Lege Artis Medicinae

[Laparoscopically assisted percutaneous nephrolithotomy from a pelvic dystopic kidney]

HOLMAN Endre1, PÁSZTOR Imre1, FICSÓR Ervin1, PAPP Ferenc1, TÓTH Csaba1

AUGUST 26, 1992

Lege Artis Medicinae - 1992;2(08)

[Authors removed pyelic stones from a pelvic dystopic kidney by percutaneous nephrolithotomy with laparoscopic controll. Dislocation of the bowels was assured with forceps inserted through a separate laparoscopic trocar, thus the transabdominal operation was avoidable. ]

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  1. Kecskeméti Megyei Kórház Urológiai Sebészeti Osztály

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[The significance of interleuktin-6, it's molecular regulation in acute phase reaction]

FALUS András, BÍRÓ Judit, RÁKÁSZ Éva

[The multiple effectiveness of a hormone-like cytokine, interleukin-6 (IL-6) is highly important in a series of immunological, neuroendocrinological and inflammatory reactions of the mammalian organism. In this review a complex view of the gene and its regulation of IL-6 and the significance of the cytokine network in acute phase reaction is discussed. Manipulation of this complex network studied by the methodology of molecular biology and genetics provides entirely new approaches for the biotechnological and pharmacological regulation of inflammation.]

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[Call for support for the Healthy Breasts Foundation]

MONOS Emil

[Hungary is one of the world's leading countries in the grim international statistics on cardiovascular disease mortality, with around 80 000 people dying every year from serious cardiovascular disorders. This figure represents nearly 55% of all deaths! The vast majority of heart disease is related to the failure of the heart's own coronary arteries, and a significant proportion of brain disease is related to damage to the brain vessels themselves.]

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[The application of argon laser in cosmetological therapy]

DIMITRIJE Katalinic

[The author was one of the first in 1976 who began to use the various types of lasers for plastic-esthetical reasons and for therapy of skin lesions. He considers the indication spectrum of the argon laser to be the largest and its results are the best. The author summarizes and makes known the tissue-effects of the argon laser and compaes it with the tissue-destruction of other lasers and classical methods. The quality of the tissue destruction determines the indications and the applications, among them the therapy of the port wine syndrome. In the author's opini on, not the exposition time and the energy of the argon laser could be exactly determined. The experience of the physician plays the most important tole in the therapy. ]

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[The mode of action of bath therapy]

BENDER Tamás

[Bath therapy includes both hydro- and balneotherapy. During hydrotherapy the patient is treated by the physical parameters of the water. The effect of balneotherapy is based on the penetration of the mineral water. Its me chanism is not yet clear. There are several double-blind studies which prove the benefits of balneotherapy. Further studies are needed to judge the objective effects of balneotherapy. ]

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[Correlation between clinical data and histologycal findings assessing the severity of ulcerative colitis]

NAGY Ferenc, KARÁCSONY Gizella

[ A knowledge of the current activity of ulcerative colitis is essential in planning appropiate follow-up. Histological findings obtained from 209 colonoscopies were compared with the values of 22 clinical variables. One way analysis of variance was carried out. Of the 22 variables 11 proved to be significantly different between the groups of the clinically valuable classification (inactive, chronic, acute). Each of the three groups differed in the number of bloody stools. The acute inflammatory process was characterized by the high numbers of bowel movements, mucus and bloody mucus defecation, bowel movements at night, and haematocrit values suggesting anaemia. The serum iron levels in the inactive group differed significantly from the levels of both the acute and the chronic groups. The count of thrombocyte and the general well being were found to be valuable only in the differentiation between the acute and the inactive inflammatory processes. The computed haematocrit value proved to be useful in distinguishing the acute stage from the inactive and the chronic process. Out of the 22 variables only 11 had clinical importance in the evaluation of the activity of ulcerative colitis. ]

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[In this review, we compared economic and physiological observations reported in the literature that are related to laparoscopic versus conventional colorectal surgery. Our study group has modeled the patient journey of those with colorectal disease, and analysed the accounting and controlling data of an impatient institution in Budapest for various types of colorectal interventions. We compared the costs determined for laparoscopic and conventional colorectal surgery and the actual costs spent by the inpatient care institution with financing data of the National Health Insurance Fund. On the basis of our study, we conclude that in Hungary colorectal surgery performed by laparoscopy is much more expensive that conventional surgery as the cost of the operating room - in particular, the disposable tools - is high and currently it is not financed as a separate intervention type. In case of colorectal diseases, laparoscopic and traditional interventions have not been differentiated, observed and compared yet.]

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[THE PLACE OF OPEN SURGICAL INTERVENTIONS IN THE ERA OF LAPAROSCOPIC HIATAL HERNIA RECONSTRUCTION AND ANTIREFLUX SURGERY]

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[INTRODUCTION - The leading role of laparoscopy in the surgical treatment of functional diseases of the gastro-esophageal junction has become indisputable. But has the time of the “classic”, open surgical interventions really gone for good? PATIENTS AND METHODS - Between January 1., 2000 and December 31., 2004 we performed hiatal reconstruction and antireflux plastics for 186 patients. 83.3% (155/186) of the operations was performed laparoscopically, while 16.7% (31/186) with the traditional approach. The average age of patients was 46.9 years, 7% of the operations was performed on children. In case of recurrent paraoesophageal hernias the surgical plan was drawn up based on the result of the barium swallow X-ray performed after endoscopic clipping of the Z-line. In case of a brachy-esophagus, we formed the neo-esophagus by performing the Collis-Nissen operation modified by us (Neodinium magnet + plastic sliding scale) from the traditional abdominal exposure. RESULTS - The indication for hiatal reconstruction and antireflux operation was sliding hernia in 68.2%, paraesophageal hernia in 17.8% and reflux disease in 14%. We observed signs of panmural esophagitis in 22%, while latent or true brachy-esophagus in 10.7%. Antireflux procedures were grouped as Nissen type operation in 82.7%, Toupet type in 9.67%, Narbona in 2.1%, Belsey-Mark IV in 1.61%, and resection type operation in 3.76%. To narrow the diaphragmatic openings, two sutures were needed in most cases (57.1%). Conversion to laparotomy was necessary in 3.2%. We observed recurrences in 3.3% after laparoscopic interventions. In case of open operations we experienced no recurrences in the studied period. The barium swallow X-ray examination performed after endoscopic clipping of the Z-line could reveal brachy-esophagus before the operation. CONCLUSION - Open surgical interventions can not fall into oblivion even in the age of laparoscopic hiatal reconstructions and antireflux plastics. Open surgical procedures are justified even in the new milennium in cases when the patient's medical history contains upper abdominal operations - due to an increased risk of injury because of adhesions -,in cases of primarily recurrent paraesophageal hernias after an unsuccessful open and/or laparoscopic reconstruction, as well as in cases of reflux with complications.]

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[The successful development of laparoscopic surgery has made it possible to treat of inguinal hernias endoscopically. The technique is based on the principle of preperitoneal inguinal herniorrhaphy and is performed by internal dissection of the musculofascial defect. Mersilene mesh is placed into the defect and fixed with a special stapler to obliterate the space, and then the edges of the peritoneum are reapproximated. As the history of laparoscopic herniorrhaphy is rather short, long term follow-up data are not yet available. A review of the literature and the authors' initial experience indicate that the method is promising. Details of the surgical technique are presented.]

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