Pál Ondrejka

Special wound healing methods used in ancient egypt and the mythological background.

The Egyptian civilisation is one of the oldest in history and was renowned for its scientific and artistic achievements, and medicine was no exception. The ancient Egyptians were masters in applying and arranging bandages, and they recognized the cardinal signs of infection and inflammation. Egyptian drug therapy can be regarded as having evolved from a system rooted in magic and empirical observation. To illustrate how the Egyptian wound healing methods provided a major stimulus for the development of surgery, we conducted a literature search.RésuméLa civilisation d’Egypte est une des plus anciennes de l’histoire et reconnue pour ses accomplissements scientifiques et artistiques: la médecine n’a pas été une exception. Les égyptiens ont bríllés particulièrement en matière d’application et de soins par les pansements; ils reconnaissaient les signes cardinaux de l’infection et de l’inflammation. La thérapeutique médicamenteuse des égyptiens peut être regardée comme ayant évolué à partir d’un système dont les racines relevaient à la fois de la magie et de l’observation empirique. Afin d’illustrer comment la méthode de cicatrisation des égyptiens était un stimulus majeur dans le développement de la chirurgie, nous avons mené une recherche bibliographique.ResumenLa civilización egipcia es una de las más antiguas en la historia de la humanidad y es famosa por sus logros científicos y artísticos, y la medicina no fue excepción. Los antiguos egipcios fueron maestros en la aplicación de vendas, y reconocieron los signos principales de la infección y la inflamación. La terapia farmacológica egipcia se desarrolló a partir de un sistema mágico y de la observación empírica. Hemos realizado una investigación de la literatura con el propósito de ilustrar cómo el método egipcio de cicatrízación de las heridas significó un estímulo mayor para el desarrolló de la cirugía.

Gastric outlet obstruction caused by gallstone: Bouveret’s syndrome

SummaryBackground: A case of a gallstone penetrating into the duodenal bulb, and simulating pyloric stenosis is reported. The clinical picture is known as Bouveret’s syndrome. Among the rather uncommon occurrences of gallstone ileus, this form of manifestation is of great rarity, only a few cases are known.Methods: Radiography of the stomach is decisivive for diagnosis as it can detect calculi and biliodigestive fistulae as well. The primary therapy can be endoscopic removal, occasionally after extracorporal shock wave lithotripsy (ESWL). If this procedure is ineffective, operation therapy is mandatory. As a minimal solution, mainly for elderly patients, removal of the gallstone by means of duodenogastrotomy should be performed.Results: Hoping to remove the stone per vias naturales, we tried to crush the calculus by ESWL. Although the trial remained unsuccessful, ESWL may have caused the gallstone to move from duodenum to jejunum. This enabled us to perform enterolithotomy, which involves less surgical stress.Conclusions: In case of symptoms of gastric outlet obstruction with an unoperated gallstone in the history of the patient, we have to think of Bouveret’s syndrome.ZusammenfassungGrundlagen: Die Autoren stellen den Fall eines Ileus vor, der durch einen in den Bulbus duodeni penetrierenden Gallenstein verursacht wurde und das klinische Bild einer Pylorusstenose imitierte. Das Krankheitsbild ist in der Literatur als Bouveret-Syndrom bekannt. Diese Form eines Gallensteinileus ist eine Rarität. In der Literatur sind nur wenige Fälle beschrieben.Methodik: In der Diagnose ist die radiologische Untersuchung des Magens entscheidend, die nicht nur Gallensteine, sondern auch biliodigestive Fisteln darstellen kann. Als Behandlung kommen Endoskopie und ESWL-Therapie in Frage. Ist diese Maßnahme erfolglos, ist eine Operation notwendig. Da diese Patienten oftmals älter sind und sich in einem schlechten Algemeinzustand befinden, kommt als Minimaleingriff die Entfernung des Steines durch Duodenogastrotomie in Frage.Ergebnisse: Die Autoren versuchten zuerst die ESWL-Behandlung. Obwohl die Zertrümmerung des Gallensteines nicht gelang, verursachte die ESWL wahrscheinlich eine Verlagerung des Steines vom Duodenum ins Jejunum. So konnte als kleinere operative Maßnahme die Enterolithotomie durchgeführt werden, anstatt das durch die begleitende Entzündung schwer verwachsene Duodenum freipräparieren zu müssen.Schlußfolgerungen: Bei Patienten mit Entleerungsstörung des Magens und noch nicht operierten Gallensteine in der Anamnese muß man auch an ein Bouveret-Syndrome denken.

