Biomedical subjects
Publications and source records attributed to P Bösze.
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The value of colposcopy and cytology in screening CIN was analyzed in a retrospective study of 1,504 patients treated at the Department of Gynecologic Oncology, National Institute of Oncology, Budapest from 1980 to 1991. The majority (1,451) of the patients were admitted for histological confirmation of atypical colposcopic and/or cytologic findings, and 53 women were treated for cervical repair. All women underwent either cervical excision or conization. Cytologic and colposcopic findings were compared with the histological results. Sensitivity and specificity rates of cytology were 47% and 77%, respectively. The corresponding figures for colposcopy were 87% and 15% and for cytology and colposcopy together, 96% and 14%. The low sensitivity of cytology suggests that as many as 50% of CIN lesions may be overlooked if cytology alone is used for screening, i.e. in 50% of CIN associated with abnormal colposcopy the cytology was negative. We found 194 asymptomatic patients with carcinoma in situ, 40 with microinvasive and 8 with frank invasive carcinoma. This finding emphasizes the importance of cervical cancer screening. Our data suggest that, with colposcopy as a screening tool, the rate of false-negative cytology can be significantly reduced. Clinical implications of the "cytology-negative abnormal colposcopy and cytology-negative CIN" have yet to be determined. The major drawback of primary colposcopy is its low specificity with the consequence of high false-positive rate and over-treatment in a substantial number of cases. To overcome the problem of low specificity, further studies are required to identify those atypical colposcopic changes that most likely represent CIN--and high-grade CIN in particular.
Current evidence suggests that epoetin alpha administration is well tolerated and effective in the management of anemia of cancer and cancer chemotherapy. An open-label, multinational, non-comparative study was conducted in 215 cancer patients with anemia secondary to chemotherapy with platinum- or non-platinum-based combinations. Epoetin alpha was administered s.c. (150 IU/kg three times/week) for a planned period of 16 weeks. The response rate of epoetin alpha, defined as an increase in hemoglobin level of 2 g/dl or more from baseline, was 67%. The rate of response was not related to the chemotherapy regimen administered (platinum or non-platinum based). The percentage of patients transfused and the transfusion rate during epoetin alpha treatment were reduced. Transfusional need was eliminated in 64 (75%) of the 85 patients transfused before the study start, after 1 month of therapy. Quality of life, assessed using a visual analog scale, improved markedly in patients who experienced a hematological response. These patients also experienced a statistically significant (p < 0.0001) improvement in mean WHO performance score. These findings indicate that epoetin alpha is a well tolerated and effective agent which increases hemoglobin concentration and reduces transfusion requirements in anemic cancer patients receiving chemotherapy.
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The proband was referred to familial ovarian cancer surveillance because two of her sisters died of carcinoma of the ovary. Her third sister succumbed of cervical cancer and her brother had acute myeloblastic leukaemia. Her second brother is alive and healthy. None of her parents and their sibs suffered of malignant disease. The offspring of the proband's sibs are young and appear to be normal. During surveillance she developed a stage I vaginal cancer. Following preoperative brachytherapy she underwent a radical hysterectomy and bilateral salpingoophorectomy with pelvic lymphadenectomy, and she is free of disease during 2 years of follow-up. The authors are not aware of any similar case.
Twenty-seven anemic patients with malignant tumour who received chemotherapy were treated with recombinant human erythropoietin (r-HuEPO). The objective of this study was to evaluate the effect of r-huEPO on hematologic and quality of life parameters as well as on transfusion requirement in patients with anemia secondary to cancer and cyclic chemotherapy. Patient population was allocated into two groups based on the chemotherapeutic regimens: 1. cisplatin containing and 2, non cisplatin containing regimen. Using 2 g/dl increase in haemoglobin levels as the criteria for response, twenty women responded to r-huEPO treatment. The response was more marked in the cisplatin group. R-huEPO treatment saved transfusion in both groups. Again, less patients required transfusion among those treated with cisplatin. There was a marked improvement in the quality of life which was more pronounced in patients who responded to r-huEPO treatment and in those receiving non cisplatin chemotherapy. No serious adverse experiences occurred. In conclusion, two third of patients with anemia secondary to cancer and cyclic chemotherapy can be effectively treated with r-huEPO. R-huEPO treatment invariably saves transfusion and is highly effective in improving quality of life. Adverse reaction is exceptional.
