD Operations were performed with the coagulation of the uterine arteries at their origin right at the beginning of the procedure. Inclusion criteria were the use of the standardized method, video documentation of the surgery, and pre- and postoperative haemostatus results. RESULTS Our results confirm that the procedure involves an acceptable operating time that is comparable to that of open abdominal and vaginal hysterectomies, minimal blood loss that is far less than that in open procedures, a much shorter duration of hospitalization and a low complication rate. CONCLUSION In skilled hands with proper knowledge of the anatomy the standardized method of total laparoscopic hysterectomy with the coagulation of the uterine arteries at their origin is a safe and reproducible technique which suitably utilizes the advantages of minimally invasive surgery. Orv. Hetil., 2017, 158(8), 298-303.
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Affiliation(s)
- Rudolf Lampé
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Csaba Móré
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Ilona Fazekas
- Szülészeti és Nőgyógyászati Osztály, Kenézy Gyula Kórház és Rendelőintézet Debrecen
| | - Róbert Póka
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
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Lampé R, Kövér Á, Szűcs S, Pál L, Árnyas E, Póka R. The effect of healthy pregnant plasma and preeclamptic plasma on the phagocytosis index of neutrophil granulocytes and monocytes of nonpregnant women. Hypertens Pregnancy 2016; 36:59-63. [DOI: 10.1080/10641955.2016.1237644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rudolf Lampé
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Ágnes Kövér
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | - Sándor Szűcs
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - László Pál
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ervin Árnyas
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Robert Póka
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
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Lampé R, Kövér Á, Póka R. O74. Granulocyte and monocyte phagocytosis index affected by plasma factors in normal and preeclamptic pregnancy. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2015.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lampé R, Szucs S, Ádány R, Póka R. O382 THE POSSIBLE ROLE OF NEUTROPHIL GRANULOCYTES IN HEALTHY AND PREECLAMPTIC PREGNANCY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Data on respiratory burst activity of granulocytes from healthy and preeclamptic pregnant women are contradictory. To further investigate a possible role of reactive oxygen species in the etiology of preeclampsia, the induced superoxide-anion generation by granulocytes from non-pregnant, healthy pregnant and preeclamptic pregnant women were measured. The reciprocal effects of heat-inactivated and non-inactivated plasma on superoxide production by neutrophils from non-pregnant, healthy pregnant and preeclamptic pregnant subjects were also examined. Superoxide generation was measured by ferricytochrome c reduction. Both phorbol-12.13-dibutirate- and N-formyl-methionyl-leucyl-phenylalanine-induced superoxide production was significantly decreased in normal pregnancy compared to results obtained in non-pregnant and preeclamptic pregnant women. Phorbol-12.13-dibutirate-induced superoxide generation by non-pregnant and preeclamptic neutrophils was significantly inhibited by heat-inactivated and non-inactivated healthy pregnant plasma. N-formyl-methionyl-leucyl-phenylalanine-stimulated superoxide production by non-pregnant and preeclamptic granulocytes was suppressed only by non-inactivated healthy pregnant plasma. Phorbol-12.13-dibutirate-induced superoxide generation of healthy pregnant neutrophils was significantly increased by inactivated and non-inactivated non-pregnant and preeclamptic plasma. N-formyl-methionyl-leucyl-phenylalanine-stimulated superoxide production by healthy pregnant granulocytes was significantly enhanced following treatment of the cells with non-inactivated non-pregnant and preeclamptic pregnant plasma. Deficient superoxide generation in normal pregnancy may be caused by maternal immunosuppressive factors. The failure of reduction in superoxide production in preeclampsia may be partly responsible for endothelial dysfunction. Apart from oxidative stress, a possible role of inefficient maternal immunosuppression should also be considered in the pathogenesis of preeclampsia.
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Affiliation(s)
- Rudolf Lampé
- DeOrvos- és Egészségtudományi Centrum Szülészeti és Nőgyógyászati Klinika és Megelőző Orovostani Intézet Debrecen Nagyerdei krt 98. 4032.
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Csorba R, Tsikouras P, Lampé R, Póka R. The sexual abuse of female children in Hungary: 20 years' experience. Arch Gynecol Obstet 2012; 286:161-6. [PMID: 22395864 DOI: 10.1007/s00404-012-2282-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/23/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study is to describe the characteristics of female children who experience sexual abuse and explore common features that may assist in developing prevention strategies. MATERIALS AND METHODS Between 1990 and 2010, 266 girls under the age of 18 years, suspected of being sexually abused, visited the Department of Adolescent Gynecology. We retrospectively collected data illustrating the features of all cases. Seventy-eight percent of the victims were primary school students, and 45% of them were between 11 and 14 years of age. RESULTS The perpetrator knew the victim in 67% of the cases and was a stranger in 33%. Seventy-five (28%) perpetrators were members of the victims' families. In 14% of cases, the perpetrator was the victim's father and in 9% her stepfather. The abuse had occurred on multiple occasions in 29% of the cases. The occurrence rate of abuse was highest in the summer season (54%). As much as 63% of children experienced vaginal penetration, while 37% experienced a variety of sexual contact that did not involve penetration. Eighty-five victims were physically injured, and in 40 cases the presence of sperm was confirmed in vulvo-vaginal smears. A high proportion of female child sexual abuse takes place within the family and is revealed only after multiple episodes. The true prevalence of sexual abuse is being appreciated now that Hungarian law and society have recognized this societal problem. CONCLUSION Prevention requires a systematic and lifelong approach to educating children about personal space and privacy and is the responsibility of parents and professionals.
