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Biomedical subjects

L Ungár

Publications and source records attributed to L Ungár.

At least 19 recordsLinked to original sources
PubMed2005

Laparoscopic abdominal radical trachelectomy.

BACKGROUND: Radical trachelectomy is a fertility preserving alternative for young women with early stages of cervical cancer. Currently, a technique of abdominal radical approach is used in a few centres. With growing availability of laparoscopy, a novel technique of laparoscopic radical trachelectomy might be an alternative. CASE: Presented is one case of laparoscopic pelvic lymphadenectomy with radical trachelectomy in young woman with IB cervical cancer. No intraoperative or postoperative complications occurred. Operation time reached 250 min, estimated blood loss was 250 ml. Limited follow-up of 9 months was uneventful and patient indicates normal menstrual pattern and satisfactory sexual intercourse. CONCLUSION: Laparoscopic abdominal radical trachelectomy with pelvic lymphadenectomy might be an alternative technique in the treatment of early stages cervical cancer in patients who desire future pregnancy. The procedure is in principle identical to the standard abdominal radical hysterectomy. Centres practising laparoscopic radical hysterectomy can adopt the technique without any special surgical training.

Adult↗
PubMed2005

[Abdominal radical trachelectomy--technique and experience].

OBJECTIVE: Discussion of current experiences with abdominal radical trachelectomy in the treatment of early stages of cervical cancer in fertile women. DESIGN: Case-reports. SETTING: Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague. METHODS: Presentation of 4 cases of abdominal radical trachelectomy and pelvic lymphadenectomy. Discussion with published data. RESULTS: Three cases of open abdominal and one case of laparoscopic abdominal radical trachelectomies together with pelvic lymphadenectomies are presented. All procedures were indicated for cervical cancer stages IA2-IB1. Frozen section of pelvic nodes and a slice of upper margin of cervix revealed no metastasis or infiltration. In total 22-43 pelvic nodes were removed, being negative in all cases. Operative time ranged between 148 and 270 min. in laparotomy and 250 min. in laparoscopy. Blood loss reached 350-3500 ml. There were no intraoperative complications, postoperatively one case of bladder atony was treated by suprapubic drainage for 30 days, one case of ileus was managed pharmacologically. Vaginal suture healed properly in all cases. No complications occurred within limited follow-up of 1-5 months. CONCLUSION: Abdominal radical trachelectomy with pelvic lymphadenectomy is a rational alternative in the treatment of stages IA2-IIA cervical cancer in women of fertile age. Standard radicality in parametria resection and easy incorporation into armamentarium of oncogynecological centers are main advantages of such approach. Laparotomy can be avoided using laparoscopy.

Adult↗
PubMed2004

[Initial experience in exenteration interventions in the pelvis].

OBJECTIVE: Discussion of experiences with pelvic exenterations. DESIGN: Case-report. SETTING: Department of Obstetrics and Gynecology, Department of Urology, Department of Surgery, Department of Pathology, Department of Clinical Oncology, General Teaching Hospital and Ist Medical Faculty of the Charles University, Prague, Czech Republic. METHODS: Presentation of 4 cases of pelvic exenterations. Discussion with published data. RESULTS: Altogether four cases of pelvic exenterations are presented, one case of supralevator total exenteration for recurrent cervical cancer, one case of infralevator total exenteration for recurrent vaginal cancer, one case of supralevator anterior exenteration in the treatment of locally advanced cancer of urinary bladder, and one case of supralevator posterior exenteration for recurrent vaginal cancer.

Adult↗
PubMed2000

[Successful outcome of an intrauterine twin pregnancy combined with ectopic pregnancy].

Authors present a case of twin intrauterine pregnancy combined with ectopic pregnancy. The simultaneous pregnancies occurred after the use of clomiphene citrate. In this case viable intrauterine twin gestation was observed by vaginal ultrasound examination, the simultaneous ectopic pregnancy was observed by laparotomy. Right salpingectomy was performed. The intrauterine twin pregnancy continued normally to the 35th week of pregnancy, finished with normal vaginal delivery. The healthy twin boys weighed 2650 g and 2070 g left the hospital in a good general condition on the 5th past delivery day. Authors discuss the etiology, the mode of diagnosis and the therapy of this rare condition.

Adult↗
PubMed1997

[Merkel cell tumor].

