Lege Artis Medicinae

[THE ROLE OF OBESITY IN GASTROENTEROLOGICAL DISEASES]

GYÖKERES Tibor, KIRÁLY Ágnes, LAKATOS László, MADÁCSY László

JUNE 21, 2006

Lege Artis Medicinae - 2006;16(06)

[This paper reviews the current knowledge on the association of obesity and gastrointestinal disorders. While the relationship between obesity and cardiovascular disorders has recently gained wide professional publicity, there are few data on the gastroenterological aspects of obesity. After a discussion on obesity as an epidemic, its international and national prevalence, and public health risks, the most common obesity-related gastrointestinal disorders, their incidence, pathomechanism and consequences are presented by the organ systems affected, including gastrooesophageal reflux disease, fatty liver, gallstone disease, diseases of the pancreas, and colorectal carcinoma. Finally, the means of prevention and treatment are summarized.]

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Lege Artis Medicinae

[PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CLINICAL PRACTICE]

TALLER András

[PEG (percutaneous endoscopic gastrostomy) has by now become a widely used method, especially to ensure long-term enteral nutrition. In developed countries nearly 1 in 1000 people have a PEG. Although the use of PEG increases year by year in Hungary, it is still performed too rarely or too late. PEG is an invasive but simple endoscopic technique that may be carried out even at the patient's bed. In cases when the routinely used oral route for oesophago-gastro-duodenoscopy is impossible one of the following alternative ways can be chosen: endoscopy via a laryngoscope, through the opened pharynx, through a large pharyngo-oesophageal fistula or transnasally. These allow the bypassing of stenoses and the placement of PEG. There are few absolute contraindications and complications occur rarely. Early treatment and follow-up of dermatitis is important since it may be the first sign of severe complications. PEG tubes may function for many years with proper maintenance. Feeding via PEG tubes is especially effective in head and neck malignancies or injuries and in neurological disorders. In surgery it can be used for the management of surgical complications or for decompression of the stomach and duodenum. PEG-feeding is common in geriatrics and in paediatrics, sometimes with questionable indications. If used with adequate indications, ethical considerations, wise forethought, and a decision made together with the patient and family, PEG may improve lifespan and quality of life, decrease complications and side effects of the therapy and owing to its cosmetic benefits it facilitates re-socialisation.]

Lege Artis Medicinae

[MUMMIFIED ANCYLOSTOMA DUODENALE IN THE DUODENUM CAUSING SEVERE ANAEMIA]

KOVÁCS Valéria, SZABÓ Andrea, GODA Mária, MAGYAR Éva, RÁCZ István

[INTRODUCTION - We report on a patient with the remains of a mummified hookworm (Ancylostoma duodenale) found in his duodenal bulb which was later successfully removed with a polypectomy snare. CASE PRESENTATION - An 81-year-old man who took 100 mg aspirin daily was admitted because of severe iron-deficiency anaemia. After transfusion with 5 units of packed red blood cells upper endoscopy was performed. On the anterior wall of the duodenal bulb an 8 to10 mm long thread-like foreign body was found embedded in a sessile polyp-like mucosal protuberation with ulcerated inner margin. The entire pathologic structure was removed by mucosectomy. Histologically the thread-like body was found to be a lifeless female Ancylostoma duodenale containing a large amount of eggs and the surrounding ulcerated mucosa was also deeply infiltrated by hookworm particles. Follow-up endoscopy after four months showed normal gastroduodenal mucosa. CONCLUSION - An interesting case of hookworm infection is reported where an old infection caused chronic mucosal injury with reactive inflammation and mucosal ulceration. Aspirin therapy provoked chronic occult bleeding causing severe anaemia. With the endoscopic removal of the unusual structure total mucosal and clinical healing was achieved.]

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[In the trap of polypragmacy]

NEMESÁNSZKY Elemér

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[Risc score for predicting death, myocardial infarction, and stroke in patients with stable angina, based on a large randomized trial cohort of patients]

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[INTRODUCTION - The correlation between biochemical parameters and sonographic appearance of the liver in children and young adults receiving cytostatic therapy was investigated. PATIENTS AND METHODS - 104 (54 male, 50 female) patients at the hemato-oncologic unit of 2nd Department of Pediatrics, Semmelweis University Budapest were enrolled into this prospective, single-blind, uncontrolled study: patients’ ages were between 2.0 and 32.7 years (mean 12.2 yrs, ± SD 5.7). 69 patients received chemotherapy for acute lymphoblastic leukemia (ALL), 35 patiens for osteogenic osteosarcoma (OSC). The time interval between the initiation of the cytostatic therapy and the examination was between 1 month and 16 years (mean 3.9 yrs). Ultrasonography was performed after 5-8 hours of fasting, without sedation. Echogenicity, distal attenuation of liver parenchyma and Doppler waveforms of the hepatic vein branches were evaluated. Alanine-aminotransferase (ALT) and gamma-glutamyltransferase (GGT) activity were measured in peripheric blood samples. Statistical correlation was analysed between sonographic appearance and biochemical parameters of the liver. RESULTS - 35 patients had at least one sonographic abnormality: of these, 9 had elevated enzyme activity. Among the 69 patients with normal ultrasound findings, only 2 had increased enzyme activity (Chi square test, p=0.001). When tested against enzyme activity, echogenicity and attenuation showed significant (p=0.002 and p=0.01, respectively), Doppler waveform in the hepatic vein branches showed marginally significant correlation (p=0.05). All three ultrasound parameters had low sensitivity regarding the elevation of enzyme levels, however attenuation and hepatic vein waveform proved to be specific (both 94%) for enzyme level elevation and all three showed high negative predictive values (96%, 93% and 92%, respectively). When combining all three sonographic parameters in a single variable, correlation was even higher (p=0.001), sensitivity became acceptable (82%) and negative predictive value increased further to 97%. CONCLUSIONS - The authors conclude that a correlation exists between three simple sonographic indicators (echogenecity, distal attenuation, Doppler waveforms of the HVs) and liver injury detected by biochemical parameters. Due to the low sensitivity of the ultrasound parameters to confirm of the presence of diffuse liver injury is not possible. However, the combined use of the ultrasound and biochemical parameters a good negative predictive power can be achieved and therefore this is a useful tool in the follow-up for hepatic status.]

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