[Surgery of peritoneal surface malignancies - surgical cytoreduction and hyperthermic intraperitoneal chemotherapy]. / A peritoneális felszín tumorainak sebészete ­ citoreduktív sebészet és hipertermiás intraperitoneális kemoterápia.

Peritoneal carcinosis has historically been considered as inoperable, although the technique of its resesection together with high dose intraperitoneal chemotherapy potentiated by heat has been described decades ago. It has not became a widely practiced routine except in specialized centers - the complex technique, weakly standardized but resource demanding chemotherapy, lacking financial background and the many times questionable clinical benefit at a cost of high surgical load might have been the key factors. Refined technology, developing chemotherapy protocols together with growing clinical evidence are now more sharply delineating the range of indications where the procedure might be beneficial, increases survival, or is the only curative therapy. These include tumors of the appendix and pseudomyxoma peritonei, mesothelioma, and selected cases of ovarian, colorectal and gastric cancer. In addition to technical description of the intervention, we summarize the currently valid indications and describe our institutional protocol for the treatment of appendiceal malignancies.

[The treatment of ovarian cancer. Recommendation of the Hungarian Society of Gynaecologic Oncologists]. / A petefészekrák kezelése. A Magyar Nogyógyász Onkológusok Társaságának (MNOT) ajánlása.

In Hungary, there is no actual ovarian cancer guideline, despite this disease being the most lethal gynaecologic cancer. An expert panel was created by the Hungarian Society of Gynaecologic Oncologists to prepare a recommendation for the reatment of ovarian cancer patients. This multidisciplinary expert group worked together during the first trimester of 2022 using the guidelines and recommendations of the European Society of Gynaecologic Oncologists (ESGO) and the European Society for Medical Oncology (ESMO) and created the updated recommendations. This paper presents the recommended surgical and medical treatment of early, advanced stage and recurrent ovarian cancer.

[Medical therapy of cervical cancer]. / A méhnyakrák gyógyszeres kezelése.

Early stage cervical cancer can be successfully treated with either surgery or radiotherapy, but medical therapy is inevitably necessary for the treatment of locally advanced and metastatic cases. Chemotherapy is routinely used to increase the efficacy of radiation therapy (chemoradiation) and in the palliative setting, but it has also been investigated as neoadjuvant and adjuvant therapy. Due to the limited efficacy of chemotherapies in cervical cancer and to the development of the oncological therapies, in the last decade many studies have been performed with novel agents. First the anti-VEGF antibody bevacizumab, later immunotherapeutic agents, lately an antibody drug conjugate have proven their efficiency and gained approval from the federal and European medical agencies. The aim of this paper is to give an overview of the medical therapies of cervical cancer (excluding chemoradiation), focusing on currently available modern treatment options and future possibilities.

[The effect of surgical treatment of bowel endometriosis on fertility]. / A bélendometriosis miatt végzett mutétek hatása a fertilitásra.

Introduction: Bowel endometriosis is when endometrial-like tissue penetrates the bowel serosa, or it reaches the subserous neurovascular plexus. The effect of surgery for colorectal endometriosis on infertility and pregnancy is not fully proven. Aim: The aim of the present study was to analyse the pregnancy outcome and mode of delivery of patients who underwent 'nerve sparing' anterior resection of the colon. Method: Between 2009 and 2017, we operated 121 patients with bowel endometriosis, and built up a prospective database where we assessed their wish of pregnancy, the way of the conception, pathologies during pregnancy and mode of delivery. Statistical analysis: The relationship between endometriosis and pregnancy pathologies was tested by a χ2 probe and Fisher's exact test, additionally the odds ratio (OR) and 95% confidence interval (CI) were determined. For p<0.05, the result was considered significant. Results: Out of 121 bowel endometriosis patients, 48 (39.6%) women got pregnant, 37 (30.5%) of them with in vitro fertilisation. The control group was built from patients who underwent in vitro fertilisation because of andrological factors. We found that women with endometriosis have a significantly higher risk for praeeclampsia (p = 0.023) and placenta praevia (p = 0.045) during pregnancy. Conclusions: Our study is a unique description of pregnancy outcome and mode of delivery after surgery for bowel endometriosis, which, despite the small number of cases, has yielded similar results to the previous multicentric studies. Orv Hetil. 2019; 160(41): 1633-1638.

Role of Apoptosis in the Development of Uterine Leiomyoma: Analysis of Expression Patterns of Bcl-2 and Bax in Human Leiomyoma Tissue With Clinical Correlations.

To describe gene expression patterns of the apoptotic regulatory genes Bcl and Bax in human uterine leiomyoma tissue. To investigate the relationship between alterations of gene expression patterns and several relevant clinical parameters. We obtained samples from 101 cases undergoing surgery for uterine leiomyoma for gene expression analysis of the Bcl-2 and Bax genes. Gene expression was quantified using RT-PCR technique. In the leiomyoma group, the Bcl-2 gene was significantly overexpressed compared with the control group although there was no such difference in the gene expression of Bax. Gene activity of Bcl-2 positively correlated with the tumor number in individual uterine leiomyoma cases. Although there was no significant correlation between the length of the cumulative lactation period before the development of uterine leiomyoma and Bcl-2 gene expression in the leiomyoma tissue, we observed a trend for a shorter cumulative lactation period to be associated with overexpression of the Bcl-2 gene. Overexpression of the antiapoptotic Bcl-2 gene appeared to be a factor in the development of uterine leiomyoma, whereas gene activity of the proapoptotic Bax gene did not seem to play a role in the process.

