Péter Török - Academia.edu (original) (raw)

Papers by Péter Török

Archives of Gynecology and Obstetrics

Background To date hysteroscopy is the gold standard technique for the evaluation and management ... more Background To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal. Purpose In this review, we summarize the scientific evidence about cervical stenosis, aiming to identify the best strategy to overcome this challenging condition. Methods The literature review followed the scale for the quality assessment of narrative review articles (SANRA). All articles describing the hysteroscopic management of cervical stenosis were considered eligible. Only original papers that reported data on the topic were included. Results Various strategies have been proposed to address cervical stenosis, i...

Healthcare

Borderline ovarian tumors (BOTs) comprise 15–20% of primary ovarian neoplasms and represent an in... more Borderline ovarian tumors (BOTs) comprise 15–20% of primary ovarian neoplasms and represent an independent disease entity among epithelial ovarian cancers. The present study (Clinical Trial ID: NCT05791838) aimed to report a retrospective analysis of the management and outcomes of 86 consecutive BOTs patients, 54 of which were at a reproductive age. All patients with BOTs undergoing surgical treatment from January 2010 to December 2017 were included. Data were retrospectively reviewed. High levels of Ca-125 were observed in 25.6% of the FIGO stage I patients and 58.3% of the advanced disease patients. Fertility-sparing surgery and comprehensive surgical staging were performed in 36.7% and 49.3% of the patients, respectively. Laparotomy was the most frequent surgical approach (65.1%). The most common diagnosis at frozen sections was serous BOT (50.6%). Serous BOTs have significantly smaller tumor diameters than mucinous BOTs (p < 0.0001). The mean postoperative follow-up was 29.8 ...

Journal of Investigative Surgery, 2022

Minimally Invasive Therapy & Allied Technologies, 2021

Abstract The extent of the 2020 pandemic not only extends to the infected patients but also to pa... more Abstract The extent of the 2020 pandemic not only extends to the infected patients but also to patients who have been waiting for medical procedures. Reevaluation of the healthcare system is important in order to help assist the needs of intensive care units. The urgency of the gynaecological cases should be aligned based on surgical interventions and minimally invasive methods should be preferred. This will not endanger professional and other resource demands of ICUs. In acute cases, laparoscopy or hysteroscopy (preferring office hysteroscopy) should be chosen, that require no or only short period of hospitalization. Postponing non-acute surgeries is recommended to the post-pandemic period. Abbreviations: ICU: intensive care unit; COVID-19: coronavirus disease; SARS-CoV-2: severe acute respiratory syndrome Coronaviruses; IgM–IgG: immunoglobulin M; GAGP: aerosol generating procedures; PPE: personal protective equipment; ERAS: early recovery after surgery; mESAS: modified elective surgery acuity scale; RPOC: retained product of concept; PMB: postmenopausal bleeding

Minimally Invasive Therapy & Allied Technologies, 2021

OBJECTIVE To evaluate the diagnostic accuracy of a bygone method, hystero-salpingo-scintigraphy (... more OBJECTIVE To evaluate the diagnostic accuracy of a bygone method, hystero-salpingo-scintigraphy (HSSG), for tubal patency assessment of infertile women. MATERIAL AND METHODS Prospective cohort study involving women in the infertility workup at the University of Debrecen, Hungary. Seventy infertile patients were scheduled to either basic dynamic HSSG, post-purge dynamic HSSG, or post-purge dynamic HSSG followed by SPECT/CT for reducing tracer contamination. The primary endpoint was the evaluation of the diagnostic accuracy of HSSG for the three methods. RESULTS During the basic dynamic group, the examination yielded a sensitivity of 87.5%, with a specificity of 71.7%, while positive and negative predictive values were 31.8%, and 97.4% respectively. Using post purge dynamic HSSG, it resulted in a sensitivity of 87.5%, a specificity of 88.7%, a positive predictive value of 53.8%, and a negative predictive value of 97.9%. Adding SPECT/CT to post-purge dynamic HSSG increased diagnostic accuracy with 100% sensitivity and 88.7% specificity, while positive and negative predictive values were 57.1% and 100%, respectively. CONCLUSION HSSG is a non-invasive and well-tolerated technique for tubal patency. It could be used initially to predict tubal patency in case of infertility. Its diagnostic accuracy is higher when it is carried out by adding SPECT/CT to the post-purge dynamic method.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020

Our purpose was to investigate the predictive value of visible air bubble sign for real tubal pat... more Our purpose was to investigate the predictive value of visible air bubble sign for real tubal patency during hysteroscopic procedures. Methods: In this cross-sectional study, clinical data of 61 infertile women who underwent diagnostic hysteroscopy and laparoscopy have been analysed. Results: Mean age of patients was 33.45 AE 3.25 years. Bubble sign for the detection of patency demonstrated 73 % (95 % CI: 57-86 %) sensitivity, 70 % (95 % CI: 46-88 %) specificity, a positive predictive value of 83 % (95 % CI: 67-94 %), and a negative predictive value of 56 % (95 % CI: 35-76 %). Conclusions: A visible tubal "flow" of air bubbles during hysteroscopy was not accurate in the prediction of tubal patency.

