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Introduction: Skin cancers are the most common human neoplasms with head and neck localization in 90% of cases. Primary therapy is surgery, resulting in absolute skin defects in a number of cases. The reconstruction of these is performed with local skin flaps showing identical colour, texture and follicle density with the defect site., Objective: In the present study, we report our preliminary experience with the head and neck application of double hatchet flap, a random pattern flap., Method: In our study, results of patients undergoing double hatchet flap reconstruction in the period between November 2021 and June 2023 were analyzed prospectively in terms of tumor site, defect size, method of anesthesia, and early and late complication rates. Patients followed up to a minimum of 6 months were asked to fill in a questionnaire concerning their postoperative status., Results: A total of 13 patients with a mean age of 79.6 years underwent double hatchet flap reconstruction. The most frequent defect site was the scalp and the mean defect size was 40.5 × 32.1 mm. Histopathological examination showed R0 resection of the tumor in each case. The closure of the skin defect was insufficient in 1 case. Partial flap necrosis and mimical paralysis were observed as early and late complications in 2 cases, respectively. The most bothersome sequel reported by patients was scarring., Discussion: For selection of a local flap, the following factors need to be considered: localization and size of the defect, skin elasticity, amount of adjacent skin to mobilize, direction of relaxed skin tension lines and wrinkles, and aesthetic units. If the principles of the hatchet flap design (the ratio of flap length and width and pedicle width to the defect size) are adhered, the resulting technique is reliable with an acceptable complication rate., Conclusion: The double hatchet flap as a random pattern flap is a fast, reliable technique especially for the closure of 2-5 cm skin defects of the scalp and forehead. Orv Hetil. 2023; 164(44): 1755-1763.

Összefoglaló. A szájüregi daganatok kuratív kezelésében az elsődlegesen választandó műtét mellett a sugárterápiának is jelentős szerepe van. A lokális tumormentesség biztosításához azonban dóziseszkaláció szükséges. Ennek külső besugárzással való megvalósítása a környező normálszövetek fölösleges dózisterhelésével és az ebből következő mellékhatások előfordulásának emelkedésével jár. A brachytherapia (BT) - amelynek során radioaktív sugárforrást/sugárforrásokat juttatunk a tumorba vagy annak közelébe - lehetővé teszi a helyileg magasabb dózis leadását a környező ép szövetek kímélésével. A BT a korai, T1-2N0 stádiumú szájüregi tumoroknál - kedvező prognosztikai faktorok mellett - akár kizárólagosan vagy mint posztoperatíve egyedül alkalmazott terápiás modalitás jön szóba. Kedvezőtlenebb prognózis esetén vagy előrehaladottabb stádiumban (T3-4 vagy N+) a műtétet és/vagy a percutan irradiációt kiegészítő eljárásként alkalmazható kedvező sugárfizikai tulajdonságai miatt. A kis dózisteljesítményű (low-dose-rate, LDR) BT-t már évtizedek óta alkalmazzák a terápiában, de ezt kezdi kiszorítani a nagy dózisteljesítményű (high-dose-rate, HDR), illetve a pulzáló dózisteljesítményű (pulse-dose-rate, PDR) BT. A jelen áttekintő tanulmány célja irodalmi adatok alapján a BT szerepének és indikációjának ismertetése a szájüregi daganatok kuratív kezelésében, alrégiókra lebontva. Orv Hetil. 2021; 162(37): 1471-1479. Summary. Radiation therapy plays a significant role in the curative treatment of oral cavity tumors, in addition to the primary choice of surgery. However, dose escalation is required to ensure local tumor control. Its implementation with external irradiation is accompanied by an unnecessary dose exposure to the surrounding normal tissues and an increase in the incidence of consequent side effects. Brachytherapy (BT), in which a radiation source/sources is/are placed inside or close to the tumor, allows a higher dose to be delivered locally, sparing the surrounding intact tissues. In addition to favorable prognostic factors in early T1-2N0 stage oral cavity tumors, BT is considered either exclusively or as a sole postoperative therapeutic modality. At less favorable prognosis or at a more advanced stage (T3-4 or N+), BT can be used as a complementary procedure after surgery and/or percutaneous irradiation based on its favorable radio-physical properties. Low-dose-rate (LDR) BT has been used in the therapy for decades, but recently it has been replaced by high-dose-rate (HDR) and pulse-dose-rate (PDR) BT. The purpose of this review is to describe the role and indications of BT in the treatment of oral cavity tumors categorized into subregions, based on the literature data. Orv Hetil. 2021; 162(37): 1471-1479.

