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G Lukács

Publications and source records attributed to G Lukács.

At least 19 recordsLinked to original sources
PubMed2006

Renal artery aneurysm at the anastomosis after kidney transplantation.

Vascular complications represent serious problems after kidney transplantation. An aneurysm of the transplanted renal artery is an extremely rare but potentially devastating complication that which occurs in fewer than 1% of recipients. It can cause hypertension, functional impairment, and even graft loss. A 49-year-old man was admitted 6 months after his second renal transplantation. Duplex ultrasonography demonstrated an aneurysm at the anastomosis of the transplanted renal artery. The patient has not had any complaints. The function of the graft was stable. A computed tomography scan confirmed the diagnosis. Because of the high risk of rupture we decided upon surgical repair. During the operation, blood flow to the kidney was occluded; the graft was cooled with Euro-Collin's solution and ice-cold saline. After the resection there was enough usable arterial wall to construct a new anastomosis. The patient had an uneventful postoperative period, the serum creatinine decreased to the preoperative level, and the function of the graft was stable. Renal artery aneurysms represent high-risk complications. We decided on surgical repair, which was performed with simultaneous perfusion and cooling of the graft. There are only a few similar cases in the literature; it was the first operation using this method in our practice. Surgical reconstruction of a renal artery aneurysm, if feasible, is a safe procedure that prevents aneurysm rupture and saves the graft.

Anastomosis, Surgical↗
PubMed2003

Comparison of calcium and alfacalcidol supplement in the prevention of osteopenia after kidney transplantation.

The aim of this observational study was to compare the effect of calcium and alfacalcidol supplementation on the regression of hyperparathyroidism and on prevention of osteopenia in patients up to 3 years after renal transplantation. Two historical cohorts were compared for that purpose. One hundred and fifty-nine patients received calcium carbonate supplement (group 1), while 81 patients were treated with alfacalcidol (group 2). Serum Ca, phosphate (P), Mg, creatinine, alkaline phosphatase (AP) and parathyroid hormone (PTH) levels were determined before and after transplantation in the two groups, for 3 years. Femoral neck and lumbar spine bone mineral density (BMD) was measured only at 3 and 6 months and 1, 2 and 3 years after transplantation. At baseline there was no difference in age or sex ratio, but prevalence in post-menopausal women was higher in group 1 (6.9% versus 1.2%). Duration on dialysis was comparable but prevalence of interstitial and undetermined nephropathies was higher in group 1. Baseline serum concentrations of PTH, Ca and P were comparable in both groups. After transplantation, plasma creatinine decreased to comparable levels in both groups. Immunosuppression by triple therapy was more prevalent in group 2, so that cumulative dose of steroid was higher in group 1, especially at 1 month because of higher incidence of acute rejections (51% versus 13%). Mean intact PTH levels decreased in both groups, from 18 pmol/l to 8.4 and 7.9 at 3 years, but the decrease was significantly greater with alfacalcidol at 6 and 12 months. At 3 months, BMD were comparable at both sites. From 3 months to 3 years after kidney transplantation, mean lumbar spine BMD significantly increased from 0.963 to 1.054 g/cm(2) in group 1, whereas there was no significant decrease (1.048 to 1.006 g/cm(2)) in group 2, the difference in changes being significant ( P<0.05). Femoral neck BMD was not significantly increased in either group (0.932 to 0.993 g/cm(2) in group 1, and 0.850 to 0.907 g/cm(2) in group 2). Expressed as percentages, these changes were +9.4% and -4% for lumbar BMD and +6.5% and +6.7% for femoral neck, for groups 1 and 2, respectively. Prevalence of osteopenia was not significantly lower at 3 years in group 1 (45% and 51%) than in group 2. During the follow-up period, osteonecrosis was diagnosed in six patients (3.8%) in group 1 and in nine (11%) in group 2. In conclusion, alfacalcidol compared to CaCO3 supplement suppressed hyperparathyroidism more rapidly and strongly. In spite of higher osteopenia risk in the CaCO3 group, lumbar BMD increase was greater and incidence of osteonecrosis higher in this group, suggesting better bone protection with CaCO3 than with alfacalcidol.

