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1.
Ann Thorac Surg ; 72(5): 1691-7, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11722066

ABSTRACT

BACKGROUND: We studied the incidences and evaluated the management of early postoperative complications after thymectomy for myasthenia gravis. METHODS: During the period between 1987 and 1996, 324 thymectomies were performed through median sternotomy access under general anesthesia. Postoperative management was administered according to a standardized protocol of anticholinesterase medication, which was withdrawn for the 48 hours of obligatory postoperative mechanical ventilation. The mean age of patients was 34 years (range, 8 to 71 years). RESULTS: One hundred forty-nine patients made an uneventful recovery; 104 patients had only minor complications, whereas 71 patients had major complications. The mortality rate was 0.6% (2 patients). The major surgical complications were recorded as sternal bleeding (1 patient) and sternal disruption (1 patient). The major general complications were recorded as tracheal stenosis (1 patient), pneumonia (3 patients), heart failure (1 patient), gastric hemorrhage (1 patient), and respiratory insufficiency (71 patients). Forty-six reintubations were performed on 40 patients and 19 tracheostomies (6%) were performed postoperatively. CONCLUSIONS: The excessive incidence of respiratory insufficiency and airway-associated morbidity was potentially related, at least partially, to prolonged mechanical ventilation and withdrawal of anticholinesterase medication. Earlier weaning of patients with revision of 48-hour withdrawal of anticholinesterase medication is necessary.


Subject(s)
Myasthenia Gravis/surgery , Thymectomy/adverse effects , Thymectomy/methods , Adolescent , Adult , Aged , Child , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/epidemiology , Sternum , Time Factors
2.
Magy Seb ; 54(1): 57-9, 2001 Feb.
Article in Hungarian | MEDLINE | ID: mdl-11299868

ABSTRACT

The authors present the history of a 79 years old female patient who had to be operated on with paraesophageal hiatal hernia causing cahexia, hematemesis, dysphagia and pain. They found an upside down stomach with cancer inside. They emphasize that endoscopy is very important in the diagnostic process and that cancer can develop even if the stomach is located in the chest.


Subject(s)
Hernia, Hiatal/complications , Hernia, Hiatal/diagnosis , Stomach Neoplasms/complications , Stomach Neoplasms/diagnosis , Aged , Esophagoscopy , Female , Gastroscopy , Hernia, Hiatal/surgery , Humans , Stomach Neoplasms/surgery
3.
Orv Hetil ; 137(48): 2671-4, 1996 Dec 01.
Article in Hungarian | MEDLINE | ID: mdl-9679598

ABSTRACT

Authors analyse the cases of lung metastasectomy collected during fourteen years in eleven thoracic surgical departments in Hungary. 668 operations were carried out on 620 patients. The primary tumor originated mainly from kidney, testis and colo-rectum. Most of the interventions were performed through median sternotomy. The tumors were removed by tissue sparing lung resections (wedge resection). The prognosis depends basically on tumor free interval, however the number and the size of the metastases and the histology of the primary tumor have also impact on it. When lung lesions appear in a cancer patient, thoracic surgeon should be consulted to consider operability. In certain cases metastasectomies can result in longer survival and better quality of life.


Subject(s)
Lung Neoplasms/secondary , Neoplasm Metastasis , Colorectal Neoplasms/pathology , Female , Humans , Kidney Neoplasms/pathology , Lung Neoplasms/surgery , Male , Pneumonectomy/methods , Testicular Neoplasms/pathology
4.
Surg Today ; 26(5): 362-7, 1996.
Article in English | MEDLINE | ID: mdl-8726624

ABSTRACT

Breast cancer is the most common type of cancer in women throughout the world (18%), with a yearly morbidity that is already over half a million. Its incidence in Hungary is increasing in each age group, and the mortality is strikingly high. This study was conducted to assess the effectiveness of breast-conserving surgery in comparison to more radical surgery on a large group of patients. During the 15 years between 1980 and 1994, a total of 6,358 patients with primary breast cancer underwent surgery at the National Institute of Oncology in Budapest, Hungary, as breast-conserving surgery in 2,026 patients (31.8%). Breast-conserving surgery is being performed in an ever-increasing number of patients, followed by adjuvant radiochemotherapy in premenopausal patients, or radiohormone therapy in menopausal patients. During follow-up, recurrence was found in only 5.9% of the patients who underwent breast-conserving treatment. Thus, according to our experience, breast conservation therapy for the management of breast cancer offers favourable results, provided that the preconditions to this treatment are adequately met.


