[Esophageal endoprosthesis by laparo-gastroscopy with transtumoral approach in advanced esophageal and esophagogastric cancer]. / Endoprotezarea esofagiana laparo-gastroscopica prin foraj transtumoral in neoplasmele esofagiene si esogastrice depasite.

INTRODUCTION: Romania is part of the countries with low incidence of esophagus cancer (the mortality rate M/W at 100,000 peoples being 1.6/0.3), but the diagnosis of the disease, is most frequently incidental in stages that make any intention of radical treatment a desideratum frequently unattainable. MATERIAL AND METHOD: In the impossibillity of curative treatment we realised laparoscopic procedure of esophageal prosthesis (through traction not through pushing as in endoscopic procedures) at 60 patients with esophageal and esogastric cancer in advanced stages (distance metastasis, almost non-existing lumen, emaciation, severe decline of general state). The originality of the laparogastroscopic method has been international recognized. RESULTS AND DISCUSSIONS: This minimally invasive prosthetic original method presumes minimal agression, gastroscopic approach, the insertion of the prosthesis is made through traction not through pushing (transtumoral drilling, compresive and styptic insertion, etc.). The patient can eat at 8-12 hours after operation and the contact with the hospital is shorter, the hospitalization period was between 3 and 7 days. We had survivals between 5 months and 4 years. CONCLUSION: The method that we propose is simple and efficient is a solution for repairing the endoscopic failure, is an alternative for the crippling gastrostomy, or, for the cases when the preoperative most optimistic estimations might comply a sick person and unbalanced immunological, nutritional and psychological, to an intervention to vast in scope (anaesthetic and surgical), compared to the final solution, palliative, in fact.

The Hungarian periconceptional service as a model for community genetics.

OBJECTIVES: This review describes the methods and results of the Hungarian periconceptional service consisting of counselling, examinations and medical interventions. (The term periconceptional is used instead of preconceptional because the early postconceptional period is also involved to this service.) METHODS: The service was based on three steps: check-up examination of reproductive health (i.e., preconceptional screenings), a 3-month preparation for conception, dispensed and/or supervised by qualified nurses, and a better protection in early pregnancy for the most sensitive early development of the embryo for voluntary and eligible couples. RESULTS: Experiences from the coordinating centre of the Hungarian periconceptional service are summarized between February 1, 1984, and January 31, 1999, thus 15 years. Participants with positive family histories, case histories and subjects with genito-urinary infections had a more effective flow towards secondary care. Infertile couples were diagnosed and treated sooner. The periconceptional service is effective for the introduction of periconceptional folic acid-containing multivitamin supplementation and for the reduction of smoking and alcohol consumption in females in the preconceptional period. The rate of major congenital abnormalities (20.6 per 1,000) was significantly lower than expected. CONCLUSIONS: The periconceptional service is feasible and has many benefits. Thus, proper preparation for conception is the earliest and probably the most important effort to prevent genetic diseases.

[Peri-conceptional multivitamin administration may result in higher frequency of twin pregnancies]. / Multivitamin periconceptionalis adását követóen észlelt nagyobb ikergyakoriság.

A randomized controlled trial of periconceptional multivitamin supplementation including 0.8 mg folic acid was carried out for at least 28 days before conception. The trial was continued until at least until the second missed menstrual period to test the effectiveness of this new primary preventive method in the reduction of neural tube defects. However, other pregnancy outcomes were also evaluated. Of total of 5,502 pregnant women, 4,846 births were analysed in the final data base. The rate of multiple births was significantly higher in the multivitamin group (3.8%) than in the placebo-like trace-element control group (2.7%), and in both groups exceeded the multiple birth rate of 2.2% of women in the Hungarian population at large. 7.3% of women in the multivitamin and 7.9% of women in the trace-element groups received ovarian stimulation treatment (mainly clomiphen) for hormonal dysfunctions, e.g. anovulation. Nonetheless, our study showed that periconceptional multivitamin supplementation, with or without stimulation, increases the rate of multiple births.

The effect of preconceptional multivitamin supplementation on fertility.

A significantly higher rate of conceptions occurred after preconceptional multivitamin supplementation in comparison with a placebo-like trace element supplementation in the Hungarian randomised, double-blind, controlled trial. This difference was explained by 5% shorter time in the achievement of conception.

Efficient Nondestructive Sampler for Carcasses and Other Surfaces.