[Methods and conditions of fertility preservation in early-stage ovarian tumors]. / A fertilitás megtartásának lehetoségei, feltételei és módjai korai petefészek-daganatok esetén.

The aim of this study is to review the literature of fertility-sparing techniques and their safety in early-stage malignant ovarian tumors, especially in epithelial ovarian cancer. Fertility preservation is widely accepted in early-stage borderline, germ cell and sex cord-stromal tumors. Based on data from retrospective studies, fertility-sparing surgery in epithelial ovarian cancer can be recommended in stage IA, grade 1-2 and favorable hystologic type ovarian cancer. Above stage IA, or in grade 3, or in clear-cell tumors decision making process about fertility-sparing surgery should be individual. Correct surgical staging is mandatory and oncologic safety should be of primary importance. In the group of carefully selected patients oncological outcomes are identical to those of radical surgery. Spontaneous pregnancy rates vary, but they are generally high. Adequate counseling with patients, detailed documentation and careful follow-up is of outstanding importance. In order to improve the quality of fertility preservation techniques, establishment of treatment centers is recommended.

[Giant uterine leiomyoma causing acute symptoms]. / Akut tüneteket okozó óriásmyoma.

The case history of a 71-year-old woman with acute dyspnoea caused by a giant leiomyoma and severe acute anemia due to intratumoral hemorrhage is presented. Urgent operation was performed, and a 13.5 kg pendular tumor was removed. The cornerstones of the differential diagnoses and therapy of giant abdominal tumors is discussed.

[Clinical-genetic care of BRCA-mutation carrier women: prevention, diagnosis and therapy]. / A BRCA-génmutációt hordozó nok klinikogenetikai ellátása: szurés, diagnosztika, terápia.

Predictive genetics opens a considerable perspective in the diagnostics as well as the treatment of breast and ovarian cancer. Current recommendations and guidelines for the management of BRCA 1 and BRCA 2 mutation carriers are not based on controlled randomized trials, but on expert opinions. The existing options of prevention, early diagnosis and treatment must be clearly interpreted to the patient. In the context of a dedicated genetic counseling the participation of all involved professionals (geneticist, oncologist, surgeon, gynecologist) is required. The decision-making process concerning the possibilities of prevention, diagnosis and treatment is always deeply influenced by the patient's own experience with the cancer occurred in the family, as well as by her values and expectations of life. The focused multidisciplinary approach, with the application of results from prospective studies in cohorts of BRCA mutation carriers allow the concerned individuals to benefit from this kind of approach of medical treatment.

[Risk assessment in familial breast cancer]. / Az ismétlodési kockázat becslése családi halmozódást mutató emlorák esetén.

Women with a history of breast cancer are common at centers for cancer genetic risk all over Europe. Given limited health care resources, managing this demand, while achieving good value for money coming from health services, is generally a major challenge. This paper recapitulates and summarizes the available methods of the risk assessment of familial breast cancer. After a systematic review of the literature Gail-model, Claus-model and BOADICEA-model were selected, as well as softwares (LINKAGE software; MENDEL v3.3 software) available in the application of these algorhythms are also summarized. Comparisons were made between the models concerning their advantages and disadvantages. The really reliable methods of risk estimation of familial breast cancer are always based on the analysis of the pedigree structure and allow the estimation of the patient's probability of carrying a susceptibility gene under a particular genetic model, given her family history. For this method the knowledge of BRCA mutation status is absolutely indispensable. The methods of BRCA mutation analysis as well as the main characteristics of the occurrence of BRCA mutation carrier condition are discussed in details.

Chlamydia prevalence and correlates among female adolescents in Hungary.

PURPOSE: To evaluate the prevalence and the behavioral and historical determinants of genital chlamydial infection among adolescent females in Hungary. METHODS: A total of 214 consecutive, unselected, self-referred, sexually active, nonpregnant female individuals aged 16-20 years were evaluated by polymerase chain reaction through the use of questionnaires. RESULTS: The prevalence of chlamydial infection within this population was 7.9%. We find that the most important correlates of chlamydial infection were at least three lifetime sexual partners (p < .005), two or more sexual partners in the preceding 3 months (p < .05), and symptoms of vaginitis (p = .002). CONCLUSIONS: The high prevalence of chlamydia in this study population may justify universal testing in Hungary.

[Radical vulvectomy to treat severe vulvar acne inversa]. / Szeméremtesten megjelenõ acne inversa sikeres kezelése radikális vulvectomia útján.

UNLABELLED: A rare case, when radical vulvectomy had to be done to treat a benign skin disorder is presented. PATIENT AND METHOD: A 56-year-old white woman suffered from severe vulvar acne inversa. The systemic treatments, the incisions and drainages were not successful. The only solution was the radical excision of the seriously damaged vulva, with a satisfactory cosmetic and functional result. The pathology, the diagnosis and the treatment of the disease are also discussed. CONCLUSION: The authors put emphasis on the importance of the interdisciplinary collaboration.