Zoltán Langmár

Possible association of folic acid supplementation during pregnancy with reduction of preterm birth: a population-based study.

OBJECTIVE Periconceptional folic acid or multivitamin supplementation is recommended for prospective pregnant women to prevent neural-tube defects. The question is whether it is worth continuing these supplementations after the first trimester of pregnancy or not. Thus the possible fetal growth promoting and/or preterm birth reducing effect of vitamin supplements in the second and mainly in the third trimester was studied. STUDY DESIGN Comparison of birth outcomes of singletons born to primiparous pregnant women with prospectively and medically recorded vitamin supplement in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980-1996 contained 6293, 169, and 311 primiparae with folic acid alone, multivitamins and folic acid+multivitamin supplementation, respectively, and their data were compared to the data of 7319 pregnant women without folic acid and folic acid-containing multivitamin supplementation as reference. RESULTS Mean gestational age was 0.3 week longer and mean birth weight was by 37 g higher in the group of folic acid alone, than in the reference group (39.2 weeks; 3216 g). The rate of preterm births (7.6%) was significantly lower compared with the reference sample (11.8%), but the rate of low birth weight newborns did not show significant reduction. Folic acid alone in the third trimester associated with 0.6 week longer gestational age and a more significant reduction in the rate of preterm births (4.8%). CONCLUSIONS Minor increase in mean birth weight after high dose of folic acid supplementation during pregnancy would not be expected to result in too large babies; however, the significant reduction in the rate of preterm births may have great public health benefit.

Women’s knowledge about cervical cancer

The human papillomavirus-infection is one of the most frequent sexually transmitted disease; it is detectable in nearly all cases of cervical cancer. Nowadays, the incidence of cervical cancer is unacceptable high. Aim: Our aim was to evaluate women’s knowledge about the human papillomaviruses and cervical cancer. We tried to determine the possible connection between the higher mortality rates, the low participation rate of screenings and the knowledge about cervical cancer. Methods: The related questionnaire contained 18 questions and was fi lled in by 422 women in certain cities and villages. The completed questionnaires were classifi ed by age, place of residence, qualifi cation, children in family, and human papillomavirus vaccination in anamnesis. Results: The results showed that almost half of the women had a basic knowledge, but the number of correct answers to functional questions (e.g. „How can one decrease the risk of infection?”) were less than it was expected according to the international literature. 56% of the women knew that the cervical cancer mainly caused by viruses, but only 17% of them named the right combination of the risk factors. The rate of correct answers was much lower in high school circles and 42% of the women knew that males can be infected by human papillomaviruses. Only 44% of them participate on cervical cancer screening once a year and 43% of them thought that cervical cancer and precancerous lesions do not mean serious risk and danger. 80% of the women knew that screening involves smear taking. The signifi cance of knowledge level differences between groups was estimated by χ²-probe. Conclusions: On the basis of the results, half of the women said to be familiar with the basic questions. In our opinion, it can be a benefi cial consequence of educational campaigns. Although there were several issues, which were implemented by not more than 20% of correct answers.

Connections between apolipoprotein E genotypes and the development of cardiovascular diseases

Elevated plasma lipid level is one of the main risk factors for cardiovascular diseases, which are considered to be primary causes of death. Apolipoprotein E plays a part in the lipid transport in the blood, thus polimophisms of that affect the lipid composition of the plasma. The three most common alleles of apolipoprotein E are e2, e3, e4. Out of the two non-wild type alleles, the e2 and e4, the latter was shown to play a role in the development of cardiovascular diseases and Alzheimers disease. Some studies mention the e2/e2 homozygote genotype as one of the causes of hyperlipoproteinemia type III. Besides lipid metabolism, apolipoprotein E also influences the manifestation of cardiovascular diseases through other biochemical pathways, therefore it is essential to explore the molecular background of these metabolic pathways.

The potential role of heat shock proteins in the treatment of ovarian cancer

Ovarian carcinoma has the highest mortality among gynecologic cancers. Most of the patients are sensitive to the first-line platinum-based combined chemotherapy and they will present a complete response, but most of them will relapse within 24 months. The resistance to chemotherapy is a great therapeutic challenge. Recent figures show that heat shock proteins play a significant role in certain mechanisms of carcinogenesis and are involved in the resistance to anticancer drug therapy. Our paper gives a summary of recent data concerning heat shock proteins in ovarian carcinoma.

Management of hereditary ovarian cancer

Mutations in BRCA1 and BRCA2 genes account for the majority of hereditary breast and ovarian cancers. Approximately 10% of cases of ovarian cancer are due to germline mutations in BRCA1 and BRCA2. Ovarian cancer associated with BRCA1 and BRCA2 mutations has a distinct histological phenotype. This type of cancer is predominantly of serous or endometrioid histology and is high grade. Patients with BRCA1 or BRCA2 mutations should be offered risk-reducing salpingo-oophorectomy by age 40 years, or when childbearing is complete. Nowadays there are no differences between the treatments provided for sporadic and hereditary ovarian cancer, although there are indications that targeted therapy is effective in women with BRCA1/BRCA2-associated tumors. Retrospective studies reveal a high level of sensitivity to platinum agents in BRCA-associated tumors and initial trials show good efficacy and tolerability for polyADP-ribose polymerase inhibitors in mutation carriers with advanced ovarian cancers. These agents might also potentially be used in chemoprevention. Authors review the current management of hereditary ovarian cancer.