Journal of Investigative Surgery, 2021

Orvosi Hetilap, May 16, 2021

Bevezetés: A citológiai alapú méhnyakrákszűrés átmeneti kategóriáinak optimális menedzselése a hu... more Bevezetés: A citológiai alapú méhnyakrákszűrés átmeneti kategóriáinak optimális menedzselése a humán papillomavírus (HPV) szűrése és tipizálása ellenére jelenleg is kihívás. Vizsgálatunk célja a modern cervixspektroszkópiának (multimodális hiperspektroszkópia-MHS), egy azonnali eredményt nyújtó, digitális technológiára épülő módszernek a vizsgálata volt a citológiai alapú méhnyakszűrés találati biztonságának javítására. Betegek és módszer: Vizsgálatainkat 208, 18 és 75 év közötti nőbeteg bevonásával végeztük, akiknél már indikálásra került valamely, a méhnyakon végzendő műtét, citológiai eredményük rendelkezésre állt (a HPV-tesztet, amennyiben nem történt meg, elvégeztük), valamint valamennyi betegnél elvégeztük a műtét előtt az MHS-vizsgálatot. A szövettani mintavétel 166 betegnél történt meg. Eredmények: A citológiai vizsgálatot (az összes betegre tekintve) magas álpozitív arány jellemezte (69,28%), amely megfigyelések mindenképpen utalnak az újabb komponens alkalmazásának igényére a triázsban. Az összes citológiai kategóriára nézve az MHS-eredmények közül kiemelendő az álnegatív leletek rendkívül alacsony aránya (3/166 = 1,8%), mely a HPV-teszt esetén ennél magasabb volt (11/165 = 6,66%). A spektroszkópiás vizsgálat álpozitív aránya ugyanakkor kedvezőtlenebbnek bizonyult (91/166 = 54,81%) a HPV-vizsgálat álpozitív arányánál (40/165 = 24,24%). Az atípusos laphámsejt (ASC-US/ASC-H) citológiai kategória esetén a spektroszkópia álnegatív eredményeinek aránya (3/126 = 2,38%) szintén kedvezőbb volt, mint a HPV-vizsgálaté (9/126 = 7,14%). A cervicalis intraepithelialis neoplasia-2 vagy súlyosabb fokozatú hámelváltozások azonosításában a spektroszkópia szenzitivitása 94% (95% CI = 0,84-0,99), specificitása 22% (95% CI = 0,15-0,31), negatív prediktív értéke 90% (95% CI = 0,73-0,98), pozitív prediktív értéke 34% (95% CI = 0,26-0,43) volt (p = 0,00130). Következtetés: Az MHS fejlett innovatív technológián alapuló, azonnali eredményt adó vizsgálóeljárás, amely kiemelkedően alacsony álnegatív eredménye miatt nagy segítséget nyújt a citológiai eltéréssel rendelkező betegek további vizsgálatában.

Orvosi Hetilap, Nov 29, 2020

Bevezetés: Jelenleg a méh méretének pontos megítélése meglehetősen szubjektív, az azt leíró ultra... more Bevezetés: Jelenleg a méh méretének pontos megítélése meglehetősen szubjektív, az azt leíró ultrahangleletek igen nagy eltérést mutatnak. Számos klinikai szituációban azonban nagyon fontos az eltérések méretének, elhelyezkedésének, meghatározott anatómiai pontokhoz való viszonyának pontos leírása. Célkitűzés: Célunk egy egységes mérési módszer kifejlesztése, mellyel sorvezetőt adunk a vizsgálók kezébe, így csökkentve az egyéni variabilitásból adódó eltéréseket. A standardizált adatok lehetőséget adnak a szisztematikus gyűjtésre, azok egységes feldolgozására, rendszerbe foglalására, tudományos értékelésére, segítséget nyújtva a mindennapi klinikai gyakorlatban és kutatásokban. Módszer: A méh általunk végzett ultrahangvizsgálatait, valamint a nemzetközi tanulmányokat alapul véve kívánunk javaslatot tenni egy egységes mérési módszer kialakítására, mellyel egyértelmű, pontos, reprodukálható adatokat kaphatunk a méhről. Eredmények: Létrehoztunk egy standardizált paraméterekkel rendelkező mérési eljárást Uteromap néven, melyet alkalmazva objektív méretadatokat kaphatunk a méh ultrahangvizsgálata során. Külön figyelmet fordítottunk arra, hogy az általunk létrehozni kívánt standardizált mérési eljárás alkalmas legyen minden általános, valamint speciális esetben is. A kipróbálás során a legelső 253 páciens adatait elemeztük retrospektív módon. Eredményeink szerint az idősebb életkor megnövekedett méhmagassággal és nagyobb hátsó falvastagsággal korrelált. Következtetés: Arra a következtetésre jutottunk, hogy standardizált mérési módszerünk alkalmazásával a méhről és elváltozásairól sokkal pontosabb, objektívebb és egységesebb adatokat nyerhetünk anélkül, hogy a vizsgálathoz szükséges idő szignifikánsan hosszabb lenne. Munkánk folytatásaként minél több vizsgáló bevonásával szeretnénk a standardizált módszert a mindennapi gyakorlatra kiterjeszteni, a felmerülő igények, javaslatok alapján fejleszteni és létrehozni egy nemzetközileg elfogadott, standardizált mérési eljárást, mellyel az ultrahangvizsgálatok minőségét növelhetnénk, azzal a végső céllal, hogy javítsuk a betegek biztonságát és az ellátás eredményességét.

Background Endometrial polyps are frequently found in infertile patients, but most of them are as... more Background Endometrial polyps are frequently found in infertile patients, but most of them are asymptomatic. They can be effectively detected by ultrasound using contrast media or color Doppler, but the gold standard is hysteroscopy. In reproductive age, they carry low risk of malignancy. It is assumed that larger polyps hamper implantation. However, it is not clear yet, whether resection of all polyps necessarily improves the fertility, and is the polyp localization influence the implantation failure.

