Carbon Nanotubes as Electrically Active Nanoreactors for Multi-Step Inorganic Synthesis: Sequential Transformations of Molecules to Nanoclusters and Nanoclusters to Nanoribbons.

In organic synthesis, the composition and structure of products are predetermined by the reaction conditions; however, the synthesis of well-defined inorganic nanostructures often presents a significant challenge yielding nonstoichiometric or polymorphic products. In this study, confinement in the nanoscale cavities of single-walled carbon nanotubes (SWNTs) provides a new approach for multistep inorganic synthesis where sequential chemical transformations take place within the same nanotube. In the first step, SWNTs donate electrons to reactant iodine molecules (I2), transforming them to iodide anions (I(-)). These then react with metal hexacarbonyls (M(CO)6, M = Mo or W) in the next step, yielding anionic nanoclusters [M6I14](2-), the size and composition of which are strictly dictated by the nanotube cavity, as demonstrated by aberration-corrected high resolution transmission electron microscopy, scanning transmission electron microscopy, and energy dispersive X-ray spectroscopy. Atoms in the nanoclusters [M6I14](2-) are arranged in a perfect octahedral geometry and can engage in further chemical reactions within the nanotube, either reacting with each other leading to a new polymeric phase of molybdenum iodide [Mo6I12]n or with hydrogen sulfide gas giving rise to nanoribbons of molybdenum/tungsten disulfide [MS2]n in the third step of the synthesis. Electron microscopy measurements demonstrate that the products of the multistep inorganic transformations are precisely controlled by the SWNT nanoreactor with complementary Raman spectroscopy revealing the remarkable property of SWNTs to act as a reservoir of electrons during the chemical transformation. The electron transfer from the host nanotube to the reacting guest molecules is essential for stabilizing the anionic metal iodide nanoclusters and for their further transformation to metal disulfide nanoribbons synthesized in the nanotubes in high yield.

[Outcomes following rectal and recto-sigmoid cancer resections: comparison of the laparoscopic and open techniques]. / Rectum- és rectosigmoidealis tumorresectiók eredményei: a laparoscopos és nyitott technika összehasonlítása.

BACKGROUND/AIMS: Surgical technique and experience are considered as significant determinants of the successful treatment of recto-sigmoid malignancies. METHODS: Two hundred patients operated on between 2005 and 2009 were prospectively followed with an average of 39.8 months. Patients with rectosigmoid or rectal cancer were included, either with primary resection or resection after neoadjuvant therapy. The primary aim was to assess the average survival in the two groups; secondary outcomes were stage specific survival and the incidence of loco-regional recurrence and distant metastases. Intra- and postoperative complications, operating time, onco-pathological specimen quality and length of stay were also analysed. RESULTS: During the follow-up comparable rates for 3-year survival and recurrence rates were found without statistical difference. Hospital stay in the laparoscopic group was significantly shorter and the mid-term survival rates were also better in the more advanced stages. Incisional hernia rate was significantly lower in the laparoscopic group. CONCLUSIONS: The results of laparoscopic rectal and recto-sigmoid resections were not inferior, and - in some aspects - they were even better compared to open procedures. Adding the properties of the minimally invasive technique (shorter recovery, reduced surgical stress reaction) this should be the preferred method of operative approach.

Malignus emlotumor? Gyulladásos emloelváltozás? Ritka benignus kórkép?

Case-report: Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy is a rare, benign non-Langerhans cell histiocytosis, that typically involves the lymph nodes, but may also involve extranodal sites. We present a 58- years- old female patient who complained of a palpable mass in her left breast surrounded by 15-20 livid cutaneous lesions, resembling malignant breast cancer with cutaneous metastasis. Despite of core biopsy of the tumor and excisional biopsy one of the lesions, correct diagnosis of RDD was achieved only by complete pathological examination of the whole lesion after surgical excision. Conclusion: Rosai-Dorfman disease confined to the breast is extremely rare, that clinically may mimic breast cancer.

Impact of positive intraabdominal lavage cytology on the long-term prognosis of colorectal cancer patients.