Adjuvants, Immunologic↗
PubMed2002

Flow cytometric DNA analysis of benign hyperfunctioning parathyroid glands: significant difference in the S phase fraction and proliferative index between adenomas and hyperplasias.

AIMS: Flow cytometric DNA analysis was performed to measure the DNA content of benign parathyroid tumours in patients with primary hyperparathyroidism. METHODS: DNA analysis of paraffin-embedded parathyroid samples was performed on 51 parathyroid glands from 29 patients after parathyroidectomy. Histopathology showed parathyroid adenoma in 25 cases and hyperplasia in four patients. DNA ploidy status, DNA index (DI), percentage of cells in S phase and proliferative index (PI) were determined. RESULTS: Normal cells from normal glands were all diploid. DNA cytometry showed 12 aneuploid and 13 diploid adenomas. There were 12 diploid and four aneuploid hyperplastic glands. Incidence of aneuploid DNA histograms did not show a statistically significant difference between adenomas and hyperplasias (P=0.216). Mean S phase fraction was 3.45% in adenomas and 1.53% in hyperplasias (P= 0.015). Mean PI was 6.48% in adenomas and 2.78% in hyperplastic parathyroid glands. This difference was statistically significant (P=0.006). Diploid cases had a mean PI of 4.78% and aneuploid glands a mean PI of 7.7% (P=0.08). Aneuploid DNA content did not reveal statistically significant correlation with age, gender, pre-operative Ca, alkaline phosphatase, i-PTH levels, and tumour size. The mean S phase fraction and PI were 2.25% and 4.78% in diploid glands, and 4.5% and 7.7% in aneuploid cases. CONCLUSION: Aneuploid DNA content may be present in benign parathyroid diseases, but not in normal parathyroid glands. Aneuploid DNA histograms and higher PI occur more often in adenomas compared with hyperplasias, but the nuclear DNA analysis is unable to make a distinction between adenomas and hyperplasias.

Adenoma↗
PubMed2001

Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localization in primary hyperparathyroidism.

A prospective study was performed to evaluate the efficacy of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scanning and US for imaging parathyroid glands in primary hyperparathyroidism. Sixty-three patients were surgically treated for primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were performed in all cases. Bilateral neck exploration was carried out on each patient. Results of radionuclide studies and US were compared with surgical and histological findings. In 57 patients with primary HPT the radionuclide scanning gave true-positive results. Four false-negative and two false-positive scintigrams were obtained. The sensitivity and the positive predictive value (PPV) of scintigraphy were 93 and 97%, respectively. Forty-one cases were correctly localized by the US. Seventeen US results were false negative and five were false positive. The sensitivity and the PPV for US were 71 and 89%, respectively. There was a statistically significant difference between the sensitivity of the scintigraphy compared with the US ( p=0.001). Sensitivities of radionuclide scans and US were higher for adenomas (100 and 83%) than for hyperplastic glands (75 and 40%). The sensitivity of technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction scintigraphy was significantly higher compared with US. This sensitive method could help surgeons in performing a rapid and directed parathyroidectomy.

Adenoma↗
PubMed2001

[The role of MIBI scintigraphy in the early detection of breast cancer].

The authors investigate the role of MIBI scintigraphy in the early diagnosis of breast cancer. The importance of early diagnosis is emphasized by the fact that breast cancer has the highest morbidity and mortality preceding cervical carcinoma amongst women. Retrospective examinations were made in case of 42 patients operated before because of breast cancer in order to examine accuracy of both mammography and scintigraphy in comparison with the results of histological diagnosis. In these cases sensitivity of scintigraphy turned out to be 69%, while its specificity 42%. In cases of mammographical investigations the sensitivity proved to be 74% and specificity was 61%. Besides mammography, scintigraphy has a very important additional role in the diagnosis of breast cancer. Because of its results and costs scintigraphy is not able to take over the mammography's dominant position (as a popular diagnostic method) but in selected patients' groups it can help to realise tumors as well as to avoid unnecessary operations or needle biopsis. Based on our results this method can give significant additional information in T1b and especially in T1c states of tumors. Therefore this method can be offered as an additional investigation in cases of physically realised or mammographically screened, but not-palpable, larger than 1 cm size lumps when there is little or moderate risk of malignancy.