Összefoglaló. A lateralis cysticus nyaki terimék két leggyakoribb oka a branchiogen cysta és a cysticus nyaki áttét. Az átfedő lokalizáció (a leggyakrabban a IIA nyaki régióban), a betegek életkora és az esetenként hirtelen kezdet alapján a két leggyakoribb ok differenciáldiagnózisa nagy kihívást jelenthet. Egy hirtelen fellépő fájdalmas, bal oldali nyaki duzzanattal, dysphagiával és lázzal jelentkező 72 éves férfi esetét ismertetjük. A nyak komputertomográfiás vizsgálata egy 6 cm legnagyobb átmérőjű, vastag falú, többrekeszes cysticus terimét igazolt. Infektív branchiogen cysta lehetőségére gondolva az elváltozást eltávolítottuk. A szövettan azonban p16-pozitív laphámrákot igazolt. A primer tumort végül az ipsilateralis tonsilla palatina állományában sikerült azonosítani. A beteg definitív radioterápiában részesült, és 18 hónappal a diagnózis után tumormentes. A nyaki cystákon, az infektív nyaki cystákon és a cysticus metastasisokon kívül a humán papillómavírussal összefüggő szájgarati laphámrákok infektív cysticus vagy necroticus metastasisait is figyelembe kell venni a lateralis cysticus nyaki terimék differenciáldiagnózisában. Orv Hetil. 2020; 162(15): 595-600. Summary. Branchial cleft cysts and cystic neck metastases are the two most common causes of cystic lateral neck masses. Based on the overlapping location (neck level IIA), patient age at onset and the occasionally sudden onset, their differential diagnosis is challenging. We present a 72-year-old male presenting with a suddenly emerging painful, left-sided neck swelling, dysphagia and fever. Computed tomography showed a 6 cm thick-walled multicystic mass. With the suspected diagnosis of an infected branchial cleft cyst, the lesion was removed. Histology confirmed p16 positive squamous cell carcinoma. Primary tumor was identified in the ipsilateral palatine tonsil. Definive radiotherapy was performed and the patient is free of disease at the 18-month follow-up. Beyond pure and infected branchial cleft cysts and pure cystic metastases, infected cystic or necrotic metastasis of human papillomavirus associated oropharyngeal squamous cell carcinoma should be included in the differential diagnosis of cystic lateral neck lesions. Orv Hetil. 2021; 162(15): 595-600.

Introduction: Total hip arthroplasty is one of the most common surgical procedures that requires blood transfusion, with the possible risk of significant complications. Aim: A retrospective study was performed to analyze the predictors of blood transfusion after primary total hip arthroplasty. Method: We collected the data of 210 consecutive patients undergoing total hip arthroplasty. Patient's data, preoperative hemoglobin and hematocrit level, the type of the prosthesis, the use of a suction drain, tranexamic acid or anticoagulants and the type and amount of blood transfusion were recorded. Results: A total of 41% of our patients required transfusion, 8.6% receiving allogenic blood. Significant predictors of allogenic blood transfusion were preoperative hemoglobin and hematocrit levels, the type of prosthesis, the use of suction drainage and the use of tranexamic acid. Patients with pre-donated autologous blood did not require allogenic blood transfusion. Conclusion: Based on our study, total hip arthroplasty necessitates allogenic blood transfusion in 8.6%. Major predictors associated with the need for transfusion are preoperative hemoglobin and hematocrit levels, the type of prosthesis, the use of suction drainage and the use of tranexamic acid. Pre-donated autologous blood helps to reduce allogenic transfusion rate. Orv Hetil. 2020; 161(8): 290-294.

Introduction: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant multisystemic vascular disease with a worldwide prevalence of 1 : 5000 - 1 : 10 000. Diagnosis is based on clinical Curacao criteria. Approximately 85% of HHT cases have heterozygous family-specific mutations in the ENG or ACVRL1 genes. Aim: We investigated 23 Hungarian HHT families, established the genetic diagnosis, executed family-screening and confirmed founder effects. Method: Probands were identified by the stratified population screening of the primary attendance area of our institution and from individuals contacting our study group voluntarily. Diagnosis is based on the otorhinolaryngological physical examination completed with characteristic telangiectasis sites, a visceral arteriovenous malformation screening and the sequence analysis of ENG and ACVRL1 genes. The family screening consists of physical examination and genetic screening for the family-specific mutation, followed by the arteriovenous malformation screening in patients with definite/suspected HHT and/or in individuals with the mutation. Results: Sixty-three individuals with family-specific mutations were identified in 22 families, 48 of them with definite and 12 with suspected HHT. Seven ENG and ACVRL1 mutations were detected, respectively; most of these are pathogenic. Three founder mutations were observed. One proband with definite HHT had wild-type alleles in all tested HHT-specific loci. Conclusions: The significance of genetic testing is confirming or excluding HHT in young asymptomatic individuals in families with pathogenic mutations. As ENG and ACVRL1 mutations result in overlapping fenotypes, the genetic testing lacks any prognostic value. The identification of founder effects might simplify the genetic diagnosis of new HHT patients from a given region. Orv Hetil. 2019; 160(18): 710-719.

