Lege Artis Medicinae

[NECROTIZING VASCULITIS AND THE GRANULOMATOUS INFLAMMATION OF THE SMALL INTESTINE. IS IT A SEPARATE ENTITY OR A SPECIAL FORM OF CROHN'S DISEASE?]

HIDVÉGI Judit, SZELECZKY Márton, SCHNABEL Róbert, KASZÁS Ilona, BAJTAI Attila

JUNE 20, 2005

Lege Artis Medicinae - 2005;15(06)

[INTRODUCTION - Churg and Strauss has reported a disease entity in 1951 characterized by asthma, eosinophilia in the peripheral blood as well as in different organs or tissues, systemic necrotizing vasculitis and extravascular tuberculoid granulomas. This granulomatous inflammation affected dominantly the wall of small vessels. The reason of allergic angiitis and granulomatous reaction is unknown but the role of some drugs used in the treatment of asthma was raised. There are a few reviews mentioning that the gastrointestinal tract, especially the small intestine can alos be involved. According to Morson, the clinical symptomes of these cases are mimicking Crohn’s disease. Oral contraceptives can also provoke allergic granulomatous angiitis, involving the gastrointestinal tract too. CASE REPORT - Two cases are described. One of them is a 35-year-old woman (the mother) who was treated because of idiopathic ulcerative colitis for a long time. Later, she was operated on because of mechanical ileus. Microscopically, in the resected specimen there was an intact mucous membrane and submucosal layer of small intestine, contradicting Crohn’s disease. On the other hand, the subserosal and the muscular layers were involved. The characteristic microscopic change were: necrotizing vasculitis involving the small vessels and a granulomatous change in the vessel walls. One of the daughters of a patient had to be been operated due to Crohn's disease. CONCLUSION - The accumulation of the cases affected by inflammatory bowel disease in the same family is reported raising the possibility of pathogenetic relationship.]

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Lege Artis Medicinae

[SUBCONJUNCTIVAL NEMATODE INFECTION]

ACZÉL Klára, DEÁK György, FARKAS Róbert, MAJOROS Gábor

[INTRODUCTION - Nematode infection of the eye occur only sporadically in the continental area. The pathogenic parasite in these cases is usually a Dirofilaria species, mostly D. repens. CASE REPORT - A case of human subconjunctival dirofilariosis is reported, where acquisition from abroad or animal contact in the background of the infection were excluded. The surgical removal of the entire living worm resulted in the complete cure of the patient. CONCLUSION - Knowing the occurrence of Dirofilaria infection of dogs and the increasing spread of the vector mosquitoes during the summer (in towns, too), the increasing occurrence of human dirofilariosis affecting the eye and orbital area in 10-20% of the cases must be taken into account.]

Lege Artis Medicinae

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

ALTORJAY Áron, VARGA István, SÁRKÁNY Ágnes, TÓTH Sándor, MUCS Mihály, HAMVAS Balázs, PAÁL Balázs, THAN Zoltán

[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.]

Lege Artis Medicinae

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