Adult↗
PubMed2001

[Differentiated thyroid carcinoma: prognostic factors].

Factors influencing prognosis and long term outcome of thyroid cancer have been described by several groups. It is, however, not clear how the moderate iodine deficiency in Hungary can influence the previously described prognostic factors by other means than shifting differentiated cancer incidence toward the follicular type. Data of 423 out of 472 patients who had been operated on for papillary (372) and follicular (100) thyroid cancer between 1971 and 1997 at our institution have been analyzed retrospectively. Histological specimens were re-evaluated and, if needed, revised. Survival curves were compared using the Kaplan-Meier method. The overall 5 and 10 year survival rates were 93% and 89% for papillary, and 92% and 80% for follicular carcinoma. As an independent factor extrathyroidal invasion (papillary p = 0.000, follicular p = 0.000), lymph node involvement (papillary p = 0.000, follicular 0.011), distant metastases (papillary p = 0.000, follicular p = 0.000), and age over 40 years (papillary p = 0.000, follicular p = 0.000) had negative influence on survival. Multifocality, gender, type of surgery (total or near-total thyroidectomy vs. less than near-total thyroidectomy), and lymphocytic infiltration did not influence survival. Iodine intake did not influence survival, however, the incidence of follicular cancer was higher in iodine deficient regions. When analyzing the papillary and follicular groups separately by Cox regression, extrathyroidal invasion (p = 0.008), lymph node metastasis (p = 0.004), distant metastasis (p = 0.000), and age over 40 years (p = 0.000) were significant predictors in the papillary group, while only tumor extrathyroidal invasion (p = 0.019), and distant metastases (p = 0.000) were significant negative factors in the follicular group.

Adenocarcinoma, Follicular↗
PubMed2001

[Fifteen years experience in the surgical treatment of primary hyperparathyroidism].

We measured the efficacy of preoperative localization techniques and results of parathyroidectomy in patients with primary hyperparathyroidism (HPT). From 1986 to 2001, 92 patients were treated with primary HPT. Preoperative localization technique was used in all patients (US n = 85, Tc-99m-sestamibi/Tc-99m-pertechnetate subtraction scintigraphy n = 67, CT n = 18, MRI n = 14) to visualize the abnormal parathyroids. Results of localization studies were compared with surgical and pathological findings. Bilateral neck exploration was carried out in each patient for the identification of all parathyroid glands. If parathyroid adenoma was diagnosed, exstirpation of the abnormal parathyroid was performed. If diffuse hyperplasia was diagnosed, subtotal parathyroidectomy (3 1/2) was performed. The overall sensitivity was 94% for scintigraphy, 74% for US, 67% for CT and 50% for MRI. The PPV was 97% for scintigraphy, 92% for US, 100% for CT and for MRI. At surgery 66 patients had single adenomas and 3 patients had double adenomas. Diffuse hyperplasia was diagnosed in 21 and parathyroid carcinoma was found in 2 patients. Persistent HPT was noted in 1 patient. Recurrent HTP occurred 4 times. After a second operation their HPT disappeared. In conclusion, the sensitivity of Technetium-99m-sestambi and Technetium-99m-pertechnetate subtraction scanning was significantly superior compared to other localization methods. The use of these sensitive preoperative technique can improve the success rate, and decrease the incidence of persistent and recurrent HPT.

Humans↗
PubMed2001

[Results and complications of parathyroidectomy in secondary hyperparathyroidism].

