Tamás Winternitz

Laparoscopic surgery of benign liver tumours

273 patients underwent elective surgical treatment for benign liver lesions at the 1st Surgical Department of Semmelweis University, Budapest, Hungary between 2004 and 2014. Laparoscopic (LAP) interventions were performed in 83 cases. Cyst fenestration in 52, and hepatic resection in 31 cases. LAP liver resections were set against to open surgery of paired group of patients with comparable demographic and clinical parameters. Data revealed that the operative time in LAP group (113.7 min) was significantly longer than that in the open surgery group (89.5 min). The average postoperative length of hospital stay was shorter after LAP surgery (5.8 vs 9.1 days). There was no postoperative complication in the LAP group, two wound infections and one biliary collection were treated by ultrasonic drainage in the open group. Three patients were given blood transfusion in the LAP, four in the open group. Operative mortality was zero, and no reoperation required. The surgical technique which is described in detail in the text enables safe resection of segments 7-8 which are difficult to approach. Our data support the safety and feasibility of laparoscopic liver resection after adequate preoperative investigations.

Verner-Morrison syndrome: a case study

Verner and Morrison described a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA) in 1958. VIPomas producing high amounts of vasoactive intestinal peptide (VIP) commonly originate from the pancreas. Typical symptoms play a momentous role in the diagnosis of VIPoma. Diarrhea may persist for years before the diagnosis. Morbidity from untreated WDHA syndrome is associated with long-standing dehydration and with electrolyte and acid-base metabolism disorders, which may cause chronic renal failure. Assessment of specific marker (VIP) offers high sensitivity in establishing the diagnosis. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogues. Treatment options include resection of the tumor, chemotherapy or the reduction of symptoms with somatostatin analogues. Early diagnosis and management may affect survival of patients favorably. VIPoma cases may be associated with multiple endocrine neoplasia type 1.1958-ban Verner es Morrison irta le az elnevezeseben a vizes hasmenesre, hypokalaemiara es achlorhydriara utalo szindromat (watery diarrhea, hypokalaemia, achlorhydria – WDHA). A nagy mennyisegű vazoaktiv intestinalis peptidet (VIP) termelő VIPomak rendszerint a hasnyalmirigyből szarmaznak. A tipikus tunetek fontos szerepet jatszanak a VIPoma diagnozisaban. A hasmenes a diagnozis felismerese előtt evekig perzisztalhat. A kezeletlen WDHA-szindroma a hosszabb ideig fennallo exsiccosis, illetve az elektrolit- es sav-bazis haztartas zavara miatt kronikus veseelegtelenseghez vezethet, ami a betegseg lefolyasat sulyosbithatja. Specifikus marker (VIP) meghatarozasa erzekeny modszer a korisme felallitasahoz. A felismeresben segitseget nyujt az endoszkopos ultrahang, komputertomografia, magneses rezonancia es főleg a szomatosztatinanalogokkal vegzett szcintigrafias vizsgalat. A kezelesi lehetősegek koze tartozik a daganat reszekcioja, a kemoterapia es a tunetek csokkentese erdekeben a szomatosztatinanalogok alkalmazasa. A korai diagnozis es kezeles kedvezően hathat a betegek eletben maradasara. A VIPomak tarsulhatnak az 1-es tipusu multiplex endokrin neoplasia (MEN-1) szindromahoz. | Verner and Morrison described a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA) in 1958. VIPomas producing high amounts of vasoactive intestinal peptide (VIP) commonly originate from the pancreas. Typical symptoms play a momentous role in the diagnosis of VIPoma. Diarrhea may persist for years before the diagnosis. Morbidity from untreated WDHA syndrome is associated with long-standing dehydration and with electrolyte and acid-base metabolism disorders, which may cause chronic renal failure. Assessment of specific marker (VIP) offers high sensitivity in establishing the diagnosis. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogues. Treatment options include resection of the tumor, chemotherapy or the reduction of symptoms with somatostatin analogues. Early diagnosis and management may affect survival of patients favorably. VIPoma cases may be associated with multiple endocrine neoplasia type 1.

