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Lege Artis Medicinae

MARCH 20, 2014

[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.]

Lege Artis Medicinae

JANUARY 20, 2012

[Efficiency and safety of the vaccination against H1N1 influenza virus in inflammatory bowel disease]

FARKAS Klaudia, JANKOVICS István, MELLES Márta, NAGY Ferenc, SZEPES Zoltán, WITTMANN Tibor, MOLNÁR Tamás

[INTRODUCTION - Inactivated influenza and H1N1 vaccination is recommended yearly for patients with inflammatory bowel disease receiving immunosuppressive therapy; however, immunomodulator and biological therapy might impair the immune response to the vaccination. In our study, we assessed whether immunity can develop in response to H1N1 influenza vaccination in patients receiving immunomodulator and/or biological therapy. We also assessed the occurrence of side effects after the immunisation in these patients. PATIENTS AND METHODS - In our prospective study, blood samples were obtained from 24 patients (12 Crohn’sdisease, 12 ulcerative colitis) one month after immunisation against influenza A/California/ 07/2009 (H1N1) virus. At the time of vaccination, all patients have been receiving immunomodulator and/or biological therapy for at least three month. Antiviral antibodies were detected by using microneutralisation assay. The safety of the vaccination was assessed by questionnaires. RESULTS - Every patient developed complete immunity against influenza A (H1N1) virus, independently from the type of immunosuppressive therapy. Regarding side effects, local symptoms occurred in six patients and systemic symptoms in another six patients. Mild diarrhea occurred in five patients. Moderate exacerbation of the disease was observed in 2 patients with Crohn’s disease and in one patient with ulcerative colitis. CONCLUSIONS - According to our results, immunocompromised patients with IBD can be safely advised to receive the vaccination. In our study, all patients developed adequate immunity according to microneutralisation titers.]

Lege Artis Medicinae

FEBRUARY 21, 2006


LAKATOS Péter László

[The pathogenesis of inflammatory bowel disease is only partly understood; various environmental and host factors (e.g., genetic, epithelial, immune and non-immune) are involved. It is a multifactorial polygenic disease probably with genetic heterogeneity; some genes confer susceptibility to IBD in general, while others specifically increase the risk of ulcerative colitis or Crohn's disease or affect location (localized or extensive) and/or behaviour (e.g., mild, severe, aggressive). This review presents recent advances in the genetics of inflammatory bowel disease including chromosome segments newly recognized to be involved in inflammatory bowel disease as well as the role of NOD2/CARD15, SLC22A4/A5 and DLG5. The increasing genetic information provides, for the time being, a better understanding of the pathogenesis of the disease thus setting a basis for potential targets for therapeutic intervention. In the future, however, genetics may also help in refining the diagnosis or predicting disease course.]

Clinical Neuroscience

APRIL 20, 2003

[Cerebral sinusthrombosis and ulcerative colitis - two cases]


[Inflammatory bowel diseases (IBD) - ulcerative colitis and Crohn’s disease - are associated with increased risk for thrombotic complications both in the arterial and venous system. Cerebral sinus thrombosis is a rare but potentially fatal consequence of these diseases. Modern imaging methods made this uncommon complication of IBD more frequently recognized. The link between IBDs and thrombosis has been extensively studied. Inherited coagulation disorders (APC resistance, antithrombin III and protein-S deficiency), acquired diseases (antiphospholipid syndrome), and the frequent use of corticosteroids were suspected. Two cases of ulcerative colitis associated with cerebral sinusthrombosis successfully treated are reported. The connection between IBD and thrombotic complications and the therapeutic risks are discussed as well.]

