[Current therapy of the pancreato-pleural fistula]. / A pancreatopleuralis fistula sikeres konzervatív kezelése.

This case report summarizes therapeutic options for the management of pancreato-pleural fistula (PPF) following a successful conservative treatment of one of our patients. PPF is a rare complication of chronic pancreatitis. The main aetiological factor is alcohol, which causes relapse of chronic pancreatitis associated with dyspnoea. Diagnosis is confirmed by physical examinations, laboratory tests of pleural fluid as well as ERCP being the most important diagnostic procedure. Conservative treatment of PPF consists of endoscopic therapy (endoscopic sphincterotomy with stenting of the pancreatic duct), octreotid combined with continuous enteral nutrition (jejunal feeding). If the above complex therapy fails, surgical treatment of PPF is advised.

[Late complication after mesh repair of incisional hernias: pseudocyst formation]. / A hegsérvek hálóval történo rekonstrukcióját követo késoi szövodmény: a pseudocysta-képzodés.

INTRODUCTION: Using mesh for hernia repair is a very common procedure; they are particularly useful for postoperative incisional hernias. The most common complications of mesh repair are seroma, haematoma or abscess formation. Previous literature data suggested that fibrotic cyst formation appearing in the late postoperative period is relatively rare. However, more recent studies and our own experience indicate that its incidence is more common and we have to consider it in the differential diagnosis of the complications of hernia repair. PATIENTS: 148 incisional hernia mesh repairs were carried out between a period of 1st January, 2001 to 31st December, 2005. Fibrotic pseudocyst formation was observed in five cases. All developed as a late complication between 4 to 25 months postoperatively. An onlay polypropylene mesh was used in each case. All five patients underwent a wide excision of the pseudocyst wall and they recovered without complications. DISCUSSION: The etiology of pseudocyst formation is unclear. Nevertheless, a possible relationship between the development of seroma and haematoma can not be ruled out, despite no fibrotic pseudocyst formation was observed in the early postoperative period. There is no evidence whether the characteristics of the mesh or the way of implantation would have any effect on pseudocyst formation, as well. It is noted that the only treatment of this late complication is surgical excision. Pseudocyst formation might be prevented by the application of sublay and minimally invasive techniques.

Dynamic in vivo observation of villus microcirculation during small bowel autotransplantation: effects of endothelin-A receptor inhibition.

BACKGROUND: The aims of this study were to characterize the structural and microcirculatory changes in single intestinal villi during ischemia and reperfusion and determine the site of action of endothelin (ET)-A receptor inhibition during compromised mucosal perfusion. METHODS: Small bowel autotransplantation was performed in anesthetized dogs. One group was treated with the ET-A receptor antagonist ETR-p1/fl peptide. The epithelial thickness and villus microcirculatory parameters were observed by orthogonal polarization spectral imaging; the leukocyte-endothelial cell interactions were quantified with fluorescence videomicroscopy. RESULTS: Sixty-minute cold ischemia and 240-min reperfusion induced a decrease in villus functional capillary density and leukocyte-endothelial cell interactions. The epithelial layer was gradually removed, but denuded villi were not observed. ET-A receptor inhibition reduced the leukocyte adherence and attenuated epithelial exfoliation and the decrease in villus functional capillary density. CONCLUSIONS: ET-A receptor activation mediates microvascular dysfunction through precapillary blockades and leukocyte-endothelial cell interactions after cold ischemia and reperfusion in the canine small bowel.