Orvosi Hetilap, May 1, 2022

Bevezetés: Az endokrin betegségekhez társuló ovulációs diszfunkció gyakori vezető vagy társuló ok... more Bevezetés: Az endokrin betegségekhez társuló ovulációs diszfunkció gyakori vezető vagy társuló oka a női infertilitásnak, de optimális reprodukciós korban oki vagy ovulációindukciós kezeléssel többnyire rendezhető a fertilitás. Az in vitro fertilizációs (IVF-) kezelések vezető indikációi jelenleg az andrológiai és a női életkorból adódó, petefészekeredetű infertilitás, de egyéb endokrin diszfunkció társulása befolyásolja a kezelési eredményeket. Célkitűzés: Az endokrin betegségek gyakoriságának vizsgálata az IVF-programban részt vevő párok nőtagjainál. Módszer: Az IVF-program előtti alkalmassági vizsgálatok során a vezető indikációtól függetlenül részletes endokrinológiai kivizsgálást végeztünk 231 nőnél (átlagéletkor 34 év). A vizsgálatok kiterjedtek a hypothalamus-és petefészekfunkcióra, a pajzsmirigyfunkcióra és pajzsmirigy-autoimmunitásra, a mellékvese-funkcióra, a szénhidrát-anyagcserére és az inzulinrezisztenciára. Az egyes endokrin betegségek előfordulásán túl azok társulási gyakoriságát is elemeztük. Eredmények: Az IVF vezető javallatainak megoszlása megfelelt a nemzetközi tendenciáknak, endokrin jellegű volt 87 esetben (37,6%; csökkent petefészek-tartalék: 55 eset és krónikus anovuláció: 32 eset). Társuló endokrin eltérést 141 esetben találtunk, így összesen 161 nőt érintett az endokrin diszfunkció (69,7%; átlagéletkor 35 év). Az endokrin diszfunkciók előfordulása gyakorisági sorrendben: pajzsmirigy-diszfunkció (32,5%), csökkent petefészek-tartalék (23,8%), pajzsmirigy-autoimmunitás (22,5%), polycystás ovarium szindróma (15,6%), inzulinrezisztencia (22,5%), elhízás (23,8%), hyperprolactinaemia (13,4%). Az endokrin betegségek társulása minden kórkép esetében fellelhető volt. Hypogonadotrop hypogonadismus 2, congenitalis adrenalis hyperplasia 1 esetben fordult elő. Nem találtunk endokrin eltérést 70 esetben (30,3%). Következtetés: Vizsgálatunk igazolja az endokrin diszfunkciók halmozott megjelenését és gyakori társulását az IFVprogram résztvevőinél, bármely indikáció esetén. A részletes endokrin kivizsgálás és az IVF-kezelést végzők endokrin jártassága hozzájárulhat az IVF-kezelés sikerességéhez.

2019 11th International Symposium on Image and Signal Processing and Analysis (ISPA)

Though they rarely become malignant, the surgical removal of fibroids (uterine myomas) is commonl... more Though they rarely become malignant, the surgical removal of fibroids (uterine myomas) is commonly considered to prevent any possible future risks. As the least invasive intervention, endoscopic surgery is the most popular approach for this aim. However, since these compact tumors reside in the deep (muscle/connective) tissues of the uterus, they are hardly visible using only the video stream provided by the endoscopic camera. Thus, conform to the current general trend in human surgery, in this paper we propose a multimodal approach to make these tumors more visible during endoscopic interventions, namely, the reconstruction of the whole three-dimensional model of the uterus from ultrasound images and segmentation of the fibroids using this modality. Then, we map the result of the segmentation on the surface of the uterus, hence they become visible during endoscopic surgery. Similar efforts have already been made, considering the usage of MRI for this purpose, but ultrasound image acquisition is more widely available, faster, and cheaper next to the lower image quality. Our aim is to use the output of the 3D ultrasound imaging device during the laparoscopic surgery. Our segmentation pipeline processes the ultrasound images and consists of Otsu's thresholding using a special mask derived from image averages and morphological snakes to extract uterus boundary. As the final step, we project the segmented 3D model of the uterus with its lesion on an endoscope camera flow in real time to provide an augmented reality application.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2019

firmation, study of tumour resectability, second-look to evaluate response to chemotherapy and, i... more firmation, study of tumour resectability, second-look to evaluate response to chemotherapy and, in selected cases, complete cytoreductive surgery. Objective: To reaffirm the valuable role of the minimal invasive approach to advanced tumours. Methods: Retrospective observational study of all women who underwent laparoscopic surgery in the context of ovarian cancer and occult primary tumours in FIGO stages III and IV, between January 2011 and December 2017. Discussion and conclusions: Results: 19 women were included, mean age was 67 years old, twelve (63%) of them with ovarian cancer (8 were stage IV) and seven (37%) with occult primary tumors (all stage IV). In total, 20 laparoscopic procedures were performed. 85% of them had a diagnostic component, complemented by aspiration of ascites (often associated to symptomatic relief post-operatively) and biopsies (after intraoperative confirmation of unresectability criteria). The remaining 15% consisted of a second-look after chemotherapy. Mean operative time was 62 min and estimated blood loss was 25 mL in average. Mean length of stay in the Hospital was 3 days. Post-operative complications occurred in 2 (10%) cases: one infection of the suprapubic port-site wound and one case of umbilical port-site metastasis. 74% of patients started chemotherapy after surgery. The average number of days for the tumour board meeting, first medical oncology appointment and first cycle of chemotherapy was 18, 27 and 34 days, respectively. Over the follow-up period 8 (42%) patients died, all due to disease progression. Conclusion: In the challenging management of these advanced tumours at diagnosis, laparoscopy offers multiple advantages over traditional laparotomy, including smaller incisions with a quicker tissue healing interval, improved visualization for intra-operative staging, reduced blood loss and need for medication, lower risk of thromboembolism, faster overall recovery and an earlier start of treatment by chemotherapy.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2004

Study objective: This study was set up to evaluate the predictive value of hysteroscopic examinat... more Study objective: This study was set up to evaluate the predictive value of hysteroscopic examination in patients referred to the Department of Obstetrics and Gynecology at the Medical and Health Science Center, Debrecen, Hungary. Study design: The authors performed 835 biopsies by hysteroscopy over more than 13 years. They compared their findings with histological findings held in a a computerized clinical database. Results: The sensitivity of hysteroscopy was 0.52 for hyperplasia, 0.87 for polyps, 0.85 for myomas, 0.68 for carcinoma, and 0.73 for atrophy. Conclusion: It seems that for findings facing into the uterine cavity (such as submucosal myomas and peduncular polyps), hysteroscopy can predict the histological results. The evaluation of endometrial cycles and of the thickness of the endometrium by hysteroscopy is less accurate.