Retrospective study was performed to measure the results of parathyroidectomy in patients with secondary hyperparathyroidism. From 1987 to 2000, 48 patients underwent surgery for secondary hyperparathyroidism. There were 30 of 48 patients on haemodialysis treatment, and 11 patients were in pre-dialysis stage. Parathyroidectomy was performed after successful kidney transplantation in 4 cases. Indication of the surgery was extremely elevated serum level of parathyroid hormone (at least 10 fold elevation), which was resistant for the conservative medical therapy. Subtotal parathyroidectomy (3 1/2) was performed in 30 patients. Five patients underwent total parathyroidectomy and autotransplantation. Only 2 or 3 parathyroid glands have been removed in 13 patients. Haematoma occurred in 3 cases after parathyroidectomy. Recurrent nerve injury or septic complication did not occur. Two patients died in the early postoperative period due to cardiac failure. Tetania was noted in 2 patients after surgery. Permanent postoperative hypocalcaemia (over 6 months) occurred in 3 cases. Persistent hyperparathyroidism was diagnosed in 5 patients. In these patients 2 parathyroid glands were removed during the primary operation. Recurrent hyperparathyroidism was detected in 2 patients. Subtotal parathyroidectomy was carried out in these cases previously. At the reoperation for persistent and recurrent hyperparathyroidism, total parathyroidectomy and autotransplantation was performed. Serum alkaline phosphatase level and serum parathyroid hormone value decreased after surgery, except those patients with persistent hyperparathyroidism. Bone pain decreased in 96% of the cases and pruritus decreased in 92% of the patients after parathyroidectomy. Soft tissue calcification showed improvement in 45% of cases. In conclusion, the subtotal parathyroidectomy or total parathyroidectomy with autotransplantation cause a rapid decrease of PTH level and the improvement of the clinical symptoms in patients with medical treatment resistant secondary hyperparathyroidism. Persistent hyperparathyroidism occurs in those cases when inadequate parathyroidectomy was performed.

Adolescent↗
PubMed2000

[Current diagnostic method, prognosis estimation and therapy of papillary thyroid cancer: recommendations of the medical universities and the National Oncologic Institute of Budapest].

Physical examination, cervical ultrasonography (US) and aspiration cytology are the mainstays of the preoperative diagnostics of papillary thyroid carcinoma. For the staging of suspected malignant cases, cervical and mediastinal CT (MRI for inconclusive results) is indicated before any surgery. The end-result of primary treatment is assessed by total-body iodine scintigraphy and the serum human thyroglobulin (hTG) level. For long-term follow-up, physical examination and the serum hTG level are the most reliable tools (6-monthly), supplemented by cervical US and chest X-ray (yearly), and total-body iodine scintigraphy (2-yearly). If these furnish positive results, further examinations may be indicated. In suspected relapses of hTG non-producing and iodine non-accumulating papillary carcinomas, 201thallium chloride or 99mTc-sesta-MIBI (methoxy-isobutyl-isonitrile) scintigraphy, and positron emission tomography with 18fluoro-deoxyglucose or 11C-methionine may be of help. For estimation of the prognosis (cause-specific survival) of the patients, the MACIS score system of the Mayo Clinic is widely accepted, the patients being divided into low-risk and intermediate/high-risk categories. The recommended standard surgical intervention is near-total thyroidectomy (2-4 g residual glandular tissue left at the upper pole of the less-involved lobe), with a central cervical lymph node dissection for diagnostic purposes. In cases of lymph node dissemination, dissection (radical, modified radical, selective or microdissection) of any of the involved compartments (central, right or left cervical, or upper mediastinal) is indicated for therapeutic reasons, the method of which is depending on the extent of the metastatic involvement. Following adequate surgical intervention, no adjuvant radioiodine therapy is indicated for low-risk cases with a tumour of less than 1 cm diameter. For other low-risk or intermediate/high-risk patients, radioiodine ablation (R0N0M0) or a therapeutic radioiodine dosage (R2N1M1) is indicated. In cases at high-risk of local/regional relapse and in radioiodine non-accumulating tumorous cases, external radiotherapy may be applied. Thyroid hormone medication in a TSH suppressive dose is indicated during the first 5 postsurgical years: the goal is to achieve a TSH level below 0.1 (determined by a 3rd generation assay). If no relapse occurs or the case is a low-risk one, following the 5 years, it is enough to maintain the TSH level in a subnormal range (0.1-0.3).

Carcinoma, Papillary↗
PubMed1999

Stereochemistry and enantiomeric purity of a novel anxiolytic agent, deramciclane fumarate.