Two versions of an electrically powered device (Rotorinser) to sample carcasses or other surfaces in situ for microbiological analysis and several different sampling protocols were evaluated against excision plus stomaching for ability to remove bacteria from pig skin and beef carcass tissue. Both devices sampled circular areas of approximately 14 cm2. Ten tissue samples were used for each set of conditions. Rotorinser bacterial removal efficiency was calculated as R/(R + S), where R is the Rotorinser count (CFU cm-2) and S is the count on stomached excised tissue after rotorinsing. Stomacher efficiencies were calculated as S1/(S1 + S2), where S1 is the first stomacher count of excised tissue and S2 is the count from a second stomaching. Both Rotorinsers were much better than traditional swabs. Rotorinser 1 gave removal efficiencies of 0.79 to 0.88 for beef, and 0.79 to 0.95 for pork. Prewetting surfaces for 5 min improved removal, but mixtures of enzymes did not. Rotorinser 2 applied with NaCl or NaCl-Tween 80 diluent for either 30 or 60 s was significantly better (0.93 and 0.98) than the stomacher (0.86) at removing aerobic mesophilic bacteria from pork skin. The Rotorinser causes negligible tissue damage and can be used on surfaces at any angle.

The effect of preconceptional multivitamin supplementation on the menstrual cycle.

The database of the Hungarian randomised controlled trial of periconceptional multivitamin supplementation for the prevention of neural-tube defects was used to evaluate the length of the pre- and postovulatory phases of the menstrual cycle before and during multivitamin supplementation. The female cycle was more regular (i.e., the variance was lower) during the multivitamin supplementation.

[Prevention of the first occurrence of anencephaly and spina bifida with periconceptional multivitamin supplementation (conclusion)]. / Az anencephalia--spina bifida elsö elöfordulásának megelözése multivitamin periconceptionális adásával (záró értékelés).

The risk of recurrent neural-tube defect was decreased in women who took folic acid or multivitamin containing folic acid during the periconceptional period. The extent to which such supplementation can reduce the first occurrence of defects is not known. A randomized, controlled trial of periconcepctional multivitamin supplementation to test the efficacy of this treatment in reducing the incidence of a first occurrence of neural-tube defects was conducted. Women planning a pregnancy (in most cases their first) were randomly assigned to receive a single tablet of a multivitamin supplement (containing 12 vitamins, including 0.8 mg of folic acid; 4 minerals; and 3 trace elements) or a trace-element supplement (containing copper, manganese, zinc, and a very low dose of vitamin C) daily for at least one month before conception and until the date of the second missed menstrual period or later. Pregnancy was confirmed in 5502 women. The outcomes of the informative offspring (whether the fetus or infant had a neural-tube defect or other congenital abnormality) was known in 2471 women who received the multivitamin supplement and in 2391 who received the trace-element supplement. There were six offspring of neural-tube defects in the group receiving the trace-element supplement, as compared with none in the multivitamin-supplement group (p = 0.0014). Congenital abnormalities were significantly more prevalent in the group receiving the trace-element supplement than in the multivitamin-supplement group (2.22 per 1009 vs 1.25 per 1009, p = 0.002).

Pregnancy outcomes in a randomised controlled trial of periconceptional multivitamin supplementation. Final report.

The effect of periconceptional multivitamin/trace element supplementation on pregnancy outcomes was evaluated in a randomised controlled trial. The final data-base included 5,502 females with confirmed pregnancy. A multivitamin including 0.8 mg folic acid or a trace element were supplemented for at least 28 days before conception and continuing for at least until the second missed menstrual period. Number of pregnancies, terminations of pregnancies, four types of fetal deaths, livebirths including low birth weight, preterm birth and sex ratio were analysed. Periconceptional multivitamin supplementation increased fertility (higher rates of cumulative conceptions and multiple births), had no significant effect on the rate of different groups of fetal deaths, low birth weight and preterm birth in singletons. This primary preventive method can reduce the occurrence and recurrence of neural-tube defects and had no other significant effect on pregnancy outcomes except multiple births.

The higher rate of multiple births after periconceptional multivitamin supplementation: an analysis of causes.