In this country, hormone replacement therapy (HRT) has been used more extensively in the last few years. The benefits of HRT in cardiovascular diseases, osteoporosis and quality of life has been well established. Breast cancer and endometrial carcinoma have been considered as contraindications for HRT. A reappraisal of this practice is necessary since we have no evidence that HRT may adversely influence the outcome of these tumours. Nevertheless, theoretically this is possible because the effect of estrogens on occult metastases in unknown. The relationship between replacement therapy and the uterine sarcomas is of particular concern. HRT is safe in patients successfully treated for carcinoma of the vulva, vagina, uterine cervix and in those with ovarian cancer. Experience suggests that the estrogen can also be used safely in women treated previously for endometrial cancer. As far as breast cancer is concerned it appears logical to discuss the risk-benefit considerations with our patients before embarking on using HRT. Consultation with a gynaecological oncologist prior to HRT in patients with endometrial and/or breast cancer is strongly recommended.
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.
Autoimmune oophoritis, which is frequently associated with other autoimmune diseases including other endocrine organs (autoimmune polyglandular syndrome), may precede the associated diseases by several years. The clinical significance of this association has increasingly been emphasized. And, this should facilitate early diagnosis since early initiation of replacement therapy can be life-saving. Thus, a review article on this subject apparently is of interest not only for gynaecologists but for internists, general practitioners and others.
The authors report on the complications of 58 radical vulvectomy with bilateral inguinal lymphadenectomy due to vulvar carcinoma. There was no operative mortality and no serious intraoperative complication was encountered. Wound disruption with or without infection was the most frequent early postoperative complication that occurred in 59% of the cases. Surgical intervention for secondary haemorrhage was necessary in 3 patients. Lymphatic fistula and lower extremity oedema developed in 3 women. The most disturbing long term complication, the persistent lower extremity oedema, occurred in 11 patients. Difficulties with micturation and vaginal prolapse developed in 4 subjects. The complication rate of this series compares favourably with the literature data. In the author's view radical vulvectomy with groin node dissection is a major operation and should be performed in oncological centers.
This paper gives an overview of the familial ovarian cancer. Ovarian cancer prone families defined as two or more first or second degree relatives with ovarian cancer, are of clinical importance because first or second degree family members of affected women are at risk of developing ovarian cancer. These women need surveillance including prophylactic oophorectomy in those with increased risk. Women with hereditary ovarian cancer are at the greatest risk. Familial ovarian cancer studies are also important in terms of research. They provide the best hope of identifying a gene involved in the genesis of ovarian cancer. There is good evidence that such a gene is likely to be involved in the development of non-familial ovarian cancer as well. This might be a clue to understanding the biology of ovarian cancer. Therefore ovarian cancer prone families should be identified and, since familial ovarian cancer is rare, available details about affected and non-affected family members should be registered at least at national level. The author set up the Hungarian Registry for familial ovarian carcinoma at the National Institute of Oncology Budapest.