Lege Artis Medicinae

APRIL 20, 2003

[Extraintestinal manifestations in inflammatory bowel diseases]


[Inflammatory bowel diseases (IBD) are systemic disorders. Bowel symptoms are the predominant manifestations, however during the course of the disease a lot of intestinal and extraintestinal complications may occur. Systemic complications are responsible for substantial co-morbidity and they have negative influence on the quality of life. A part of the extraintestinal symptoms seem to have common pathogenetic background with IBD, while others are the consequences of subsequent metabolic and endocrine abnormalities or may relate to local complications and adverse effects of treatment. Growing evidence is available on the role of genetic and immunologic factors in the pathogenesis of extraintestinal manifestations. Most important systemic complications are: peripheral and axial arthritides, osteoporosis, uveitis, erythema nodosum, pyoderma gangraenosum, primary sclerosing cholangitis, nonalcoholic steatohepatitis, different types of anaemia, thromboembolism, kidney stones and urinary complications. Cooperation with the specialists is very important in the diagnosis and treatment of these comlications. During followup of IBD patients special attention is needed to monitor possible extraintestinal manifestations.]

Lege Artis Medicinae

NOVEMBER 20, 2009

[The role of double-balloon endoscopy in the diagnosis and treatment of small intestinal disease compared with capsule endoscopy]

LAKATOS Péter László, HORVÁTH Henrik Csaba, ZUBEK László, PÁK Gábor, NÉMETH Artúr, RÁCZ István, PÁK Péter, FUSZEK Péter, NAGYPÁL Anna, GEMELA Orsolya, PAPP János

[INTRODUCTION - Until recently, only the proximal small bowel was accessible for diagnostic or therapeutic endoscopy. A new method, doubleballoon enteroscopy (DBE), provides high-resolution imaging and enables both diagnostic and therapeutic interventions in all segments of the gastrointestinal tract. Our aim was to report our experiences with the Fujinon EN-450 T5 therapeutic double-balloon endoscope and compare our findings with the results of earlier capsule endoscopy where this was available. METHODS - Between August 2005 and July 2009, 150 DBE procedures were conducted in 139 consecutive patients (M/F: 67/72, age: 51.1±18.6 years) who presented at our tertiary referral hospital. The examination was performed via the oral route in 112 patients, via the anal route in 16 patients, and via both routes in 11 patients. DBE was indicated due to obscure gastrointestinal bleeding in most cases (83), due to diagnosis or complication of IBD in 29 cases and due to polyposis syndrome or suspected neoplasia in 25 patients. In one patient we performed endoscopic retrograde cholangiopancreatography (ERCP). All procedures were performed using i.v. anaesthesia at our outpatient clinic. After the procedure, the patients were monitored in a recovery room for at least four hours. The results of previous capsule endoscopy were available in 27 patients. RESULTS - Small-bowel abnormalities ? mostly angiodysplasias, minor erosions or ulcers ? were detected in 50 (60.2%) of the patients with obscure gastrointestinal bleeding. Malignancy was found in 7,2% (6/83) of the patients who were examined because of bleeding (three gastrointestinal stoma tumour, one non-Hodgkin lymphoma, one previously undetected melanoma metastasis and one pancreatic adenomacarcinoma that involved the duodenum) Intervention was performed in 24 patients. IBD was diagnosed in five (38.5%) of the 13 patients in whom the disease was suspected. In patients with known Crohn-disease, DBE was indicated on the basis of the extent, behaviour and activity of the disease. Polypectomy was performed in eight patients with Peutz-Jeghers syndrome or familial adenomatous polyposis syndrome, whereas small-bowel adenocarcinoma was diagnosed in four patients. The concordance between the findings of capsule endoscopy and DBE was 51.8% (14/27), and in one patient DBE revealed malignancy that has not been detected by endoscopy. The average insertion length during the procedure was approximately 213 cm (range 50-480 cm, SD 111). CONCLUSIONS - On the basis of our results, DBE is a safe and useful method for assessing and treating small bowel disease, even if capsule endoscopy is contraindicated due to suspected strictures.]

