Non-active implantable device treating acid reflux with a new dynamic treatment approach: 1-year results : RefluxStop™ device; a new method in acid reflux surgery obtaining CE mark.

BACKGROUND: RefluxStop™ is an implantable, non-active, single use device used in the laparoscopic treatment of GERD. RefluxStop™ aims to block the movement of the LES up into the thorax and keep the angle of His in its original, anatomically correct position. This new device restores normal anatomy, leaving the food passageway unaffected. METHODS: In a prospective, single arm, multicentric clinical investigation analyzing safety and effectiveness of the RefluxStop™ device to treat GERD, 50 subjects with chronic GERD were operated using a standardized surgical technique between December 2016 and September 2017. They were followed up for 1 year (CE-mark investigation 6-months). Primary safety outcome was prevalence of serious adverse events related to the device, and primary effectiveness outcome reduction of GERD symptoms based on GERD-HRQL score. Secondary outcomes were prevalence of adverse events other than serious adverse events, reduction of total acid exposure time in 24-h pH monitoring, and reduction in average daily PPI usage and subject satisfaction. RESULTS: There were no serious adverse events related to the device. Average GERD-HRQL total score at 1 year improved 86% from baseline (p < 0.001). 24-h pH monitoring compared to baseline showed a mean reduction percentage of overall time with pH < 4 from 16.35 to 0.80% at the 6-month visit (p < 0.001), with 98% of subjects showing normal 24-h pH. At 1 year: No new cases of dysphagia were recorded, present in 2 subjects, which existed already at baseline. Regular daily PPI usage occurred in all 50 subjects at baseline. At 1-year follow-up, only 1 subject took regular daily PPIs due to a too low placement of the device thereby prohibiting its function. None or minimal occasional episodes of regurgitation occurred in 97.8% of evaluable subjects. Gas bloating disappeared in 30 subjects and improved in 7 subjects. CONCLUSION: The new principle of RefluxStop™ is safe and effective to treat GERD according to investigation results. At 1-year follow-up, both the GERD-HRQL score and 24-h pH monitoring results indicate success for the new treatment principle. In addition, with the dynamic treatment for acid reflux, which avoids compressing the food passageway, prevalence of dysphagia and gas bloating are significantly reduced. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02759094 . Registered 3 May, 2016.

Transoral mucosal excision sutured gastroplasty: a pilot study for GERD and obesity with two-year follow-up.

INTRODUCTION: An outpatient transoral endoscopic procedure for gastroesophageal reflux disease (GERD) and obesity would be appealing if safe, effective, and durable. We present the first in human experience with a new system. METHODS: Eight patients with GERD (3) and obesity (5) were selected according to a preapproved study protocol. All GERD patients had preprocedure manometry and pH monitoring to document GERD as well as quality of life and symptom questionnaires. Obese patients (body mass index >35) underwent a psychological evaluation and tests for comorbidities. Under general anesthesia, a procedure was performed at the gastroesophageal junction including mucosal excision, suturing of the excision beds for apposition, and suture knotting. RESULTS: One patient with micrognathia could not undergo the required preprocedural passage of a 60 F dilator and was excluded. The first 2 GERD patients had incomplete procedures due to instrument malfunction. The subsequent 5 subjects had a successfully completed procedure. Four patients were treated for obesity and had an average excess weight loss of 30.3% at 2-year follow-up. Of these patients, one had an 8-mm outlet at the end of the procedure recognized on video review--a correctable error--and another vomited multiple times postoperatively and loosened the gastroplasty sutures. The treated GERD patient had resolution of reflux-related symptoms and is off all antisecretory medications at 2-year follow-up. Her DeMeester score was 8.9 at 24 months. CONCLUSION: The initial human clinical experience showed promising results for effective and safe GERD and obesity therapy.

[Intestinal bleeding and obstruction in the small intestine caused by metastatic thyroid angiosarcoma. Case report]. / Pajzsmirigy-angiosarcoma gastrointestinalis vérzést, obstrukciót okozó áttéte a vékonybélben.