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.

Detection of Human Papillomavirus Type 16 in Squamous Cell Carcinoma of the Colon and Its Lymph Node Metastases with PCR and Southern Blot Hybridization

The etiological role of human papillomavirus (HPV) in a number of squamous malignant tumors is well known. Squamous cell carcinoma (SCC) of colon is a rare disease with uncertain etiology. Our objective was to detect possible HPV infection in a colon SCC patient. The 94-year-old female patient was operated due to colon tumor causing passage disturbances. Histology confirmed SCC. Tumor tissue and the removed lymph nodes were examined with polymerase chain reaction and Southern blot hybridization techniques. Of HPV types most often occurring in malignant tumors (16, 18) the presence of HPV type 16 could be confirmed in the primary tumor and in four out of the nine surrounding lymph nodes, of which two were metastatic. HPV-16 infection could be detected in an SCC patient in the primary tumor and in surrounding lymph nodes. According to our knowledge, no similar study has been published yet.

Resection and Replacement in the Treatment of Cancer of the Esophagus and the Esophagogastric Junction

The treatment and the surgical management of esophageal and cardiac cancer is the one of the most controversial questions in the field of gastroenterological surgery and it represents a rather ungrateful surgical task. Despite progress in anesthesia and operative technique and the considerable improvement in postoperative care and intensive therapy, resections and reconstructions of the esophagus have remained formidable operations with high risk in patients, who usually are in a poor general condition. The only way to manage esophageal carcinoma successfully is by radical surgery [2, 9]. On the other hand, the best palliative procedure for the restoration of swallowing is resection and immediate esophageal replacement [3, 10].

Két műtéti technika elemzése laparoscopos splenectomiák kapcsán

INTRODUCTION Laparosocopic splenectomy gradually became the gold standard procedure in the surgical treatment of certain haematological disorders. Operative experience in laparoscopic procedures facilitates the comparison of various techniques. AIM Two variants in laparoscopic spelenectomy are analysed and presented. MATERIAL AND METHOD Sixteen patients underwent laparoscopic spelenectomy. Anterior- and postero-anterior laparoscopic approaches are compared with respect to clinicopathologic features. CONCLUSIONS Using the postero-anterior technique dissection of splenic hilum is more straightforward, recognition of accessory spleen is easier and the likelihood of intraoperative complications is less. In selected cases of splenomegaly the anterior technique is recommended though.

Kizárt combsérv klinikai képét mutató recidív retroperitonealis liposarcomar

56-year-old man was admitted to our hospital 18 month after extirpation of retroperitoneal liposarcoma. We diagnosed recurrent tumor in the inguinal fossa. The tumor situated along the femoral artery and propagated to the thigh among the muscles, mimicking incarcerated femoral hernia. We performed resection with synchronous abdominal and femoral exploration. By our knowledge this is the first case report about recurrent retroperitoneal liposarcoma presenting as an incarcerated femoral hernia.

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.

Fast track colo-rectal surgery

A vastagbelműteteket kovető gyors felepuleshez sok tenyező jarul hozza. A műtethez kapcsolodo folyamatok optimalissa tetelehez nemcsak az operacios technika, hanem ezen tul a műtet előtti es utani tenyezők is nagyban hozzajarulnak. A Medline elektronikus adatbazisbol kulcsszavakra valo keresessel gyűjtottuk ki a megfelelő cikkeket, majd az oxfordi Evidence Based Medicine beosztasa alapjan rangsoroltuk őket es a legrelevansabbakat hasznaltuk fel. Randomizalt, multicentrikus tanulmanyok igazoltak, hogy a vastagbelműteteket megelőző hashajtas nem csokkenti az anastomosis insufficientiak es sebszovődmenyek szamat; a hasi drenek rutinszerű hasznalata nem szukseges; a korultekintő, korai taplalas a vastagbelsebeszetben is biztonsagos es jol toleralhato, es a laparoszkopos vastagbelműtetek a nyilt műtetekkel egyenertekűek. A kapott evidenciakat jelenleg nem teljes mertekben alkalmazzuk. A laparoszkopos műteti technika előnyeit a fast track perioperativ ellatas nagyban fokozza. Ahhoz, hogy a vastagbelsebeszet per...

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.