Introduction and Aim: To report the clinical outcomes of second breast-conserving therapy with perioperative interstitial radiotherapy for the treatment of ipsilateral breast tumor recurrences., Method: Between 1999 and 2015, 33 patients, presenting with an ipsilateral breast tumor recurrence after previous breast conserving therapy, were salvaged by re-excision and perioperative high-dose-rate interstitial brachytherapy. A median of 8 (range: 4-24) catheters were implanted into the tumor bed intraoperatively. A total dose of 22 Gy in 5 fractions of 4.4 Gy was delivered to the tumor bed with a margin of 1-2 cm, on 3 consecutive days. The adjuvant systemic treatments consisted of hormonal therapy for 24 patients (73%) and chemotherapy for 6 patients (18%). The survival results were estimated by the Kaplan-Meier method. Late side effects and cosmetic results were also registered., Results: The median follow-up time following the second breast conserving therapy was 61 months (range: 26-189 months). During the follow-up, 4 patients (12.1%) developed second local recurrence. The five-year actuarial rates of the second local, regional and distant recurrence were 6.3%, 6.1%, and 14.9%, respectively. The five-year probabilities of disease-free, cancer-specific and overall survival were 76.2%, 92.4%, and 89.2%, respectively. Four (12%), 19 (58%), 4 (12%) and 6 (18%) patients had excellent, good, fair and poor cosmetic results, respectively. Grade 2 and 3 fibrosis developed in 9 (27%) and 1 (3%) patients. Asymptomatic fat necrosis was detected in 7 (21%) women., Conclusion: Second breast conserving therapy with perioperative high-dose-rate interstitial brachytherapy is a safe and feasible option for the management of ipsilateral breast tumor recurrences. Interstitial brachytherapy may decrease the risk of second local relapse with acceptable cosmetic results and low rate of late side effects. Hence, in selected cases it can provide a feasible alternative to salvage mastectomy. Orv Hetil. 2018; 159(11): 430-438.

Introduction and Aim: To implement lipiodol as a fiducial marker of the tumor bed for image-guided radiotherapy with simultaneous integrated boost technique as part of radiochemotherapy for muscle invasive bladder tumors., Method: Since April 2016, radiochemotherapy was performed in 3 male patients with muscle invasive, transitional cell bladder carcinoma. Prior to radiochemotherapy, tumor bed resection was performed for each patient, at the same time 10 ml of lipiodol solution was injected submucosally into the resection site, thus marking the tumor bed for escalated dose irradiation. During radiochemotherapy 51 Gy (1.7 Gy/die) to the pelvis, 57 Gy (1.9 Gy/die) to the whole bladder, and 63 Gy (2.1 Gy/die) to the lipiodol-labeled tumor bed was delivered with simultaneous integrated boost technique. The accuracy of the irradiation was controlled by daily kilovoltage CT. Early radiogenic urogenital and gastrointestinal side effects were recorded according to Radiation Therapy Oncology Group side-effects grading recommendation., Results: Substantial perioperative side effect or toxicity were not observed during and after the injection of lipiodol. The prescribed dose was successfully delivered in all patients. Radiotherapy duration was 6 weeks. The lipiodol-labeled tumor bed was clearly visible on daily kilovoltage cone beam CT. In one patient grade II cystitis and proctitis was observed, another patient experienced only grade I cystitis. These complaints improved with symptomatic medication. In the third patient no significant side effect occurred., Conclusions: The injection of lipiodol into the bladder wall is a safe technique, without any perioperative toxicity or complication. The tumor bed demarcated by lipiodol was visible both on treatment planning and kilovoltage CTs. The total treatment time was shortened by 4 days. The treatment was well tolerated, early side effects were moderate, or slight. Orv Hetil. 2017; 158(51): 2041-2047.

Introduction: Several studies have been published which questioned the use of suction drain during elective hip arthroplasty., Aim: In this prospective study the authors examined how the use of suction drainage affected complications related to perioperative blood loss and hemorrhage in patients undergoing elective hip arthroplasty., Method: Eighty-six patients undergoing elective hip arthroplasty were divided into two groups. In 54 patients ("drain" group) suction drains were used during operation, whereas in 32 patients no suction drain was applied. Perioperative blood loss, use of tranexamic acid, method of thrombosis prophylaxis, transfusion requirement, incidental postoperative hemorrhage, septic complications, and all other postoperative complications were recorded., Results: Perioperative blood loss was affected with the use of tranexamic acid but not with the use of drainage (p = 0.94). Patients without the use of drain showed a tendency of lower transfusion requirement (p = 0.08). There was no correlation between any complications and the use of drainage., Conclusion: In accordance with published results the authors conclude that the routine use of suction drainage during elective hip arthroplasty is not definitely necessary. Orv. Hetil., 2016, 157(29), 1171-1176.

Incidence of infertility increased in the past years and it affects 15% of couples. Female and male factors are responsible in 40% and 40% of the cases, respectively, while factors present in both females and males can be found in 20% of cases. Female factors can be further divided into organic and functional ones. Function of the female organs can be evaluated in an outpatient setting by well-developed laboratory techniques but evaluation of the uterine cavity and inspection of the tubal patency have been traditionally carried out in one-day surgery. However, the latter can be performed under ambulatory setting with the use of office hysteroscopy, so that the use of operating theatre and staff costs can be saved. Using selective pertubation for the evaluation of tubal patency via office hysteroscopy can reduce cost further. The new methods in infertility workup which can be performed in ambulatory setting have several advantages for the patients.

