New trends in the surgical treatment of axilla in breast cancer / Új trendek az axilla sebészi kezelésében emlorák esetén

Oncosurgical treatment of breast tumors involves the removal of metastatic axillary lymph nodes. In the last 30 years, the diagnosis and treatment of axillary lymph nodes have also undergone significant changes. The introduction of sentinel lymph node biopsy in 1993 made axillary block dissection with high morbidity safely omitted in a significant proportion of patients, and similarly, the staging of breast tumors and thus oncology and complex treatment became significantly more accurate. Shortly after the introduction of sentinel lymph node biopsy, intraoperative examination of sentinel lymph nodes (e.g. imprint cytology) also appeared, which significantly reduced the number of surgeries performed in the two sessions, thereby significantly reducing patient burden and surgical costs. The results of our study indicate that axillary block dissection is required in the treatment of axilla in an ever-decreasing group of patients and this proportion will decrease further in the future, with the increasing use of alternative axillary radiotherapy. The imprint cytological examination of sentinel lymph nodes taking into account current guidelines, no longer provides demonstrable benefits and its routine use is not justified. According to the latest international recommendations, intraoperative examination of the sentinel lymph node may be indicated in connection with mastectomy (when postoperative radiotherapy is not planned) and after neoadjuvant treatment. Our results suggest that the detection of suspected lymph nodes during preoperative axillary ultrasound may predict the stage of the disease. Based on our research results confirm that in patients receiving neoadjuvant therapy, in addition to the preoperative size of the tumour (≤20 mm, P = 0.002), the preoperative size of the lymph node (≤15 mm, P = 0.04) may also be used to predict that the stage of the disease is N0-1.

The reliability and validity of the Hungarian version of the Brief Illness Perception Questionnaire / A Rövid Betegségpercepció Kérdoív magyar változatának megbízhatósági vizsgálata.

Összefoglaló. Bevezetés: Interdiszciplináris kutatásokkal igazolták, hogy a páciensnek a betegségérol kialakított elképzelései meghatározó szerepet játszanak a gyógyulási folyamat sikerességében. Célkituzés: Vizsgálatunk célja az ezen elképzelések felmérésére kifejlesztett Rövid Betegségpercepció Kérdoív magyar nyelvu változatának megbízhatósági és validitási vizsgálata krónikus betegségben szenvedo, daganattal küzdo és transzplantált páciensek körében. Módszer: Keresztmetszeti vizsgálatunkban 490 páciens vett részt. A kérdoív validitásának vizsgálatára a Spielberger-féle Állapot- és Vonásszorongás Kérdoívet, a Beck Depresszió Kérdoívet és a Poszttraumás Növekedésérzés Kérdoívet alkalmaztuk, illetve felmértük a betegcsoportok életminoségét. Eredmények: A kérdoív belso megbízhatósága, a teszt-reteszt megbízhatósága kiváló. A konstruktumvaliditást vizsgálva közepesen eros összefüggést találtunk a szorongás, a depresszió, a poszttraumás növekedésérzés, az életminoség és a Rövid Betegségpercepció Kérdoív között. A prediktív validitást vizsgálva igazolást nyert, hogy a betegségpercepció összefüggésben áll a vesemuködést jelzo eGFR-szinttel (p = 0,027). A kérdoív diszkrimináns validitását igazolta, hogy képes különbséget tenni a különbözo betegcsoportok között. Következtetés: A Rövid Betegségpercepció Kérdoív magyar verziójának reliabilitása és validitása a vizsgált populáción jónak mutatkozott. A kérdoív megbízható információt ad a pácienseknek a betegségükrol kialakított elképzeléseirol. Orv Hetil. 2021; 162(6): 212-218. INTRODUCTION: Interdisciplinary studies confirm that patients' illness perception can have a substantial effect on the healing process. OBJECTIVE: The aim of this study was to assess the reliability and validity of the Hungarian version of the Brief Illness Perception Questionnaire in chronic disease, cancer, and transplant patients. METHOD: 490 patients were assessed using the Spielberger Anxiety Inventory, the Beck Depression Inventory, Posttraumatic Growth Inventory and quality of life questionnaires. RESULTS: The scale showed good internal consistency, and the test-retest reliability was excellent. The Brief Illness Perception Questionnaire scores moderately correlated with anxiety, depression, posttraumatic growth and quality of life. Examining predictive validity, the questionnaire correlated with eGFR level (p = 0.027). The discriminant validity of the questionnaire was supported by its ability to distinguish between different patient groups. CONCLUSION: The reliability and validity of the Hungarian version of the Brief Illness Perception Questionnaire in the sample were excellent. The questionnaire turned out to be a useful psychometric tool in the measurement of illness perception. Orv Hetil. 2021; 162(6): 212-218.