Merkel cell cancer is a rare carcinoma arising from the neuroendocrin cells of the skin. The diagnosis is based on the clinical behaviour, histopathologic and ultrastructural findings and immunohistochemical results. An unusual case of Merkel cell carcinoma is presented. Mass from the umbiculus and a right inguinal lymph node was excised in a 63-year-old female. The histologic features of a typical, primitive small cell tumor combined with the immunohistochemical evaluations established the diagnosis. Rare polynuclear giant cells were focally present in our case. Patient was treated with combination of chemotherapy (Cisplatin, Etoposid) and radiotherapy. Control examinations showed complete respond. One year later metastasis developed. Resection of all known metastasis were performed. Two months after the laparotomy she died of metastatic disease. The autopsy did not reveal any other primary tumor. The capricious nature of the clinical course and the differences between this tumor and other carcinomas is emphasized.

Carcinoma, Merkel Cell↗
PubMed1995

A simplified version of the "Indiana pouch" technique for urinary diversion. Experience of the first 18 cases.

During the last 3 years, a modified technique of the continent urinary diversion, known as the "Indiana pouch" has been performed in 18 patients as part of pelvic exenteration. The narrowing of the ileum and/or the site of Bauchin valve was excluded from the procedure. In order to achieve anti reflux effect, ureters were implanted to the urinary reservoir by the "split cuff nipple" technique instead of tunnelling ureters. Sufficient urine continence and lack of urine reflux in the ureters indicated that satisfactory function could be achieved by the simplified technique. A quality of life questionnaire has suggested that most of our modified Indiana Pouch patients coped well. Operative technique, indications, operative results, and complications are discussed.

Adult↗
PubMed1994

[Experience with urinary conduit procedures].

Between 1989 and 1993, 32 urinary conduit procedures were carried out at the Department of Gynaecological Oncology, National Institute of Oncology Budapest. Of these, 26 patients with pelvic tumour underwent total or anterior pelvic exenteration. The urinary conduit operation was performed in associated with radical hysterectomy due 2 vesico-urinary fistula in 2 patients, and as a palliative procedure in 4 instances (bladder fistula 2, bladder fistula and ureter occlusion 1 and bilateral ureteric obstruction 1). Mean age of the patients was 46, range 20-73 years. 23 patients underwent bladder replacement with "Bricker pouch" or ileal conduit, mostly in the first 2 years, and as a palliative procedure. Kock pouch was constructed in 3 and an Indiana pouch in 6 women. There was no intraoperative mortality. 3 patients died in the postoperative period, none of them due to complication of the urinary diversion procedure. Postoperative bleeding occurred in one ileal conduit that ceased spontaneously and in one Indiana pouch that required reoperation. Haematuria was a common finding in the first 3 to 5 days following surgery. Urinary leakage in the abdominal cavity lasting for 7 to 10 days postoperatively occurred in almost all instances in those who underwent a Bricker pouch. This did not require surgical intervention. 3 patients with Bricker pouch experienced pyelonephritis. Continent pouches are emptied by self-catheterization, 6-8 times daily. There were no other early complications. Techniques of urinary diversion are discussed.

Adult↗
PubMed1993

Vascular injuries in the surgical management of gynaecological malignancies.

From 1989 to 1991 we performed 184 radical gynaecological interventions. In the vast majority of the cases lymph node dissection was part of the procedure. Thirteen out of the 184 patients suffered vascular injury, accounting 7% complication rate. The sites of the injured vessels included the external iliac artery in four patients, the vena cava in three, the external iliac vein in five and the femoral vein in one patient. All of them were primarily sutured; no prosthesis or venous patch was needed. In four cases postoperative complications occurred in relation to vascular surgery: two deep thrombosis of the femoral vein and two occlusions of the external iliac artery. The latter two patients had permanent sequelae, i.e. difficulties in walking. Our study suggests that vascular injuries represent an utmost important intraoperative risk in the course of lymph node dissection in gynaecological malignancies. Thus, gynaecological surgeons performing radical operations must be prepared to deal with the problem.

Blood Vessels↗
PubMed1993

Perioperative complications of 116 radical hysterectomies and pelvic node dissections.

