István Sugár

Secondary iliac-enteric fistula to the sigmoid colon complicated with entero-grafto-cutaneous fistula.

We report the case of a 67-year-old man who was admitted to our department with acute rectal bleeding. The patient had had previous aortoiliac surgery with the utilization of an aortobifemoral vascular prosthesis. Diagnosis of aortoenteric fistula was made between the distal suture line of the right graft leg and the sigmoid colon. This fistula had an enterocutaneous component. After exploratory laparotomy, primary resection of the sigmoid colon, exstirpation of the enterocutaneous fistula, excision of the right graft leg and extraanatomical crossover bypass were successfully performed. This study reports a rare type of aorto/ilac-enteric fistula to the left colon complicated with an entero-grafto-cutaneous component and describes an unusual and successful surgical treatment method.

A Wilkie-syndromárólr

Loss of retroperitoneal fatty tissue as a result of a variety of debilitating conditions and noxa is believed to be the etiologic factor of superior mesenteric artery syndrome. A case of a 35 years old female patient with severe malnutrition and weight loss is presented, who developed superior mesenteric artery syndrome. Various theories of etiology, clinical course and treatment options of this uncommon disease are discussed. In our case, conservative management was inefficient, while surgical treatment aiming to bypass the obstruction by an anastomosis between the jejunum and the proximal duodenum (duodenojejunostomy) was successful. An interdisciplinary teamwork provides the most beneficial diagnostic and therapeutic result in this often underestimated disease.

Teljes gyomorkimeneti elzáródás ritka esete: gyomorgyűrű eltávolítását követő belső kizáródás

The laparoscopically administrated adjustable gastric banding used to be widely practiced as treatment of extreme obesity. As lots of complaints and complications arose sooner or later after this procedure, they had to be removed quite often. Half year after such a removal we observed a 37-year-old female patient with complete gastric outlet obstruction. The patient was operated and cured completely. The cause of gastric obstruction was an internal incarceration of the pyloric region between the plication made at the time of the ring removal and the gastric body. We found no similar case of gastric outlet obstruction in the corresponding literature.Absztrakt: Az extrem koverseg kezelesere kifejlesztett eljarasok kozul az allithato gyomorgyűrű korabban igen elterjedt volt. Alkalmazasat azonban szamos kesői panasz, illetve szovődmeny kiserte, ezert egyre gyakrabban fordul elő, hogy eltavolitasra kerulnek. Egy ilyen beavatkozas utan fel evvel kialakult teljes gyomorkimeneti elzarodas klinikai kepet előidező belső kizarodas esetet mutatjuk be. A belső kizarodast az okozta, hogy a pylorusregio becsuszott a gyűrű eltavolitasakor keszitett plicatio es a gyomorcorpus fala koze. A beteg a műteti megoldas utan gyogyult. Hasonlo okbol kialakult gyomorelzarodas esetevel az irodalom tanulmanyozasa soran nem talalkoztunk.

Masszív gastrointestinalis vérzést okozó „görögdinnyegyomor”

Absztrakt A gastrointestinalis verzes oka lehet a gyomor antralis regiojanak es neha a cardiatajeknak a koros ertagulata. Első leiroja a mult szazad 50-es eveinek elejen a GAVE (Gastric Antral Vascular Ectasia) nevvel illette, miutan ekkor meg a hasonlo jelenseget a cardiatajon nem regisztraltak. Negyed szazaddal kesőbb – nehany eset kozlese kapcsan – egy szellemes belgyogyasz ragasztotta ra a gorogdinnye (watermelon) elnevezest, minthogy a makroszkopos kep az emlitett gyumolcs „hejara hajaz”. A raritasnak szamito korkep sulyos tars betegsegekkel terhelt betegunknel jelentkezett.

Phaeochromocytomás krízisben végzett acut laparoscopos adrenalectomia

CASE REPORT Authors present the case of a 30-year-old female patient, who was admitted to the ICU because of hypertensive crisis accompanied by chest complains, cardiac decompensation, progrediating short of breath and unconsciousness. Despite the quick examinations and the prompt treatment multi-organ failure developed 3 days after admission. Investigations revealed the underlying cause, which was a left-sided suprarenal neoplasm. Hence, multidisciplinary decision was made to carry out a laparoscopic adrenalectomy urgently. The histology examination of the removed neoplasm was pheochromocytoma. In the postoperative period the condition of the patient gradually improved, her symptoms and complains settled, and finally she was discharged in a healthy condition. DISCUSSION The diagnosis of a pheochromocytoma is a difficult task, the symptoms and complains caused by it can simulate many other illnesses. The acute crisis caused by pheochromocytoma usually can be treated conservatively, but in more severe cases with impending multi-organ failure an urgent operative treatment can be unavoidable. Though the operative risk is relatively high, the correct intra- and postoperative treatment with a quick laparoscopic procedure can be effective.