Use of laparoscopic technique in the treatment of ulcerative colitis / A laparoszkópia szerepe a colitis ulcerosa kezelésében

INTRODUCTION: An estimated 20-30% of patients with ulcerative colitis need surgery. The generally accepted procedure for the surgical treatment is total proctocolectomy with ileal pouch-anal anastomosis. Nowadays laparoscopic technique is used more frequently. AIM: Our aim was to compare the last 13 years results of patients treated with conventional and laparoscopic methods. METHOD: Between 01. 01. 2005 and 31. 05. 2018, 89 patients (n = 48 female, n = 41 male) received surgery. The mean age of the patients was 45.06 ± 14.4 and 39.8 ± 13.4 years in the laparoscopy and the open surgery groups. General status of patients, early and late results of surgical treatment, mainly complications and quality of life, were analyzed. RESULTS: There was no difference between the groups in hospital stay (10.3 ± 3.3 vs. 11.2 ± 3.7 days) and need for transfusion (2.6 ± 2.2 vs. 2.8 ± 1.7 units). During the follow-up period, the time to the recovery of the bowel function (1.2 ± 0.5 vs. 1.6 ± 0.7 days), the number of days spent in the intensive care unit (2.1 ± 0.9 vs. 2.5 ± 1.6 days) and the occurrence of late complications, such as intestinal obstruction, septic condition, postoperative hernias and 'other' complications were significantly lower in the laparoscopically operated group of patients. In the case of acute operations, the laparoscopic technique provided significantly better recovery of the bowel function (1.2 ± 0.4 vs. 1.8 ± 0.7 days). CONCLUSION: During the surgical treatment of ulcerative colitis, the minimally invasive technique provided more favourable perioperative results and a better long-term quality of life due to the lower rate of late complications and the more stable psychic status. Orv Hetil. 2020; 161(33): 1363-1372.

[Complex supportive care of patients with breast cancer. The preliminary results of a psychological intervention study]. / Emlodaganatos nobetegek komplex támogató terápiája. Egy pszichológiai intervenciós kutatás elozetes eredményei.

Introduction: Interdisciplinary studies confirm that the traumatic nature of cancer diagnosis and the long course of treatment may often lead to a series of emotional problems among cancer patients, this way precluding physical and psychological recovery. Aim: The aim of the study was to create a complex psychosocial intervention program for breast cancer patients and to present our preliminary results. Method: In our 6 week long study, 50 breast cancer patients were assessed. The intervention group comprised of 20 patients, the control group comprised of 30 patients. Measurements included the Beck Depression Inventory (BDI), the Spielberger State and Trait Anxiety Inventory (STAI), the Surgical Fear Questionnaire (SFQ), the Visual Analogue Scale (VAS), the Functional Assessment of Cancer Therapy - Breast (FACT-B) and the Breast-Impact of Treatment Scale (BITS). Therapeutic tools used were the PRISM-D and the Body-Sculpture Test. Results: Our results indicate that the psychological interventions may have an instant stress-relieving and calming effect on our patients, this way providing social support. The type of surgery significantly influenced the levels of body change stress. Conclusion: Our results highlight the importance of early psychological screening among breast cancer patients before and after surgery as well. Orv Hetil. 2019; 160(18): 700-709.

Effect of Laparoscopic Surgery on Quality of Life in Ulcerative Colitis.

AIM: To evaluate quality of life after surgery for ulcerative colitis (UC) the gastroenterological and psychological conditions were examined. MATERIALS AND METHODS: Between January 1, 2005 and March 1, 2016, surgery was performed for UC in a total of 75 patients. Our examinations were performed in 58 cases. Quality of life was examined with questionnaires. Functional Scoring System, Gastrointestinal Quality of Life Index (GIQLI), and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) were used for testing gastroenterological conditions; Spielberger's State-Trait Anxiety Questionnaire, Beck Depression Inventory, and Brief Illness Perception Questionnaire (BIPQ) were performed to consider psychological status. RESULTS: Trait anxiety and the incidence of abdominal pain were significantly lower in patients having undergone laparoscopic surgery. No difference was found between the minimally invasive and conventional methods in the early complications. There were significantly more late complications developing after 30 days in patients who had undergone open surgery. Differences were found in personal control between patients with a stoma and patients without a stoma. Patients with a stoma felt they had less control over their disease. A significant correlation was found between the results of the psychological and gastrointestinal questionnaires. CONCLUSIONS: Minimally invasive technique provides a better long-term outcome for patients with UC, fewer complications, and a more balanced emotional condition. Favorable gastroenterological condition leads to better psychological status, which is negatively influenced by stoma or complications.