A randomized controlled trial of periconceptional multivitamin supplementation (including 0.8 mg folic acid--see the Materials and Methods section for the precise composition of the multivitamin and trace-element supplementation) was carried out for at least 28 days before conception. The trial was continued until at least until the second missed menstrual period to test the effectiveness of this new primary preventive method in the reduction of neural tube defects. However, other pregnancy outcomes were also evaluated. Of a total of 5,502 pregnant women, 4,846 births were analysed in the final data base. The rate of multiple births was significantly higher in the multivitamin group (3.8%) than in the placebo-like trace-element control group (2.7%), and in both groups exceeded the multiple birth rate of 2.2% in the Hungarian population at large. 7.3% of women in the multivitamin and 7.9% of women in the trace-element groups had received ovarian stimulation treatment (mainly clomiphene) for hormonal dysfunctions, eg. anovulation. Nonetheless, our study showed that periconceptional multivitamin supplementation, with or without ovarian stimulation, increases the rate of multiple births.

Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation.

BACKGROUND: The risk of recurrent neural-tube defects is decreased in women who take folic acid or multivitamins containing such during the periconceptional period. The extent to which folic acid supplementation can reduce the first occurrence of defects is not known. METHODS: We conducted a randomized, controlled trial of periconceptional multivitamin supplementation to test the efficacy of this treatment in reducing the incidence of a first occurrence of neural-tube defects. Women planning a pregnancy (in most cases their first) were randomly assigned to receive a single tablet of a vitamin supplement (containing 12 vitamins, including 0.8 mg of folic acid; 4 minerals; and 3 trace elements) or a trace-element supplement (containing copper, manganese, zinc, and a very low dose of vitamin C) daily for at least one month before conception and until the date of the second missed menstrual period or later. RESULTS: Pregnancy was confirmed in 4753 women. The outcome of the pregnancy (whether the fetus or infant had a neural-tube defect or congenital malformation) was known in 2104 women who received the vitamin supplement and in 2052 who received the trace-element supplement. Congenital malformations were significantly more prevalent in the group receiving the trace-element supplement than in the vitamin-supplement group (22.9 per 1000 vs. 13.3 per 1000, P = 0.02). There were six cases of neural-tube defects in the group receiving the trace-element supplement, as compared with none in the vitamin-supplement group (P = 0.029). The prevalence of cleft lip with or without cleft palate was not reduced by periconceptional vitamin supplementation. CONCLUSIONS: Periconceptional vitamin use decreases the incidence of a first occurrence of neural-tube defects.

Maternal weight gain and birth weight.

The data of first 1000 non-malformed, mature (greater than or equal to 2500 g) singletons of participants in the Hungarian Family Planning Programme were evaluated. The mean maternal weight gain during pregnancy was 13 kg which was modified by the body weight of women. Maternal weight gain exceeded 13 kg in 54% of pregnant women. There was a positive correlation between maternal weight gain and birth weight which was calculated as 26.6 g/kg.

[Relationship between weight increase during pregnancy and weight of the newborn]. / A terhesség alatti testsúlynövekedés és kapcsolata az újszülött súlyával.

The data of first 1000 first-born, non-malformed, mature (greater than or equal to 2500 g) offspring of participants in the Hungarian "Optimal" Family Planning Programme were evaluated. The mean maternal weight gain during pregnancy was 13 kg which was modified by the body weight of women. Maternal weight gain exceeded 13 kg in 54% of pregnant women. There was an obvious positive correlation between maternal weight gain and birth weight which was calculated as 26.6 g/kg.

The check-up of reproductive health and genetic counseling.

The Hungarian Family Planning Program was a feasibility study on combining methods of periconceptional care. The first step was the check-up of reproductive health, including family history of the couples, case history of females, pre-pregnancy examination (vaginal and cervical smears), and the measurement of basal body temperature, sperm examination, psycho-sexual exploration and exclusion of some risk factors. This preconception screening program was carried out by graduate trainee nurses to identify those participants secondary health services. The data of 4,240 couples attending in the Budapest Center indicated a useful relationship between the check-up of reproductive health and genetic counseling clinics, by selecting couples requiring genetic counseling and preventing other couples making unnecessary visits.

[Family planning counseling after extrauterine pregnancy]. / Családtervezési tanácsadás méhenkívüli terhességet követöen.

In the past 30 years the Hungarian incidence of ectopic pregnancies decreased after the maximum in 1961 till the minimum in 1974, however, there was a slight increase after this. The proportion of maternal mortality due to ectopic pregnancies was 8 per cent in 1970-1986. The recurrence risk of ectopic pregnancy is about 12 per cent and about one-third of these women will be infertile. Thus, the appropriate family planning counselling is an important medical task after ectopic pregnancy.