Verner-morrison-szindróma egy esete

Verner and Morrison described a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA) in 1958. VIPomas producing high amounts of vasoactive intestinal peptide (VIP) commonly originate from the pancreas. Typical symptoms play a momentous role in the diagnosis of VIPoma. Diarrhea may persist for years before the diagnosis. Morbidity from untreated WDHA syndrome is associated with long-standing dehydration and with electrolyte and acid-base metabolism disorders, which may cause chronic renal failure. Assessment of specific marker (VIP) offers high sensitivity in establishing the diagnosis. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogues. Treatment options include resection of the tumor, chemotherapy or the reduction of symptoms with somatostatin analogues. Early diagnosis and management may affect survival of patients favorably. VIPoma cases may be associated with multiple endocrine neoplasia type 1.1958-ban Verner es Morrison irta le az elnevezeseben a vizes hasmenesre, hypokalaemiara es achlorhydriara utalo szindromat (watery diarrhea, hypokalaemia, achlorhydria – WDHA). A nagy mennyisegű vazoaktiv intestinalis peptidet (VIP) termelő VIPomak rendszerint a hasnyalmirigyből szarmaznak. A tipikus tunetek fontos szerepet jatszanak a VIPoma diagnozisaban. A hasmenes a diagnozis felismerese előtt evekig perzisztalhat. A kezeletlen WDHA-szindroma a hosszabb ideig fennallo exsiccosis, illetve az elektrolit- es sav-bazis haztartas zavara miatt kronikus veseelegtelenseghez vezethet, ami a betegseg lefolyasat sulyosbithatja. Specifikus marker (VIP) meghatarozasa erzekeny modszer a korisme felallitasahoz. A felismeresben segitseget nyujt az endoszkopos ultrahang, komputertomografia, magneses rezonancia es főleg a szomatosztatinanalogokkal vegzett szcintigrafias vizsgalat. A kezelesi lehetősegek koze tartozik a daganat reszekcioja, a kemoterapia es a tunetek csokkentese erdekeben a szomatosztatinanalogok alkalmazasa. A korai diagnozis es kezeles kedvezően hathat a betegek eletben maradasara. A VIPomak tarsulhatnak az 1-es tipusu multiplex endokrin neoplasia (MEN-1) szindromahoz. | Verner and Morrison described a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA) in 1958. VIPomas producing high amounts of vasoactive intestinal peptide (VIP) commonly originate from the pancreas. Typical symptoms play a momentous role in the diagnosis of VIPoma. Diarrhea may persist for years before the diagnosis. Morbidity from untreated WDHA syndrome is associated with long-standing dehydration and with electrolyte and acid-base metabolism disorders, which may cause chronic renal failure. Assessment of specific marker (VIP) offers high sensitivity in establishing the diagnosis. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogues. Treatment options include resection of the tumor, chemotherapy or the reduction of symptoms with somatostatin analogues. Early diagnosis and management may affect survival of patients favorably. VIPoma cases may be associated with multiple endocrine neoplasia type 1.