Middle East Fertility Society Journal, 2017

Introduction: Tubal flushing effect is a published phenomena of hysterosalpingography in connecti... more Introduction: Tubal flushing effect is a published phenomena of hysterosalpingography in connection with tubal patency test. The aim of the study was to evaluate the flushing effect of the outpatient method: selective chromopertubation via office hysteroscopy (OHSC-SPT), and compare it to that of HSG. Materials and methods: Sixty infertile patients receiving OHSC-SPT (mean [SD] age: 34.1 [3.2] years) and 163 receiving HSG (32.7 [4.7] years) took part in the study. As part of the infertility work-up, diagnostic office hysteroscopy was performed to evaluate the uterine cavity. Patients with at least one patent tube had a 12-month follow-up, during which their obstetrical events, including successful conception of pregnancy after a sterile period, were recorded. The between-groups comparison was quantified by calculating a pregnancy proportion ratio. Results: Out of the 60 OHSC-SPT subjects, both tubes were blocked in 24 cases, and at least one of the tubes was patent in 36 cases. Out of these 36 cases, 7 (19.4%) spontaneous pregnancies were conceived; in three (8.3%) cases, pregnancy was conceived after intrauterine insemination (IUI) performed on male indication. The number of pregnancies observed in the HSG group (163 examined subjects) was 37 (32 spontaneous, 5 IUI-assisted) out of 153 followed-up subjects (24.4%). The pregnancy proportion ratio estimate was 1.15 (90% CI: 0.70-1.90; p = 0.671). Conclusions: The novel method of OHSC-SPT has a tubal flushing effect that is non-inferior to that observed with HSG.

Journal of Gynecology Obstetrics and Human Reproduction, 2022

During the last decades, the number of couples with reproductive issues has substantially increas... more During the last decades, the number of couples with reproductive issues has substantially increased. Many different factors are implicated in reproductive failure, including uterine factors. Endometrial pathologies, such as endometrial polyps, hyperplasia, endometritis, and Mullerian anomalies, can also hinder embryo implantation. Hysteroscopy remains the gold standard for the evaluation and treatment of intrauterine pathology. Over the last few years, advances in hysteroscopic instrumentations and surgical techniques have significantly evolved, the refinement in technology, miniaturization of instruments, and improved image quality have rendered hysteroscopy a more patient and user-friendly procedure that has enhanced its use in reproductive medicine. Nowadays, hysteroscopy is essential in the evaluation and treatment of women with infertility. This article underscores the major technological breakthroughs achieved over the last few years with emphasis on the role of artificial intelligence, augmented reality, and 3D hysteroscopy, which can set new benchmarks in hysteroscopy applied to reproductive medicine.

Archives of Gynecology and Obstetrics, 2020

The aim of this review is to provide an overview of the literature about the perception and manag... more The aim of this review is to provide an overview of the literature about the perception and management of anxiety and pain in women undergoing an office hysteroscopic procedure. Methods We performed a systematic literature search in Embase, PubMed/MEDLINE, Cochrane Library and Web of Science for original studies written in English (registered in PROSPERO 2019-CRD42019132341), using the terms 'hysteroscopy' AND 'pain' AND 'anxiety' published up to January 2019. Only original articles (randomized, observational and retrospective studies) about management of anxiety and pain related to the hysteroscopic procedure were considered eligible. Results Our literature search produced 84 records. After exclusions, 11 studies including 2222 patients showed the following results: (a) pain experienced during hysteroscopy is negatively affected by preprocedural anxiety; (b) pharmacological interventions seem to be help in reducing pain during hysteroscopy; (c) waiting time before the procedure is a significant factor affecting patients' anxiety; (d) music during the procedure may be helpful in reducing anxiety. Conclusions The utilization of office hysteroscopy is hampered by varying levels of anxiety and pain perceived by women who are candidates for the procedure. For these reasons, it is essential to identify effective pharmacological and non-pharmacological strategies to alleviate these factors. We recommend further studies especially focusing on non-pharmacological interventions to facilitate the dissemination of good clinical practices among hysteroscopists.

Antioxidants, 2019

Gestational diabetes mellitus (GDM) is a very common condition among pregnant women worldwide wit... more Gestational diabetes mellitus (GDM) is a very common condition among pregnant women worldwide with important metabolic implications on the mother and the offspring. Vitamin D status has been suggested to potentially play a role in GDM risk with no documented consequences for the offspring. The purpose of this article was to review currently available evidence on the relationship between vitamin D and GDM. Current evidence shows an association between vitamin D blood levels and risk of GDM, despite heterogeneity of results across studies limit the conclusions. Moreover, data from randomized controlled trials is scarce and resulting in null findings. Among the limitations to be noted, improving the standardization of dosages, the characteristics of individuals in the sample, and the appropriate outcome measurement could provide a more effective approach in understanding the relationship between vitamin D and GDM. In conclusions, despite observational studies may suggest that adequate ...

Archives of Gynecology and Obstetrics, 2019

Aim Our purpose is to investigate if transcervical resection of endometrial polyps improves the f... more Aim Our purpose is to investigate if transcervical resection of endometrial polyps improves the fertility in ovulatory infertile women, and whether polyp histology, intrauterine location, and the technique of polypectomy have any influence on the pregnancy rates. Methods In this retrospective study, clinical data of 87 ovulatory infertile women who underwent hysteroscopy and polypectomy, and their 12-month follow-up have been analyzed. Subgroups according to the method of polyp removal (resectoscope or curettage), the polyp localization (utero-tubal, anterior, posterior, lateral, multiple) and the histological result were interpreted. Results Mean age of patients was 33.99 ± 4.24 years. There were no differences in the BMI and basal FSH levels between the subgroups. Pregnancy was recorded in 30 (34.5%) within the next 12 months without any difference between the subgroups of polypectomy method applied. Posterior wall polyp resection increased the pregnancy chance (OR 5.02), but no other differences were observed in 1-year pregnancy rates to other localizations. Removal of polyps which had normal endometrial histology had lower pregnancy rates as compared to that of polyps with hyperplasia or endometrial polyp histology results (OR 0.25). Conclusions Polypectomy improved the conception rate in the subsequent year regardless of the intrauterine localization and the method of its surgical removal. Therefore, we can conclude that polypectomy should be considered in infertile women.

