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Clinical Oncology

DECEMBER 10, 2015

[Current treatment of gastrointestinal lymphomas]

PAKSI Melinda, ISTENES Ildikó, KÖRÖSMEZEY Gábor, DEMETER Judit

[The most common extranodal site involved by lymphoma is the gastrointestinal tract. The majority of extranodal lymphoma cases are of the non-Hodgkin subtype. Usually, the involvement of the gastrointestinal tract by nodal lymphomas is secondary, the primary gastrointestinal localisation is rather rare. The most common pathological types are diffuse large B-cell lymphomas and extranodal marginal zone lymphomas of the mucosa-associated tissue (MALT) subtype. Although the primary gastrointestinal lymphoma can involve any part of the gastrointestinal tract, the stomach is the most frequently involved site. The treatment and prognosis are determinated primarily by the histologic type of lymphoma, the stage of disease and the patient’s age and general condition. Helicobacter pylori (HP) infection is one of the major risk factors for gastric lymphomas, the presence or abscence of which radically infl uences the effectivity of treatment. In case of HP positivity, HP eradication itself can result in complete remission. In most cases the treatment is immuno- and/or combination chemotherapy, which is performed according to the internationally accepted protocols, specifi c to the type of lymphoma. Radiotherapy plays a lesser role in the treatment of GI lymphomas, while surgery is performed almost only in complicated cases, such as haemorrhage, occlusion or perforation.]

Hungarian Radiology

SEPTEMBER 20, 2008

[The bubble-sign of spontaneous pneumoperitoneum]

SZÁNTÓ Dezső

[INTRODUCTION - Pneumoperitoneum is a reliable indicator of serious underlying damage. There are four etiologic categories of extraluminal-intraperitoneal gas collections: spontaneous, iatrogenic, traumatic and criminal perforations. The erect posteroanterior chest radiograph is the most sensitive plain film projection for detecting pneumoperitoneum and it may show 0.5-1 ml free abdominal gas when meticulous radiographic techniques (lateral, oblique, air-gap, lordotic, inspiratory and expiratory exposures) are used. The appearances of extraluminal gas collections are specified by physical rules and individual preferences. The bubble-sign is an uncommon, pathognomonic phenomenon. CASE REPORT - A case of an 86 years old female patient with spontaneous pneumoperitoneum, diagnosed on the basis of the bubble-sign is presented. On erect, lordotic inspiratory chest film, right medial inversion of diaphragm, left pleural effusion, emphysema, cardiomegaly and aortectasia were observed. The bubble-sign and hydromediastinum became evident in the right phrenicocostal angle on expiratory view. Our patient expired before the surgical intervention.The postmortem demonstrated double peptic duodenal ulcers; the older ulcer had penetrated and encapsulated in the hepatoduodenal ligament, while the more recent one perforated through the intraperitoneal space. CONCLUSION - Routine upright chest films are valuable screening tools for uncommon signs of pneumoperitoneum, also.]

Lege Artis Medicinae

MAY 16, 2007

[NSAID-ASSOCIATED GASTROPATHY: RECENT ASPECTS OF PREVENTION]

HERSZÉNYI László

[Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs worldwide. Gastroduodenal ulcers are found at endoscopy in 15 to 30% of patients who use NSAIDs regularly. The annual incidence of severe upper gastrointestinal complications such as bleeding or perforation is 1.0 to 1.5%. From a cost-benefit perspective, prevention strategies should consider both gastrointestinal, and recently, cardiovascular risk factors. No prophylaxis is necessary with low gastrointestinal risk. There are currently four possible strategies to reduce the risk of adverse gastrointestinal effects: 1. the use of selective COX-2 inhibitors or coxibs rather than traditional NSAIDs; 2. cotherapy, primarily with proton pump inhibitors, to ensure protection to gastric mucous membrane; 3. co-therapy with a coxib and a proton pump inhibitor in patients with very high risk (eg., history of bleeding); 4. eradication of Helicobacter pylori infection in patients with a history of ulcer. The use of coxibs decrease the risk of gastrointestinal damage by roughly 50%. In the presence of gastrointestinal risk factors or for patients on aspirin also treated with an NSAID or a coxib, protection with a proton pump inhibitor is recommended. Proton pump inhibitor therapy is also useful for the prevention and treatment of NSAID-induced dyspepsia. The beneficial effects of proton pump inhibitors cannot solely be explained by their profound antisecretory action. Therefore, several acid secretion- independent mechanisms of action have been proposed.]