What contributes to long-term quality of life in breast cancer patients who are undergoing surgery? Results of a multidimensional study.

PURPOSE: This study aims to examine the key determinants of long-term quality of life in breast cancer patients who are undergoing surgery using a multidimensional approach and taking into account preoperative and post-operative psychological characteristics such as anxiety, depression, posttraumatic growth, body image, and physical activity as well as medical parameters. METHODS: The study involved 63 breast cancer patients from the Department of Surgery at the University of Szeged. Assessments occurred 1 day before surgery as well as 3 days and 18 months after surgery using the Spielberger State and Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI), Functional Assessment of Cancer Therapy-Breast Cancer Scale (FACT-B), Posttraumatic Growth Inventory (PTGI) and Breast Impact of Treatment Scale (BITS). Data relating to physical activity, medical parameters and sociodemographic characteristics were also collected. RESULTS: The level of depression did not change over time. State anxiety decreased 18 months after the surgery compared to before the surgery; however, there was a greater decrease immediately after the surgery and then anxiety increased again 18 months later. Trait anxiety was associated with quality of life, posttraumatic growth and body image. Posttraumatic growth and the level of depression were found to be possible contributing factors to the increase in long-term quality of life. CONCLUSIONS: The results show that the timely detection and proper management of psychological distress and the enhancement of posttraumatic growth are of great value, as they might be important contributing factors to long-term quality of life in breast cancer patients.

[Tension-type headache in ulcerative colitis]. / Tenziós típusú fejfájás és colitis ulcerosa.

BACKGROUND AND PURPOSE: Tension-type headache is a very common disease with a high socio-economic impact as its lifetime prevalence is 30-78% in the general population. The incidence of inflammatory bowel diseases is continuously rising. Limited data are accessible on quality of life in patients with surgically treated ulcerative colitis. The aim of our study is to examine quality of life, concerning headache, among patients who had undergone surgery due to ulcerative colitis. METHODS: Between 1 January 2005 and 1 March 2016, surgery was performed due to ulcerative colitis in 75 patients. During this retrospective analysis the average duration of the follow-up was 46 (1-124) months. The pre-sence of headache was evaluated by the use of Brief Illness Perception and Headache Questionnaires. RESULTS: Among the primary headache disorders (n=27), tension-type headache occurred in 19 (70.4%) cases, and 8 (29.6%) patients had migraine (without aura). Among tension-type headache cases 17 (89.5%) patients experienced episodic form and 2 (10.5%) suffered from chronic form. Patients with headache had obtained a significantly higher score on Brief Illness Perception Questionnaire. CONCLUSION: According to our study tension-type headache is common among patients with ulcerative colitis. This observation raises the question whether stress plays role in the pathogenesis of both diseases, which influences and worsens considerably quality of life. Neurological examination, psychological and psychiatric guidance are worth considering in patients with ulcerative colitis.

[Psychological factors of successful kidney transplantations. The effects of anxiety and intrapsychic integration of the organ on recovery]. / A vesetranszplantáció sikerességének pszichológiai tényezoi. A szorongásszint és a szerv intrapszichés integrációjának hatása a gyógyulási folyamatra.

UNLABELLED: Transplant patients' attitudes and representations related to their illness, their body, and the healing process have a significant impact on their recovery. AIMS: The study involved 51 patients from the Department of Surgery, University of Szeged, Hungary. The primary aim was to examine the possible connections between emotional and mood factors, illness and body representations, and the successful onset of renal functions after surgery. METHODS: Patients were tested with a combination of 4 instruments: Spielberger's anxiety scale and Beck depression scale, self and organ drawings, and a questionnaire designed by the authors. RESULTS: Our data suggest that high distress correlates with kidney disfunction after transplantation. Patients with higher anxiety drew the kidney larger in their projective drawing test. It was a remarkable result that post-transplant blood test on Day 10 showed significantly lower creatinine and urea levels in those patients who had drawn the kidney smaller in their projective drawing test. This might indicate that the organ's normal intrapsychic integration and the related kidney functions are disturbed. CONCLUSIONS: The results of this study provide useful information about the psychological background, which has received relatively little attention so far. It can also give important clues for further research on clinical health psychology in supporting the healing process.