Molnár Tamás

A fém- és műanyag stentek költséghatékonysága malignus epeúti szűkületek esetében – összehasonlító vizsgálat[Cost-effectiveness trial of self-expandable metal stents and plastic biliary stents in malignant biliary obstruction]

INTRODUCTION Self-expandable metal and plastic stents can be applied in the palliative endoscopic treatment of patients with unresectable malignant biliary obstruction. The use of metal stentsis recommended if the patients life expectancy is more than four months. AIM To compare the therapeutic efficacy and cost-effectiveness of metal and plastic stents in the treatment of malignant biliary obstruction. METHOD The authors retrospectively enrolled patients who received metal (37 patients) or plastic stent (37 patients). The complication rate, stent patency and cumulative cost of treatment were assessed in the two groups. RESULTS The complication rate of metal stents was lower (37.84% vs. 56.76%), but the stent patency was higher compared with plastic stents (19.11 vs. 8.29 weeks; p = 0.0041). In the plastic stent group the frequency of hospitalization of patients in context with stent complications (1.18 vs. 2.32; p = 0.05) and the necessity of reintervention for stent dysfunction (17 vs. 27; p = 0.033) were substantially higher. In this group multiple stent implantation raised the stent patency from 7.68 to 10.75 weeks. There was no difference in the total cost of treatment of malignant biliary obstruction between the two groups (p = 0.848). CONCLUSIONS Considering the cost of treatment and the burden of patients the authors recommend self-expandable metal sten timplantation if the life expectancy of patients is more than two months. In short survival cases multiple plastic stent implantation is recommended.Absztrakt Bevezetes: A malignus epeuti szűkuletek palliativ endoszkopos kezelesekor ontagulo fem- es műanyag stentek alkalmazhatok. Az iranyelvek a femstenteket magas koltseguk miatt negy honapot meghalado varhato tuleles eseten javasoljak. Celkitűzes: A szerzők celul tűztek ki a malignus epeuti szűkuletek eseten alkalmazott ketfele stent eredmenyessegenek es koltseghatekonysaganak osszehasonlitasat. Modszer: A retrospektiv vizsgalatba 37 fem- es 37 műanyag stentet kapott beteget vontak be. Meghataroztak a stentek atjarhatosagi idejet, szovődmenyratajat es az ellatas kumulativ koltseget. Eredmenyek: A femstentek komplikacios rataja a műanyag stentekhez kepest alacsonyabbnak (37,84 es 56,76%), mig atlagos atjarhatosagi idejuk hosszabbnak (19,11 es 8,29 het; p = 0,0041) bizonyult. A stentelessel osszefuggő hospitalizaciok (1,18 es 2,32; p = 0,05) es intervenciok szama szignifikansan magasabb volt a műanyag stentes csoportban (17 es 27; p = 0,033). Esetukben a kettős stentimplantacio az atjarhatosagi időt 7,...

Colitis ulcerosa minimálisan invazív sebészi kezelése - hosszú távú eredmények: Minimally invasive surgical treatment of ulcerative colitis – long-term results

Absztrakt Bevezetes: A colitis ulcerosa sebeszi kezeleseben egyre szelesebb korben alkalmazzak a laparoszkopos technikat, azonban hosszu tavu magyarorszagi eredmenyekkel eddig meg nem rendelkeztunk. Celkitűzes: A szerzők celja a hagyomanyos es a minimalisan invaziv modszerrel operalt betegek műteti es 47,8 honapos utankovetesi eredmenyeinek osszehasonlitasa. Modszer: 2005. januar 1. es 2014. december 31. kozott osszesen 56 beteg kerult műtetre colitis ulcerosa diagnozissal, akik kozul 20-at surgősseggel, 36-ot tervezetten műtottek. Laparoszkopos technikaval 33, nyitottan 23 műtetet vegeztek. Eredmenyek: A perioperativ időszakban az apolasi idő, passzazsmegindulas, az intenziv osztalyos es transzfuzios igeny es szovődmenyek teren a csoportok kozott kulonbseget nem eszleltek. Hosszu tavu szovődmenyek tekinteteben az intestinalis obstrukcio, a szeptikus allapot es az egyeb komplikaciok előfordulasa szignifikansan alacsonyabb volt a laparoszkopos műteten atesett betegek csoportjaban. Mindket csoport eletminős...INTRODUCTION For the surgical treatment of ulcerative colitis, laparoscopy is used more widely, but less data are available on long-term results in Hungary. AIM The aim of the authors was to compare the mean 47.8-month follow-up results of patients treated with conventional and minimally invasive surgical methods. METHOD Between January 1, 2005 and December 31, 2014, 56 patients were treated with surgery (20 emergencies, and 36 elective cases). Laparoscopy was used in 33 and conventional method in 23 cases. RESULTS There was no difference between the two groups in hospital and intensive care unit stay, bowel function recovery, need for transfusion, and complications during the perioperative period. Regarding long-term complications, the occurrence of intestinal obstruction, septic condition and other complications were significantly fewer in the laparoscopy group. The quality of life improved in both groups after the surgery. CONCLUSIONS Laparoscopy can be used safely; it provides good quality of life and better cosmetic results, and the long-term rate of complications is lower as compared to open surgery.