The synthesis, stereostructure, and enantiomeric separation by chromatography of a new, chiral anxiolytic agent, deramciclane fumarate (2, (-)-[1R,2S,4R]-2-(2-dimethylaminoethoxy)-2-phenyl-1,7, 7-trimethylbicyclo[2.2.1]heptane fumarate, EGIS-3886), is described. The optical antipode and the racemate of compound 2 were also prepared. The structure was determined by single crystal X-ray diffraction analysis. The enantiomeric separation was accomplished by HPLC on Chiralcel OD (250 x 4.6 mm; 10 microm) and hexane-ethanol (99.5:0.5) as mobile phase at room temperature. The enantiomeric purity of the synthesized drug substance proved to be very high (>99. 9%). Some statements published earlier on the stereostructure of deramciclane fumarate are critically discussed.

Anti-Anxiety Agents↗
PubMed1999

Surgically treated Hashimoto's thyroiditis.

The primary way to treat Hashimoto's thyroiditis is conservative. However, it has a relatively high occurrence in operated patients, up to 13% in the literature. Indications for surgery are suspicion of malignancy, and/or trachea/esophagus compression. 2818 thyroid operations were performed at our department between 1986 and 1995. 279 patients suffered from thyroid cancer and 2539 had benign disease. Histology revealed Hashimoto's thyroiditis in 118 cases. Coexisting malignant thyroid tumor was found in 14 cases (11.8%): 9 papillary, 2 follicular, 1 anaplastic cancer, and 2 non-Hodgkin lymphoma. Postoperative recurrent laryngeal nerve paralysis occurred in 8 cases, of which 6 remained permanent. This relatively high incidence supports the importance to identify the laryngeal nerve during every operation for Hashimoto's thyroiditis. Four patients had temporary and one had permanent hypoparathyroidism. Coexistence of Hashimoto's thyroiditis and thyroid carcinoma, the increased risk for the development of non-Hodgkin's lymphoma in chronic lymphocytic thyroiditis and the need for thyroxin supplementation in many cases justify a careful, long-term follow-up of patients with Hashimoto's disease.

Female↗
PubMed1998

Long-term follow-up of node-positive papillary thyroid carcinomas.

INTRODUCTION: We retrospectively reviewed the data of patients with papillary thyroid cancer who were node positive and treated at our department between 1955 and 1994. Of 362 cases of papillary cancer, 134 were identified with lymph-node metastases (37%). METHODS: Two types of dissection procedures were applied by a large community of surgeons. When only the cervical central lymph nodes were involved, the procedure of choice was thyroidectomy, with local lymph-node excision (LD); if the lateral nodes were also affected, modified radical neck dissection (MRND) was applied. RESULTS: Of 88 patients considered to have minimal involvement, 70 underwent procedures of a lesser magnitude than MRND. Most of the operations were localised "picking procedures". Recurrence of the disease developed in 16 cases, twice in 8 of these. The new tumourous lymph node was found to be ipsilateral in every case and close to the place of the first operation. The rate of recurrence was 23%. In the same group, 18 MRNDs were performed, with ipsilateral lymph-node recurrence in six cases. In 41 patients undergoing surgery for extended lymph-node metastases, conservative excisions were carried out in 17 and MRND in 24 cases, including six bilateral dissections. In this group, late recurrence was 47%. CONCLUSION: The results of the follow-up of 30 childhood and juvenile patients with papillary thyroid carcinoma is very interesting; all of our young patients are alive.

Adolescent↗
PubMed1997

Interdisciplinary treatment of the malignant lymphoma of the thyroid.

720 patients with malignant tumor of the thyroid were treated at our department between 1950 and 1996. Histological examination revealed 15 cases (2%) of malignant lymphoma (14 female, 1 male mean age: 69.8 year). In 8 cases Hashimoto thyroiditis, in 1 case chronic lymphocytic thyroiditis was verified beyond the lymphoma. According to Ann Arbor staging, 9 patients were stage I E, 3 II E, 1 III E, and 2 IV E. Radical surgical treatment was performed in 7, palliative in also 7, and only biopsy in one case. Irradiation was administered in 9, chemotherapy in 8 patients. In 5 out of the 7 palliative operated patients tracheostomy was performed. 10 patients were lost. The therapy of the non-Hodgkin lymphoma of the thyroid is debated in the literature. There are some authors, who question the role of surgery. Our experience, based on the longer survival of the patients, who underwent radical operation, support those, who consider the possible surgical treatment as the initial part of the multimodal therapy.

