Ákos Balázs

Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period.

OBJECTIVE Esophagorespiratory fistulas developing from malignant tumors have serious complications by maintaining continuous airway contamination. The objective was to reveal the incidence, causes and characteristics of fistula formation and to examine the possibilities and efficiency of the treatment. METHODS In a single-center study between 1984 and 2004, the data of 2113 patients with tumorous esophageal stenosis were analyzed. Esophagorespiratory fistulas were detected in 264 cases (12.5%). Successful esophageal intubation, stent correction or replacement was performed in 188 cases, while there was one lethal complication. Twenty-seven patients had an intervention for nutritional support: 25 gastrostomies, 1 jejunostomy and 1 percutaneous endoscopic gastrostomy. RESULTS The mean survival period of all patients was 2.8 months; patients with implanted endoprosthesis 3.4 months; with nutritional support 1.1 months and with only supportive therapy 1.3 months, respectively. The differences between the endoprosthesis implanted group and the other two groups were significant (p<0.001). CONCLUSIONS By sealing the fistula, a successful endoscopic esophageal intubation ends the severe respiratory contamination and the inability to swallow, improving the quality of life and survival period. After the procedure, it is the malignant tumor and not the fistula that determines the future of the patient.

Quantitative Liver Lesion Volume Determination by Nanoparticle-Based SPECT

PurposeThe aim of this paper is to present a simple and quantitative data analysis method with a new potential in the application of liver single-photon emission computed tomography (SPECT) imaging. We have established quantitative SPECT/computed tomography (CT) in vivo imaging protocols for determination of liver tumor burden based on the known role of Kupffer cells in cancer of the liver.ProceduresAs it is also known that functional Kupffer cells accumulate particulate material contained in the arterial blood of liver supply, we used radiolabeled macro-aggregated albumin particles ([99mTc]-MAA) injected intravenously to image liver disease. Quantification of cold spot liver lesion imaging was also a general objective.MethodsWe examined a healthy control group (BALB/C mice, n = 6) and group of induced hepatocellular carcinoma (HCC, matrilin-2 transgenic KO mice, n = 9), where hepatocellular carcinoma was induced by diethylnitrosamine. We used [99mTc]-MAA as radiopharmaceutical for liver SPECT imaging in a small animal SPECT/CT system. A liver radioactivity overview map was generated. Segmentation of the liver was calculated by Otsu thresholding method. Based on the segmentation the radioactivity volume and the summarized liver activity were determined.ResultsTumor burden of the livers was quantitatively determined by creating parametric data from the resulting volumetric maps. Ex vivo liver mass data were applied for the validation of in vivo measurements. An uptake with cold spots as tumors was observed in all diseased animals in SPECT/CT scans. Isotope-labeled particle uptake (standardized uptake concentration) of control (median 0.33) and HCC (median 0.18) groups was significantly different (p = 0.0015, Mann Whitney U test).ConclusionA new potential application of [99mTc]-MAA was developed and presents a simple and very effective means to quantitatively characterize liver cold spot lesions resulting from Kupffer cell dysfunctions as a consequence of tumor burden.

Experience with stent implantation in malignant esophageal strictures: Analysis of 1185 consecutive cases

Purpose: The aim of this retrospective study was to analyze the experience in endoprosthesis implantation in cases of malignant esophageal strictures. Methods: A total of 1185 consecutive patients underwent endoprosthesis implantation: through open surgery in 42 cases and by endoscopy in 1143 cases. Results: Stent implantation was performed successfully in 61.2% of cases. Dysphagia was resolved temporarily in 6.2% and permanently in 93.5% of cases. The score of dysphagia decreased from 1.93 to 0.38. Complications were detected in 23.7% of patients, and 69.2% of cases were treated by endoscopy. Wound complications were seen in 21.9% of patients intubated through surgery. The mean survival time of patients with esophageal intubation was 5.4 months and that of patients not eligible for stent implantation was 3.3 months. Conclusions: Stent implantation improves the quality of life and gives an opportunity for adjuvant oncological therapy. Evaluation of morphologic anomalies is of considerable importance for achieving success in treatment through implantation.

