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Lege Artis Medicinae

JULY 20, 2005

[MANAGEMENT OF CUTANEOUS MALIGNANT MELANOMAS]

OLÁH Judit

[Malignant melanoma, the disease originating from pigment cells of the skin, mucous membrane, eye and rarely from other tissues, shows increasing incidence in the Caucasian population. The Hungarian statistical data correspond with the data of other countries. In the early stages of malignant melanoma surgical removal of the tumor is often curative, but patients with disseminated tumors have a poor survival rate. Regrettably, in Hungary the majority of melanoma patients are diagnosed with advanced tumors, with nodal or systemic metastasis. Physicians working in other fields of medicine have a great responsibility in patient education and in early detection of susceptible pigmented lesions. Diagnosis and treatment of malignant melanoma requires an experienced dermatologist. The clinical diagnosis of melanoma is aided by several new techniques, like digital dermatoscopy. In recent years, surgical therapy of malignant melanoma has changed: today we routinely perform sentinel node biopsy. This type of surgical technique requires experience. In advanced disease the use of chemotherapy and immunotherapy requires onco-dermatological experience. Educating the public and physicians provides the basis for prevention. Survival rate is mainly dependent on the quality of primary care which determines survival rate, therefore it is essential that patients with melanomas are followed up in onco-dermatological centers.]

Lege Artis Medicinae

MAY 20, 2004

[NEUROFIBROMATOSIS, MALIGNANT MELANOMA AND HYPERTHYREOIDISM IN A HCV POSITIVE PATIENT]

FOLHOFFER Anikó, HORVÁTH Andrea, CSÁK Tímea, NÉBENFÜHRER László, TELKES Márta, IVÁNYI András, SZALAY Ferenc

[INTRODUCTION - Similar occirrence of neurofibromatosis and malignant melanoma is rare. We report a patient with neurofibromatosis, cutaneous melanoma, hyperthyreoidism and HCV positivity. CASE REPORT - A 43-year-old woman has been under care for neurofibromatosis for 16 years when she presented with increased serum ?- glutamyltransferase, alkaline phosphatase activity and anti-HCV antibody positivity at regular checkup. A pigmented lesion removed from her back histologically proved to be cutan melanoma. Interferon treatment was applied. She lost 8 kilograms in half a year which was caused not by the tumor progression, but hyperthyreoidism. A rapid clinical and laboratory improvement was observed for thyreostatic treatment and she regained her bodyweight. One year later she presented with a cough caused by pulmonary tumor. The tumor was surgically removed and histologically diagnosed as metastasis of melanoma. Cytostatic treatment was applied and she became asymptomatic. Four years after the diagnosis of melanoma she died of apoplexy. During the autopsy there was no sign of either melanoma or liver disease. CONCLUSIONS - The careful investigation of skin should be emphasised even in case of long established neurofibromatosis. The presented case shows an association of malignant melanoma and neurofibromatosis. In the background of loss of bodyweight even in a patient with history of malignant disease other causes should also be searched such as hyperthyreoidism especially during interferon therapy.]

Lege Artis Medicinae

SEPTEMBER 10, 2001

[Sentinel node biopsy in melanoma malignum]

OLÁH Judit, GYULAI Rolland, VARGA János, MOHOS Gábor, KAPITÁNY Klára, PAPOS Miklós, PÁVICS László, VARGA Erika, KOROM Irma, DOBOZY Attila

[INTRODUCTION - For many decades there has been no adequate treatment for affected regional lymph nodes in melanoma malignum. In the last couple of years with the implementation of the sentinel lymph node biopsy technique, it became possible to perform selective lymphadenectomy, i.e. to perform radical block dissection only in cases of histologically proven metastases in the sentinel lymph nodes. Since the lymphatic involvement in melanoma malignum is the most important prognostic factor, it is essential to treat lymphatic etastases as early as possible to get the best results. PATIENTS AND METHODS - In the past two years we have removed the sentinel lymph nodes together with primary tumors being 1 mm or thicker, ulcerated and regressive, based on clinical appearance in 120 melanoma cases. RESULTS - Of the 120 sentinel lymph node biopsies 58 contained metastatic cells. Beside tumor thickness, histological features of regression were found to correlate with the positivity of the sentinel nodes in thin melanoma cases. CONCLUSIONS - Sentinel lymph node biopsy is a relatively simple procedure with minimal complication rate. It allows early therapeutical block dissection and the selection of patients who require adjuvant therapy. Our clinical observations suggest that beside tumor thickness and ulceration, the clinical and histological signs of regression are important factors to consider for the indication of sentinel node biopsy.]

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.]