This study was undertaken to determine the accuracy of ultrasonography in depicting the depth of myometrial invasion and cervical involvement in women with adenocarcinoma of the endometrium. During the past 2 years, pelvic ultrasound using abdominal and vaginal probes was carried out as part of routine preoperative work-up in 69 consecutive patients with carcinoma of the endometrium. Fifty-eight patients were primarily operated on; the remaining 11 had preoperative intracavitary irradiation followed by surgery at the referral hospital. All patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and staging laparotomy. A Hitachi EUB 450 ultrasound machine with a high-resolution 6.5-MHz transvaginal transducer was used to assess the intrauterine extension of the tumor. Myometrial extension was measured from the endometrial-myometrial interface to the deepest edge of the tumor extension into the myometrium and was categorized as 0%, < 50%, or > 50% myometrial invasion. Cervical involvement was determined based on irregular echogenicity of the tumor in the cervix of the uterus. Sixty-three of 69 patients had no cervical involvement on ultrasound, whereas the cervix was negative in 60 subjects on pathological examination; i.e., there were 3 false-negative and no false-positive results. The correlation was highly significant (P < 0.001). Of these, the endocervix was involved in 5 cases (stage IIa) and there were 4 patients with stage IIb disease. All 3 false-negative cases were stage IIa, with microscopical involvement in 2 patients. In the third case histology demonstrated disease extending low to the inner cervical os and was considered involvement of the cervix. The inner half of myometrium was involved in 28 patients and the outer half in 31, and there was no myometrial invasion in 10 cases. The corresponding values for ultrasound were 29, 31, and 9, respectively; i.e., there was only 1 false-positive and no false-negative results. The correlation is highly significant (P < 0.001). Sonography revealed irregular interface between the endometrium and myometrium, giving the appearance of measurable myometrial involvement in the only woman with a false-positive result. Our results indicate that transvaginal sonography correctly predicts endometrial and cervical involvement in endometrial carcinoma. In evaluating these factors, ultrasound using transvaginal probes is probably more accurate than intraoperative gross evaluation or frozen section analysis. Preoperative knowledge of these variables allows the gynecologists an appropriate consultation in terms of extended surgery and to select those patients who might benefit from referral to gynecologic oncology centers.
Surgery of advanced ovarian carcinoma includes total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial or total omental resection and removal as much secondaries as possible. Distinction between optimal and suboptimal debulking is important in terms of survival. This is based on the size of the diameter of the largest residual tumour following primary surgery (< 2 cm vs > 2 cm). The value of lymphadenectomy is still controversial. However, it should be explored in prospective studies. The role of second-look laparotomy in advanced ovarian carcinoma remains debatable. Secondary debulking appears to be beneficial only if it is followed by adjunctive chemotherapy.
The surgical aspect of ovarian cancer, based on the author's personal experience upon several hundreds patients and on the literature data, has been reviewed. Primary laparotomy is the cornerstone of the management of early stage ovarian cancer. This should include removal of the tumour and staging laparotomy. Better understanding of the tumour biological behavior is important to make a firm decision on conservative surgery in young patients with unilateral tumour who desire preservation of fertility. Rutin second-look laparotomy does not seem to be indicated in early stage disease.
Nineteen paraffin-embedded breast cancer tissue samples selected for long survival (more than 5 years) were analysed for detecting the amplification of the c-erbB-2 (Her-2/neu) oncogene by Polymerase Chain Reaction (PCR). Strong correlation was elucidated between c-erbB-2 amplification and survival; such correlation was also observed with histopathologic types and nuclear grading. Because of the similarity of the breast and ovarian cancer in the etiology of the diseases, amplification of c-erbB-2, c-myc and Ki-ras genes was examined in 32 ovarian carcinoma samples (stage I-IV). In ovarian carcinomas c-erbB-2 amplification occurred in 34% (11/32) of the fresh tumour samples, and correlation between amplification and clinical staging at P < 0.05 significance level was observed. Amplification of c-myc was detected in 9% (3/32) and none of the tumours showed amplification of Ki-ras.
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.
Patterns of bone loss in the axial and the appendicular skeleton were studied in 48 women with streak gonad syndrome (age: between 14-38 years, mean: 25.5 years). Bone mineral content was measured in vivo at the lumbar spine and right femoral neck by dual photon absorptiometry and at the midradius and distal radius by single photon absorptiometry. The bone mineral status of 20 patients was evaluated by radiomorphometrical indices of the metacarpals, femorals and lumbar spine, too. Mean bone mineral content and radiomorphometrical indices were significantly lower in patients with streak gonad syndrome than in age-matched normal subjects at all three scanning sites. The patients lost cortical and trabecular bone mineral content at the same rate, suggesting that bone loss in streak gonad syndrome is a generalized phenomenon. In spite of serious bone loss osteoporotic fractures were not observed in the patients, in contrast to patients with pathological post-menopausal osteoporosis having equal degree of bone deficiency. The authors did not find any relationship between the occurrence of osteoporosis and the karyotype of the patients. It is suggested that the osteoporosis in streak gonad syndrome--at least after puberty--is a consequence of gonadal hormone deficiency.