A szájüreg baktériumflórájának összefüggése az anastomosiselégtelenség következményeivel nyelőcső- és cardiatumoros betegeknél

Absztrakt: Bevezetes: A tumor miatt vegzett műtetek soran keszult nyelőcső-anastomosisok elegtelensege kapcsan az insufficientian at kilepő tartalom bakterialis osszetetelenek a szovődmeny kimeneteleben jelentős befolyasolo szerepet tetelezhetjuk fel. Celkitűzes: A vizsgalat celja az anastomosiselegtelenseg kovetkezmenyeinek osszevetese a betegek szajuregi bakterialis florajaval. Modszer: A prospektiv vizsgalat soran 131, műtetre kerult betegnel kozvetlenul a műtet előtti orakban mintavetelt vegeztunk. A betegek szajuregi florajanak osszetetelet elemeztuk. Az anastomosiselegtelenseg kovetkezmenyei es a bakteriumflora osszetetele kozotti korrelaciot vizsgaltuk. Eredmenyek: Patogen bakterium jelenlete a szajuregi floraban 50 esetben (38,2%) volt kimutathato. A szovődmeny sulyossaga es a patogen bakteriumok előfordulasi gyakorisaga kozott a korrelacioanalizis kozepes erőssegű kapcsolatot mutatott ki (rs = 0,553), az eredmeny szignifikans (p≤0,05). Kovetkeztetesek: A patogen agenseket tartalmazo flora a varra...

Surgical repair of postintubation esophago-tracheal fistulas: report of two operated cases

A konzervativ kezeles mellett tartosan fennallo, zarodasi hajlamot nem mutato posztintubacios oesophagotrachealis fistulak műteti kezelese bonyolult sebesztechnikai kerdes. A szerzők ket eredmenyesen kezelt eset kapcsan nyert tapasztalatokat elemzik. A műtet soran bal oldali collaris behatolas, a nyelőcső es legcső osszenyilt szakaszanak szetvalasztasa, mindket oldal varrattal valo zarasa, a nyelőcső kirekesztese oldallagos oesophagostomiaval es gepi kapocssoros okkluzioval, valamint a ket varratsor izom-interpozitummal valo szeparacioja tortent. Egyik betegnel az okkluzio spontan rekanalizacioja elhuzodo volt, emellett a sipoly recidivaja alakult ki. Reoperacio soran a korabbi műteti eljarast alkalmaztak a nyelőcső kirekesztese nelkul. A masodik betegnel az oesophagostomia zarodasanak elhuzodasa miatt kellett beavatkozni. Mindket beteg gyogyulasa teljes volt. Tanulsagkent megallapithato, hogy a posztintubacios sipolyok műteti kezeleseben a technikai lehetősegek adott szituaciora valo adaptalasa jelentheti a sikerhez vezető utat. Orv. Hetil., 2011, 152, 1618–1622. | Persistence of postintubation esophago-tracheal fistulas is a difficult therapeutic problem. Authors present and discuss two successfully operated cases. Surgical reconstruction was done via left lateral cervical approach, including dissection of the fistulous tract, closure of the defect on both sides by suture, exclusion of the esophagus with a linear stapler beyond a loop esophagostomy, separation the suture lines with interposing of omohioid muscle flap, and making a Pezzer-catheter splinted esophagostomy. In the first case the spontaneous recanalization of the occluded esophagus was prolonged and the fistula recurred. Reoperation was done by the same procedure without exclusion of the esophagus. The second patient needed intervention because of the prolonged closure of esophagostomy. Recovery of both patients was successful. In conclusion, it can be stated that adaptation of surgical techniques for the individual pathologic situation helped the authors to find the way to the successful outcome. Orv. Hetil., 2011, 152, 1618–1622.Persistence of postintubation esophago-tracheal fistulas is a difficult therapeutic problem. Authors present and discuss two successfully operated cases. Surgical reconstruction was done via left lateral cervical approach, including dissection of the fistulous tract, closure of the defect on both sides by suture, exclusion of the esophagus with a linear stapler beyond a loop esophagostomy, separation the suture lines with interposing of omohioid muscle flap, and making a Pezzer-catheter splinted esophagostomy. In the first case the spontaneous recanalization of the occluded esophagus was prolonged and the fistula recurred. Reoperation was done by the same procedure without exclusion of the esophagus. The second patient needed intervention because of the prolonged closure of esophagostomy. Recovery of both patients was successful. In conclusion, it can be stated that adaptation of surgical techniques for the individual pathologic situation helped the authors to find the way to the successful outcome.