Lege Artis Medicinae

JANUARY 20, 2011

[Effective adalimumab treatment of a steroid-dependent Crohns’ disease patient suffering from general, abdominal and joint symptoms of multiple etiology]

JUHÁSZ Márk, TÓTH Zsuzsanna, MIHELLER Pál, SZŰTS Ildikó, GAÁL Ramóna, PÁPAY Judit, PREGUN István, TULASSAY Zsolt, RÁCZ Károly, MŰZES Györgyi

[The 69-year-old male patient had been suffering from periodically relapsing rheumatological symptoms involving variable localisations (knee, ankle, MTP, sternoclavicular and hip joint) since 1964. On the basis of his joint symptoms, load-independent lower back pain, sacroileitis, recurrent iridocyclitis, urethroprostatitis and oral aphtous lesions, Reiter disease was diagnosed in 2000. The patient had Lyme-disease (confirmed Borrelia burgdorferi seropositivity) with peripheral facial paresis in 2003. The patients joint problems relapsed in 2006, accompanied by diarrhoea and fever, independent of any infecions. The possibility of IBD could not be confirmed either by macroscopic examination using colonoscopy or hystology. The patient was admitted to our department in March 2008 for the first time, presenting again with joint pain and disability of gait, 7-8 bowel movements a day, and fever. Taken together the clinical symptoms, the typical radiological findings and HLA-B27 positivity, Bechterew disease was diagnosed. Colonoscopy performed because of diarrhea revealed multiple segmental aphtoid lesions and irregular ulcers, suggesting Crohn disease that was confirmed by histology (cryptal abscess formation and microgranulomas). Sulfasalazin, 5-ASA, and other NSAIDs applied to treat rheumatological symptoms could not eliminate either the gastrointestinal or the rheumatological symptoms of the patient, which necessitated regular steroid therapy. Because of the patient’s steroid dependency, and considering his rheumatological symptoms, in June 2008 he was treated with adalimumab (ADA) induction therapy (80-40-40 mg s.c.). In two weeks, his gastrointestinal as well as extraintestinal symptoms substantially improved, and completely diminished through the course of maintenance ADA therapy (40mg weekly). The patient is still asymptomatic and is excercising (jogging) regularly.]

Hungarian Immunology

MARCH 20, 2007

[Adalimumab in the treatment of Crohn’s disease]

LAKATOS Péter László

[Crohn’s disease (CD) is a chronic inflammatory disorder which may involve any part of gastrointestinal tract. The pathogenesis is only partially understood; various environmental and host (e.g. genetic-, epithelial-, immune and non-immune) factors are involved resulting in chronic uncontrolled inflammation, and among pro-inflammatory cytokines tumor necrosis factor-α (TNF-α) seems to play a central role in CD. The last few years have witnessed a significant change in the management of Crohn’s disease. The role of and indications for conventional therapy (aminosalicylates, steroids and immunomodulators) have been reassessed. Over the past decade the increasing knowledge on the pathogenesis of CD led to the development of a number of biological agents targeting specific molecules involved in gut inflammation, first of all TNF-α and its receptors. The aim of this paper is to review the rationale for the use one of the new anti TNF-inhibitors, adalimumab in the treatment of CD.]

Lege Artis Medicinae

MARCH 21, 2006



[INTRODUCTION - Natural antioxidants have been shown to indirectly act on signal transduction pathways and influence the induction of apoptotic genes in several ways. The black radish-based granules contain several bioactive components including isothiocyanates, flavonoids, vitamins and trace elements that can modify various molecular biological pathways. The aim of this study was to find out whether this preparation has an effect on the redox homeostasis of patients with inflammatory bowel disease. PATIENTS AND METHODS - Data from 32 middleaged patients (13 male, 19 female) with moderately active IBD were evaluated. Half of the patients (6 male, 10 female) received 0.2 g/day granules for 6 months in addition to regular treatment. Apart from other routine laboratory measurements, redox parameters including plasma reducing power, H-donor ability, free SH groups and IL-6, IL-1, TNFalpha, bile acids, cholesterol, triglycerides, red blood cell chemiluminescence and HbA1c level were determined. RESULTS - The black radish-based granules had no effect on the activity of inflammatory bowel disease. Beside a positive subjective judgement, bile acid levels had slightly increased and the values of redox parameters had decreased in the plasma by the end of the study period. The granules significantly diminished red blood cell chemiluminescence and moderately reduced the HbA1c-level. CONCLUSION - The results show that the granules rich in antioxidants and isothiocianate have a marked effect on the redox homeostasis of IBD patients even at low doses.]