Subject(s)
Breast Neoplasms/surgery , Mastectomy, Segmental , Mastectomy , Adult , Aged , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Female , Humans , Hungary/epidemiology , Mastectomy/statistics & numerical data , Mastectomy, Segmental/statistics & numerical data , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Survival Analysis
5.
Orv Hetil ; 135(41): 2259-62, 1994 Oct 09.
Article in Hungarian | MEDLINE | ID: mdl-7970640

ABSTRACT

Clinical and morphological characteristics of two malignant cystosarcoma phyllodes mammae were reported with the review of recent literature. One of the patients went to see her doctor 2 years after she had noticed the tumour because of "problems in her family". In the removed giant fibroadenoma osteo-chondrosarcomatous transformation was found. The other patient tried "to mobilise her inner energies against the growth" for 3 years. The removed tumour weighed 2100 grams and there were metastases in the axillary lymph nodes. Histological examination showed malignant cystosarcoma phyllodes with vasoformative tendency. Electron microscopical studies confirmed in both cases that the tumors with varying structures originated from immature mesenchymal cells. Authors agree on wide extirpation of the tumour. According to the literature adjuvant chemo- or radiotherapy do not improve patients survival. In case of early radical operation the malignant transformation is less probable.


Subject(s)
Breast Neoplasms/pathology , Phyllodes Tumor/pathology , Diagnosis, Differential , Female , Humans , Middle Aged
6.
Orv Hetil ; 135(10): 513-7, 1994 Mar 06.
Article in Hungarian | MEDLINE | ID: mdl-8146006

ABSTRACT

The steroid receptor determination (first of all estrogen receptor--ER--) of the breast cancer tissue has become an important factor for prognostication and treatment. Authors from the Surgical Department of the National Institute of Oncology provide a biostatistical survey of their 727 breast cancer patients. Following factors proved to have significant impact on the prognosis: positivity of ER, the quantitative value of ER, ER vs. lymph node status, ER vs. DFI, ER and the site of metastases and the hormone therapy. The progesterone receptor (PR) provides indication in case only for DFI for metastases. However, in this very respect it has a more significant value than that of ER. Multidimensional analysis has shown that the most important prognostic factors are the lymph node status, patient's age, size of the tumour and the ER value.


Subject(s)
Breast Neoplasms/metabolism , Receptors, Estrogen/analysis , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Humans , Hungary/epidemiology , Mastectomy , Prognosis , Survival Rate
7.
Eur J Surg Oncol ; 19(6): 575-80, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8270047

ABSTRACT

The literature of occult breast cancer is reviewed and the management of our 43 patients is discussed. In 20 patients mastectomy and axillary block dissection, in nine upper-outer quadrant resection of the breast with axillary block dissection, and in two axillary biopsy were carried out. The primary tumour was found only in 11 patients during the first operation, either by macroscopic or microscopic examination. In 12 patients the primary breast tumour became detectable only later. Out of the 20 mastectomy specimens two primary tumours could not be identified even with the most thorough examination. In four patients of the breast conservation group the primary tumour remained occult until recently, and in the axillary block dissection group (12 patients) the site of the primary cancer could be identified only in two patients. The difficulties of the diagnosis and the dilemmas of the surgical indications and treatment are dealt with.


Subject(s)
Breast Neoplasms/diagnosis , Adult , Aged , Axilla , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Diagnosis, Differential , Female , Humans , Lymphatic Metastasis , Middle Aged , Retrospective Studies , Survival Analysis
8.
Orv Hetil ; 134(22): 1181-5, 1993 May 30.
Article in Hungarian | MEDLINE | ID: mdl-8506107

ABSTRACT

Since 1980, based on international experience, breast conserving operations have been introduced at the Surgical Department, in the National Oncological Institute, Budapest. In 12 years, out of 4622 primary breast cancer operations, 1055 breast preserving interventions were carried out. For all patients adjuvant radiotherapy was indicated. In lymph node positive premenopausal cases chemo-radio-chemotherapy, for postmenopausal patients radiotherapy with tamoxifen has been provided. The first 604 patients (10 years) have been evaluated and 489 of them could be followed. The mean follow-up time was 49 months. During this period of time metastases have developed in 61 patients (12.5%); 26 (5.3%) of them died with the disease. Local recurrences occurred in 29 patients (5.9%). For small recurrences reexcision, for the others mastectomy or/and radiotherapy was carried out. Critical evaluation of the local recurrences was done.