The authors present a case of a primary angiosarcoma of the thyroid gland with an intestinal metastasis. The 59-year-old female patient with tarry stool and anemia was referred to the outpatient hospital. Her past history included a thyroid "cold" nodule. Gastroscopy and colonoscopy failed to identify the origin of gastrointestinal bleeding, however, capsule endoscopy verified synchronous tumors in the small intestine. The distal tumor showed signs of bleeding and caused bowel obstruction. An urgent operation was performed and the tumorous part of the ileum was resected. Histology of the removed specimen indicated cleft-like spaces in the mucosa with CD31+ epithelial cells. Pathological report described metastatic epithelial angiosarcoma with an unknown origin. Before chemotherapy the patient underwent total thyroidectomy and histology confirmed malignancy similar to that found in the intestinal surgical specimens. This case seems particularly interesting, because bleeding from intestinal metastasis leaded to the diagnosis of the primary tumor located in the thyroid gland.

[Laparoscopic reconstruction in traumatic rupture of the diaphragm]. / Traumás rekeszruptura laparoscopos reconstructiója.

The authors report the case of a 63-year-old patient who was polytraumatized in a motor vehicle accident and suffered multiple traumatic injuries. Chest and pelvic fractures as well as left-sided diaphragmatic rupture with associated omentum herniation were diagnosed on CT scan. None of the injuries required urgent surgical intervention. After 10 days supportive therapy, elective laparoscopic reconstruction of the diaphragmatic hernia was performed. The authors discuss the role of laparoscopic diaphragm reconstruction.

[Implantation metastasis of colorectal adenocarcinoma in an anal fistula]. / Colorectalis adenocarcinoma implantációs áttéte végbélsipolyban.

In our case report, we describe a rare form of metastatic colorectal carcinoma, in which tumor cells spread intraluminally and metastasis occurs with implantation mechanism far from the primary tumor. A 43-year-old male patient developed perianal abscess. After surgical intervention a fistula-in-ano appeared at the site of the abscess. Fistulotomy was performed in another hospital. A few months later, we admitted him to our department with an abnormal tissue proliferation appearing in the surgical area. Histology confirmed adenocarcinoma. Colonoscopy detected tissue proliferation in the sigmoid colon, causing a subtotal stenosis. Laparoscopic rectosigmoid resection and per anum tumor excision were performed. Detailed histological examination confirmed the same mucinous adenocarcinoma in the colon and the anorectal malformation. In this case, implantation mechanism is likely in the development of a synchronous tumor at the site of the fistula-in-ano. Implantation metastasis is considered rare, only a few cases have been reported in the international literature so far. We are not aware of any similar case reported from Hungary. Orv Hetil. 2023; 164(3): 110-113.

Effectiveness of negative pressure wound therapy: Minimum five-year follow-up and review of the literature.

OBJECTIVES: In this study, we aimed to assess the effectiveness of negative pressure wound therapy (NPWT) in a five-year patient cohort and to discuss the results in the light of literature data. PATIENTS AND METHODS: Between January 2012 and December 2016, a total of 74 patients (35 males, 39 females; median age: 60 years; range, 20 to 95 years) who received NPWT were retrospectively analyzed. The patients included 49 orthopedic and traumatology, 12 vascular surgery, and 13 general surgery patients. The efficacy of wound healing, bacterial load, and the impact of comorbidities on wound healing were examined. RESULTS: The distribution of wound types varied very widely. Certain comorbidities affected wound healing. In orthopedic traumatology patients, we observed mainly skin flora infection (57.14%), while in surgical and vascular patients, mixed flora (80%) and in many cases poly-resistant pathogens were present (methicillin-resistant Staphylococcus aureus 24%) A total of 43.3% of wounds were completely closed, while 44.6% of patients had a wound healing. Successful skin grafting was performed in 75% of wounds. CONCLUSION: This technique may be used as widely and as early as possible. However, further large-scale, multi-center, randomized clinical trials are needed worldwide to find a place for this technique in wound care and even in primary care.

[Reconstruction of large tissue loss of the anus and perineum with bilateral inferior gluteal and right gracilis myocutaneous flaps]. / Jelentos végbél- és gáttáji lágyrész-hiány fedése kétoldali musculus gluteus major és jobb oldali gracilis musculocutan lebenyplasztikával.

The authors present a case of locally advanced anal squamous cell carcinoma which, due to infiltration of deep structures, caused anal incontinence, serious pain, exulceration, and bleeding. Neoadjuvant radiotherapy made the tumour operable and abdominoperineal extirpation was performed. The large tissue loss of the anal and perineal region was covered by bilateral gluteus maximus myocutaneous flaps, and the loss of the pelvic musculature and the remaining pelvic skin loss were replaced by a right gracilis myocutaneous flap. The patient was discharged on the 36th postoperative day. There was no flap necrosis noted and an incomplete lesion of the proximal urethra healed after direct suturing. The patient was allowed to lye on the flap in the second postoperative month and sitting on the third month. Unfortunately, an inoperable infiltrative lymph node metastasis occurred in the right inguinal region after six months, and the patient died 10 months after the surgery. We believe that in cases of large, ulcerating anal tumours, when direct closure would be impossible due to massive tissue loss after resection, quality of life can be significantly improved by resection and closure with myocutaneous flaps.

