József Eller

Benefits of Periodontal Therapy When Preterm Birth Threatens

There is growing evidence that chronic periodontitis may be a risk factor for pre-term birth. The goal of this intervention study was to determine the effect of periodontal treatment on the pregnancy outcome in women with threatening pre-term birth and initial localized chronic periodontitis. Forty-one women with a singleton pregnancy were enrolled in the study. For this treatment group, oral hygiene instruction and periodontal therapy were provided in the third trimester, while those in the control group (42 persons) did not receive any periodontal treatment. In the treatment group, the mean weight of newborns was 3079.0 g, compared with the control group mean of 2602.4 g. The incidence of pre-term birth and low birthweight in the treatment group was significantly less than in the control group (p = 0.015). Periodontal treatment completed before the 35th week appeared to have a beneficial effect on birth weight and time of delivery.

Bronchioloalveolar lung cancer: Occurrence, surgical treatment and survival

OBJECTIVE The prevalence of pulmonary adenocarcinoma has risen worldwide. Bronchioloalveolar carcinoma (BAC) was studied with regard to whether it exhibits a similar tendency, and its typical features were analysed. METHODS Between 1992 and 2001, 278 lung resections were carried out for adenocarcinoma. Of these, 67 (24.1%) proved to involve BAC. Whereas BAC accounted for 6.9% of the cases in 1992, in 2001 the proportion was 46.9%. There were 37 men (55.2%) and 30 women (44.7%); the average age was 60.5 years. 58.2% of them had no complaints. Of the 26 non-smokers, 69.2% were women; of the 41 smokers, 29.2% were women. In consequence of the tumour, 49 lobectomies, three bilobectomies, six pneumonectomies and nine wedge resections were performed. RESULTS The surgical mortality was 1.6%. The pathology revealed that 26 (38.8%) tumours were in stage I/A. In 15 cases (22.4%), tuberculosis (TB) could be revealed besides the BAC: by skin tests in four cases, by CT in three cases, by case history in four cases, and by pathology in four cases. For the overall group of 67 patients, the 5-year survival rate was 61.9%, and the mean survival time was 75.7 months. The 5-year survival rate among the women (74%) was significantly better than that among the men (37%) (P=0.030). There was no significant difference in survival with regard to the multiple BAC (85%). The 5-year survival rate was significantly worse in the mixed BAC group (20%) than in the non-mucinous (62.7%) and in mucinous (59%) group. The overall 5-year survival rate among the smokers and TB patients was 61 and 79%, respectively, which is higher than that among the non-smokers (47%) and non-TB patients (56%). The survival rate for the wedge resection cases was 37%, which was lower than that for the cases involving major resections (60%) (P=0.939). CONCLUSION BAC has a favourable survival, particularly in women. In spite of this, resection smaller than lobectomy is recommended only as a compromise. A multiple appearance does not imply a worse survival. The best survival rate was found in the non-mucinous BAC among the histological groups. TB seems to be frequent among BAC patients.

Prevention of preterm delivery with periodontal treatment

Objective: To demonstrate the role of periodontal treatment (PT) in the prevention of preterm delivery (PD). Methods: A comparative prospective study of two groups of pregnant women with threatening PD was carried out at the Department of Obstetrics and Gynaecology of the University of Szeged: group A (n = 39) comprised patients who were merely examined dentally for periodontitis, and group B (n = 44) consisted of patients who received periodontal treatment during pregnancy. Results: Periodontitis was identified in 19 cases (48.7%) in group A and in 18 cases (40.9%) in group B. The mean birth weight of the newborns was significantly higher in group B (3,009.1 g) than in group A (2,580.8 g; p = 0.007). The rate of premature birth was significantly lower in the group who received PT (p = 0.012, odds ratio = 3.5, 95% confidence interval = 1.38–8.86). Conclusions: The PT of pregnant women can decrease the rate of premature birth and consequently lead to a better neonatal health outcome.