This review summarizes the possible options for the prevention of preeclampsia based on important factors of patomechanism. The effects of antioxidants have been described in numerous clinical researches based on the oxidative hypothesis. Another important factor is the change of nitric oxide activity. Nitric oxide donors are able to compensate the symptoms of preeclampsia. The inverse relationship between the calcium intake and gestational hypertension has been known for a long time. The calcium supplementation seems to be a good opportunity to prevent preeclampsia. With low molecular weight heparins we can intervene in the patomechanisms of preeclampsia by antithrombocyte effects, vasoactive properties and impact on throphoblast cell morphology and differentiation. Thrombocyte aggregation inhibitors were examined in number of studies because they reduced thromboxane mediated vasoconstriction and inhibited placental thrombosis. Several studies verify whether prophylaxis with low molecular weight heparins and low dose aspirin could improve pregnancy outcome in preeclampsia.

In the last four decades breast-conserving surgery followed by whole breast irradiation has become the standard of care for the treatment of early-stage (0-I-II) breast carcinoma. With the advent of breast-screening, incidence of breast carcinomas with more favorable prognostic characteristics has increased significantly. This change in the prognostic profile of newly diagnosed breast cancers opened a new horizon for clinical research seeking for individual risk-adapted protocols of breast cancer radiotherapy. Several groups have been tested the efficacy of accelerated (partial or whole) breast irradiation, which has become the new treatment paradigm in the radiotherapy of early-stage breast cancers. Furthermore, others have attempted to identify subgroups of patients for whom radiotherapy after breast-conserving surgery could be safely omitted. Recently molecular gene expression assays have emerged as promising prognostic and predictive markers for local recurrence. This article reviews the results of these studies focusing on individual risk-adapted radiotherapy after breast-conserving surgery for patients with early-stage breast carcinoma.

Unlabelled: Psychoneuroimmunologic studies on positive emotions are few, and their clinical relevance is limited., Aims: This "SHoRT" (Smiling Hospital Research Team) study evaluates the effects that Smiling Hospital artists have on hospitalized children., Methods: Blood samples were taken in a non-painful way through branules in an accredited Infectology Ward, 30 minutes before and 1 hour after a visit of tale tellers, puppeteers and handicraft artists. 24 children were visited and 9 were included in the control group. Blood lymphocyte counts and Th1/Th2 cytokine levels were determined. Artists evaluated their effect on a subjective scale., Results: In the visited group, the increase of lymphocytes was 8.43% higher, the decrease was 12.45% lower, and the proportion of children showing increased lymphocyte counts was more increased. Changes were more marked after more successful visits. Authors found non-significant, still considerable changes in interferon-γ level (p < 0.055) and in Th1/Th2 cytokine ratios., Conclusions: This pediatric study suggests that immunological changes may develop when more attention is given to hospitalized children.

This review summarizes the hemorheological changes during gestation and their clinical relevance in pre-eclampsia. The gestational disease named pre-eclampsia, characterized by proteinuria (more than 0.3 g/day) and hypertension (blood pressure above 140/90 mmHg), exists from the 20th gestational week until the sixth postpartum week. Its etiology is complex; the pathomechanism mainly involves disturbances in cross talks among the vegetative system, the placenta and the circulatory system. Soluble factors of placenta mediate circulatory changes, which result in adaptive responses in both vegetative and circulatory systems. Derailment of this adaption, however, leads to increased turbulence and local damages in cellular elements of the circulatory system. The initial local lesion progresses to a generalized form. Later, these events will continue to strengthen their own cycle. As a result, an unstable circulatory state will be established, which causes organ damages.

Hysteroscopy is a widely used endoscopic method, the "gold standard" for the examination of uterine cavity changes. Office hysteroscopy is an intervention that makes the accomplishment of ambulant examination, opposite to the traditional method. Due to the small diameter of the device the anesthesia is unnecessary, because there is no need of the dilatation of the cervix. Indications of the examination are wide-ranging. Besides the abnormal uterine bleeding, it can be used in the examination of infertility, and those intrauterine changes (polyp, submucosus myoma, adhesion), that were diagnosed by other imagining methods that cause infertility complaints. The aim of our present review is recommend the use of this method because it does not need any preparation and it is minimal invasive. The use of traditional method that needs longer preparation, observation, anesthesia and operating theatre, is only suggested in cases of proven pathology.