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.]

Hungarian Radiology

DECEMBER 20, 2006

[Pneumoportogram without intestinal pneumatosis]

HERBERT Zsuzsanna, LAKATOS Levente, RADNAI Béla, SEMJÉN Dávid, BOROS Szilvia

[INTRODUCTION - Classical radiological signs of ischemic bowel wall necrosis are the presence of gas in the affected bowel wall and intrahepatic gas in the portal venous system. CASE REPORT - A 76-year-old male patient was admitted to the hospital with the suspicion of ileus and perforation. Plain abdominal X-ray showed presence of gas in the portal venous system in addition to small bowel and colonic ileus. Pneumoportogram was present without intestinal pneumatosis. Abdominal laparotomy revealed extensive bowel wall necrosis and no surgical solution was possible. After surgery the patient died. CONCLUSION - Reviewing our case and the medical literature, the significance of plain abdominal X-ray in addition to abdominal CT and ultrasound examination should be emphasized. This case report helps to differentiate the origin of intrahepatic gas in order to select proper therapeutical approach.]

Hungarian Radiology

DECEMBER 20, 2003

[Small bowel perforation due to blunt abdominal trauma in case of an inguinal hernia]

GION Katalin, SÉLEI Ágnes, CSÁSZÁR József, PALKÓ András

[INTRODUCTION - The injury of fixed bowel loops occurs more frequently due abdominal trauma. Authors review the CT signs of bowel injury in conjunction of the presented case. PATIENTS, METHODS - The inguinal hernia of the male patient was present for approximately 30 years prior the abdominal trauma. Due to the trauma the fixed small bowel loop became perforated. CT examination, beside using the conventional methods established the diagnosis of bowel wall perforation and the site of the perforation was localized before surgery. CONCLUSIONS - CT provied additional information compared to X-ray and US in the localization of the lesion due to the blunt abdominal trauma.]

Hungarian Radiology

DECEMBER 20, 2006

[Gas collection in the superior mesenteric and in the portal veins]

LUDVIG Zsuzsanna, PAP Tímea, SZILÁGYI Adrienn, KOSTYÁL László, BARTA Szabolcs, BOTOS Ákos

[INTRODUCTION - Intrahepatic gas is frequently seen during abdominal ultrasound studies which is generally of biliary origin due to biliary interventional procedures e.g. endoscopic sphincterotomy. In our case, large amount of intrahepatic gas was present originated from the superior mesenteric and portal veins. CASE REPORT - A 94-year-old male patient with vomiting, shivering and heavy abdominal pain was admitted in bad condition to the department of surgery. Billroth II gastric resection was noted in the case history. Chest, plain abdominal X-ray and abdominal ultrasound examination was performed. Ultrasonography showed a large amount gas collection in the region of the left liver lobe (no prior history of endoscopic sphincterotomy). It was difficult to perform abdominal ultrasound due to the intrahepatic gas collection and abdominal bowel gas. Computer tomographic examination confirmed the presence of intrahepatic gas which is localized in the portal venous system. Large amount of gas collection was seen in the abdominal cavity, in the mesenterium and in the retroperitoneum. In addition a gallstone of 2 cm in size was found in the duodenum. CONCLUSION - CT scans confirmed the perforation of gall bladder due to subsequent cholecystic- duodenal fistula. As a consequence of perforation, inflammation of the mesentery and retroperitoneum developed causing mesenteric vein thrombosis and bowel wall necrosis. Bacteria in the necrotic bowel wall produced gas which entered into the veins and reached the portal system.]