Correlation of Treatment Time and Ultrafiltration Rate with Serum Albumin and C-Reactive Protein Levels in Patients with End-Stage Kidney Disease Receiving Chronic Maintenance Hemodialysis: A Cross-Sectional Study

Background: The relationship between treatment time, ultrafiltration rate (UFR) and inflammation has received limited exploration so far. Methods: This is a cross-sectional cohort study of 12 hemodialysis clinics. Statistical models explored the association of multiple patient- and dialysis-specific covariates with low albumin (≤40 g/l) or high C-reactive protein (CRP) (>5 mg/dl) and calculated the ORs and 95% CIs. Results: 616 patients with a mean age of 60.9 ± 14.4 years participated in our study. Mean treatment time was 237.3 ± 23.8 min and mean UFR was 7.0 ± 4.0 ml/kg/h. In stepwise logistic regression, treatment time >4 h reduced the risk of low albumin (OR 0.397, 95% CI 0.235–0.672, p < 0.001). Congestive heart failure (OR 1.634, 95% CI 1.154–2.312, p = 0.006) and acute infection (OR 1.799, 95% CI 1.059–3.056, p = 0.03) were significant correlates of the risk of high CRP. There was no association between UFR and either CRP or albumin. Conclusion: Treatment time had a significant cross-sectional association with serum albumin but not with CRP.

Birth prevalence of neural tube defects: A population-based study in South-Eastern Hungary

PurposePrimary prevention by periconceptional folic acid supplementation can significantly reduce the risk of neural tube defects. EUROCAT, the European network of population-based registries for the epidemiologic surveillance of congenital anomalies, lacks sufficient data on the birth prevalence of neural tube defects in Hungary before and after the promotion of primary prevention by folic acid. Our aims were to compare the birth prevalence of neural tube defects (myelomeningocele, anencephaly and encephalocele) over two 12-year periods in South-Eastern Hungary. Further aims were to compare our data to those ones in other areas in Europe.MethodsData were collected from the databases of the Department of Hungarian Congenital Abnormality Registry. The total and live birth prevalence rate of neural tube defects were calculated and compared over 1980–1991 and 1994–2005. In addition, the trends in the total birth prevalence, the number of live births and terminations for and stillbirths with neural tube defects were analysed throughout the period of 1994–2005.ResultsA significant decline was found in the total and live birth prevalence of myelomeningocele, anencephaly and encephalocele over 1994–2005 compared to the period of 1980–1991. The total birth prevalence of neural tube defects, however, showed a trend of increase after 1994, with declining number of live births and increasing number of terminations for neural tube defects.ConclusionPublic health measures are warranted in order to replace termination of pregnancy with primary prevention in South-Eastern Hungary.

Long-Term Efficiency and Toxicity of Adjuvant Dose-Dense Sequential Adriamycin-Paclitaxel-Cyclophosphamide Chemotherapy in High-Risk Breast Cancer

Objectives: To perform a protocol-specified analysis of the dose-dense adriamycin-paclitaxel-cyclophosphamide (ddATC) study. Methods: Survival and late toxicity were analyzed in 55 patients enrolled to receive 4 × adriamycin 60 mg/m2, 4 × paclitaxel 200 mg/m2, 4 × cyclophosphamide 800 mg/m2, every 2 weeks, with cardioxane and filgrastim support. Kaplan-Meier curves were used to analyze relapse-free survival (RFS), distant disease-free survival (DDFS), and overall survival (OS). Survival analyses were performed according to the presence of casting-type calcifications on the mammogram. Results: After a median follow-up time of 78.5 (64.3–100.0) months, 29 (52.7%) patients were free of relapse (local, regional, distant or contralateral breast cancer), 34 (61.8%) patients were free of distant metastases, and 36 patients (65.5%) survived. The median times of RFS, DDFS and OS were not yet reached at 100.0 months. The median RFS, DDFS and OS times among breast cancer patients with tumors not associated with casting-type calcifications were >100.0 months, the corresponding parameters among patients with tumors accompanied by casting calcifications were 11.5 (p < 0.001), 11.5 (p < 0.001) and 29.6 months (p = 0.035), respectively. None of the patients developed myelodysplastic syndrome or leukemia. No cardiac failure occurred during the follow-up period. Conclusions: Our results indicate that adjuvant sequential ddATC is an efficient and less toxic chemotherapy regimen in high-risk breast cancer. The presence of casting-type calcifications on the mammogram points to a special biologic nature with very poor prognosis.