Tibor Géczi

[Comparison of surgical patients with gastroesophageal reflux disease and Barrett's esophagus].

INTRODUCTION Barretts esophagus (BE) is the only known precursor of adenocarcinoma occuring in the lower third of the esophagus. According to statistics, severity and elapsed time of gastroesophageal reflux disease (GERD) are major pathogenetic factors in the development of Barretts esophagus. PATIENTS AND METHODS In a retrospective study between 2001 and 2008, we compared the preoperative results (signs and sympthoms, 24 hour pH manometry, esophageal manometry, Bilitec) and treatment efficacy of 176 GERD patients and 78 BE patients, who have undergone laparoscopic Nissen procedure for reflux disease. RESULTS The two groups of patients had similar demographic features, and elapsed time of reflux sympthoms were also equal. Both groups were admitted for surgery after a median time of 1.5 years (19.87 vs. 19.20 months) of ineffective medical (proton pump inhibitors) treatment. Preoperative functional tests showed a more severe presence of acid reflux in the BE group (DeMeester score 18.9 versus 41.9, p < 0.001). On the other hand, mano-metry - despite confirming lower esophageal sphincter (LES) damage - did not show difference between the two groups (12.10 vs. 12.57 mmHg, p = 0.892). We did not experience any mortality cases with laparoscopic antireflux procedures, although in two cases we had to convert during the operation (1 due to extensive adhesions, and 1 due to injury to the spleen). 3 months after the procedure - according to Visick score - both groups experienced a significant decrease, or lapse in reflux complaints (group I: 73%, group II: 81% of patients), LES functions improved (17.58 vs.18.70 mmHg), and the frequency and exposition of acid reflux decreased (DeMeester score 7.73 vs. 12.72). CONCLUSION The severity of abnormal acid reflux occuring parallel with the incompetent function of the damaged LES triggers not only inflammation in the gastroesophageal junction (GEJ), but also metaplastic process, and the development of Barretts esophagus. Laparoscopic Nissen procedure for reflux disease can further improve outcome among patients with GERD not responding to conservative therapy.

Minimálisan invazív tüdőlebeny-eltávolítás eredményei osztályunk ötéves anyagában

Absztrakt Bevezetes: Munkankban bemutatjuk az elmult ot evben osztalyunkon, minimalisan invaziv modszerrel (video-assisted thoracic surgery – VATS) elvegzett tudőlobectomiak sebeszi vonatkozasait es korai posztoperativ eredmenyeit. Betegek es modszerek: 2011. januar 1. es 2015. december 31. kozott harom mellkassebesz es egy rezidens 197 VATS-lobectomiat vegzett, 176 esetben malignus es 21 betegnel joindulatu folyamat miatt. A betegek demografiai adatai a kovetkezők: 119 nő es 78 ferfi; atlageletkor 62,4 (41–82) ev. 2011-ben harom VATS-lobectomia tortent, ami az osszlobectomiak 2,2%-a volt, 2012-ben het (7,3%), 2013-ban 13 (12%), 2014-ben 59 (34,5%) es 2015-ben 119 (68,5%). 153 esetben multiportal (78%) es 44 alkalommal uniportal (22%) elulső feltarast alkalmaztunk. Az eltavolitott lebenyek megoszlasa a kovetkező: jobb felső 85, kozepső ot, jobb also 28, bal felső 44, bal also 34, egy felső bilobectomia. Ket alkalommal sleeve lobectomia tortent. Nyolc betegnel (4%) kenyszerultunk thoracotomiara tortenő kon...

Myasthenia gravis miatt végzett három különböző típusú csecsemőmirigy-eltávolítás sebészeti és korai neurológiai eredményei

Absztrakt Celkitűzes: A myasthenia gravis (MG) kezeleseben szamos nyitott, illetve minimalisan invaziv thymectomia ismert. A tanulmany ugyanazon intezeten belul a transsternalis (TS), illetve ketfele minimalisan invaziv thymectomia (video-assisted thoracoscopic extended thymectomy – VATET; unilateral video-assisted thoracoscopic surgery – UL-VATS) eredmenyeit hasonlitja ossze. Anyag es modszerek: Harom kulonboző időintervallumban 71 betegnel tortent thymectomia MG miatt (60 nő, 11 ferfi): 23 transsternalis thymectomia (1995. januar–2004. szeptember), 22 VATET (2004. szeptember – 2009. augusztus) es 26 UL-VATS thymectomia (2009. szeptember – 2011. december). Az eredmenyek ertekelesenel a műteti idő, MG-hez tarsulo neurologiai es a műtet utani sebeszi szovődmenyek, valamint az MG statuszaban az egyeves utankoveteskor eszlelt neurologiai valtozasok szerepeltek. Eredmenyek: Perioperativ mortalitas nem fordult elő. A műteti idő 112, 211, 116 perc (p = 0,001), a korhazi napok szama: 8,9, 5,6 es 4 nap (p = 0,001...

A mellhártya elsődleges daganatainak sebészi kezelése osztályunk anyagában

AIM The authors analyzed the results and outcome of surgical treatment of primary pleural tumors in patients treated in the last 11 years. METHODS 31 operations were performed for primary pleural tumors in 25 patients (17 males, 8 females). The tumors were classified into the following groups: benign local fibrous tumors (benign LFTP; n = 15), recurrent malignant fibrous tumors (recurrent malignant LFTP; n = 2) and malignant mesotheliomas (MPM; n = 12). 40% of patients with MPM were exposed to asbestos. Complete resections of benign LFTPs were performed, with additional resection of the chest wall and lobectomy in two cases. Completion pneumonectomy and lobectomy were done in recurrent malignant LFTP cases. Five biopsies and pleurodesis, and one open decortication were performed. In four cases, after the biopsy, two pleurectomies and decortications (P/D) and two pleuropneumonectomies (PPN)/extra-pleural pneumonectomies (EPP) were carried out. RESULTS There was no operative mortality. Pathological examination revealed seven epithelial, two sarcomatous and one biphasic malignant mesotheliomas. Survival was one (currently alive) and 49 months after malignant recurrent LFTP. Survival in MPM cases was 9,7 months (3-17) without resection and 17,3 months (5 (currently alive) - 29) in P/D or PPN (EPP) cases. CONCLUSIONS The PPN (EPP) and P/D are safe procedures providing relatively good survival when it is done as part of complete oncological treatment. In cases of recurrent LFTP, anatomical resections recommended with completion pneumonectomy or lobectomy.

Bal főhörgő-bifurcatio resectiója és anatómiai segmentectomia kettős granularis sejtes daganat miattr

The authors report a case of a 57-year old asymptomatic patient, whose routine chest X-ray demonstrated a left-sided lung tumour. Bronchoscopy, chest CT and PET-CT revealed double granular cell tumours on the posterior wall of the distal part of the left mainstem bronchus as well as in the bronchus of the segment 6, in addition to the suspected malignant tumour in the 2nd segment. His surgical management involved the atypical resection of segment 2 lesion first, which was tuberculotic origin based on frozen section. Next, the double granular cell tumours were removed by segmentectomy of segment 6 and bifurcation resection of the mainstem bronchus. In case of granular cell tumours, resection of the mainstem bronchus is a safe procedure with good results. Further, surgical exploration is indicated in symptomatic patients with a suspicion of malignant coin lesions.