Subject(s)
Breast Neoplasms/surgery , Mastectomy, Segmental , Mastectomy, Simple , Adult , Aged , Breast Neoplasms/pathology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Reoperation
9.
Orv Hetil ; 134(4): 177-81, 1993 Jan 24.
Article in Hungarian | MEDLINE | ID: mdl-8423979

ABSTRACT

Authors review 43 cases of occult breast cancer selected from 6396 patients operated on for breast cancer in the National Institute of Oncology, Budapest over a 20-year period (1972-1991). In 20 patients mastectomy and axillary block dissection, in 9 upper-outer quadrant resection of the breast with axillary block dissection, in 12 only axillary block dissection, and in 2 axillary biopsy were carried out. The primary tumor was localized only in 11 patients during the first operation either by macroscopic or by microscopic examination. In 12 patients' breast the primary tumor became detectable only later. Out of the 20 mastectomy specimens, 2 primary tumors could not be identified even with the most thoroughful examination. Out of the breast conservation group in 4 patients, the primary tumor remained occult until recently, and in the axillary block dissection group (12 patients) the site of the primary cancer could be identified only in 2 patients. The authors deal with diagnostic difficulties and the dilemmas of the surgical indications and treatment.


Subject(s)
Breast Neoplasms/pathology , Lymphatic Metastasis/diagnosis , Adult , Biopsy , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Female , Humans , Lymph Node Excision , Lymphatic Metastasis/pathology , Middle Aged
12.
Acta Morphol Hung ; 38(1): 55-60, 1990.
Article in English | MEDLINE | ID: mdl-1708644

ABSTRACT

The case of a 27-year-old female patient presenting with a Wilms' tumour is reported. The tumour was dominantly of blastemal type showing minor epithelial (tubular) areas and anaplastic portions. Thorough immunohistochemical examinations were performed to solve differential diagnostic problems. Keratin positivity was found to be of differential diagnostic value in the distinction of this tumour from the so called small round cell tumours. Prognostic aspects of Wilms' tumour are also discussed.


Subject(s)
Kidney Neoplasms/pathology , Wilms Tumor/pathology , Adolescent , Female , Humans , Immunohistochemistry , Keratins/metabolism , Kidney/pathology , Kidney Neoplasms/metabolism , Wilms Tumor/metabolism
13.
J Surg Oncol ; 41(1): 19-21, 1989 May.
Article in English | MEDLINE | ID: mdl-2716330

ABSTRACT

Do age, associated diseases, general state, or the stage of tumor determine the operability of breast cancer in the elderly? Risk factors are studied on the basis of data on 465 patients over 70 years of age who had breast cancer surgery between 1977 and 1986. Operative mortality of patients is analyzed, and according to the results, the outcome of the surgery is mainly influenced by patients' performance status (Karnofsky/Zubrod index) and stage of disease and not by the associated diseases or patient age.


Subject(s)
Breast Neoplasms/surgery , Age Factors , Aged , Aged, 80 and over , Breast Neoplasms/mortality , Cardiovascular Diseases/complications , Female , Humans , Mastectomy, Modified Radical/mortality , Mastectomy, Simple/mortality
14.
Acta Chir Hung ; 29(3): 287-97, 1988.
Article in English | MEDLINE | ID: mdl-3239328

ABSTRACT

239 women with stage III carcinoma of the breast were treated by primary radiation therapy from 1977 to 1985. Of them 212 had an objective response and 27 showed no response to irradiation. From the objective responders, 105 patients were subjected to mastectomy and axillary dissection and in 107 cases the radiotherapy was not followed by surgery. Patients of operated group had a 71% and the RT alone group had a 61% local-regional tumor control at 5 years. The analysis of local-regional recurrences revealed that none of the operated patients had axillary recurrence but 8 had in the RT alone group. Postirradiation surgery is recommended for patients who have residual disease especially in the axillary region. The 5-year survival rate of operated patients was significantly better, 58% vs. 35%. However, these results are not comparable since the incidence of less favourable cases was higher in the RT alone group. Chemotherapy was initiated for the 27 patients who failed to respond to RT, but results were unsatisfactory. None of them survived three years. Further studies are needed to explore the role of chemotherapy in this stage of breast cancer.


Subject(s)
Breast Neoplasms/therapy , Adult , Aged , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Staging
17.
Acta Chir Hung ; 26(1): 19-26, 1985.
Article in English | MEDLINE | ID: mdl-4002967

ABSTRACT

Authors report on 25 patients treated for gastric cancers associated, synchronously or metachronously, with other malignant tumour. Hypotheses for the development of multiple malignant tumours are reviewed. They state that the prognosis of the second tumour is worse for its late detection and stress the importance of follow-up that also considers the possible development of a new tumour.


Subject(s)
Neoplasms, Multiple Primary , Stomach Neoplasms/complications , Adult , Aged , Breast Neoplasms/complications , Female , Head and Neck Neoplasms/complications , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Time Factors
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