Archives of Gynecology and Obstetrics

Background To date hysteroscopy is the gold standard technique for the evaluation and management ... more Background To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal. Purpose In this review, we summarize the scientific evidence about cervical stenosis, aiming to identify the best strategy to overcome this challenging condition. Methods The literature review followed the scale for the quality assessment of narrative review articles (SANRA). All articles describing the hysteroscopic management of cervical stenosis were considered eligible. Only original papers that reported data on the topic were included. Results Various strategies have been proposed to address cervical stenosis, i...

Healthcare

Borderline ovarian tumors (BOTs) comprise 15–20% of primary ovarian neoplasms and represent an in... more Borderline ovarian tumors (BOTs) comprise 15–20% of primary ovarian neoplasms and represent an independent disease entity among epithelial ovarian cancers. The present study (Clinical Trial ID: NCT05791838) aimed to report a retrospective analysis of the management and outcomes of 86 consecutive BOTs patients, 54 of which were at a reproductive age. All patients with BOTs undergoing surgical treatment from January 2010 to December 2017 were included. Data were retrospectively reviewed. High levels of Ca-125 were observed in 25.6% of the FIGO stage I patients and 58.3% of the advanced disease patients. Fertility-sparing surgery and comprehensive surgical staging were performed in 36.7% and 49.3% of the patients, respectively. Laparotomy was the most frequent surgical approach (65.1%). The most common diagnosis at frozen sections was serous BOT (50.6%). Serous BOTs have significantly smaller tumor diameters than mucinous BOTs (p < 0.0001). The mean postoperative follow-up was 29.8 ...

Journal of Investigative Surgery, 2022

Minimally Invasive Therapy & Allied Technologies, 2021

Abstract The extent of the 2020 pandemic not only extends to the infected patients but also to pa... more Abstract The extent of the 2020 pandemic not only extends to the infected patients but also to patients who have been waiting for medical procedures. Reevaluation of the healthcare system is important in order to help assist the needs of intensive care units. The urgency of the gynaecological cases should be aligned based on surgical interventions and minimally invasive methods should be preferred. This will not endanger professional and other resource demands of ICUs. In acute cases, laparoscopy or hysteroscopy (preferring office hysteroscopy) should be chosen, that require no or only short period of hospitalization. Postponing non-acute surgeries is recommended to the post-pandemic period. Abbreviations: ICU: intensive care unit; COVID-19: coronavirus disease; SARS-CoV-2: severe acute respiratory syndrome Coronaviruses; IgM–IgG: immunoglobulin M; GAGP: aerosol generating procedures; PPE: personal protective equipment; ERAS: early recovery after surgery; mESAS: modified elective surgery acuity scale; RPOC: retained product of concept; PMB: postmenopausal bleeding

Minimally Invasive Therapy & Allied Technologies, 2021

OBJECTIVE To evaluate the diagnostic accuracy of a bygone method, hystero-salpingo-scintigraphy (... more OBJECTIVE To evaluate the diagnostic accuracy of a bygone method, hystero-salpingo-scintigraphy (HSSG), for tubal patency assessment of infertile women. MATERIAL AND METHODS Prospective cohort study involving women in the infertility workup at the University of Debrecen, Hungary. Seventy infertile patients were scheduled to either basic dynamic HSSG, post-purge dynamic HSSG, or post-purge dynamic HSSG followed by SPECT/CT for reducing tracer contamination. The primary endpoint was the evaluation of the diagnostic accuracy of HSSG for the three methods. RESULTS During the basic dynamic group, the examination yielded a sensitivity of 87.5%, with a specificity of 71.7%, while positive and negative predictive values were 31.8%, and 97.4% respectively. Using post purge dynamic HSSG, it resulted in a sensitivity of 87.5%, a specificity of 88.7%, a positive predictive value of 53.8%, and a negative predictive value of 97.9%. Adding SPECT/CT to post-purge dynamic HSSG increased diagnostic accuracy with 100% sensitivity and 88.7% specificity, while positive and negative predictive values were 57.1% and 100%, respectively. CONCLUSION HSSG is a non-invasive and well-tolerated technique for tubal patency. It could be used initially to predict tubal patency in case of infertility. Its diagnostic accuracy is higher when it is carried out by adding SPECT/CT to the post-purge dynamic method.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2020

Our purpose was to investigate the predictive value of visible air bubble sign for real tubal pat... more Our purpose was to investigate the predictive value of visible air bubble sign for real tubal patency during hysteroscopic procedures. Methods: In this cross-sectional study, clinical data of 61 infertile women who underwent diagnostic hysteroscopy and laparoscopy have been analysed. Results: Mean age of patients was 33.45 AE 3.25 years. Bubble sign for the detection of patency demonstrated 73 % (95 % CI: 57-86 %) sensitivity, 70 % (95 % CI: 46-88 %) specificity, a positive predictive value of 83 % (95 % CI: 67-94 %), and a negative predictive value of 56 % (95 % CI: 35-76 %). Conclusions: A visible tubal "flow" of air bubbles during hysteroscopy was not accurate in the prediction of tubal patency.