Aged↗
PubMed1997

Distribution of calcitonin-containing parafollicular cells of the thyroid in patients with chronic lymphocytic thyroiditis: a clinical, pathological and immunohistochemical study.

The C-cell hyperplasia of the thyroid gland is recognized as precursor to medullary carcinoma, particularly in multiple endocrine neoplasias, however it can be associated with hypercalcemic states and follicular tumours as well. The authors analysed 46 of their cases with Hashimoto's and/or lymphocytic thyroiditis from the immunohistological point of view with the aim of determining to what extent is C-cell hyperplasia associated with these pathological pictures. C-cell hyperplasia was demonstrated on sections of intraoperative preparations with the immunoperoxidase method with anticalcitonin MoAb. Moderate, focal C-cell hyperplasia was found in 17.4% (8 patients), extensive focal hyperplasia similarly in 17.4% (8 patients). Diffuse C-cell hyperplasia occurred in 1 case (2.2%). These results suggest the possibility that in the case of diffuse or more pronounced focal hyperplasia the serum calcitonin concentration of these patients is also elevated. Further clinical and pathological studies are needed to find out whether there is some pathogenetic relationship between chronic lymphocytic thyroiditis and C-cell hyperplasia or whether the finding is coincidental, and to establish what degree of C-cell hyperplasia is associated with elevated serum calcitonin levels. This relationship has been unknown until the present time, whereas it can be of great clinical significance, in part because of the changes in serum calcitonin levels, in part for screening out the MEN IIa type and working out the operating strategy.

Adolescent↗
PubMed1997

Surgical treatment of gastric cancer: a retrospective study with special reference to epidemiology.

The present retrospective study gives the analysis of the epidemiological data of 1474 patients with gastric cancer, who were operated on at the 1st Department of Surgery of the University Medical School of Debrecen in the course of 35 years. In spite of the changes in diagnostics and therapeutic management it was impossible to raise, during this period, the rate of resectability: in the first 10 years it was 56%, and 55% in the last five years. There was no improvement in the proportion of curative and palliative resection, either: 50/6 vs 49/6. The number of gastrectomies increased to 22.5% from 17%, in a quarter of the cases, in the last two periods, extended multivisceral interventions were also performed. In the location of resectable carcinomas the number of those spreading over more than one third increased from 2% to 7%, and similar growth was encountered in the rate of diffuse-type carcinomas. The postoperative surgical complications decreased to 18% from 27%, and early postoperative death from 19.6 to 10.1%. In the last two periods 46% of the patients were admitted in advanced stages of tumor (UICC III B or IV), with half a year's or longer histories. Exclusively surgical treatment is not effective in these cases.

Carcinoma↗
PubMed1996

[Pulmonary tuberculosis revealed by lupus vulgaris].

The incidence of pulmonary tuberculosis in Hungary had been significantly decreased until the 1980s and its common cutaneous manifestation was found to be extremely rare. During the past years an increasing number of reports were dealing the novel increasing incidence of tuberculosis, mostly on homeless and immunocompromized persons. The present report dealt with a pulmonary tuberculotic patient on whom severe cutaneous TBC manifestations (lupus vulgaris) that was heralded the underlying systemic tuberculotic disease.

Humans↗
PubMed1996

Special features of childhood and juvenile thyroid carcinomas.

A retrospective analysis was conducted on 36 patients who underwent surgery for childhood or juvenile thyroid cancers and who were regularly followed up during the course of 30 years. The biological properties and late prognosis of these patients were assessed, and the clinical and morphological characteristics of the tumors were examined. The distribution of the DNA content in the tumor cells was compared with that in adult tumor cells, and the results of cytogenetic tests performed on mothers operated on for thyroid tumors and their children are also discussed.

Adenocarcinoma, Follicular↗