Perioperative morbidity and mortality were studied in 116 patients who underwent radical hysterectomy and lymph node dissection. Type II radical hysterectomy was performed in two, type III in 97, type IV in 12 and type V in five patients, and the perioperative morbidity was assessed accordingly. Because of the short follow-up time the late sequelae could not be evaluated. There was no operative death. Haemorrhage was the most common complication and it was more frequent and serious in type IV and V classes. Prolonged bladder atony was also frequent, particularly in type IV radical hysterectomy. The infection rate was comparable. One patient developed ureteric fistula, and one woman had ureteric stricture. Lymphocyst formation, nerve damage, lymphoedema and thromboembolic disease were rarely encountered and there was no bowel obstruction. Injury to the great vessels was a major problem. It appears that the rate of complications in this study is acceptable and comparable with or favourable to other reported series. In spite of this, every effort should be made to reduce the operative morbidity as far as possible.

Adult↗
PubMed1991

Stage I endometrial carcinoma: treatment of nonoperable patients with intracavitary radiation therapy alone.

From 1976 to 1981, 171 patients with stage I endometrial adenocarcinoma (FIGO, 1971) underwent intracavitary radiotherapy alone because of medical contraindications to surgery and external-beam irradiation. The mean age of patients was 71 years, with the majority of patients being in the age group of 70-79 years. The intracavitary therapy consisted of intrauterine insertions of radium implants in three consecutive courses according to the packing method of Heyman. The estimated dose delivered to point A and to point B was 80 and 20 Gy (3500-7000 mg-hr; mean, 5500 mg-hr), respectively. The corrected 5-year survival rate for stage Ia was 76% and for stage Ib 72%. Grade had a profound effect on survival; corrected 5-year survival for G1 was 77%, for G2 68%, and for G3 53%, respectively. The total failure rate was 24% (40/171). Most of the recurrences occurred in the pelvis (35/171): uterus, 22; vagina, 9; rectum, 2; and bladder, 1. One patient had both vaginal and uterine failure and five had distant metastases (four abdominal and one pulmonary). No difference was seen in the failure rates of stage Ia and stage Ib patients. No major complications (necessitating hospital care or delay of treatment) were seen. Our findings suggest that for patients with stage I endometrial cancer who are unfit for surgery, intracavitary low-dose-rate radiation therapy alone is an effective alternative treatment with a low risk of complications.

Adenocarcinoma↗
PubMed1990

Serum dehydroepiandrosterone and cortisol concentration in the maternal-fetoplacental hormonal system in elective caesarean section and spontaneous vaginal delivery in the 28th to 36th and 40th weeks of pregnancy.

The authors compared the serum DHAS and cortisol level in 53 vaginal deliveries with those of 21 caesarean sections prior to the onset of labour at the 28th to 36th weeks. They also compared 18 vaginal deliveries with 16 elective caesarean sections at the 40th week. The serum hormone concentrations were measured in the maternal vein, the umbilical vein and the umbilical artery. The results indicate that the serum DHAS and cortisol level was higher after vaginal delivery than after caesarean section in the maternal vein, umbilical vein and umbilical artery at the 28th to 36th and also at the 40th week. The authors suggest that, although the role of the fetal adrenal cortex is not so definitive as in the case of some species in the onset of labour, it may be presumed that the increase in adrenal cortical activity cannot be explained exclusively by maternal stress.

Adrenal Cortex↗
PubMed1989

[Prospective study of K-cell activity in patients with malignant gynecologic tumors. Effect of radiation therapy].

K cell activity was measured in the enzyme-like kinetic model of cytotoxicity against O, Rh (D) positive erythrocytes in 127 patients with carcinoma of the uterine cervix, 55 with carcinoma of the corpus uteri and 30 with malignant tumors of the ovary. The control groups included 62 healthy age matched women and 39 patients with benign tumor of the ovary. The cytotoxic activity was measured in a number of cases before any treatment and after irradiation and surgery in patients with cervical and endometrial cancer. The target cells were obtained from the same donor. ADCC activity of cervical and ovarian tumor patients enhanced depends on the stage of the disease. K cell activity of endometrial carcinoma patients was similar to the controls. ADCC activity of patients with carcinoma of the uterine cervix was increased, with carcinoma of the uterine corpus was indicated an increasing tendency following irradiation. There was connection with the dose of the irradiation and K cell activity. On the contrary, operation did not influence ADCC activity.