Hungarian Radiology

FEBRUARY 20, 2002

[Frequency and diagnosis of pediatric air gun injuries]

MAKRA József, LOMBAY Béla, RIVASZ-TÓTH Gyula

[INTRODUCTION - Air guns are frequently given to children as toys. Air guns have a pellet caliber of 0.17 or 0.22 and are propelled by compressed gas. Though they have little penetrating effect, they may cause life threatening injuries. Our purpose was to evaluate the frequency and the development of the diagnostic opportunities in children with air gun injuries during the last 30 years (1971-2000). PATIENTS AND METHODS - 52 patients (39 boys and 13 girls) were admitted to our pediatric surgery department due to of air gun injuries. The average age was 9 years (range 2 to 14 years). During the first fourteen years conventional X-ray (plain film and fluoroscopy), since 1984 ultrasonography and later (1986) CT has also been used for the diagnosis. RESULTS - In the first ten years 12 patients, in the second decade 18 patients and in the third ten years 22 patients were admitted and treated with air gun injuries. The sites of injury included upper, lower extremities (n=23), head (n=10), neck (n=5), chest (n=9) and the abdomen (n=5). The majority of patients had superficial injury and Xray plain films in different views were obtained, only. Major complication occured in 10 cases: bone fracture (n=1), soft tissue abscess (n=4) pneumothorax and hemothorax (n=4), bowel perforation (n=1). In these cases ultrasonography and/or CT was performed and they were helpful to establish the correct diagnosis. CONCLUSION - The general conception that air guns are toys, is basically wrong. The practice of placing air guns in the hands of children by their parents is very dangerous. On the basis of our results, the frequency of air gun injuries in children increased significantly in the last decade and the injuries were more serious than before (due to thew technologic modification of air gun). Ultrasonography and CT have important role in the diagnosis, but conventional X-ray remains the basic method in most of cases.]

Lege Artis Medicinae

NOVEMBER 30, 2004

[FROM ASPIRIN TO COXIBS - JANUS-FACE OF THE NONSTEROIDAL ANTI-INFLAMMATORY THERAPY]

NEMESÁNSZKY Elemér

[Since the introduction of aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) proved to be the most commonly used drugs in the world. One of the major factors limiting their use is gastrointestinal toxicity. It has long been recognised that NSAID use is associated with serious, sometimes life-threatening adverse effects, like gastrointestinal ulcers, bleeding and perforation. Recent studies have indicated that the combination of NSAID and aspirin significantly increases the risk of complications. Aspirin is like a two-edged sword, balancing cardiovascular prevention with the risk of gastrointestinal side effects. Past history of ulcer carries the highest individual risk and other contributing factors include age, concurrent anticoagulation, cortocisteroid therapy, as well as high-dose or multipleforms of NSAID use. The mechanism of action of NSAID is to inhibit prostaglandin production through cyclooxygenase (COX). The inhibition of COX-2 isoenzyme reduces inflammatory-mediated prostaglandins, while the inhibition of COX-1 reduces the level of prostaglandins needed for normal protecting mechanism of the gastric mucosa. Non-selective NSAID has impact on both COX-enzymes, while selective COX-2-inhibitors (such as coxibs) exert their effects without affecting mucosal defence significantly. It is important to note that the risk of complications can not be reduced to zero by any therapeutic approach. The most appropriate treatment modality is to administer PPI co-therapy for the sake of gastro-protection, especially in high-risk cases. Histamine-2-receptor antagonists are not effective in reducing ulcer and complication in that particular group of patients. It has turned out that the inhibition of the synthesis of COX-2 by rofecoxib increases the risk of developing thromboembolic events and myocardial infaction. This has led to the withdrawal of Vioxx from the market on 30. 09. 2004. Studies conducted in recents years shed new light on numerous beneficial effects of NSAID other than alleviate pain, cure inflammatory processes and diminish higher temperature. The incidence of colon polyps and adenomas as well as cancers is reduced among people who are on maintanance NSAID therapy. The process of stone formation in the biliary tract is also reduced in patients who are on NSAID treatment. Development of Alzheimer's disease seems to be hindered, however, this finding can not yet be considered as evidence based.]

Lege Artis Medicinae

JUNE 10, 2009