Feasibility and safety of emergency ERCP and small-caliber pancreatic stenting as a bridging procedure in patients with acute biliary pancreatitis but difficult sphincterotomy.

BACKGROUND: The aims of the present study were: (1) to assess the feasibility and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) and pancreatic duct (PD) stenting with small-caliber stents as a bridging procedure in acute biliary pancreatitis (ABP) patients in whom biliary endoscopic sphincterotomy (EST) proved difficult, failed or was contraindicated, and (2) to compare the clinical outcome of those patients having emergency ERCP with and without pancreatic stent. METHOD: Eighty-seven consecutive patients with ABP were referred for emergency ERCP. In 60 of these ABP patients, ERCP, EST, and stone extraction (if necessary) were performed without PD stenting. In the remaining 27 patients, small-caliber (3-5 F, 4 cm) pancreatic stent insertion was initially applied. All patients were hospitalized for medical therapy and were followed up. RESULTS: The mean ages, the initial symptom-to-ERCP times, the Glasgow severity scores, and the peak amylase and CRP levels at initial presentation were not significantly different in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group. More importantly, the complication rate was significantly lower in the ERCP + EST with PD stent group versus the ERCP + EST without PD stent group (7.4% vs. 25%); while the mortality rates (0% vs. 6.7%) were comparable, reasonably low, and demonstrated no statistically significant differences. CONCLUSIONS: Temporary PD stenting with small-caliber stents is a safe and effective procedure that may afford sufficient PD decompression to reverse the process of ABP and serve as a bridging procedure in severe ABP in patients with failed, complicated, or contraindicated biliary EST.

[Liver failure a la Eastern Europe]. / Májelégtelenség kelet-európai módra.

The use of valeriana was underplayed at the beginning of the 20th century because of its addictive and side effects. The 38-year-old woman, mother of a 20-month-old child from Eastern Europe, was treated with liver insufficiency and vascular, parenchymal decompensated cirrhosis needing plasmapheresis for the first time in our hospital. In case history, abusus of aethyl-alcohol and valeriana was found to be as toxic agent which was treated as the etiologic factor of the liver disease and liver failure. After intensive and conservative treatment her status was stabilised, during the follow-up she had no signs and symptoms, the laboratory results tend to be in normal range. Half year after her hospitalization intensive care treatment was necessary abroad due to gastric bleeding. In the background the histology of gastric biopsy taken during gastroscopic examination showed gastric sigillocellular carcinoma in our hospital. Total gastrectomy, omentectomy, lymphadenectomy were performed, the tumor was removed and she received cytostatic treatment. The use of valeriana and aethyl-alcohol is supposed to have a potential effect on tumorgenesis and on the increase of toxicity.

[The role of radical surgical approach in the treatment of benign multinodular goitre depending on anatomical variations of the recurrent laryngeal nerve]. / A radikalitás helye a benignus pajzsmirigybetegségek sebészi kezelésében a nervus rekurrens anatómiai sajátságainak tükrében.

UNLABELLED: From time to time there is a surprise at the end of surgery - even after subtotal resection - when a vocal cord is observed on indirect laryngoscopy to be non-functional. Surgeons are highly individualistic and develop their own special ways of locating and protecting the nerve. The present study has tried to clarify whether relying on palpation alone during surgery is safe enough in each case. MATERIALS AND METHODS: Between 01.01.2001 and 31.12.2008, 1228 recurrent laryngeal nerve (RLN) were exposed in 702 patients on thyroid surgery. The RLN was found and traced until the laryngeal entry point in all patients. Substernal spreading was noted in 38.6% (271/702), while tracheal compression or dislocation was present in 19.5% (137/702). Recurrent thyroid disease counted for 8.4% (59/702) of all cases. Total thyroid lobectomy was carried out in 82.2% (1009/1228), near-total thyroidectomy in 15.5% (191/1228), and subtotal resection only in 2.3% (28/1228). RESULTS: Palpation was helpful in 80.7% (991/1228), proved false positive in 8.7% (107/1228), while in 10.6% (130/1228) it did not provide any help in the localization. The palpability of the RLN showed marked discrepancy between the two sides. False positivity was noted with palpation in 3.4% (21/625) and 14.3% (86/603) on the right and left side, respectively. On the other hand, palpation helped localization in 4.8% (29/603) on the left side, while the same figure was 16.2% (101/603) on the right side. Definitive RLN palsy was experienced in 0.8% of all cases (10/1228), whilst transient paresis was encountered in 1.4% (17/1228). Occult malignancy was noticed in 5.6% (39/702). CONCLUSIONS: No indication has been left for subtotal resection. Even if benign multinodular goitre is present, since the clinical and pathophysiological evidences suggest that multinodular goitre affects the entire gland, any surgery that leaves potentially abnormal thyroid tissue in situ carries a risk of recurrent disease. RLN palpatory method is a useful part of thyroid surgery but it is suitable for rough orientation only.

