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Clinical Oncology

MAY 10, 2015

[Invasive endoscopy in oncology]

MADÁCSY László

[Recent advances in interventional gastrointestinal endoscopy have led to a large variety of new diagnostic and minimally invasive endoscopic surgical procedures in oncological patients. Endoscopic ultrasound with the possibility of fi ne needle aspiration is currently one of the most accurate imaging technology for adequate staging of gastrointestinal cancers including oesophageal, gastric, rectal and pancreatic cancer. Endoscopic mucosal resection and endoscopic submucosal dissection offers a minimal invasive endoscopic treatment modality as an alternative for laparoscopic surgery for patients with early intramucosal neoplasias, fl at adenomas and laterally spreading tumors of the oesophagus, stomach, duodenum and colorectum. Self-expandable metal stents are now readily available for endoscopic palliation of different type of malignant gastrointestinal obstructions including oesophageal, duodenal, colonic and biliary stenosis. These recent developments of interventional gastrointestinal endoscopy lead to more precise and accurate tumor staging and more effective oncological therapy for patients with gastrointestinal cancers.]

Hungarian Radiology

OCTOBER 20, 2004

[Esophageal perforation in pneumectomized patient]

SZÁNTÓ Dezső, SZŰCS Gabriella, DITRÓI Edit

[INTRODUCTION - In 58 per cent of cases the fistulas and perforations are developing in middle third part of the esophagus. CASE REPORT - A 58 year old male patient's left lung was surgically removed due to drug-resistant actinomycosis. The pneumectomy has induced mediastinal dislocation and fibrothorax. Six years later the patient complained of odyno-dysphagia and of swallowing cough. On chest plain film we observed left-sided hydrothorax and barium swallows showed perforation of esophagus at the ipsilateral side. Esophageal adenocarcinoma and exudative pleuritis were confirmed by endoscopy and by histology following thoracocentesis. CONCLUSION - In case of pneumectomized patient with swallowing cough, dysphagy and recently development of pleural fluid collection the diagnosis of esophageal perforation is likely. The pleural pain is usually missing due to postoperative indurative pleurisy.]

Lege Artis Medicinae

SEPTEMBER 20, 2005

[RARE CAUSES OF GASTROINTESTINAL BLEEDING]

TAHIN Balázs, TÓTH Csaba, KOVÁCS Attila, DOBOS András, DÖBRÖNTE Zoltán, NAGY Lajos, TARABÓ Zoltán, MÁRKUS Béla, GARZULY Ferenc

[INTRODUCTION - The efforts to eliminate the source of gastrointestinal bleeding are not always successful, especially in rare diseases. CASE REPORT - In three patients causes and sites of haemorrhages were detected only at autopsy. The first patient underwent upper gastrointestinal endoscopy as well as surgical exploration. The post-mortem examination showed multiple gastric Dieulafoy’s vascular lesion. The second patient was examined by repeated upper gastrointestinal panendoscopy, but the site of haemorrhage remained unknown. Two polyps were removed during colonoscopy. Unexpected haemorrhage caused sudden death. The aortobifemoral graft, which had been implanted two years earlier had destroyed the duodenal wall, a fistula developed and caused haemorrhage. The third patient had had a right hemicolectomy abroad because of angiodysplasia, but the bleeding episodes repeated. The cause was revealed at autopsy as angiodysplasia of the small bowel. CONCLUSION - Dieulafoy’s disease can sometimes be discovered only by repeated endoscopy but sudden death may precede diagnosis. In the presence of an aortic graft we have to keep in mind that this could be the cause of catastrophic bleeding. Therefore, the examinations should be performed immediately - endoscopy has to involve the distal part of the duodenum - and operation is urgent. Angiodysplasia of the small bowel is a rare site of angiodysplasia which requires special diagnostic procedures like capsule endoscopy. The multiplicity of the disease and the age of the patients made the diagnostic difficult.]

Lege Artis Medicinae

SEPTEMBER 15, 2006

[STATE-OF-THE-ART DIAGNOSIS AND TREATMENT OF PITUITARY ADENOMAS SECRETING GROWTH HORMONE]

CZIRJÁK Sándor

[The history of the treatment of pituitary adenomas that cause acromegaly is as long as that of neurosurgery. While in the first half of the past century the aim of surgery was to save the patient's life, later the radical removal of the tumour was coupled with an effort to decrease complications, morbidity and mortality to the minimum. Today, beside all these, the complete sparing of the remaining hypophyseal substance and restoration of normal pituitary function are also important goals. The achievement of these goals is efficiently served by recent advances in microscopy, the minimally invasive methods of craniotomy, the availability of endoscopy in neurosurgery, three-dimensional computerguided neuronavigation, intraoperative colour Doppler sonography, as well as intraoperative real-time MRI. Recent developments in pharmacological research have created new promising conservative treatment modalities that supplement surgery, including somatostatin analogues and growth hormone receptor agonists. Also as supplementary treatment to surgery, occasionally replacing it, new radiosurgical methods, such as stereotaxic radiation, gamma knife, and heavy particle irradiation have gained grounds in neurosurgical practice.]

