Lege Artis Medicinae

[RIGHT HEMICOLECTOMY FOR SUBMUCOUS LIPOMA CAUSING PARTIAL BOWEL OBSTRUCTION]

SVÉBIS Mihály, BORI Rita, KOCSIS Lajos, PAP-SZEKERES József, CSERNI Gábor

OCTOBER 20, 2005

Lege Artis Medicinae - 2005;15(10)

[INTRODUCTION - Submucous lipomas are rare tumors of the colon and may be misdiagnosed as cancer because of their exophytic, polypoid growth and threatening bowel obstruction. CASE REPORT - A protruding, ulcerated and firm tumor preventing the investigation of the coecum was found by endoscopy in the ascending colon of a 50-year-old woman, who was subsequently operated on. The preoperative biopsy revealed only necrotic debris. Right hemicolectomy was performed because of threatening bowel obstruction and the presumed diagnosis of cancer. The tumor proved to be a 4 cm-large pedunculated submucosal lipoma. CONCLUSION - Despite recent diagnostic developments and the availability of better tools for the preoperative diagnosis of colonic lipomas, these tumors may still be misdiagnosed as carcinomas. Several circumstances contradict malignant dignity, such as: the relative circumscription of the mass, the trophic and only partial ulceration of the surface which is covered by normal mucosal layer elsewhere. To avoid unnecessary radicality in treatment, colon tumors with an uncertain preoperative diagnosis should undergo further diagnostic steps in order to clarify their nature. This could allow a more optimal therapeutic planning.]

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[THE DIAGNOSIS OF CARDIOVASCULAR COMPLICATIONS IN DIABETES MELLITUS]

NIESZNER Éva, BÁRDOS Petra, BARANYI Éva, PRÉDA István

[In spite of establishing new therapeutical approaches in the medical care of type 1 and type 2 diabetic patients, the complications of diabetes still remain as one of the leaders in mortality statistics. The main problem is the high rate of cardiovascular mortality (80%) originating from hyperglycemia induced micro- and macroangiopathy. With the development of new diagnostic methods the cardiovascular impairment of diabetic patients is expected to be fully screened. The assessment of late complications and the incipient functional alterations in vasoregulation should also be part of the screening. The treatment strategy, primary and secondary preventive care are also based on the screening of advanced vascular complications and simultaneously existing endothelial functional alterations.]

Lege Artis Medicinae

[End-of-Life Dilemmas Some Ethical and Legal Issues Concerning Euthanasia and Palliative Care]

HEGEDŰS Katalin

Lege Artis Medicinae

[65th Congress of the American Diabetes Association]

JERMENDY György

Lege Artis Medicinae

[SCIENTIFIC DIGEST]

Lege Artis Medicinae

[THE INFLUENCE OF IMMUNOGENOMIC FACTORS ON HIV-INFECTION]

FÜST György

[Authors discuss data published in the last 2-3 years indicating that besides the characteristics of the virus itself, the natural course of HIV disease is also regulated by genetic factors from the very onset till the end. Susceptibility for HIV infection of the carriers of a non-expressing mutant allele (CCR5Δ32) of one of the main coreceptors of HIV is markedly lower than that of the non-carriers. HLA-concordancy, that is few differences in the HLA alleles between the infected and noninfected partners, increases the chance of the HIVtransmittal. On the other hand, carriage of some HLA genotype e.g. that of the HLA A2/6802 supertype may significantly decrease the risk of the sexually transmitted HIV infection or that of the HIV infection from the mother to child. The rate of progression of the HIV disease which may vary in broad range from the median value of 10 years is also dependent on genetic factors. Progression is lower than the average in the carriers of the CCR5Δ32, HLA-B*27 and HLAB* 57 alleles while it is significantly more rapid in carriers of the HLA-B*35.1 allele. Recent data on the regulation by genetic factors of some sideeffects and the efficacy of combined antiretroviral treatment indicate that in the near future individual treatment may be used on the basis of the genetic background of the patients.]