Verner–Morrison-szindróma egy esete = Verner-Morrison syndrome: a case study

Verner and Morrison described a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA) in 1958. VIPomas producing high amounts of vasoactive intestinal peptide (VIP) commonly originate from the pancreas. Typical symptoms play a momentous role in the diagnosis of VIPoma. Diarrhea may persist for years before the diagnosis. Morbidity from untreated WDHA syndrome is associated with long-standing dehydration and with electrolyte and acid-base metabolism disorders, which may cause chronic renal failure. Assessment of specific marker (VIP) offers high sensitivity in establishing the diagnosis. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogues. Treatment options include resection of the tumor, chemotherapy or the reduction of symptoms with somatostatin analogues. Early diagnosis and management may affect survival of patients favorably. VIPoma cases may be associated with multiple endocrine neoplasia type 1.1958-ban Verner es Morrison irta le az elnevezeseben a vizes hasmenesre, hypokalaemiara es achlorhydriara utalo szindromat (watery diarrhea, hypokalaemia, achlorhydria – WDHA). A nagy mennyisegű vazoaktiv intestinalis peptidet (VIP) termelő VIPomak rendszerint a hasnyalmirigyből szarmaznak. A tipikus tunetek fontos szerepet jatszanak a VIPoma diagnozisaban. A hasmenes a diagnozis felismerese előtt evekig perzisztalhat. A kezeletlen WDHA-szindroma a hosszabb ideig fennallo exsiccosis, illetve az elektrolit- es sav-bazis haztartas zavara miatt kronikus veseelegtelenseghez vezethet, ami a betegseg lefolyasat sulyosbithatja. Specifikus marker (VIP) meghatarozasa erzekeny modszer a korisme felallitasahoz. A felismeresben segitseget nyujt az endoszkopos ultrahang, komputertomografia, magneses rezonancia es főleg a szomatosztatinanalogokkal vegzett szcintigrafias vizsgalat. A kezelesi lehetősegek koze tartozik a daganat reszekcioja, a kemoterapia es a tunetek csokkentese erdekeben a szomatosztatinanalogok alkalmazasa. A korai diagnozis es kezeles kedvezően hathat a betegek eletben maradasara. A VIPomak tarsulhatnak az 1-es tipusu multiplex endokrin neoplasia (MEN-1) szindromahoz. | Verner and Morrison described a syndrome of watery diarrhea, hypokalemia, and achlorhydria (WDHA) in 1958. VIPomas producing high amounts of vasoactive intestinal peptide (VIP) commonly originate from the pancreas. Typical symptoms play a momentous role in the diagnosis of VIPoma. Diarrhea may persist for years before the diagnosis. Morbidity from untreated WDHA syndrome is associated with long-standing dehydration and with electrolyte and acid-base metabolism disorders, which may cause chronic renal failure. Assessment of specific marker (VIP) offers high sensitivity in establishing the diagnosis. Imaging modalities include endoscopic ultrasonography, computed tomography and magnetic resonance imaging, and particularly, scintigraphy with somatostatin analogues. Treatment options include resection of the tumor, chemotherapy or the reduction of symptoms with somatostatin analogues. Early diagnosis and management may affect survival of patients favorably. VIPoma cases may be associated with multiple endocrine neoplasia type 1.

[Ultrasound-guided central venous catheterization].

Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.

Ultrasound guidance during central venous catheterization

Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.

Centrális véna kanülálása ultrahangvezérléssel@@@Ultrasound guidance during central venous catheterization

Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.

Centrális véna kanülálása ultrahangvezérléssel

Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.Central venous cannulation is frequently used in patients with serious diseases, although it may be unsuccessful and known to have complications in many cases. It is especially true in more complicated cases e.g. after unsuccessful punctures or cervical operations. With the use of ultrasound control success rate increases, while the chance of the complications decreases. In this prospective study, authors used ultrasound control during jugular vein punction in complicated cases. 56 successful central venous cannulation controlled by ultrasound has been performed since year 2000. This report overviews these cases and the related literature.

Minimally invasive interventions in the treatment of pancreatic diseases

We have used minimal invasive therapy in the treatment of pancreatic diseases for a long time. CT and/or ultrasound guided techniques have been used for the treatment of pancreatic pseudocysts for more than 20 years. The development of technology has also made an opportunity for the extensive use of laparoscopic surgery at patients suffering from pancreatic diseases. Currently, almost every type of open operation has a laparoscopic version, too. By now we can take part in the combined use of the CT/US and laparoscopic techniques. Recently the new NOTES procedures have appeared. Based on the literary items, the author summarizes the possibilities of minimal invasive treatments in pancreatic diseases.