Introduction: Dysmenorrhea is highly prevalent during adolescence but the incidence of this disease is very often underestimated. Depending on different measurement methods 20-90% of adolescent girls report dysmenorrhea., Objectives: This study examined the prevalence of dysmenorrhea among high-school female adolescent students in Eastern-Hungary. Early diagnosis and treatment of the possible pathological background is very important to prevent long term consequences., Results: 2337 girls were interviewed in this study about their menstrual cycle. The overall prevalence of dysmenorrhea in this population was 79.2%. Altogether 67.0% described their pain and cramp as severe. 61.2% of the girls use some kind of medication due to dysmenorrhea. Despite these data only 1.2% of them had previous medical counseling because of their complains., Conclusions: It is important to screen female adolescents for dysmenorrhea and provide them with information on the disease and possible treatment options. Follow up of these adolescents is mandatory especially in cases not responding to standard medical treatment.

Introduction: The rate of multiple births has increased all over the world in the past decade. This is mainly due to the widespread use of infertility treatments and assisted reproductive techniques. Despite of improvements in obstetric and neonatal care, twin pregnancy still mean high risk both for the mothers and their babies. The management of twin delivery remains controversial., Patients and Method: Authors analyzed the data of all twin pregnancies at the Department of Obstetrics and Gynecology, University of Debrecen between January 2002 and December 2003. The data of 113 twin pregnancies were analyzed. Details of gestational age, presentation, birth weight discordance, mode of delivery were reviewed., Results: From the 113 analyzed twin births, 27 pregnancies have been conceived after successful assisted reproductive technique. In 18 cases more than 500 grams of body weight difference was detected between the two babies at the time of delivery. The rate of preterm birth was 69%, and cesarean section was performed in 64% of preterm births compared to 68.6% in the matured delivery group., Conclusions: On the basis of recent data a large prospective, randomized trial is mandatory to determine the optimal management of twin deliveries.

Introduction: The role of labor induction has been gradually increasing in the last decade all over Europe due to the early detection of fetal jeopardy, improvement of neonatal therapy and availability of cervical ripening agents. Success rate of vaginal delivery depends on maternal, fetal condition and cervical status., Patients: Authors report the outcome of 795 labor inductions during the period from 1996 to 2000 at the Department of Obstetrics and Gynecology at the University of Debrecen, Hungary. Preinduction cervical ripening and induction method was based on Bishop score and clinical situation., Results: The rate of induced labor was 5.97% out of 13312 consecutive deliveries. The outcome of induction is discussed in details. The caesarean section rate after induction of vaginal delivery was 25% in this high risk group, and 33.3% among the total number of inductions., Conclusions: The clinical application of prostaglandins for cervical ripening among high risk pregnant women facilitates the decision of labor induction and provides a favourable rate of vaginal deliveries.

Introduction: The anatomical abnormalities of the uterus could be the cause of infertility and spontaneous abortion in several cases., Objects: Authors would like to measure the successfulness of a modern endoscopic operative method among their own patients and the outcome of the pregnancies., Methods: Between 1st of January 1993 and 31st of December 1999 authors performed hysteroscopic septotomy in 66 patients with the history of recurrent miscarriage or uterus septum causing infertility. Based on the data of the clinical electronic database and by personal interviews 52 patients were followed up., Results: 36 deliveries at term were registered, 28 were spontaneous and 8 were C-sections. In none of the C-section cases the previous septotomy was marked as indication for the operation. There wasn't any pregnancy found with subsequent miscarriage., Conclusion: Authors emphasized the advantages of hysteroscopic septotomy against abdominal metroplasty.

Background: Breast reconstruction after mastectomy represents an improvement in the quality of life of breast cancer patients. Radiotherapy is also suggested for many of them to prevent local relapse. However, irradiation increases the risk of complications require surgical procedures., Purpose: This study was undertaken to analyse the compatibility of breast reconstruction and irradiation in the treatment of breast cancer., Methods: Computerised searches for publications debating this issue were done of MEDLINE data. Studies were grouped according to the techniques and types of reconstruction: reconstruction with silicone implant or autogenous skin-muscle flap, timing of reconstruction (immediate or delayed), and sequencing of treatments (pre- or post-reconstruction irradiation). The results of studies were assessed and compared in respect to reconstruction related chronic complications., Results: The incidence of complications was significant even in the absence of irradiation, but radiotherapy increased the risk of complications to less or more extent. When reconstruction was done with implant, the most common type of complication was Grade III-IV capsular contracture. In patients subjected to immediate reconstruction, the complication rates with or without radiotherapy were from 0% to 64% and from 0% to 12%, respectively. In women who underwent delayed reconstruction, the incidence of complications with or without irradiation was from 22% to 55%, and from 17% to 34%, respectively. The negative effect of radiotherapy was more significant with immediate than with delayed reconstruction. In patients who underwent reconstruction with skin-muscle flaps, the most common type of complication was skin necrosis. The incidence of complications with or without radiotherapy was from 12% to 39% and from 5% to 25%, respectively. Cancer, developing after cosmetic augmentation mammaplasty in the breast, can be treated with lumpectomy and radiotherapy without removal of the implant. In series with this method of treatment the incidence of complications (mainly capsular contracture) was from 0% to 65%. The use of moderate dose (45-50 Gy), wedge filters, and no use of bolus application decreased the risk of complications., Conclusions: Radiotherapy and breast reconstruction are not incompatible, but careful consideration of their relative timing and technique is important. Plastic surgeons should counsel patients before starting their cancer disease treatment, and those who choose to have reconstruction need to be informed about risks for specific complications associated with the procedure. Results of the studies debating this issue are controversial. Longer follow-up time, larger patient material and better specified parameters are needed to validate results.