Simultaneous bilateral occurrence of a mixed mesodermal tumor and cystadenocarcinoma in the ovary.

The mixed mesodermal tumor is a very uncommon malignancy. The aggressiveness of this lesion is illustrated by extremely poor prospects for afflicted patients: postoperative survival is usually shorter than 24 months. According to the literature, malignant mixed tumor of the ovary is rather rare and its occurrence with other malignancy is exceptional. We report here a case of a 62-years old woman with serous cystadenocarcinoma in the right ovary and a heterologous malignant mixed mesodermal tumor in the left one. Both tumors expressed cytokeratins, while only the mesodermal tumor expressed S-100 and focal NSE.(Pathology Oncology Research Vol 10, No 2, 117–120)

The role of homocysteine and methylenetetrahydrofolate reductase, methionine synthase, methionine synthase reductase polymorphisms in the development of cardiovascular diseases and hypertension

Cardiovascular diseases (CVDs) are the leading causes of death in the developed countries. Elevated homocysteine level is as an independent risk factor of CVDs. The C677T and A1298C variants of methylenetetrahydrofolate reductase gene (MTHFR) have been shown to influence folate and homocysteine metabolisms. However, the relationship between MTHFR polymorphisms and hyperhomocysteinemia has not been well established yet. The gene variants were also reported to be associated with CVDs. In addition, the C677T polymorphisms may play a role in the development of hypertension. Recent research evidence has suggested that MTHFR variants might be independently linked to CVDs and hypertension, because of the involvement of the MTHFR enzyme product (5-methyl-tetrahydrofolate /5-MTHF) in the regulation of endothelial functions. Further research is required to investigate the association between gene polymorphisms of folate-metabolizing enzymes and CVDs, and to identify the possible role of the relevant gene variants in the molecular pathogenesis of hyperhomocysteinemia.

Multidisciplinary treatment of intra-thoracic desmoid tumors: Case series and narrative review

Summary Background Primary intra-thoracic desmoids are exceedingly rare borderline tumors, with 34 reported cases in the English-language literature. The characteristic localized infiltrative growth and the high rate of recurrence can result in life-threatening conditions. Radical surgical resection is considered to be the primary treatment. Achieving negative surgical margins is a challenge. Cases with positive surgical margins are associated with a high rate of local recurrence; therefore, other multimodal approaches play a large role in their therapy. Case Reports The authors reviewed the relevant literature and presented examples of long-term follow-up of 3 intra-thoracic desmoid tumour patients, multidisciplinarily treated between 2000 and 2008. All reports of intra-thoracic desmoid tumors that the authors could find on PubMed or in the reference sections of these PubMed located articles were included using the search terms: intra-thoracic, desmoid, aggressive fibromatoses. Conclusions Because of the rarity of the disease and the heterogeneity of the cases, it is difficult to assess the importance of the information for everyday clinical practice. It does however provide a useful guide for reference.

Relations between anthropometric parameters and sexual activity of Hungarian men

In the last decades, there were visible achievements in the evaluation of sexuality-related problems and issues regarding sexual life. However, there are limited reliable and comparable data on the average values of sexual activity and its relation to anthropometric parameters in different populations and age cohorts. This study tries to examine the association between anthropometric parameters and male sexual activity. A clinical population of 1146 male patients between 25 and 45 years of age attending an outpatient clinic of andrology in Budapest (Hungary) was examined and questioned in a medical setting. Age, body height, weight, body mass index (BMI) and self-reported sexual activity were the main outcome measures. The patients were allotted into age groups (25–29, 30–39 and 40–45 years), the youngest group showing the highest coital activity. Although obesity and overweight were present in 61% of the study population, no connections between BMI and sexual activity were apparent. Comparing less active persons with those reporting at least two intercourses per week, significant difference was found between body height groups. Men below 170 cm reported higher activity than men over 180 cm. Despite the fact that the prevalence of obesity among younger generations is increasing, it has had no visible influence on the sexual activity of this age cohort as yet. Our data suggest that sexual activity was not clearly related to other anthropometric parameters, and depends mainly on the characteristics of the population examined. There is a great need for large-scale studies worldwide on larger representative samples, using similar methods, to acquire reliable data from other nations and different age groups.

Successful operative management of an intact second trimester abdominal pregnancy with additional preoperative selective catheter embolization and postoperative methotrexate therapy

Summary Background Abdominal pregnancy is a rare condition that may lead to severe complications. Case Report The authors report the case of a 17-week intact abdominal pregnancy diagnosed in the course of an investigation of lower abdominal pain. Ultrasonography and MR examination revealed an intact abdominal pregnancy. Subsequent angiography was performed to occlude the supportive artery of the pregnancy by selective embolization. The pregnancy was terminated safely by laparotomy a day later. The placenta was left in the abdominal cavity because of the high risk of massive and often uncontrollable bleeding, and treatment with methotrexate was applied postoperatively. Conclusions Preoperative embolization and the postoperative methotrexate therapy facilitate the safe surgical treatment of abdominal pregnancy.