Pyoderma gangrenosum of the breast ­ Case report / Emlo pyoderma gangraenosuma - Esetbemutatás

Pyoderma gangrenosum (PG) of the breast is a rare, ulcerative disease of rapid onset normally associated with systemic disorders and triggered by surgery or trauma. Early diagnosis and appropriate treatment of this disease pose a real challenge. We present a case of a PG of the breast in a patient with associated diabetes mellitus, with minor triggering injury. Our patient's condition was diagnosed and treated as an infected breast ulcer; after getting the correct diagnosis we treated her with systemic steroids and finally (at the patient's request) with breast ablation.

[Operative treatment of dialysis associated steal syndrome: basilic vein graft applied for revision using distal inflow (RUDI) procedure]. / Dialízis-asszociált steal syndroma mutéti kezelése: AV anastomosis distalizációjával, vena basilica interpositum felhasználásával.

Introduction: Artificial arterio-venous fistula-induced steal syndrome and subsequent distal ischemia are one of the most serious complications of arterial-venous fistula (AVF) surgery, ranging from 1 to 8% of cases. Traditionally, the complication is difficult to treat without losing the fistula. Treatment options include ligature of the fistula, fistula banding, distal revascularization with interval ligation (DRIL), proximalisation of the arterial inflow (PAI), and revision using distal inflow (RUDI). We would like to present a case of a 45-year-old woman who has developed dialysis associated steal syndrome with necrosis on the left arm 5 months after a cubital AVF was created. In order to maintain her arterio-venous fistula, RUDI procedure was performed to eliminate ischemia. We used basilic vein graft for distal revision of the astomosis. As a result of the procedure, ischemic complaints ceased, dialysis did not need to be interrupted, no further vascular access was necessary. Distalization of arterial inflow (RUDI) is an easy-to-implement, good-performing method for which the use of vena basilica graft is a very obvious solution.

[Visceral complications of the aortic dissections - indications and technique of the thoracoabdominal refenestration]. / Aortadissectiók zsigeri szövodményei ­ a thoracoabdominalis refenestratio javallata és technikája.

Aortic dissection is a life threatening cardiovascular catastrophy. Its incidence estimated to 5-6 cases per 100,000 patients/year. The intimal tear happens at the ascending aorta in Type A, meanwhile at the aortic isthmus in Type B, but entry point may develop anywhere alongside the entire aorta. All types may affect a short aortic segment resulting in a localized false aneurysm, others separate the intimal layer at longer extension down to the visceral segment and far beyond to the femoral arteries. Dissection of orifices of side branches may lead to cerebral, upper extremity, spinal, visceral, renal and lower extremity malperfusion. These complications beyond the aortic rupture contribute significantly to high mortality of dissection. Today, first line treatment option in Type A dissection is surgery, but it can be endovascular or medical in Type B dissection. However, awareness of surgical procedures in this field remains inevitable. In this paper we summarize the surgical options for distal malperfusion affecting spinal, visceral, renal and lower extremity circulation.

["Debranching" -- a new surgical option for the aortic arch and thoracoabdominal aorta hybrid interventions]. / "Debranching" -- új érsebészeti feladat az aortaív és a thoracoabdominalis aorta hibrid mutétei számára.

INTRODUCTION: Endovascular techniques in vascular surgery are frequently applied to treat aortic diseases. These minimally invasive procedures changed aortic interventions remarkably. We have to be familiar with new terminology and methods. METHOD: New and old surgical procedures gained new role in preparation of endograft implantations. Transforming anatomy of aortic branches - "debranching" - is aimed to create a sufficient fixation of the endografts at safe "landing zones". CONCLUSIONS: Knowing the option of hybrid procedures is a fundamental requirement for the vascular surgeon. Equally important is to know the biomechanical characteristics of the available endografts, the possible complications during and after implantation and the treatment options. We have to be aware of the limitations of these new methods and the role of traditional open surgery in the new era. Our intention in this paper is to summarize methods of debranching.

[Laparoscopic appendicectomy in 2013--a barely tolerated procedure turning into a gold standard operation?]. / Laparoscopos appendectomia 2013-ban - hogyan vált egy megturt mutét gold standard beavatkozássá?

INTRODUCTION: Laparoscopic appendectomy is one of the first developed minimally invasive surgical procedures, nevertheless its judgement is contradictory up to the present day as far as its advantages and indications are concerned. METHODS: The authors of this article give an overview and analyse the relevant literature concerning laparoscopic appendectomy and the data of patients on whom appendectomy was performed from 01/01/2005 to 30/09/2013 with laparoscopic and open technique. RESULTS: At the Surgical Department of the Uzsoki Hospital 1214 patients had appendectomy because of acute appendicitis from 01/01/2005 to 30/09/2013. The applied surgical procedure was laparoscopy with 1065 patients (87.73%) and the open technique with 149 patients (12.27%). Since January 2006 our main principle has been that in case of appendicitis the primary technique to be applied is laparoscopic appendectomy. We were forced to conversion with 16.5% of patients and as the operational experience of the department grows, the proportion of conversions tends to decrease. CONCLUSION: The advantages of laparoscopic appendectomy as opposed to open surgery have become obvious in the past decade, and the procedure may be recommended for all age groups. In case acute appendicitis is suspected the primary procedure to be applied in our department is the laparoscopic operation, the results of which are at least as good as that of open appendectomy. The routine application of laparoscopic appendectomy provides an excellent basis for the acquisition of advanced laparoscopic surgery thus appendectomy will not lose its training character due to the laparoscopic approach.