Introduction: The practice of image-based three dimensional treatment planning and conformal radiotherapy techniques give the opportunity to elaborate optimal treatment forms for primary brain tumours., Purpose: The authors examined the effect of two novel dose escalation methods on glioblastoma patients., Methods: In nine cases they treated T1 tumours with single HDR-AL boost of 10-12 Gy dose following the conventional fractionated 60 Gy external beam radiotherapy. In fifteen patients with T2-4 tumours an intensified, hypofractionated regimen with 2.25-2.5 Gy daily and 60 Gy total dose was applied. All the treatments were carried out with image-based conformal methods., Results: Majority of patients endured treatments without neurological deterioration. Transient neurotoxiticy was noticed in one and two cases, respectively. The median survival times (MST) were found to be 17 months (range: 9-25) and 12 months (range: 6-38) in the two groups, respectively. With respect to all patients, the MST was 13 months, while this value in the conventional treatment is generally considered to be 9-10 months. All the three patients who survived more than 18 months was treated with temozolamide chemotherapy as well., Conclusion: Based on own experience and current knowledge of authors, it seems reasonable to apply higher biological dose focal radiotherapy and chemotherapy in case of glioblastoma patients with better prognosis. To define the optimal treatment regimens randomised clinical trials should be executed.

Introduction: The benign uterine fibroid is one of the most common cause for complains of females. The most important aim of the medicine nowadays is to treat the patient with minimally invasive methods, saving the organ., Objects: Authors evaluate the efficacy of the transcervical hysteroscopic fibroid resection (TCRM) among their patients., Materials and Methods: Authors performed 66 transcervical hysteroscopic fibroid resection (TCRM) in 61 patient in a six-year period. Based on clinical computed database and mailed questionnaires 51 patients were followed up., Results: 30 out of 51 patients showed no symptoms after the procedure, in 14 cases subsequent fibroid was detected, while in 7 cases other type of complains occurred not related to the myoma. During the procedures complications appeared only in 4 cases, one perforation and three bleeding episodes occurred., Conclusions: Based on the data authors emphasize that TCRM is a safe and excellent method in treating submucosal fibroids.

Doppler ultrasound has become a part of routine antenatal fetal surveillance during the past two decades. It provides insight into the utero-placental and fetal arterial, venous circulation non-invasively. Doppler examination has a key role in the detection of hypoxic risk since abnormal blood flow patterns can be demonstrated before the clinical manifestation of fetal disorder. Doppler velocimetry facilitates judgment in the diagnosis, monitoring fetal well-being during pregnancy and labor, scheduling antenatal tests and timing delivery. Authors review the effects of chronic and acute hypoxia on fetal hemodynamics. On the basis of the present knowledge and experience a brief summary is given about the role of Doppler velocimetry in the early detection of hypoxic fetal jeopardy during pregnancy and labor.

Aim: Main objective of pregnancy care is to provide health both for the mother and baby. Two main points of this care are to preselect high and low risk pregnancies and to determine the timing of delivery in case of fetal jeopardy or maternal emergency situations in the third trimester. Although we have evidence based techniques that are effective in reducing perinatal mortality in selected high-risk groups, the content of routine pregnancy care in low-risk third trimester pregnancies is not well defined yet. Management of these patients differs from center to center and from country to country and is mainly determined by obstetrical traditions of different geographical areas., Patients/methods: Based on the data of questionnaires about recent practice of 28 European obstetrical departments in 10 countries participating in EuroGRIT trial the authors sketch out current management of third trimester low risk pregnancies., Conclusions: In spite of current discrepancy in applying functional tests it is absolutely required to introduce new methods in the future only within the framework of evidence based medicine.

Introduction: The increased prevalence of asthma has become a major public health issue worldwide. It has been proposed that this increase is due to the steady decline of infectious diseases such as tuberculosis., Aim of the Study: Supporting this view was, the suppressive effect of live Bacillus Calmette-Guerin (BCG) infection on allergen (ovalbumin) induced airway eosinophilia was published previously., Methods: Next the authors compared the effects of live, heat killed BCG and purified protein derivative of Mycobacterium tuberculosis (PPD) on a murine model of ovalbumin induced airway eosinophilia., Results: The results showed that both live and heat killed BCG, but not PPD strongly suppressed airway eosinophilia. This inhibition was correlated with the reduced number of Th2 cells in the lung., Conclusion: Their data support the hypothesis that the application of bacterial antigens may be a safe vaccination method against asthma in the future.