[Gardner's syndrome, a rare disease]. / Gardner-syndroma, avagy amikor a raritások "kopogtatnak az ajtón".

Introduction: Gardner's syndrome is a clinical subgroup of Familial Adenomatosus Polyposis, arare, autosomal disease. It is characterized by gastrointestinal polyps and extra-intestinal manifestations including multiple osteomas, skin and tissue tumours. The authors describe a case of a male patient, and discuss the diagnosis, treatment and follow-up of patients with Gardner's syndrome. We conclude that the knowledge of rare syndromes is very important for the correct treatment.

Endoscopic sphincterotoMy for delayIng choLecystectomy in mild acute biliarY pancreatitis (EMILY study): protocol of a multicentre randomised clinical trial.

INTRODUCTION: According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. METHODS/DESIGN: EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications. ETHICS AND DISSEMINATION: The trial has been registered internationally ISRCTN 10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176-5). TRIAL REGISTRATION NUMBER: ISCRTN 10667869; Pre-results.

Somatosensory hypersensitivity in the referred pain area in patients with chronic biliary pain and a sphincter of Oddi dysfunction: new aspects of an almost forgotten pathogenetic mechanism.

BACKGROUND AND AIMS: Somatosensory hyperalgesia in the referred pain area (RPA) in patients with acute or chronic abdominal pain syndromes may result from the convergence of nerve fibers from visceral and somatic tissues at the spinal and supraspinal levels. Chronic biliary pain in patients with the postcholecystectomy syndrome (i.e., biliary hypersensitivity) may be explained by persistent hyperexcitability of neurons in the central nervous system (CNS). The aim of this study was to evaluate the cutaneous neural sensory perception in the RPA in patients with chronic postcholecystectomy biliary pain and a sphincter of Oddi (SO) dysfunction (SOD). METHODS: Forty-two patients with persistent biliary pain and suspected SOD, 27 age-matched healthy volunteers, and 18 age-matched asymptomatic cholecystectomized controls were prospectively investigated by quantitative sensory testing (Neurometer CPT). The biliary symptoms and the severity of pain were classified on a visual analog pain severity scale system via a previously validated and standardized questionnaire. The patients helped the doctors locate the RPA in the right upper quadrant. The sensory detection threshold was determined noninvasively (Neurometer CPT) with transcutaneous electrical stimulation at 5, 250, and 2,000 Hz, and different current intensities (range from 0.01 to 9.99 mA) applied in a single (patient) blinded method. These three frequencies selectively excite small unmyelinated (C fibers), small myelinated (A-delta), and large myelinated (A-beta) fibers, which transmit dull pain, sharp pain, and touch, respectively. The contralateral region of the abdomen left upper quadrant served as the control area. The sensory current perception threshold ratio (SCPTR) of the data measured in the contralateral area and the RPA was calculated. RESULTS: The SCPTRs in the definite SOD patients with biliary pain, healthy volunteers, the asymptomatic cholecystectomized controls, and the symptomatic cholecystectomized patients but without SOD were 2.32 +/- 1.4 versus 1.06 +/- 0.24 versus 0.97 +/- 0.16 versus 0.83 +/- 0.35 at 2,000 Hz; 2.19 +/- 1.0 versus 1.01 +/- 0.26 versus 1.02 +/- 0.25 versus 0.88 +/- 0.35 at 250 Hz; and 2.19 +/- 1.1 versus 1.12 +/- 0.26 versus 0.99 +/- 0.37 versus 0.84 +/- 0.32 at 5 Hz, respectively. Significant hypersensitivity was detected in the RPA at different stimulation frequencies in the SOD patients with biliary pain versus the cholecystectomized controls: at 5 Hz: P = 0.00001; at 250 Hz: P = 0.00001; and at 2,000 Hz: P = 0.0001, respectively. CONCLUSION: Continuous visceral pain (biliary pain) caused by local inflammatory/sensitizing processes or a CNS malfunction could lead to significant hypersensitivity of the peripheral nociceptive nerve fibers in SOD patients. Postcholecystectomy pain may be explained by persistent hyperexcitability of the nociceptive neurons in the CNS with or without objective motility disorders of the SO.

