Tiszlavicz László

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.

Klinikai és hisztopatologiai eredmények előrehaladott rectumtumorok neoadjuvans kezelése után: Clinical and histopathological results after the neo-adjuvant treatment

2/nap 5-FU es 20 mg/m 2 /nap leucovorin kemoterapia, az utobbi időben kiegeszitve celzott an a makroszkopos tumorra biztonsagi zonaval 3x1,8 Gy előrehozott boost besugarzassal. Restaging vizsgalatokat kovetően atlagosan 8 hett el az onkologiai kezeles utan vegeztuk a műteteket. 38 (57%) elulső rectumreszekcio tortent kett ős stapler technikaval, 18 (27%) abdominoperinealis rectumexstirpaciot, 7 Hartmann-műtetet, illetve 4 per anum exciziot vegeztunk. A patologiai feldolgozas a preoperativ staginghez kepest 6 esetben (11%) teljes ( P T 0 N 0 ) remissziot, 43%-ban parcialis remissziot mutatott . A regresszios gradiens alapjan TRG 1 11%, TRG 2 25%, TRG 3 32,2%, TRG 4 26,8%, TRG 5 5% volt. Reoperaciot igenylő morbiditas 5,9% volt. Varratelegtelenseg nem fordult elő. Az onkologiai es sebeszi kezelesnek mortalitasa nem volt. A hosszuidejű neoadjuvans onkologiai kezeles az esetek tobbsegeben a rectumdaganat stadiumat csokkenti, ezzel emeli a reszekabilitast es a jobb eletminőseget jelentő reszekcios műtetek aranyat. Magyar Onkologia 54:129–135, 2010 Kulcsszavak: rectumcarcinoma, neoadjuvans radio-kemoterapia The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radiochemotherapy has improved the effi cacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2–4 N 1–2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the fi rst and last week for 5–5 days they received 350 mg/m 2 / day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3x1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average aft er restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per anum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insuffi ciency. The long-term neoadjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations. Varga L, Baradnay G, Hőhn J, Simonka Z, Hideghety K, Maraz A, Nikolenyi A, Vereb B, Tiszlavicz L, Nemeth I, Man E, Lazar G. Clinical and histopathological results aft er the neo-adjuvant treatment of advanced rectal tumors. Hungarian Oncology 54:129–135, 2010The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radio-chemotherapy has improved the efficacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2-4 N 1-2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the first and last week for 5-5 days they received 350 mg/m 2 /day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3 x 1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average after restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per annum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insufficiency. The long-term neo-adjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations.

Klinikai és hisztopatológiai eredmények előrehaladott rectumtumorok neoadjuváns kezelése után

2/nap 5-FU es 20 mg/m 2 /nap leucovorin kemoterapia, az utobbi időben kiegeszitve celzott an a makroszkopos tumorra biztonsagi zonaval 3x1,8 Gy előrehozott boost besugarzassal. Restaging vizsgalatokat kovetően atlagosan 8 hett el az onkologiai kezeles utan vegeztuk a műteteket. 38 (57%) elulső rectumreszekcio tortent kett ős stapler technikaval, 18 (27%) abdominoperinealis rectumexstirpaciot, 7 Hartmann-műtetet, illetve 4 per anum exciziot vegeztunk. A patologiai feldolgozas a preoperativ staginghez kepest 6 esetben (11%) teljes ( P T 0 N 0 ) remissziot, 43%-ban parcialis remissziot mutatott . A regresszios gradiens alapjan TRG 1 11%, TRG 2 25%, TRG 3 32,2%, TRG 4 26,8%, TRG 5 5% volt. Reoperaciot igenylő morbiditas 5,9% volt. Varratelegtelenseg nem fordult elő. Az onkologiai es sebeszi kezelesnek mortalitasa nem volt. A hosszuidejű neoadjuvans onkologiai kezeles az esetek tobbsegeben a rectumdaganat stadiumat csokkenti, ezzel emeli a reszekabilitast es a jobb eletminőseget jelentő reszekcios műtetek aranyat. Magyar Onkologia 54:129–135, 2010 Kulcsszavak: rectumcarcinoma, neoadjuvans radio-kemoterapia The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radiochemotherapy has improved the effi cacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2–4 N 1–2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the fi rst and last week for 5–5 days they received 350 mg/m 2 / day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3x1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average aft er restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per anum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insuffi ciency. The long-term neoadjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations. Varga L, Baradnay G, Hőhn J, Simonka Z, Hideghety K, Maraz A, Nikolenyi A, Vereb B, Tiszlavicz L, Nemeth I, Man E, Lazar G. Clinical and histopathological results aft er the neo-adjuvant treatment of advanced rectal tumors. Hungarian Oncology 54:129–135, 2010The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radio-chemotherapy has improved the efficacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy. We carried out neo-adjuvant and surgical treatment in case of 67 patients with rectal adenocarcinoma (T 2-4 N 1-2 M 0 ) between June 1, 2005 and July 31, 2008. The average age of the patients was 61.2 years, the division according to sex was 44 males/23 females. Regarding the local stage of the rectal process or the proximity to the sphincter, we applied radio-chemotherapy (radiotherapy 25 times altogether 45 Gy and on the first and last week for 5-5 days they received 350 mg/m 2 /day 5-FU and 20 mg/m 2 /day leucovorin chemotherapy, recently complemented with 3 x 1.8 Gy advanced boost radiation aiming at the macroscopic tumor site with security zone). Patients underwent surgery 8 weeks on average after restaging examinations. Thirty-eight patients underwent anterior rectal resection with double stapler procedure; there were 18 abdominoperineal rectal extirpations, 7 Hartmann operations and 4 per annum excisions. Compared to the preoperative staging, the histological evaluation of the resected specimens showed total remission (pT 0 N 0 ) in 11% and partial remission in 43%. The morbidity necessitating reoperation was 5.9%, without mortality and suture insufficiency. The long-term neo-adjuvant oncological treatment led to down-staging of rectal tumors in most cases and increased the resecability and rate of resection operations.

Bal főhörgő-bifurcatio resectiója és anatómiai segmentectomia kettős granularis sejtes daganat miatt Bifurcation resection of the left mainstem bronchus and segmentectomy for double granular cell tumors

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.

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.