Endoszkopos ultrahangvezerelt alkoholos ablatio: alternativ terapia a pancreasinsulinomak kezeleseben

Endoscopic ultrasound is the most accurate imaging modality for the diagnosis of pancreatic cancer, and endoscopic ultrasound-guided fine needle injection has already been used for palliative interventions. Surgical resection is currently the standard treatment for pancreatic insulinoma. Medical treatment may be necessary for symptomatic patients with unresectable disease. Case reports have been published about the success of endoscopic ultrasound-guided alcoholic ablation, but it has not been reported previously in Hungarian literature. The authors present the history of an 83-year-old woman who was evaluated because of repeated hypoglycemic coma occurring during the night. Endosonographic image and laboratory findings (elevated serum insulin and chromogranin A) revealed pancreatic insulinoma. Because of severe comorbidities and high risk of surgical resection, the decision was made to ablate the insulinoma by endoscopic ultrasound-guided alcohol injection. A total of 3 mL 95% ethanol was injected into the tumor. Despite the discontinuation of the diazoxide therapy the hypoglycemic episodes disappeared. This case history confirms that endoscopic ultrasound-guided alcoholic ablation is a novel, minimal invasive alternative treatment for patients with pancreatic neuroendocrine tumors in whom surgery is not feasible.Az endoszkopos ultrahangvizsgalat a legerzekenyebb kepalkoto eljaras a pancreastumorok diagnosztikajaban, a finomtű-injekcios technikanak koszonhetően lehetőseget ad a palliativ kezelesre is. A pancreasinsulinomak terapiajanak arany standardja a sebeszi reszekcio, gyogyszeres kezeles csak inoperabilis esetekben jon szoba. Az endoszkopos ultrahangvezerelt alkoholos ablatio eredmenyessegeről tobb esettanulmanyban szamoltak be, de mind ez idaig erre Magyarorszagon nem kerult sor. A szerzők egy 83 eves nőbeteg kortortenetet ismertetik, akinel a hypoglykaemias rosszulletek hattereben a laboratoriumi eredmenyek (emelkedett inzulin es kromogranin A) es az endoszkopos ultrahangkep alapjan pancreasinsulinomat igazoltak. A beteg eletkorara es sulyos tarsbetegsegeire tekintettel műteti beavatkozas nem jott szoba. Endoszkopos ultrahangvezerelt alkoholos ablatio mellett dontottek, amely soran osszesen 3 ml 96%-os etanolt injektaltak a tumorszovetbe. A beavatkozas utan a diazoxidterapia elhagyasa ellenere a hypoglykaemias rosszulletek nem ismetlődtek. A bemutatott eset azt bizonyitja, hogy minimalisan invaziv jellege miatt az endoszkopos ultrahangvezerelt alkoholos ablatio az inoperabilis vagy a magas műteti kockazatu pancreas neuroendokrin tumorok kezeleseben uj alternativat jelenthet. Orv. Hetil., 2014, 155(41), 1647–1651. | Endoscopic ultrasound is the most accurate imaging modality for the diagnosis of pancreatic cancer, and endoscopic ultrasound-guided fine needle injection has already been used for palliative interventions. Surgical resection is currently the standard treatment for pancreatic insulinoma. Medical treatment may be necessary for symptomatic patients with unresectable disease. Case reports have been published about the success of endoscopic ultrasound-guided alcoholic ablation, but it has not been reported previously in Hungarian literature. The authors present the history of an 83-year-old woman who was evaluated because of repeated hypoglycemic coma occurring during the night. Endosonographic image and laboratory findings (elevated serum insulin and chromogranin A) revealed pancreatic insulinoma. Because of severe comorbidities and high risk of surgical resection, the decision was made to ablate the insulinoma by endoscopic ultrasound-guided alcohol injection. A total of 3 mL 95% ethanol was injected into the tumor. Despite the discontinuation of the diazoxide therapy the hypoglycemic episodes disappeared. This case history confirms that endoscopic ultrasound-guided alcoholic ablation is a novel, minimal invasive alternative treatment for patients with pancreatic neuroendocrine tumors in whom surgery is not feasible. Orv. Hetil., 2014, 155(41), 1647–1651.

Különleges eredetű feszülő légmell An extremely rare cause of bilateral tension pneumothorax

CASE REPORT A middle-aged man presented with the diagnosis of typical spontaneous pneumothorax in the left chest. His management was initiated as usual with a chest drain and he had an uneventful recovery with good expansion of the affected lung up until the third postoperative day. But due to a fatal accident, the patient connected the oxygene supply tube into his thoracic drain. This high pressure caused a left, and a consequent bilateral pneumothorax with massive subcutanous emphysema, being the cause of a preterminal status. Cardio-pulmonary resuscitation was unsuccesfull and the patient died. Intentional suicide was excluded by forensic investigations. DISCUSSION According to our knowledge, no similar case with this mechanism of tension pnemuthorax has been published in the literature so far. The pathophysiology is similar to lung damage due to high-pressure ventillation with consecutive tension pneumothorax.

Henoch-Schönlein purpura presenting with multiplex gastrointestinal manifestations and massive nephrotic syndrome in adulthood — a case report

Henoch-Schönlein purpura (HSP) is a systemic small vessel vasculitis mainly affecting children. We report a case of a 49-year-old woman with severe gastrointestinal and renal involvement of HSP. Endoscopy revealed more characteristic findings in the terminal ileum than in the gastric antrum. Histological examinations of the biopsy samples from the ileum, antrum, skin and kidney confirmed the diagnosis of HSP. Parenteral corticosteroid therapy led to a rapid improvement of the gastrointestinal symptoms, but because of the excessive proteinuria intravenous cyclophosphamide therapy had to be introduced.