Pregnancy induced hypertension remains the most frequent reason of maternal and fetal complications. Recent studies of the entire pathophysiology of the abnormal implantation proved association between the impaired placental performance and the reduced uteroplacental circulation. Therefore the Doppler examination of uterine and umbilical blood flow may provide the early recognition of high-risk pregnancies complicated by maternal hypertension and fetal intrauterine growth retardation. The authors endeavor to describe the details and characteristics of uteroplacental haemodynamic changes during the course of physiologic and defective implantation. On the basis of the currently available scientific publications they summarize the role of the uterine and umbilical artery Doppler velocimetry as a screening tool in the detection of the consequences of the impaired uteroplacental perfusion. They conclude that abnormal velocity waveforms obtained from the uterine and umbilical arteries may help to improve the efficacy of the prenatal care and the perinatal outcome as well. The clinical benefits of this screening method will be precisely defined on the basis of further multicenter studies in Hungary.

The technical improvements gained over the last decade in neuroradiology and radiotherapy have brought significant theoretical and experimental changes in the treatment of primary glial brain tumours. The follow-up of patients with CT, MRI and isotope diagnostic examinations proves that the relapses take place in the vicinity of the primary site in most cases. Consequently, the conventional large fields or whole brain irradiation techniques have been phased out and the conformal irradiation methods focused on the tumorous targets have gained ground. The exact neuroanatomic projection, the image based 3-dimensional treatment planning methods and the conformal irradiation techniques ensure that only the tumorous or the potentially infiltrated regions become irradiated with maximal protection of the normal brain tissues. The increased protection of the normal tissues makes a dose escalation possible, which may result in the augmentation of the therapeutic benefits. In Hungary both the interstitial and the external beam conformal radiotherapies of the CNS have become accessible in practice over the recent years. In possession of manifold treatment modalities (percutaneous fractionated conformal radiotherapy, stereotactic radiosurgery, high dose rate after-loading and low dose rate interstitial irradiation), it is found necessary to overview the indicative territories, advantages, limitations and possible complications of different interventions. The authors describe the possible routes of further improvements and ways of dose escalation. Nevertheless, it is emphasised that gliomas--with reduced radiosensitivity and high potential to infiltrate the adjacent brain tissues-represent the illness in the whole CNS. It implies that in the future it will probably be necessary to initiate systemic therapeutic modalities in the course of routine treatment strategies in addition to the focused and more effective radiotherapy regimens.

Retrospective analysis of third trimester intrauterine deaths has been performed at the Department of Obstetrics and Gynecology University Medical School Debrecen, Hungary. Among 32,126 deliveries between 1988 and 1997 retrospectively 163 intrauterine deaths occurred in the third trimester. Cases were analysed on the basis of the Nordic-Baltic Perinatal Death Classification. The role of intrauterine growth retardation, cord complication and fetal malformation are discussed. An interesting finding was the high rate of intrauterine growth retardation where cord complication was supposed to be the cause of intrauterine death. Concerning both to medical and legal aspects precise and exact documentation should be needed for the correct retrospective analysis.

The aim of the retrospective study was to analyse the frequency of polyps, anamnestic data and the result of histological examination overviewing 163 polyps which was find during 1900 hysteroscopy. In the history of patients dilatation and curettage was find in 22% one time and in 6.6% two times, but the polyps were removed by hysteroscopy in the end. The indication of hysteroscopy was haemorrhage in 55%, abnormal ultrasonographic results in 25% and sterility in 15%. During 153 polypectomy were two perforations (0.89%), no other major complication. The result of histological examination of 153 removed polyps was surprising, because in 22 cases proliferative endometrium, in 17 cases hyperplasia, in 6 cases secretory endometrium, in 5-5 cases fibroid and dyshormonal effect and in 1-1 case endometritis, adenomyosis, atrophy and malignant transformation was the histological diagnosis. Despite of relatively high false positive hysteroscopic results, the endoscopic procedure is useful method for treatment of endometrial polyps if the aim is the minimal invasivity and organ saving surgery.

Purpose: To initiate fractionated, interstitial high dose rate brachytherapy of the tumour bed as the sole radiation modality after breast conserving surgery., Patients and Methods: In 41 cases of selected stage I-II breast cancer the tumour bed was marked with titanium clips during breast conserving surgery. The tumour bed was implanted with flexible plastic catheters to deliver postoperative radiotherapy. In 8 cases 7 x 4.33 Gy (30.3 Gy), in 33 cases 7 x 5.2 Gy (36.4 Gy) interstitial 192Ir high dose rate brachytherapy was given to the clipped area. Irradiation of the whole conserved breast was omitted. The radiation side effects were assessed by mammograms and MRI-examinations., Results: At a median follow up of 17 (4-36) months neither distant nor regional failure was observed. Local recurrence was detected in 1/41 (2.4%) case. G2 radiation side effects were observed in 2/21 (9.5%)., Conclusions: Postoperative sole brachytherapy of the tumour bed with careful patient selection and adequate quality assurance seems to be a feasible alternative to whole breast teletherapy. Sole brachytherapy shortens the time of radiotherapy from 5-6 weeks to 5 days, and reduces the costs of treatment. The skin and volume sparing effect of interstitial irradiation may decrease the side effects of radiotherapy.

