Giant sigmoid colon diverticulum incarcerated in an inguinal hernia / Lágyéksérvbe kizáródott óriás sigmabél diverticulum

Introduction: The diverticulosis of the sigmoid colon may be congenital or acquired. The Giant Colonic Diverticulum (GCD), defined as a diverticulum larger than 4 cm, is a rare, but clinically important entity. The McNutt (1988) classification is used differentiate the three subgroups of giant diverticula. Type 1 diverticula are pulsion pseudo-diverticula, which enlarge gradually. Type 2 are inflammatory diverticula due to a previous subserosal perforation, where the abscess cavity is communicating with the bowel lumen and its wall would be gradually composed of fibrous scar tissue, lacking the intestinal histological layers. Type 3 are the real, congenital diverticula of the colon, containing all layers of the intestinal wall. We present a case of a 59-year-old male patient, who was admitted to our Dept. of Surgery in emergency with the diagnosis of strangulated left inguinal hernia. Abdominal CT demonstrated the herniation of the sigmoid colon into the hernia sac without the signs of bowel obstruction. The patient was operated on urgently; subsequent to a left inguinal incision, a Type 3 giant diverticulum of the sigmoid colon was found in the hernia sac. Laparotomy was performed, and the unusually large, 7-8 cm long strangulated diverticulum was liberated. There were no other pathological findings, the sigmoid colon was not damaged. The diverticulum was resected with a TA stapler, and the staple line was inverted with a layer of seromuscular sutures. The inguinal hernia orifices were reconstructed both intraabdominally and externally. The postoperative course was uneventful, the patient was discharged on the 7th day. The recommendations concerning the diagnosis and treatment GCD are briefly reviewed. Due to the McNutt Type 3 characteristics, we opted for the less invasive, simple diverticulectomy instead of sigmoid resection (Hartmann's procedure). Our case was an extremely rare complication of the already uncommon GCD, resolved by an unusual surgical intervention leading to a successful cure.

The Hungarian validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery and the correlation of cognitive impairment with fatigue and quality of life.

BACKGROUND: Multiple Sclerosis (MS) causes not only somatic, but also cognitive impairment regardless of the patients׳ age or the course of the disease. The Brief International Cognitive Assessment for MS (BICAMS) test, published in 2011, is a short cognitive questionnaire: a fast, reliable, sensitive and specific tool for the evaluation of the patients׳ cognitive state. OBJECTIVES: Our primary objective was to assess the validity of the Hungarian version of the BICAMS test. Our secondary objective was to evaluate the impact of the cognitive impairment on the patient׳s quality of life and fatigue׳s impact on the patients׳ cognitive state. METHODS: 65 RR-MS patients and 65 age, sex and education matched healthy control (HC) subjects completed the test and were retested after 3 weeks. The patients also completed the MS Quality of Life 54 (MSQoL54) and the Fatigue Impact Scale (FIS) assessments. Group differences were calculated by paired sample T-tests. The test-retest reliability was measured by intraclass correlation coefficients. To analyze the difference between the test-retest performances of the two groups we used two-way repeated measures ANOVA where the BICAMS battery was the single composite outcome and one-way repeated measures ANOVA. To assess the impact of the cognitive decline on the patients׳ quality of life and fatigue׳s impact on the cognitive state, we examined the correlations between results in the BICAMS and the MSQoL54 and FIS. RESULTS: We found significant difference (p ≤ 0.001, p = 0.017 in the first CVLT-II assessment) between MS patients and members of the HC group in all four evaluated parameters of BICAMS test in both sessions. The correlation coefficients were very strong between the tests and retests (r > 0.8; p < 0.001; r = 0.678, p < 0.001 between the CVLT-II assessments). We found that the HC group performed significantly (p = 0.020) better in the retest sessions as compared to their original performance than the patients did and this difference is solely due to the difference between the CVLT-II performances. We have found significant negative correlation between the patients׳ cognitive function and the fatigue score (r < -0.3, p < 0.05). Seven of the MSQoL-54 subscales correlated with the BICAMS performance (r > 0.3; < 0 .05). CONCLUSIONS: The Hungarian version of the BICAMS test is a valid and reliable method for the evaluation of MS patients׳ cognitive function. It seems that because of the short retest period, the members of the HC group remembered the CVLT-II words thus performed better than the patients did. Also apparently fatigue can have a negative impact on the patients׳ cognitive state, and cognitive impairment could worsen the patients׳ quality of life.

Star-crossed? The association of the 5-HTTLPR s allele with season of birth in a healthy female population, and possible consequences for temperament, depression and suicide.

BACKGROUND: Birth season has well-known effects on neuropsychiatric disorders, and may also influence genotype distribution by possibly influencing chance of conception via parental idiosyncratic conception patterns or survival of foetuses or infants. The 5-HTTLPR is associated with phenomena including affective temperaments or suicide which are also associated with birth season. Our aim was to investigate the association of 5-HTTLPR genotype and birth season in a healthy female population. METHODS: Birth date and 5-HTTLPR genotype was determined for 327 psychiatrically healthy women. The association between presence of s allele and time of birth was analysed using generalized linear models. RESULTS: A significant association between s allele frequency and time of birth was detected. S allele carrier frequency was marginally significantly higher in July borns and significantly lower in autumn borns. LIMITATIONS: We investigated an adult sample so genotype frequency data do not reflect birth frequencies. Our sample consisted exclusively of females. CONCLUSIONS: There is no clear explanation for the observed association, although idiosyncratic parental conception patterns, the association of 5-HTTLPR with sudden infant/intrauterine death, or other s allele-mediated behaviours may play a role. Our results are strikingly parallel with earlier data reporting a higher risk of completed suicide in July borns, and higher scores of July borns and lower scores of autumn borns on certain affective temperament scales, both of which are also associated with the s allele of 5-HTTLPR. Thus our results may add to the growing body of evidence regarding the etiological background of affective disorders.