Hungarian Radiology

JUNE 20, 2003

[The diagnostics of paraoesophageal hiatal hernia]

TREXLER Ilona

[INTRODUCTION - The hiatal hernia is among the most common abnormalities of the gastrointestinal tract. The position of the cardia in relation to the diaphragm determines the type of the hernia, wich is important in therapy planning. The type I. sliding hernia is the most common form. Only 5-10% is type II. paraesophageal and type III. mixed hernias, which may involve serious complication. The single contrast X-ray is the best method for demonstrating the type of hiatal hernias. PATIENTS, METHODS AND RESULTS - During a 3 year period the author was investigated 336 gastric cases. Hiatal hernia was found in 73 patients, six of the cases proved to be the rare II. and III. types. A case of paraoesophageal and five mixed type cases of hernia is briefly described. CONCLUSION - Despite of the wide spread use of endoscopy in diagnosis of hiatal hernia, the traditional gastric X-ray still remains an important diagnostic tool.]

Lege Artis Medicinae

APRIL 22, 2008

[PRIMARY TUMOURS OF UNKNOWN ORIGIN WITH CERVICAL LYMPH NODE METASTASES - A RETROSPECTIVE STUDY]

GARAI Tibor, NÉMETH Zsuzsanna, TOMPOS Tamás, ZEMPLÉN Béla

[ITRODUCTION - Primary tumours are defined unknown if, despite of the presence of histologically verified metastases, the site of origin cannot be revealed even with complex investigations. On average, 5% of patients with cervical lymph node metastases belong to this group. The incidence of cervical lymph node tumours increases with age, with more than 60% arising from malignancies in patients over 40. PATIENT AND METHODS - In this retrospective study, the authors review the history of 29 patients treated or examined in their department between January 2002 and November 2006 with the starting diagnosis of cervical lymph node metastasis from a primary tumour of unknown origin. All patients had a thorough physical examination, indirect upper respiratory tract endoscopy, and aspiration cytology. In the search for the primary tumour the use of both traditional X-ray studies and modern imaging techniques are justified. RESULTS - Of the 29 patients, five did not present after surgery, and one patient died. The location of the primary tumour could be determined in 12 of the remaining 23 patients during the follow-up period. These included the palatine tonsil in four cases, the lung in three patients, the lower pharynx in two patients, and one case each of the lingual radix, the larynx and the nasal pharynx. The histology of the metastases was mostly squamous cell carcinoma and they were located in the upper parajugular region. The investigation of the remaining patients is continued. CONCLUSION - In cases of cervical lymph node metastases that histologically turn out to be squamous cell carcinoma, the primary tumour should first be searched for in the head-and-neck region, followed by the lungs. On the other hand, high-grade nasopharyngeal carcinomas warrant the search in the Waldeyer ring. The authors emphasize the importance to keep the proper order of the diagnostic and therapeutic steps and to manage these patients in experienced institutions.]

Hungarian Radiology

OCTOBER 20, 2006

[Successful radiological diagnostics in Bouveret’s syndrome]

KISS Katalin, FARKAS Szabolcs, LUKOVICH Péter, MAGYAR Péter, MESTER Ádám, MAKÓ Ernő†

[INTRODUCTION - Bouveret’s syndrome I is a rare clinical entity, a special form of gallstone ileus. Based on a case study the authors describe the clinical presentation, the complications and diagnostic work up of the Bouveret’s syndrome I. CASE REPORT - A 75-year-old female patient with repeated vomiting and haematemesis was examined. Known gallstones and obstructive jaundice was noted in the case history. Urgent gastroscopy was performed at admission, which proved haemorrhagic esophagitis as the cause of the haematemesis. A gallstone was found by endoscopy distal to the pyloric region obstructing the bowel lumen. Radiological examinations proved the presence of the stone exactly at the localization that was given. Surgery confirmed the diagnosis. CONCLUSION - Bouveret’s syndrome I should be considered in patients with repeated and long lasting vomiting and bile stone in the case history. Conventional X-ray may be sufficient to establish the diagnosis, however further imaging studies are needed to clarify exact anatomical situation and potential complications of the disease.]

Lege Artis Medicinae

JUNE 21, 2006

[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.]