BACKGROUND: Our aim was to investigate the presence of free cancer cells found in lavage cytology specimens taken from the proximity of tumors during the course of curative open and laparoscopic colorectal resections and then examine and compare the long-term disease outcomes in cases of negative and positive cytology. Based on the results, we were hoping to identify the place of peritumoral lavage cytology among prognostic factors for disease recurrence. METHODS: Between January 1, 2005 and December 31, 2007 intraoperative peritoneal lavage cytology was performed in 145 patients who underwent curative colorectal procedures. In all, 37 of the procedures were laparoscopic resections. RESULTS: Malignant cells were detected in the intraoperative peritoneal lavage cytology samples from 25 patients. Median follow-up was 47 months (3-81 months). Among the 25 patients with positive cytology; locoregional recurrence or distant metastasis was found in 14 during this period (56 %), whereas among the 120 patients with negative cytology the incidence was 28 (23 %). CONCLUSIONS: The impact of tumor stage, lymph node status, and peritoneal lavage cytology on recurrence rates is significant. Tumor, nodal, and lavage cytology status can be organized hierarchically in relation to time of recurrence. Cytology is most important, with positivity rendering long-term prognosis unfavorable. When comparing surgical techniques (open versus laparoscopic), we found no significant difference in recurrence rates. Our study has shown that conventional peritoneal lavage cytology is a prognostic factor in the case of patients undergoing curative colorectal operations.

[Laparoscopic treatment of appendiceal mucocele]. / Appendix mucokele laparoscopes mûtéti megoldása.

Mucocele is a mucin-filled cavity, which can be multi-loculated as well. Mucocele is relatively rarely found in the appendix. The disease does not cause any symptoms in most cases, and it is usually an accidental finding. A thorough investigation should be carried out to exclude malignancy. Depending on the operative findings and the full histological report, the spectrum of surgery extends from appendectomy to right hemicolectomy. In this paper, we discuss the presentation, diagnostical options, and the possible surgical treatment--based on our experience with five cases. In three cases a non-tender mass was palpable in the right lower quadrant of the abdomen, while another patient presented with right lower quadrant abdominal pain and one with abdominal pain and diarrhoea. Abdominal and pelvic ultrasound and CT scans raised the possibility of mucocele, however colonoscopy was negative. After laparoscopic exploration, laparoscopy assisted partial caecum resection was carried out in two cases, in further two cases laparoscopic appendectomy, and in one case laparoscopic partial caecum resection was done. The hystological examinations showed appendiceal mucocele with no malignancy demonstrated. All patients recovered without complications, they were discharged from hospital on postoperative day five. The patients have been disease free after a 6-30 month follow-up period. We concluded that laparoscopy is a recommended method for the surgery of appendiceal mucocele.

Comparison of atomic scale dynamics for the middle and late transition metal nanocatalysts.

Catalysis of chemical reactions by nanosized clusters of transition metals holds the key to the provision of sustainable energy and materials. However, the atomistic behaviour of nanocatalysts still remains largely unknown due to uncertainties associated with the highly labile metal nanoclusters changing their structure during the reaction. In this study, we reveal and explore reactions of nm-sized clusters of 14 technologically important metals in carbon nano test tubes using time-series imaging by atomically-resolved transmission electron microscopy (TEM), employing the electron beam simultaneously as an imaging tool and stimulus of the reactions. Defect formation in nanotubes and growth of new structures promoted by metal nanoclusters enable the ranking of the different metals both in order of their bonding with carbon and their catalytic activity, showing significant variation across the Periodic Table of Elements. Metal nanoclusters exhibit complex dynamics shedding light on atomistic workings of nanocatalysts, with key features mirroring heterogeneous catalysis.

[Laparoscopic reconstruction of abdominal wall hernias]. / Hasfali sérvek laparoscopos rekonstrukciója.