[Modern esophageal surgery and late functional results as equations with several unknowns--Hungarian Academy of Sciences Doctoral Thesis]. / A modern nyelôcsôsebészet és a késôi funkcionális eredmények "többismeretlenes egyenlete"--MTA Doktori Pályázat.

Using the same surgical method and anatomically ideal primary healing, the functional results could even be different later. Trying to identify various factors being responsible for the above differences, 637 patient's data, who underwent previous oesophago-gastric surgery between 1985-2005, were analyzed. Biochemical, histological and electrophysiological examinations had been evaluated. Developing hypertrophy-like metabolic changes and enteric ganglionitis as morphological alternations of LES muscles induced by GERD may be reasons for complaints after antireflux surgery. The marking of Z-line with endoscopic clips followed by an immediately upright contrast study and substractional evaluation is appropriate for detecting true short esophagus. Open surgical procedures are justified even in the new millennium in cases when the patient already underwent previous upper abdominal operations - due to an increased risk of injury because of adhesions - in cases of primarily recurrent paraesophageal hernias after an unsuccessful open and/or laparoscopic reconstruction, as well as in cases of reflux with complications. When adenocarcinomas of the gastro-oesophageal junction are examined preoperatively, the ratio of the performed catabolic - AMAN, CB, and DPP I - enzymatic activity of the tissue sample from the tumour and adjacent intact mucosa within 2 cm of the tumour may have a prognostic value even in the preoperative examination period, and neo-adjuvant treatment should be considered in these group of patients. The patients' post-operative complaints and symptoms change during the post-operative period and correlate with the parameters of the myoelectric and contractile activities of the "Akiyama stomach". Tachygastria seems to be the major pathogenetic factor involved in the contractile dysfunction. Gastro-jejuno-duodenal interposition represents an adequate 'second-best' method of choice if technical difficulties emerge with jejunal or colon interposition following limited resection of the oesophagus performed due to early Barrett's carcinoma or non-dilatable peptic stricture.

Expression of the Na+/I- symporter (NIS) is markedly decreased or absent in gastric cancer and intestinal metaplastic mucosa of Barrett esophagus.

BACKGROUND: The sodium/iodide symporter (NIS) is a plasma membrane glycoprotein that mediates iodide (I-) transport in the thyroid, lactating breast, salivary glands, and stomach. Whereas NIS expression and regulation have been extensively investigated in healthy and neoplastic thyroid and breast tissues, little is known about NIS expression and function along the healthy and diseased gastrointestinal tract. METHODS: Thus, we investigated NIS expression by immunohistochemical analysis in 155 gastrointestinal tissue samples and by immunoblot analysis in 17 gastric tumors from 83 patients. RESULTS: Regarding the healthy Gl tract, we observed NIS expression exclusively in the basolateral region of the gastric mucin-producing epithelial cells. In gastritis, positive NIS staining was observed in these cells both in the presence and absence of Helicobacter pylori. Significantly, NIS expression was absent in gastric cancer, independently of its histological type. Only focal faint NIS expression was detected in the direct vicinity of gastric tumors, i.e., in the histologically intact mucosa, the expression becoming gradually stronger and linear farther away from the tumor. Barrett mucosa with junctional and fundic-type columnar metaplasia displayed positive NIS staining, whereas Barrett mucosa with intestinal metaplasia was negative. NIS staining was also absent in intestinalized gastric polyps. CONCLUSION: That NIS expression is markedly decreased or absent in case of intestinalization or malignant transformation of the gastric mucosa suggests that NIS may prove to be a significant tumor marker in the diagnosis and prognosis of gastric malignancies and also precancerous lesions such as Barrett mucosa, thus extending the medical significance of NIS beyond thyroid disease.

[Adenomatoid tumor of the adrenal gland. Case report and review of the literature]. / A mellékvese adenomatoid tumora, avagy irodalmi barangolás egy igen ritka mesothelialis daganat nyomán.