Cytotoxicity, Immunologic↗
PubMed1989

Quantitative comparison of serum steroid and peptide hormone concentrations in male and female fetuses in the maternal-fetoplacental system during the 28th-40th weeks of pregnancy.

There are a great deal of data concerning the role of testosterone in the formation of the sex of the fetus. The synthesis of the testosterone is influenced by the hypophysis and the fetoplacental unit. In this study the authors conferred the progesterone, DHAS, cortisol, oestradiol, oestriol, prolactin and HPL levels of male and female newborns in the maternal vein and in the umbilical vein and artery in the 28th-32th weeks (31 parturients, 15 male and 16 female fetuses), in the 33rd-36th weeks (43 parturients, 20 male and 23 female fetuses) and in the 40th week (34 parturients, 11 male and 23 female fetuses) of pregnancy. The determination of serum hormone concentration was carried out with the RIA method in 2084 samples. There was no significant difference between the serum hormone concentrations of the male and female sex in the 28th-40th weeks of pregnancy. They assume that in the 28th-40th weeks there is no difference in the activity of steroid and peptide hormone secretion caused by the sex of the fetus.

Dehydroepiandrosterone↗
PubMed1988

Serum DHAS in the maternal-fetoplacental system during the 28th-40th weeks of pregnancy.

The authors measured the serum levels of dehydroepiandrosterone sulfate (DHAS) in the maternal vein (MV), the umbilical vein (UV) and the umbilical artery (UA) during the 28th-36th weeks of pregnancy (n = 74) and in the 40th week (n = 34), to clarify the hormonal changes that occur between the maternal and fetal compartments. The following results were found: (1) The DHAS concentration increased significantly in MV, up to twice the concentration from the 28th-32nd weeks to the 33rd-36th weeks (p less than 0.01). From the 33rd-36th weeks to the 40th week it decreased significantly to one third of this value (p less than 0.01). DHAS levels revealed a decreasing tendency in the UA and UV serum from the 28th-32nd weeks to the 33rd-36th weeks, and there was a tendency to rise from the 33rd-36th weeks to the 40th week. (2) The serum DHAS values were found to be higher than in the MV, the UA-UV difference was not significant; however, the 'UA/UV X 100' value remained higher than 100% during the 28th-40th weeks. (3) The MV DHAS value showed slight correlation with the UV and UA DHAS concentration (r = 0.2951, p less than 0.01, n = 106; r = 0.2930, p less than 0.01, n = 100). There was a close correlation between the UV and UA serum DHAS levels (r = 0.8432, p less than 0.01, n = 98). The authors consider that the adrenal activity increases independently of the maternal adrenal cortex at term.

Adolescent↗
PubMed1988

K cell activity is low in newborn infants.

K cell activity of 18 mature, healthy newborns was measured against O,Rh(D)-positive erythrocytes, sensitized by anti-D antibodies, in cord and venous blood (later obtained 3-4 days after delivery). 53 healthy women served as controls. Activity was determined as a function of target cell number in the enzyme-like kinetic model of cytotoxicity. It was low in cord blood, increased in venous blood by days 3-4 but it did not reach the level of adults. While cytotoxic activity of male infants increased significantly from birth to the 3rd-4th day of life, it did not change in female infants. No correlation was found between the weight and K cell activity of newborns.

Birth Weight↗
PubMed1988

Perinatal progesterone in maternal-fetoplacental system during mature and premature deliveries.

The role of the maternal-fetoplacental hormonal system in the maintenance of pregnancy and in the onset of labor was studied by measuring the serum progesterone level in the maternal vein, the umbilical vein and artery at term (n = 34) and in the case of premature births (n = 74). Our results show: 1) During the 28th-40th weeks the serum progesterone concentration in the umbilical vein is greater than in the maternal vein (p less than 0.01) and in the umbilical artery (p less than 0.01), and greater in the umbilical artery then in the maternal vein (p less than 0.01). 2) No correlation was found between the serum progesterone concentration in the maternal and fetal vessels, whereas a close correlation was found between the serum concentration in the umbilical vein and artery. 3) The progesterone concentration of the maternal serum increased during the 28th-40th weeks, but increased only during 28th-36th week in the umbilical vein and artery and fell significantly by the 40th week. From this it appears that the maternal and the fetal progesterone concentrations are interdependent. The progesterone concentration of the umbilical vessels falls before term but it is not an essential factor in the onset of labor.

Adolescent↗