[Influence of psychiatric and psychosomatic disorders on quality of life]. / Pszichoszomatikus és pszichiátriai zavarok hatása a betegek életminôségére.

INTRODUCTION AND AIMS: The term 'quality of life' has received a growing highlight in relation to the care of chronically ill people during the past decades. The main goal of the present study has been to analyze patients' quality of life regarding the following diagnoses: headache (tension headache); mood disorders (depression); anxiety, and comorbid states, involving some psychological variables, such as hostility or social support. METHODS: There were 157 patients participating in the study who came from a registered patients' pool in the Neuropsychiatric Rehabilitation Ward, Department of Psychiatry, University of Szeged, during the spring semester of 2005. The final sample size contained 151 patients who might be sorted into five main disease groups: mood disorders (depression); anxiety disorders; mixed psychiatric diagnosis; headache; and comorbid diagnosis (headache and psychiatric disorder together). The mean scores of the scales of patients' quality of life were investigated according to gender and disease groups; in addition, we also analyzed the psychological background of the quality of life. RESULTS: Based on factor analysis, two factors of the quality of life scale were detected: one factor labelled 'everyday activities' factor (including items such as work, financial situation, nutrition, sexual life or self-actualization), and another one labelled 'social activities' factor (e.g., activities with spouse, family, other persons, religious and community activities). According to the disease groups, differences could be detected particularly in the field of everyday activities; especially patients suffering from mood disorders reported higher levels of deterioration of their quality of life, whereas in comparison with them, patients of headache showed less changes. When there was comorbid psychiatric illness besides headache, a more determinant deterioration of the quality of life could be detected. Hostility and psychosomatic/anxiety symptoms contributed mostly to deterioration of the quality of life in the field of everyday activities, moreover, with growing age, the patients experienced a greater level of deterioration of their quality of life. Among the disease groups, the presence of mood disorder lowered mostly the patients' quality of life. In case of the quality of life factor 'social activities', social support was a protective factor. CONCLUSIONS: In this study, we would like to draw the attention to the influences of psychosomatic and psychiatric disorders on patients' quality of life since with this help we may get closer to a deeper understanding of patient behavior. The quality of life study identifies not only the non-beneficial effects but also maps the positive ones. This implies the possibility of effective adaptation.

Granulocyte activation in humans is modulated by psychological stress and relaxation.

Our aim was to study the possible relationship between psychological stress and granulocyte activation primarily in healthy students during an examination period (n = 11) and also in chronically anxious patients (n = 15). We employed cell surface markers: lactoferrin, L-selectin, alphaMbeta2-integrin and CD15s and flow cytometry to detect changes in the activation state of granulocytes, with the start of the stressed state in students at the beginning of an examination period, which was associated with elevated blood plasma cortisol level, and following relaxation hypnosis in both students, during their examination term, and patients. The ratios of all four types of marker-carrier granulocytes increased at the start of the examination period in students; an especially dramatic (ca. 5-fold) enhancement was observed in the proportion of lactoferrin-bearing cells relatively to the pre-examination term value. After hypnosis, the percentage of lactoferrin-exposing granulocytes decreased considerably both in students and in patients, by about half; a similar decrease was observed in the ratio of CD15s-carrier cells in patients. No significant alteration was observed during the study in state or trait anxiety levels, and in total or differential leukocyte counts. Thus, granulocyte activation could be associated with stress, while relaxation may facilitate reducing activation of these cells. In both groups of subjects, granulocyte surface lactoferrin appeared to be a sensitive "stress indicator". This needs further evaluation.

Modulation of pain-induced endothelial dysfunction by hypnotisability.

Mental stress induces endothelial dysfunction, that is a reduction of the post-occlusion brachial artery flow-mediated vasodilation (FMD). This does not occur in subjects highly susceptible to hypnosis (Highs) in either the waking or hypnotic state. The aim of the present experiment was to assess whether endothelial dysfunction is also induced by acute nociceptive stimulation and whether high hypnotisability and/or the specific instruction of analgesia prevent its occurrence in awake highly hypnotizable individuals. Thus, nine Highs and nine subjects with low susceptibility to hypnosis (Lows) underwent an experimental session including the administration of pressor pain and of pressor pain associated with the instruction of analgesia. Heart rate, basal artery diameters and brachial artery flow-mediated vasodilation were measured during stimulation and rest conditions. Heart rate exhibited slight changes not modulated by hypnotisability. During painful stimulation both Highs and Lows showed a decrease of FMD, but it was significantly less pronounced in Highs. During the administration of painful stimulation together with the instruction of analgesia, only Highs reported analgesia and their FMD no longer decreased. This study provides the first evidence of pain-related endothelial dysfunction and extends previous findings concerning a sort of natural protection of Highs against the vascular effects of mental stress to acute pain.