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Lege Artis Medicinae

[Resection of colonic polypoid cavernous hemangioma with help of rubber rings]

ÁCSNÉ Tóth Andrea, LUKOVICH Péter, LAKATOS Péter László, KARDOS Magdolna, ARANY Andrea Szilvia, HARSÁNYI László

[INTRODUCTION - Cavernous hemangioma is a benign, rare disorder, usually localized in the distal part of the gastrointestinal system. CASE REPORT - In a 19-year-old woman treated for Crohn’s disease localized to the colon, a polypoid lesion was found during routine colonoscopy. The lesion appeared to be vascularized, purple in color and could be localized 25 cm above the anal sphincter. MSCT examination confirmed vascularization of the lesion. Considering the high risk for severe bleeding, resection was performed with surgical assistance. At first, two rubber rings were placed around the polypoid lesion. Thereafter 1 ml of epinephrine was injected into the neck of the lesion above the rubber rings, followed by polypectomy with a standard hook. No complications were present during the observation period. Histological examination of the polypoid lesion confirmed it to be cavernous hemangioma. CONCLUSION - On the basis of previous cases and the present case there might be a connection between inflammatory bowel disease and the development of cavernous hemangioma. We have not found any previous reports of a similar application of rubber rings. However, in cases where the risk of bleeding is high, this method is safe and easy to apply.]

Hungarian Radiology

[Giant colonic diverticulum]

SARLÓS Géza, GARAMSZEGI Mária, GREXA Erzsébet

[INTRODUCTION - Very rarely do colonic diverticula grow enourmously - from 3-4 cm upto 15-20 cm in diameter - causing diagnostic difficulties. PATIENT AND METHODS - The authors present a case of an elderly male patient where the ultrasound examination accidentally revealed irregularity in a part of the sigmoid colon with thickened wall. This finding was then examined by colonoscopy, colonography (double contrast barium enema) and CT. Two giant diverticula, measuring 4-5 cm in diameter, arising from the sigmoid colon were demonstrated. Considering the old age of the patient and the lack of clinical symptoms, the affected part of the sigmoid colon had not been surgically resected. CONCLUSION - Giving a general overview on the pathogenesis, presentation and differential diagnosis of colonic diverticula, the authors emphasise the importance of colonography. Also, as far as the authors know, this is the first Hungarian report on giant colonic diverticulum.]

Clinical Oncology

[Complications of infusion treatment with emphasis on extravasation of cytostatics]

HARISI Revekka

[The extravasation of cytostatics is the most signifi cant complication of infusion therapy in cancer treatment. Extravasation refers to the inadvertent infi ltration of cytostatic drugs into subcutaneous or subdermal tissues surrounding the intravenous or intraarterial administration site. According to literature data incidence estimates between 0,01-7%. Extravasated drugs are classifi ed according to their potential for causing damage as vesicant, irritant and nonvesicant. Knowledge of risk factors, the patientrelated and treatment-related ones is important to minimize the occurrence of extravasation. In order to reduce the risk of extravasation, the staff involved in the tumor infusion therapy must be specially trained to implement several preventive and therapeutical protocols. In 2012, ESMO-EONS has put together a new comprehensive treatment protocol on the topic of cytostatics extravasation. Protocol recommended that every oncological department, who administers chemotherapy have to have extravasation trained team and a standby extravasation kit. According to the new ESMO-EONS guideline subcutaneous corticoids are not recommended, anymore. In case of mechloretamine extravasation the recommendation is immediate subcutaneous injection of sodium thiosulfate. After extravasation of anthracyclines, mitomycin C and platin salts the best treatment opportunity is subcutan dimethyl sulfoxide administration. In case of anthracyclines’ extravasation intravenous dexrazoxane treatment is also effective. Hyaluronidase, injected into or under the skin, facilitates absorption of extravasated drugs because of increases connective tissue permeability, promotes the spreading and reduces the local concentration of the extravasated citostatic agents. Hyaluronidase might be effi cacious in preventing skin necrosis by extravasation due to vinca alkaloids. The treatment of unresolved tissue necrosis or pain lasting more than 10 days is surgical debridement. Because of the medical and juristic importance of the extravasation event, it is necessary to establish uniform guidelines for treatment of extravasation, in all Hungarian Oncological Centers.]