Journal of Investigative Surgery, 2021

Orvosi Hetilap, May 16, 2021

Bevezetés: A citológiai alapú méhnyakrákszűrés átmeneti kategóriáinak optimális menedzselése a hu... more Bevezetés: A citológiai alapú méhnyakrákszűrés átmeneti kategóriáinak optimális menedzselése a humán papillomavírus (HPV) szűrése és tipizálása ellenére jelenleg is kihívás. Vizsgálatunk célja a modern cervixspektroszkópiának (multimodális hiperspektroszkópia-MHS), egy azonnali eredményt nyújtó, digitális technológiára épülő módszernek a vizsgálata volt a citológiai alapú méhnyakszűrés találati biztonságának javítására. Betegek és módszer: Vizsgálatainkat 208, 18 és 75 év közötti nőbeteg bevonásával végeztük, akiknél már indikálásra került valamely, a méhnyakon végzendő műtét, citológiai eredményük rendelkezésre állt (a HPV-tesztet, amennyiben nem történt meg, elvégeztük), valamint valamennyi betegnél elvégeztük a műtét előtt az MHS-vizsgálatot. A szövettani mintavétel 166 betegnél történt meg. Eredmények: A citológiai vizsgálatot (az összes betegre tekintve) magas álpozitív arány jellemezte (69,28%), amely megfigyelések mindenképpen utalnak az újabb komponens alkalmazásának igényére a triázsban. Az összes citológiai kategóriára nézve az MHS-eredmények közül kiemelendő az álnegatív leletek rendkívül alacsony aránya (3/166 = 1,8%), mely a HPV-teszt esetén ennél magasabb volt (11/165 = 6,66%). A spektroszkópiás vizsgálat álpozitív aránya ugyanakkor kedvezőtlenebbnek bizonyult (91/166 = 54,81%) a HPV-vizsgálat álpozitív arányánál (40/165 = 24,24%). Az atípusos laphámsejt (ASC-US/ASC-H) citológiai kategória esetén a spektroszkópia álnegatív eredményeinek aránya (3/126 = 2,38%) szintén kedvezőbb volt, mint a HPV-vizsgálaté (9/126 = 7,14%). A cervicalis intraepithelialis neoplasia-2 vagy súlyosabb fokozatú hámelváltozások azonosításában a spektroszkópia szenzitivitása 94% (95% CI = 0,84-0,99), specificitása 22% (95% CI = 0,15-0,31), negatív prediktív értéke 90% (95% CI = 0,73-0,98), pozitív prediktív értéke 34% (95% CI = 0,26-0,43) volt (p = 0,00130). Következtetés: Az MHS fejlett innovatív technológián alapuló, azonnali eredményt adó vizsgálóeljárás, amely kiemelkedően alacsony álnegatív eredménye miatt nagy segítséget nyújt a citológiai eltéréssel rendelkező betegek további vizsgálatában.

Orvosi Hetilap, Nov 29, 2020

Bevezetés: Jelenleg a méh méretének pontos megítélése meglehetősen szubjektív, az azt leíró ultra... more Bevezetés: Jelenleg a méh méretének pontos megítélése meglehetősen szubjektív, az azt leíró ultrahangleletek igen nagy eltérést mutatnak. Számos klinikai szituációban azonban nagyon fontos az eltérések méretének, elhelyezkedésének, meghatározott anatómiai pontokhoz való viszonyának pontos leírása. Célkitűzés: Célunk egy egységes mérési módszer kifejlesztése, mellyel sorvezetőt adunk a vizsgálók kezébe, így csökkentve az egyéni variabilitásból adódó eltéréseket. A standardizált adatok lehetőséget adnak a szisztematikus gyűjtésre, azok egységes feldolgozására, rendszerbe foglalására, tudományos értékelésére, segítséget nyújtva a mindennapi klinikai gyakorlatban és kutatásokban. Módszer: A méh általunk végzett ultrahangvizsgálatait, valamint a nemzetközi tanulmányokat alapul véve kívánunk javaslatot tenni egy egységes mérési módszer kialakítására, mellyel egyértelmű, pontos, reprodukálható adatokat kaphatunk a méhről. Eredmények: Létrehoztunk egy standardizált paraméterekkel rendelkező mérési eljárást Uteromap néven, melyet alkalmazva objektív méretadatokat kaphatunk a méh ultrahangvizsgálata során. Külön figyelmet fordítottunk arra, hogy az általunk létrehozni kívánt standardizált mérési eljárás alkalmas legyen minden általános, valamint speciális esetben is. A kipróbálás során a legelső 253 páciens adatait elemeztük retrospektív módon. Eredményeink szerint az idősebb életkor megnövekedett méhmagassággal és nagyobb hátsó falvastagsággal korrelált. Következtetés: Arra a következtetésre jutottunk, hogy standardizált mérési módszerünk alkalmazásával a méhről és elváltozásairól sokkal pontosabb, objektívebb és egységesebb adatokat nyerhetünk anélkül, hogy a vizsgálathoz szükséges idő szignifikánsan hosszabb lenne. Munkánk folytatásaként minél több vizsgáló bevonásával szeretnénk a standardizált módszert a mindennapi gyakorlatra kiterjeszteni, a felmerülő igények, javaslatok alapján fejleszteni és létrehozni egy nemzetközileg elfogadott, standardizált mérési eljárást, mellyel az ultrahangvizsgálatok minőségét növelhetnénk, azzal a végső céllal, hogy javítsuk a betegek biztonságát és az ellátás eredményességét.

Background Endometrial polyps are frequently found in infertile patients, but most of them are as... more Background Endometrial polyps are frequently found in infertile patients, but most of them are asymptomatic. They can be effectively detected by ultrasound using contrast media or color Doppler, but the gold standard is hysteroscopy. In reproductive age, they carry low risk of malignancy. It is assumed that larger polyps hamper implantation. However, it is not clear yet, whether resection of all polyps necessarily improves the fertility, and is the polyp localization influence the implantation failure.