The widespread use of tension free surgical techniques and the modern, tissue-friendly surgical meshes have led to the development of new surgical techniques. The increasing importance of minimal invasive surgery became apparent in abdominal wall reconstructions, too, and their use has been justified by literature data. This procedure combines the advantages of minimal invasive surgery with tension free technique. The authors discuss 102 patients operated with abdominal wall hernias using a laparoscopic technique. There were 978 abdominal wall hernia operations in our department between 1 January 1999 and 31 December 2006, of which 102 cases were done laparoscopically. The average size of the abdominal wall defects was 62 square cm (minimum size: 12, maximum size: 160). The average size of the implanted surgical mesh was 300 square cm (min size: 150, max size: 750). Operating time was between 30 and 180 minutes. (The average time was exactly 70 minutes.) The hospital stay was between 1 to 7 days (4 days on average). Two recurrences were observed during the follow-up so far. The follow-up was from 2 to 96 months, with an average of 18 months. The laparoscopic technique significantly decreased the complication and recurrence rate, and shortened hospital stay compared to open surgery. Furthermore, laparoscopic technique improves aesthetic outcome, too. In addition, the authors found that small, hidden incisional hernia orifices could be explored and closed more easily with laparoscopic hernia repair.

[Laparoscopic choledocho-duodenostomy]. / Laparoszkópos choledocho-duodenostomia.

It is widely accepted today, that laparoscopic exploration of the common bile duct is an effective method for the treatment of obstructive jaundice, when it is caused by ductal calculi. In case of periampullary lesions, endoscopic stenting or surgical biliodigestive diversion might be the treatment of choice when radical solution is impossible or not necessary. The latter is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. The authors present the case of a 76 year old patient with poor general condition, obstructive jaundice and signs of biliary calculosis by ultrasound. Attempt to its endoscopic verification and treatment has failed, due to lack of cooperation. Laparoscopic common bile duct exploration was performed which has revealed small ductal calculi and stricture of the papilla. After extraction of ductal calculi, hand sutured, side to side choledocho-duodenostomy was performed laparoscopically to achieve permanent biliary diversion. The anastomosis was prepared with absorbable, monolayer, interrupted sutures. The postoperative course was uneventful During regular follow up no complications have been observed. The authors conclude, that in selected cases, choledocho-duodenostomy might be constructed safely laparoscopically, too. This procedure is especially advantageous for elderly patients and for patients in poor condition.

[Laparoscopic rectocele repair with mesh--a case report]. / Rectokele laparoszkópos megoldása muanyag háló beültetésével--esetismertetés.

Relaxation of the pelvic floor causes changes in the anatomy. This results in symptoms, which can be treated with different operations. The use of modern, minimal invasive methods and tension free mesh implants for the reconstruction is widely used in rectocele repair as well. We present a 59 year-old patient undergone both vaginal hysterectomy and cystocele repair previously who complained of progressive constipation. Physical examination and dynamic defecography confirmed the presence of a significant rectocele. Anal manometry showed no functional loss. Mobilisation of the rectum and division of the recto-vaginal septum was performed laparoscopically followed by rectopexy and reinforcement of the septum by fixing polypropylene mesh in each position. There was no complication and recovery was fast. Control defecography and functional test one month later did not show pathological findings. One year after surgery the patient is free of complaints or recurrence. In selected patients both laparoscopic approach and mesh implants are safe.

[Laparoscopic colon operations for endoscopically unremovable polyps and tumors]. / Laparoszkópos vastagbélmuitétek endoszkóposan nem eltávolítható polip és daganat miatt.

The use of laparoscopy in colorectal surgery is expanding. Minimally invasive surgery of benign lesions is widely accepted and can be performed with good results even during the learning curve. After gaining adequate expertise one can remove polyps which can not be treated with a colonoscope and early colonic carcinomas. We performed 16 laparoscopic resections for colon polyps and early carcinomas between December 2002 and March 2005. On one occasion a benign polyp was removed through mini laparotomy after colotomy; 13 resections and 2 subtotal colectomies were performed. One conversion due to intraoperative bleeding and one reoperation for anastomotic leak was necessary. One patient died after late postoperative mesenteric artery occlusion but if there was no complication definite advantages of the minimally invasive technique were observed. The laparoscopic approach can safely be used in selected patients. After training in the standard surgical procedure one can proceed to more radical surgery in adequately controlled studies.