Adenomatoid tumors of the adrenal gland are rather rare, asymptomatic neoplasias with benign behavior and usually are diagnosed incidentally. The authors report a case of an adenomatoid tumor of the right adrenal gland in a 32-year-old man who sought evaluation because of fever and renal pain. During investigation a tumor, localized in right adrenal gland, was identified by ultrasonography and CT. The patient underwent adrenalectomy with histopathological and immunohistochemical diagnosis of adenomatoid tumor of the adrenal gland. Based on literature data the epidemiology, symptoms, differential diagnosis, treatments, histopathology and prognosis of adenomatoid tumors of the adrenal gland are discussed.

[Dilemmas associated with the surgical treatment of cutaneous B cell lymphomas]. / A cutan B-sejtes lymphomák sebészi kezelésének dilemmái.

INTRODUCTION: Cutaneous lymphomas belong to the group of non-Hodgkin lymphomas. However, in case of an in-time diagnose and adequate treatment the prognosis of the disease is fairly good. Nevertheless, a thorny path leads to the correct diagnosis as several dermatological diseases cause problems in differential diagnostics. CASE REPORT: The authors describe the case history of a 53-year-old woman patient, who had a dermatological check-up due to a dermatitis in the shoulder region. A conservative treatment was started because of a suspected mycosis. Following its inefficiency an operative excision was carried out. The postoperative biopsy verified cutaneous B-cell lymphoma. DISCUSSION: The cutaneous B-cell lymphomas are such forms of non-Hodgkin lymphomas, where the malignant proliferation appears primarily in the skin, and in 6 months after the diagnosis extracutaneous manifestation cannot be detected. Several cases can be found in the literature, which show long interval between the manifestation of the symptoms and the setting of the diagnosis. This calls the attention to the significance of difficulties in the differential diagnosis. During the treatment of cutaneous lymphomas the type, the cutaneous extension, and the extracutaneous manifestation of the disease must be defined. The therapeutic plan can be made up by analysing these findings. On the basis of findings in this case and in the literature, a surgical treatment--beyond determining the correct diagnosis--could be a therapeutic alternative in the treatment of cutaneous B-cell lymphomas.

[Celiac artery compression syndrome--stepchild of abdominal angina?]. / A truncus coeliacus kompressziós szindróma--a hasi angina "mostohagyermeke"?

BACKGROUND: Celiac trunk compression in few percentages of the cases can cause chronic abdominal pain that shows no connection with eating. CASE REPORT: Detailed preoperative examinations showed significant, segmental stenosis of the celiac trunk, caused by outer compression of a tendonous arc of diaphragm, in the background of abdominal pain and mesenteric ischemia of a 58-year-old woman. After preparation we have executed the surgery by removing a tight ring, located at around 8-10 mm from the origin of trifurcation, and a part of the celiac ganglion. The patient was dismissed from our hospital 6 days after surgery in good general condition. DISCUSSION: The abdominal pain can normally be the consequence of mesenteric ischemia. The root cause in most of the cases is the alteration of the particular artery. The outer compression is normally responsible only for a few percentages of the cases. In our case the problem was caused by a stronger tendonous part of the aortic hiatus. The first sign of this during the examination was a recognisable noise over the artery, which was caused by the poststenotic turbulent flow. Detailed radiological examinations executed based on this indeed proved this malfunction. CONCLUSION: In case of unidentified abdominal pain we have to consider the possibility of the stenosis of the celiac trunk. By our case study we would like to call the attention to the importance of the auscultation over the abdomen, which is a relevant part of the basic physical examinations. When getting to the final diagnosis, apart from the duplex doppler sonography, we also used the results of angiography. The essence of the surgery was to get rid of the outer compression of the artery, which has to be done as soon as possible in order to avoid that compression causes degeneration of the artery itself.

Magnetic Twin Stent for Short-Term Palliation of Acquired Nonmalignant Tracheoesophageal Fistula.

Through a tracheostomy with a rigid esophagoscope in the esophagus, the authors simultaneously placed self-made magnetic twin stents in a critically ill patient with high tracheoesophageal fistula. The operation took 17 minutes. Oral nutrition was started immediately. The stents were checked and changed after the months 3, 7, and 14. At 18 months, a tracheal resection and esophageal reconstruction through a partial median sternotomy was completed successfully. The magnetic twin stent technique can temporize critically ill patients with an acquired nonmalignant tracheoesophageal fistula until they become operable.