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Affiliation(s)
- Roland Csorba
- Department of Obstetrics and Gynecology, Medical and Health Science Center, Debrecen, Hungary
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Lampé R, Szűcs S, Ádány R, Póka R. Granulocyte superoxide anion production and regulation by plasma factors in normal and preeclamptic pregnancy. J Reprod Immunol 2011; 89:199-206. [DOI: 10.1016/j.jri.2011.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 01/10/2011] [Accepted: 01/19/2011] [Indexed: 01/13/2023]
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Csorba R, Lampé R, Póka R. Surgical repair of blunt force penetrating anogenital trauma in an 18-month-old sexually abused girl: a case report. Eur J Obstet Gynecol Reprod Biol 2010; 153:231. [PMID: 20817380 DOI: 10.1016/j.ejogrb.2010.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 06/12/2010] [Accepted: 07/25/2010] [Indexed: 10/19/2022]
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Csorba R, Lampé R, Póka R. [Differential diagnosis of child sexual abuse]. Orv Hetil 2009; 150:2222-7. [PMID: 19939783 DOI: 10.1556/oh.2009.28696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The evaluation of a child presenting with an anogenital complaint or lesion can be challenging for both the clinician and the patient. The doctor met the real possibility that a diagnosis of a condition caused by sexual abuse will affect significantly the child and the family. A misdiagnosis of abuse or failure to recognize a treatable condition can also have detrimental consequences. Most primary care physicians are not trained to recognize the variety of systemic and dermatologic problems that affect the anogenital area. Dermatologists and other specialists often do not appreciate the possibility of sexual abuse. In this article we present a systematic approach to the child with anogenital complaints which may mimic sexual abuse.
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Affiliation(s)
- Roland Csorba
- Debreceni Egyetem, Altalános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum, Szülészeti és Nogyógyászati Klinika, Debrecen.
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Lampé R, Szucs S, Adány R, Póka R. Preeclamptic Superoxide-Anion Production: Is There an Increase or a Failure of Reduction? Hypertension 2007; 50:e167; author reply e168. [PMID: 17893368 DOI: 10.1161/hypertensionaha.107.100107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Csorba R, Lampé R, Simó D, Bacskó G, Póka R. [Our experience with trans-obturator tape surgery in 150 cases]. Orv Hetil 2007; 148:1649-55. [PMID: 17720672 DOI: 10.1556/oh.2007.28147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nearly 30% of adult European women suffers from urinary incontinence. The recently introduced Trans-Obturator Tape (TOT) implant provides a new surgical technique for the treatment of stress incontinence. PATIENTS AND METHODS Preoperative work-up included detailed history taking, stress-test and Q-tip test, general and gynaecological physical examination and completion of the QUID questionnaire. Equivocal cases were further investigated with urodynamic assessment. TOT implantation was performed on 150 patients. Clinical efficacy of the treatment was evaluated with the QUID questionnaire. RESULTS Mean age of the patients was 50.8 years (SD = 8.64). 69 patients (46%) had genuine stress incontinence, 33 patients (22%) had urge incontinence, 48 patients (32%) had mixed type incontinence with dominant stress component. Mean length of follow-up was 16 months (4-26 months). Preoperative severity score of stress incontinence was 11.78 on average, while that of urge component was 6.63. On average, it took 25 minutes to complete the operation. Four out of the 150 operations were complicated by adverse event. Twelve patients required prolonged catheterisation exceeding 24 hours with a maximum of 5 days. The mean length of hospital stay was 4.76 days (SD = 0.8). Evaluation of postoperative questionnaires resulted in a mean severity score of 2.22 for the stress component and 2.59 for the urge component. In a patient satisfaction survey 46 patients reported the treatment as excellent (47.4%), 39 as good (40.2%), 7 as satisfactory (7.2%), 3 as suboptimal (3.1%) and 2 patients reported the procedure as ineffective (2.1%). CONCLUSIONS The procedure is an effective, quick, minimally invasive method of treating urinary incontinence. The operation requires short hospital stay and carries a low morbidity.
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Affiliation(s)
- Roland Csorba
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Szülészeti és Nogyógyászati Klinika, Debrecen.
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Lampé R, Ormos M, Szucs S, Adány R, Szikszay E, Póka R. Superoxide anion production of granulocytes in patients with endometrial cancer at presentation and after treatment. Eur J Obstet Gynecol Reprod Biol 2007; 131:231-4. [PMID: 16678329 DOI: 10.1016/j.ejogrb.2006.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 03/13/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND In current medical science the reactive oxygen intermediates play an ever more important role. METHODS The authors analysed superoxide anion production of polymorphonuclear leukocytes (PMNLs) in 30 blood samples from endometrial carcinoma patients. They measured it before the complex treatment and in nine cases at least 1 year after finishing the treatment. The results were compared with healthy controls. Phorbol dibutyrate stimulated superoxide anion production was measured spectrophotometrically as superoxide dismutase inhibitable reduction of ferricytochrome-c absorbance. RESULTS The mean superoxide anion production of PMNLs of the 31 healthy controls was 1.541 nM/min/10(5)cells (S.D.=0.201 nM/min/10(5)cells). Superoxide anion production of samples from endometrial cancer patients was much lower. The superoxide anion production of granulocytes in the early stage of endometrial cancer was lower (1.11 nM/min/10(5)cells) as in the controls. There was no essential difference in the superoxide production of patients with different depths of myometrial infiltration. After treatment, the superoxide anion production of the granulocytes of the clinically tumour-free patient had substantially progressed (1.357 nM/min/10(5)cells), but it was henceforth lower than the control. CONCLUSIONS According to our results, damage to the non-specific immunity is already advanced at the earliest stage of endometrial cancer. Further examinations are needed to decide how to normalise the superoxide production of granulocytes, and whether it has any importance in prevention and therapy.
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Affiliation(s)
- Rudolf Lampé
- Department of Obstetrics and Gynecology, University Medical School of Debrecen, Hungary
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