[Pathological characteristics of esophago-respiratory fistulas of esophageal tumor origin].

Esophago-respiratory fistulas, evolving as a result of esophageal tumors, are serious and lethal complications on account of the constant respiratory contamination and the inability to swallow. They can develop either as the complication of the end stage disease or sometimes even in the first stage of the malignancy. The objective was to reveal the characteristics of the disease. In a prospective single-center study in the period between 1984 and 2004, 243 fistulas were diagnosed. Their data were analyzed using multivariate analysis. The mean age of patients with fistula was 56.9 years, the male-to-female ratio was 4.3:1. The average time of the complaints was 5.2 months, while the time of manifestation of the fistula was 7.5 months. Dysphagia was diagnosed in 97.5% of the patients, fever in 36.9%, and cachexia in 59.5%, respectively. The average loss of weight was 10.4 kg and the average size of the tumor was 7.7 cm. Endoscopic intubation was performed in 176 cases. The average survival was 3.4 months. Patients with fistula were divided into two groups, where the characteristics of the disease were significantly different. Only in 66.3% was the fistula a late complication. In the other 33.7% of the cases the fistula was diagnosed in younger patients at the early stage of the disease, with a more aggressive, less differentiated histology. In these patients the weight loss, the grade of dysphagia and the size of the tumor were smaller, the possibilities of treatment were fewer, and survival were shorter.

Nyeloc sotumo r-eredetu oesoph ago-respiratoriCus fistulák kórtani jellemzoi

Esophago-respiratory fistulas, evolving as a result of esophageal tumors, are serious and lethal complications on account of the constant respiratory contamination and the inability to swallow. They can develop either as the complication of the end stage disease or sometimes even in the first stage of the malignancy. The objective was to reveal the characteristics of the disease. In a prospective single-center study in the period between 1984 and 2004, 243 fistulas were diagnosed. Their data were analyzed using multivariate analysis. The mean age of patients with fistula was 56.9 years, the male-to-female ratio was 4.3:1. The average time of the complaints was 5.2 months, while the time of manifestation of the fistula was 7.5 months. Dysphagia was diagnosed in 97.5% of the patients, fever in 36.9%, and cachexia in 59.5%, respectively. The average loss of weight was 10.4 kg and the average size of the tumor was 7.7 cm. Endoscopic intubation was performed in 176 cases. The average survival was 3.4 months. Patients with fistula were divided into two groups, where the characteristics of the disease were significantly different. Only in 66.3% was the fistula a late complication. In the other 33.7% of the cases the fistula was diagnosed in younger patients at the early stage of the disease, with a more aggressive, less differentiated histology. In these patients the weight loss, the grade of dysphagia and the size of the tumor were smaller, the possibilities of treatment were fewer, and survival were shorter.

Nyelőcsőtumor-eredetű oesophago-respiratoricus fistulák kórtani jellemzői@@@Pathological caracteristics of esophago-respiratory fistulas of esophageal tumor origin

Esophago-respiratory fistulas, evolving as a result of esophageal tumors, are serious and lethal complications on account of the constant respiratory contamination and the inability to swallow. They can develop either as the complication of the end stage disease or sometimes even in the first stage of the malignancy. The objective was to reveal the characteristics of the disease. In a prospective single-center study in the period between 1984 and 2004, 243 fistulas were diagnosed. Their data were analyzed using multivariate analysis. The mean age of patients with fistula was 56.9 years, the male-to-female ratio was 4.3:1. The average time of the complaints was 5.2 months, while the time of manifestation of the fistula was 7.5 months. Dysphagia was diagnosed in 97.5% of the patients, fever in 36.9%, and cachexia in 59.5%, respectively. The average loss of weight was 10.4 kg and the average size of the tumor was 7.7 cm. Endoscopic intubation was performed in 176 cases. The average survival was 3.4 months. Patients with fistula were divided into two groups, where the characteristics of the disease were significantly different. Only in 66.3% was the fistula a late complication. In the other 33.7% of the cases the fistula was diagnosed in younger patients at the early stage of the disease, with a more aggressive, less differentiated histology. In these patients the weight loss, the grade of dysphagia and the size of the tumor were smaller, the possibilities of treatment were fewer, and survival were shorter.