Orvosi Hetilap, May 1, 2022

Bevezetés: Az endokrin betegségekhez társuló ovulációs diszfunkció gyakori vezető vagy társuló ok... more Bevezetés: Az endokrin betegségekhez társuló ovulációs diszfunkció gyakori vezető vagy társuló oka a női infertilitásnak, de optimális reprodukciós korban oki vagy ovulációindukciós kezeléssel többnyire rendezhető a fertilitás. Az in vitro fertilizációs (IVF-) kezelések vezető indikációi jelenleg az andrológiai és a női életkorból adódó, petefészekeredetű infertilitás, de egyéb endokrin diszfunkció társulása befolyásolja a kezelési eredményeket. Célkitűzés: Az endokrin betegségek gyakoriságának vizsgálata az IVF-programban részt vevő párok nőtagjainál. Módszer: Az IVF-program előtti alkalmassági vizsgálatok során a vezető indikációtól függetlenül részletes endokrinológiai kivizsgálást végeztünk 231 nőnél (átlagéletkor 34 év). A vizsgálatok kiterjedtek a hypothalamus-és petefészekfunkcióra, a pajzsmirigyfunkcióra és pajzsmirigy-autoimmunitásra, a mellékvese-funkcióra, a szénhidrát-anyagcserére és az inzulinrezisztenciára. Az egyes endokrin betegségek előfordulásán túl azok társulási gyakoriságát is elemeztük. Eredmények: Az IVF vezető javallatainak megoszlása megfelelt a nemzetközi tendenciáknak, endokrin jellegű volt 87 esetben (37,6%; csökkent petefészek-tartalék: 55 eset és krónikus anovuláció: 32 eset). Társuló endokrin eltérést 141 esetben találtunk, így összesen 161 nőt érintett az endokrin diszfunkció (69,7%; átlagéletkor 35 év). Az endokrin diszfunkciók előfordulása gyakorisági sorrendben: pajzsmirigy-diszfunkció (32,5%), csökkent petefészek-tartalék (23,8%), pajzsmirigy-autoimmunitás (22,5%), polycystás ovarium szindróma (15,6%), inzulinrezisztencia (22,5%), elhízás (23,8%), hyperprolactinaemia (13,4%). Az endokrin betegségek társulása minden kórkép esetében fellelhető volt. Hypogonadotrop hypogonadismus 2, congenitalis adrenalis hyperplasia 1 esetben fordult elő. Nem találtunk endokrin eltérést 70 esetben (30,3%). Következtetés: Vizsgálatunk igazolja az endokrin diszfunkciók halmozott megjelenését és gyakori társulását az IFVprogram résztvevőinél, bármely indikáció esetén. A részletes endokrin kivizsgálás és az IVF-kezelést végzők endokrin jártassága hozzájárulhat az IVF-kezelés sikerességéhez.

2019 11th International Symposium on Image and Signal Processing and Analysis (ISPA)

Though they rarely become malignant, the surgical removal of fibroids (uterine myomas) is commonl... more Though they rarely become malignant, the surgical removal of fibroids (uterine myomas) is commonly considered to prevent any possible future risks. As the least invasive intervention, endoscopic surgery is the most popular approach for this aim. However, since these compact tumors reside in the deep (muscle/connective) tissues of the uterus, they are hardly visible using only the video stream provided by the endoscopic camera. Thus, conform to the current general trend in human surgery, in this paper we propose a multimodal approach to make these tumors more visible during endoscopic interventions, namely, the reconstruction of the whole three-dimensional model of the uterus from ultrasound images and segmentation of the fibroids using this modality. Then, we map the result of the segmentation on the surface of the uterus, hence they become visible during endoscopic surgery. Similar efforts have already been made, considering the usage of MRI for this purpose, but ultrasound image acquisition is more widely available, faster, and cheaper next to the lower image quality. Our aim is to use the output of the 3D ultrasound imaging device during the laparoscopic surgery. Our segmentation pipeline processes the ultrasound images and consists of Otsu's thresholding using a special mask derived from image averages and morphological snakes to extract uterus boundary. As the final step, we project the segmented 3D model of the uterus with its lesion on an endoscope camera flow in real time to provide an augmented reality application.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2019

firmation, study of tumour resectability, second-look to evaluate response to chemotherapy and, i... more firmation, study of tumour resectability, second-look to evaluate response to chemotherapy and, in selected cases, complete cytoreductive surgery. Objective: To reaffirm the valuable role of the minimal invasive approach to advanced tumours. Methods: Retrospective observational study of all women who underwent laparoscopic surgery in the context of ovarian cancer and occult primary tumours in FIGO stages III and IV, between January 2011 and December 2017. Discussion and conclusions: Results: 19 women were included, mean age was 67 years old, twelve (63%) of them with ovarian cancer (8 were stage IV) and seven (37%) with occult primary tumors (all stage IV). In total, 20 laparoscopic procedures were performed. 85% of them had a diagnostic component, complemented by aspiration of ascites (often associated to symptomatic relief post-operatively) and biopsies (after intraoperative confirmation of unresectability criteria). The remaining 15% consisted of a second-look after chemotherapy. Mean operative time was 62 min and estimated blood loss was 25 mL in average. Mean length of stay in the Hospital was 3 days. Post-operative complications occurred in 2 (10%) cases: one infection of the suprapubic port-site wound and one case of umbilical port-site metastasis. 74% of patients started chemotherapy after surgery. The average number of days for the tumour board meeting, first medical oncology appointment and first cycle of chemotherapy was 18, 27 and 34 days, respectively. Over the follow-up period 8 (42%) patients died, all due to disease progression. Conclusion: In the challenging management of these advanced tumours at diagnosis, laparoscopy offers multiple advantages over traditional laparotomy, including smaller incisions with a quicker tissue healing interval, improved visualization for intra-operative staging, reduced blood loss and need for medication, lower risk of thromboembolism, faster overall recovery and an earlier start of treatment by chemotherapy.

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2004

Study objective: This study was set up to evaluate the predictive value of hysteroscopic examinat... more Study objective: This study was set up to evaluate the predictive value of hysteroscopic examination in patients referred to the Department of Obstetrics and Gynecology at the Medical and Health Science Center, Debrecen, Hungary. Study design: The authors performed 835 biopsies by hysteroscopy over more than 13 years. They compared their findings with histological findings held in a a computerized clinical database. Results: The sensitivity of hysteroscopy was 0.52 for hyperplasia, 0.87 for polyps, 0.85 for myomas, 0.68 for carcinoma, and 0.73 for atrophy. Conclusion: It seems that for findings facing into the uterine cavity (such as submucosal myomas and peduncular polyps), hysteroscopy can predict the histological results. The evaluation of endometrial cycles and of the thickness of the endometrium by hysteroscopy is less accurate.