Juvenile laryngeal papillomatosis is the most common benign tumor of the larynx in childhood. The specific etiological factors are non-oncogenic human papillomavirus types 6 and 11. In the present study two cases (a 6-year-old male and a 5 and a half-year-old female) operated five times each and harbouring type 11 DNA in papillomas excised in the first operations are analysed from the following virological aspects: 1. the examination of vertical transmission by general primer-polymerase chain reaction of maternal cervical exfoliation; 2. sites of papilloma predilections in the larynx; 3. histopathology; 4. viral DNA detection from the formalin-fixed and paraffin-embedded archive tissues and from a fresh papilloma tissue in one case by polymerase chain reaction applying type-specific primers. We did not find any signs of maternofoetal transmission in the anamnesis and the maternal cervix proved to be negative for viral DNA. However, the vertical route of transmission can not be excluded due to the special natural history of papillomavirus infections. Papillomas usually localised in normal squamociliary junctions of the larynx. The histopathologic review did not reveal any signs of malignancy. Koilocytosis referring to productive viral infection and the signs of abnormal keratinisation were present in each tissue. All tissues of the patients proved to be positive for the short amplimer deriving from the genome of human papillomavirus type 11.

During a period of 17 months, a total of 101 patients were examined by high resolution computed tomography (HRCT) whose minor focal changes revealed by chest X-ray raised the suspicion of diffuse infiltrative pulmonary disease. The disease of the interstitium was primarily caused by idiopathic pulmonary fibrosis (19%), autoimmune disease (18%), Boeck sarcoidosis (18%) as well as by specific (16%) and aspecific inflammation (12%). HRCT disclosed reticular (61%), nodular (55%), ground-glass opacity-like (48%), emphysematous (33%) and ring-like changes (17%). Also transbronchial excision was performed in 51 patients the results of which were compared to the changes observed during HRCT. Concerning fibrosis and inflammation, HRCT and histological analysis showed identical results in 70%. According to the authors observations, this technique is suitable for detection of fairly fine fibrotic, empysematous and inflammatory signs and for defining the activity of the individual disease as also for the selection of the optimal site of transbronchial excision. HRCT is a useful investigative method both for diagnosing diffuse infiltrative pulmonary disease as well as in following up the effectiveness of treatment.

Tamoxifen is a non-steroidal estrogen antagonist used mainly in the adjuvant therapy of breast cancer. Tamoxifen acts primarily as an antiestrogen, but also carries estrogenic effect, mainly to the endometrium. Although diverse pathological uterine findings has been described in connection with the long term use of this drug, there is no widely accepted protocol for the monitoring of the endometrium in these patients. All patients referred for gynecologic examination at the Department of Obstetrics and Gynecology University Medical School Debrecen, Hungary with previous treatment for breast cancer were involved in a screening programme. The gradual screening programme consists of: transvaginal sonography, color doppler imaging, hysteroscopy, and endometrial curettage or sampling. If any of the first steps proved to be negative, further evaluation could be avoided. Altogether 31 patients were referred for examination and transvaginal sonography alone excluded endometrial abnormality in 9 cases, while the rest of the patients went through further evaluation. The ratio of false positive results using transvaginal sonography alone was high and could be lowered with additional color doppler imaging. Endometrial pathology could be excluded in about 50% of cases without tissue sampling. Positive histology was found in 25% of patients receiving Tamoxifen. The most frequent pathological finding was endometrial polyp. In conclusion endometrial changes found by transvaginal sonography, should be further evaluated. The gradual screening procedures enable us to the proper use of more invasive procedures.

Human papillomavirus gene sequences have been detected in a number of malignant and benign tumours. Non-oncogenic types 6 and 11 are etiological factors of benign mucosal tumours. Types 16 and 18 can be detected in malignancies most often but their role in the etiopathogenesis of cancers is still unclear. In our study we examined formalin-fixed and paraffin-embedded archive laryngeal tissues containing squamous cell carcinoma, papilloma and precancerous lesions for the presence of human papillomavirus genes. As a control we also examined tissues harbouring laryngeal nodules which represented the normal larynx in our study. After DNA preparation from the paraffin blocks we performed polymerase chain reaction to detect the DNA of human papillomavirus types 6, 11, 16 and 18. In the squamous cell carcinomas, papillomas and precancerous lesions the presence of human papillomavirus gene sequences was significantly higher than in the control group. To verify the integrity of DNA we also amplified a sequence deriving from the cellular beta-globin gene. Based on the 100% positivity for this gene we declare that the combination of our DNA preparation and polymerase chain reaction is a reliable method for detecting DNA sequences from formalin-fixed and paraffin-embedded tissues.