Aortoenteralis fistula ritka formája – sigmoideo-grafto-cutan fistular

We report a case of a 62-year-old man who presented to the emergency department with acute rectal bleeding. The patient had previous aortoiliac surgery with the utilization of an aorto-bifemoral vascular graft. Diagnosis of secondary aortoenteric fistula was made between the aortoiliac graft and sigmoid colon. This fistula had an entero-cutaneous component. After exploratory laparotomy resection of the sigma, extirpation of the entero-cutaneous fistula, excision of the graft, oversewing of the aortic stump, and extra-anatomical crossover bypass were successfully performed. This study reports a rare type of secondary aortoenteric fistula to the sigmoid colon complicated with an entero-grafto-cutaneous component and it describes an unusual and successful surgical treatment.

Myeloma multiplex kórlefolyása során megjeleno plazmasejtes borinfiltráció

UNLABELLED Authors present a case of a therapy-resistant multiple myeloma who developed plasmacytic skin infiltration in the course of the disease. AIM To define characteristics of skin infiltrating plasma cells, which differentiate them from those cells residing in the bone marrow in order to contribute to a better understanding of the epidermoinvasion process. METHODS Histidine decarboxylase is the only enzyme capable for histamine synthesis having significance in cell proliferation. Histidine decarboxylase was determined in skin samples and bone marrow slides by immunohistochemical procedures and in bone marrow cells using flow cytometry analysis. RESULTS The histidine decarboxylase expression of plasma cells participating in skin invasion disappeared, while that of bone marrow plasma cells remained. CONCLUSIONS Authors conclude that the histidine decarboxylase loss would serve as an evidence for the dedifferentiation of epidermoinvasive cells as being the result of fundamental changes in histamine metabolism. As extramedullary myeloma cells differ from those residing in the bone marrow, their therapeutical response might also be different.

Myeloma multiplex kórlefolyása során megjelenő plazmasejtes bőrinfiltráció@@@Plasmacytic skin infiltration in multiple myeloma

UNLABELLED Authors present a case of a therapy-resistant multiple myeloma who developed plasmacytic skin infiltration in the course of the disease. AIM To define characteristics of skin infiltrating plasma cells, which differentiate them from those cells residing in the bone marrow in order to contribute to a better understanding of the epidermoinvasion process. METHODS Histidine decarboxylase is the only enzyme capable for histamine synthesis having significance in cell proliferation. Histidine decarboxylase was determined in skin samples and bone marrow slides by immunohistochemical procedures and in bone marrow cells using flow cytometry analysis. RESULTS The histidine decarboxylase expression of plasma cells participating in skin invasion disappeared, while that of bone marrow plasma cells remained. CONCLUSIONS Authors conclude that the histidine decarboxylase loss would serve as an evidence for the dedifferentiation of epidermoinvasive cells as being the result of fundamental changes in histamine metabolism. As extramedullary myeloma cells differ from those residing in the bone marrow, their therapeutical response might also be different.

Plasmacytic skin infiltration in multiple myeloma

UNLABELLED Authors present a case of a therapy-resistant multiple myeloma who developed plasmacytic skin infiltration in the course of the disease. AIM To define characteristics of skin infiltrating plasma cells, which differentiate them from those cells residing in the bone marrow in order to contribute to a better understanding of the epidermoinvasion process. METHODS Histidine decarboxylase is the only enzyme capable for histamine synthesis having significance in cell proliferation. Histidine decarboxylase was determined in skin samples and bone marrow slides by immunohistochemical procedures and in bone marrow cells using flow cytometry analysis. RESULTS The histidine decarboxylase expression of plasma cells participating in skin invasion disappeared, while that of bone marrow plasma cells remained. CONCLUSIONS Authors conclude that the histidine decarboxylase loss would serve as an evidence for the dedifferentiation of epidermoinvasive cells as being the result of fundamental changes in histamine metabolism. As extramedullary myeloma cells differ from those residing in the bone marrow, their therapeutical response might also be different.

Jejunalis polyposisból származó heveny gastrointestinalis vérzés diagnosztikája és eredményes kezeléser

The authors present an interesting case of massive gastrointestinal bleeding which is caused by extended jejunal polyposis. They discuss the diagnostic challenges and the way of successful treatment of this case. The authors also summarize their experience and review the relevant literature regarding acute gastrointestinal bleeding from the small bowel.