[Lichtenstein's hernioplasty]. / Lichtenstein mutéteinkrol.

In recent years in Hungary similarly to the worldwide trend the treatment of inguinal hernias has changed. New tension-free methods were developed and--after the introduction by the Department of Surgery, Medical Faculty, University of Pécs--Lichtenstein's method is widely used. Lichtenstein's method has become the gold standard at our department because of its highly favourable results: simple technique, minimal postoperative pain, recurrence rate below 1%, short hospital stay, very low complication rate and early return to physical activity.

[Laparoscopic exploration of the common bile duct]. / A közös epevezeték laparoszkópos feltárása.

Since the first laparoscopic common bile duct exploration in Hungary published in 1999 the authors use the technique themselves. We review and analyse our activity between 1 June 1999 and 31 August 2003. The minimally invasive approach was selected in twelve patients with obstructive jaundice for suspected bile duct stones. Eight of these patients underwent preoperative endoscopy, but either the number and/or size of stones or various complications prevented successful endoscopic stone extraction; five sphincterotomies--two followed by stenting--were performed. The four other patients did not consent to endoscopy. During surgery the biliary tract was visualised by choledochoscope (a bile duct endoscope with video connection) in four cases via the distended cystic duct and in eight cases via longitudinal choledochotomy. In one case there was no occlusion at all, in another one dilatation was performed because of a structure. In nine patients stones were removed either through the choledochotomy/cystic duct or by passing them into the duodenum. In one patient we converted to open procedure due to a stone impacted in the papilla of Vater. After choledochotomy intracorporal suturing and knot tying techniques were used to close the incision. On six occasions a cystic drain, three occasions a T-tube and on three occasions primary closure was used. Two bile leaks were treated by endoscopic stenting and in one patient a laparotomy was needed. There was no mortality. We believe that laparoscopic common bile duct exploration can be successful even in complicated situations.

[Intraoperative ultrasonography for common bile duct exploration during laparoscopic cholecystectomy]. / A közös epevezeték intraoperativ ultrahangos vizsgálata laparoszkópos cholecystectomiák során.

The "Endomedix Laparoscan" and the "Leopard" and "Panther" intraoperative ultrasounds were successfully used for the detection of unsuspected common bile duct stones during laparoscopic cholecystectomy (LC). Out of 60 patients six had common bile duct (CBD) stones and in one patient sludge has been seen. In patients with CBD stones, four small calculi have been observed in one patient, despite negative intraoperative cholangiography (IC). In an other patient a stone in the retropancreatic part of the CBD was detected. Based on preoperative findings CBD stone was unsuspected. We found that intraoperative ultrasound (IOUS) is useful for in investigating the CBD to detect unsuspected common bile duct stones. It can be used for the examination of other organs (liver, pancreas, hepatoduodenal ligament) as well. The method is easy to perform, fairly simple and informative so it can replace IC during laparoscopic cholecystectomy.

[Changing trends in breast surgery over a five year period (1998-2002)--a retrospective analysis]. / Az emlosebészet változása, ot ev (1998-2002) retrospektív elemzése alapján.

Today's development in breast cancer surgery are characterized by the principle of the smallest necessary intervention in contrast with the radicality of the past. To achieve this goal the primary and crucial task is the recognition of early (stage I or II) breast cancer. The National Screening Program started 2002 provides ideal conditions. The authors present a five year (1998-2002) retrospective analysis of breast preserving surgery: over the period 861 operations were performed on breast cancer patients with an average of 46.5% of them with breast conservation. Complications after unnecessary axillary lymph node dissection occurred with a high incidence rate (60%); the authors suggest sentinel node identification and detection performed to avoid these complications. In the "early years" (1998-2001) only 15 preoperative wire-loop markings were performed in patients with non-palpable malignant lesions, whereas from 2002--owing to the National Screening Program--68 such interventions were carried out providing the immense importance of nationwide screening.