[Low-intensity, evidence-based cognitive-behavioural therapy of a patient with Crohn's disease]. / Az alacsony intenzitású, bizonyítottan hatékony kognitív viselkedésterápia Crohn-betegségben.

Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low-intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369.

[A giant myxoid leiomyoma mimicking an inguinal hernia]. / Lágyéksérvet utánzó gigantikus méretu myxoid leiomyoma.

Leiomyoma is a rare, smooth muscle tumour that can occur everywhere in the human body. The authors present the history of a 60-year-old female, who had a giant, Mullerian type myxoid leiomyoma in the inguinal region mimicking acute abdominal symptoms. After examination the authors removed the soft tissue mass in the right femoral region reaching down in supine position to the middle third of the leg measuring 335 × 495 × 437 mm in greatest diameters in weight 33 kg. Reconstruction of the tissue defect was performed using oncoplastic guidelines. During the follow-up time no tumour recurrence was detected and the quality of life of the patient improved significantly.

[Laparoscopic resection of persistent patent urachus]. / Ductus urachus persistens laparoszkópos eltávolítása.

The urachus in the foetus is a fibromuscular duct, which connects the allantois to the bladder and it is usually occluded in the 4-5th gestation months. Incomplete occlusion of the urachus at the time of birth is considered to be physiological, but later it can lead to recurrent discharge and inflammation of the umbilicus. To establish the diagnosis, ultrasound is the first examination of choice. A 19-year old obese female patient presented with umbilical discharge, and a persistent urachus was detected by ultrasound. After incision of the peritoneum the duct was excised from the umbilicus to the dome of the bladder by 3-port laparoscopy where the duct was clipped. The operation time was 38 minutes. The patient required minor analgesia on one single occasion in the postoperative period and was discharged on the first postoperative day. The authors recommend laparoscopic operation for the urachal remnant; the enlarged duct on the ventral abdominal wall can be better detected from the umbilicus to the Retzius spatium with 30-degree camera, and the cosmetic outcome is also more favourable.