Middle East Fertility Society Journal, 2017

Introduction: Tubal flushing effect is a published phenomena of hysterosalpingography in connecti... more Introduction: Tubal flushing effect is a published phenomena of hysterosalpingography in connection with tubal patency test. The aim of the study was to evaluate the flushing effect of the outpatient method: selective chromopertubation via office hysteroscopy (OHSC-SPT), and compare it to that of HSG. Materials and methods: Sixty infertile patients receiving OHSC-SPT (mean [SD] age: 34.1 [3.2] years) and 163 receiving HSG (32.7 [4.7] years) took part in the study. As part of the infertility work-up, diagnostic office hysteroscopy was performed to evaluate the uterine cavity. Patients with at least one patent tube had a 12-month follow-up, during which their obstetrical events, including successful conception of pregnancy after a sterile period, were recorded. The between-groups comparison was quantified by calculating a pregnancy proportion ratio. Results: Out of the 60 OHSC-SPT subjects, both tubes were blocked in 24 cases, and at least one of the tubes was patent in 36 cases. Out of these 36 cases, 7 (19.4%) spontaneous pregnancies were conceived; in three (8.3%) cases, pregnancy was conceived after intrauterine insemination (IUI) performed on male indication. The number of pregnancies observed in the HSG group (163 examined subjects) was 37 (32 spontaneous, 5 IUI-assisted) out of 153 followed-up subjects (24.4%). The pregnancy proportion ratio estimate was 1.15 (90% CI: 0.70-1.90; p = 0.671). Conclusions: The novel method of OHSC-SPT has a tubal flushing effect that is non-inferior to that observed with HSG.

Journal of Gynecology Obstetrics and Human Reproduction, 2022

During the last decades, the number of couples with reproductive issues has substantially increas... more During the last decades, the number of couples with reproductive issues has substantially increased. Many different factors are implicated in reproductive failure, including uterine factors. Endometrial pathologies, such as endometrial polyps, hyperplasia, endometritis, and Mullerian anomalies, can also hinder embryo implantation. Hysteroscopy remains the gold standard for the evaluation and treatment of intrauterine pathology. Over the last few years, advances in hysteroscopic instrumentations and surgical techniques have significantly evolved, the refinement in technology, miniaturization of instruments, and improved image quality have rendered hysteroscopy a more patient and user-friendly procedure that has enhanced its use in reproductive medicine. Nowadays, hysteroscopy is essential in the evaluation and treatment of women with infertility. This article underscores the major technological breakthroughs achieved over the last few years with emphasis on the role of artificial intelligence, augmented reality, and 3D hysteroscopy, which can set new benchmarks in hysteroscopy applied to reproductive medicine.

Archives of Gynecology and Obstetrics, 2020

The aim of this review is to provide an overview of the literature about the perception and manag... more The aim of this review is to provide an overview of the literature about the perception and management of anxiety and pain in women undergoing an office hysteroscopic procedure. Methods We performed a systematic literature search in Embase, PubMed/MEDLINE, Cochrane Library and Web of Science for original studies written in English (registered in PROSPERO 2019-CRD42019132341), using the terms 'hysteroscopy' AND 'pain' AND 'anxiety' published up to January 2019. Only original articles (randomized, observational and retrospective studies) about management of anxiety and pain related to the hysteroscopic procedure were considered eligible. Results Our literature search produced 84 records. After exclusions, 11 studies including 2222 patients showed the following results: (a) pain experienced during hysteroscopy is negatively affected by preprocedural anxiety; (b) pharmacological interventions seem to be help in reducing pain during hysteroscopy; (c) waiting time before the procedure is a significant factor affecting patients' anxiety; (d) music during the procedure may be helpful in reducing anxiety. Conclusions The utilization of office hysteroscopy is hampered by varying levels of anxiety and pain perceived by women who are candidates for the procedure. For these reasons, it is essential to identify effective pharmacological and non-pharmacological strategies to alleviate these factors. We recommend further studies especially focusing on non-pharmacological interventions to facilitate the dissemination of good clinical practices among hysteroscopists.

Antioxidants, 2019

Gestational diabetes mellitus (GDM) is a very common condition among pregnant women worldwide wit... more Gestational diabetes mellitus (GDM) is a very common condition among pregnant women worldwide with important metabolic implications on the mother and the offspring. Vitamin D status has been suggested to potentially play a role in GDM risk with no documented consequences for the offspring. The purpose of this article was to review currently available evidence on the relationship between vitamin D and GDM. Current evidence shows an association between vitamin D blood levels and risk of GDM, despite heterogeneity of results across studies limit the conclusions. Moreover, data from randomized controlled trials is scarce and resulting in null findings. Among the limitations to be noted, improving the standardization of dosages, the characteristics of individuals in the sample, and the appropriate outcome measurement could provide a more effective approach in understanding the relationship between vitamin D and GDM. In conclusions, despite observational studies may suggest that adequate ...

Archives of Gynecology and Obstetrics, 2019

Aim Our purpose is to investigate if transcervical resection of endometrial polyps improves the f... more Aim Our purpose is to investigate if transcervical resection of endometrial polyps improves the fertility in ovulatory infertile women, and whether polyp histology, intrauterine location, and the technique of polypectomy have any influence on the pregnancy rates. Methods In this retrospective study, clinical data of 87 ovulatory infertile women who underwent hysteroscopy and polypectomy, and their 12-month follow-up have been analyzed. Subgroups according to the method of polyp removal (resectoscope or curettage), the polyp localization (utero-tubal, anterior, posterior, lateral, multiple) and the histological result were interpreted. Results Mean age of patients was 33.99 ± 4.24 years. There were no differences in the BMI and basal FSH levels between the subgroups. Pregnancy was recorded in 30 (34.5%) within the next 12 months without any difference between the subgroups of polypectomy method applied. Posterior wall polyp resection increased the pregnancy chance (OR 5.02), but no other differences were observed in 1-year pregnancy rates to other localizations. Removal of polyps which had normal endometrial histology had lower pregnancy rates as compared to that of polyps with hyperplasia or endometrial polyp histology results (OR 0.25). Conclusions Polypectomy improved the conception rate in the subsequent year regardless of the intrauterine localization and the method of its surgical removal. Therefore, we can conclude that polypectomy should be considered in infertile women.