Transverse hepatectomy: a 14-years experience.

BACKGROUND/AIMS: Transverse hepatectomy, removal of hepatic segments IVB, V, VI, (III) in continuity with the gallbladder through the transverse portal plane, was first introduced by Paul Sugarbaker in 1990. In 1995 the first transverse hepatectomy in Hungary was carried out by our workgroup. This article summarizes our experience with transverse hepatectomies during the period from 1995 to 2008. METHODOLOGY: During this time 72 trisegmentectomies were performed 22 out of these operations were transverse hepatectomies. RESULTS: The average resection time for transverse hepatectomy was 1 hour and 20 minutes, there was an average 0.8 unit blood transfusion requirement per patient, the average exclusion time was 20.6 minutes, the average time spent in hospital postoperatively was 10.1 days and there were 2 perioperative deaths due to sepsis and hemorrhagic shock. CONCLUSIONS: In our experience transverse hepatectomy proved to be a bloodless, relatively easy procedure, which enables safe removal of the antero-lateral segments. This new type of major hepatic resection is very useful in metastasis surgery and has minimal associated morbidity and mortality.

Autoimmune pancreatitis mimicking pancreatic tumor.

Autoimmune pancreatitis (AIP) is a rare disease of unknown pathomechanism. It belongs to the IgG4-related disease family and responds well to steroids, although the relapse rate can reach up to 20-30%. Differentiating AIP from the more common pancreatic cancer can be very challenging. About 20% of AIP is diagnosed postoperatively during final histological examination. Each of the investigative tools can add something to the definitive diagnosis; the question remains whether it is possible to prevent an unnecessary resection. Through our case we would like to demonstrate the differential diagnostic opportunities and present the literary background of this issue. In conclusion, we can state that whenever a focal pancreatic lesion is encountered AIP should always be considered.

[Therapy of radiation enteritis--current challenges]. / A radiogén enteritis kezelésének kihívásai napjainkban.

Radiation enteritis is one of the most feared complications after abdominal and pelvic radiation therapy. The incidence varies from 0.5 to 5%. It is not rare that the slowly progressing condition will be fatal. During a period of 13 years 24 patients were operated due to the complication of radiation enteritis. Despite different types of surgery repeated operation was required in 25% of cases and finally 4 patients died. Analyzing these cases predisposing factors and different therapeutic options of this condition are discussed. Treatment options of radiation induced enteritis are limited; however, targeted therapy significantly improves the outcome. Cooperation between oncologist, gastroenterologist and surgeon is required to establish adequate therapeutic plan.

[Surgical prevention of radiation enteritis: case report and review of literature]. / Irradiatiós enteritis sebészeti prevenciója: esetismertetés és az irodalom áttekintése.

Due to high morbidity and mortality rates, radiation enteritis is one of the most feared complications of abdominal and pelvic radiation therapy. Advances in radiation technology and radiation planning contributed to recent significant achievements. Surgical prevention provides further opportunities in decreasing the risk of radiation enteritis. A 75 year old male underwent transurethral resection for urothelial carcinoma of the bladder. Prior to initiation of radiation therapy, we performed Shouldice repair for bilateral inguinal hernias to prevent radiation injury to the fixed small intestines. Later our patient received 55 Gy of radiation therapy and two series of Carboplatin chemotherapy. Following radio-chemotherapy our patient did not developed radiation enteritis. In our report we discuss hernioplasty as an important method for prevention of radiation enteritis. We also review other options of surgical prevention.

[From project-based sample collection to biobank]. / Projektalapú mintagyujtéstol a biobankig.

The research group takes samples for molecular genetical examinations from tumors removed during operations within ischemic time interval. Samples are stored in liquid nitrogen. Clinical data of these patients are recorded in an informatics system developed by the group. Patients are followed in an out-patient clinic set up for this purpose not financed by the National Health Insurance Fund. Tissue samples and follow up data are used to cooperate with molecular genetical laboratories.

[Symptoms, diagnosis and treatment of radiation-induced enteritis]. / Sugárkezelés mellett fellépo bélgyulladások tünettana, diagnosztikája, terápiás lehetoségei.

The number of radiotherapy in the treatment of malignant diseases is increasing worldwide. During the radiotherapy of tumors in the minor pelvis and abdomen intestinal inflammation of different degree may occur even if special attention is paid. Irradiation to the minor pelvis causes in half of the cases radiation induced acute enteritis, whereas in 25% chronic enteritis and colitis will develop. Chronic enteritis following radiotherapy raises a number of diagnostic and therapeutic problems that can be solved only with cooperation of different specialties. Authors present a short review regarding therapeutical options of radiation induced enteritis.

Pulmonary edema associated with methylene blue dye administration during sentinel lymph node biopsy.

Sentinel lymph node biopsy (SLNB) is an established procedure for staging early breast cancer. Recently, methylene blue dye has been advocated as a safe, efficacious and cost-effective substitute for isosulfan blue in sentinel lymph node mapping. In this case report, we describe a 44-year-old woman who developed pulmonary edema associated with the use of methylene blue dye for SLNB.