A bélelokészítés lehetoségei és hazai gyakorlata a tervezett colorectalis mutétek elott.

Introduction: The bowel preparation before elective colorectal surgery is a controversial topic in the surgical practice. During the last 15 years numerous publications concerning the necessity and options of the bowel preparation were published. The aim of our team was to perform a survey about the current, domestic practice as well as to give a short overview of the relevant literature and recommendations. Methods: 50 surgical departments performing colorectal surgeries routinely were asked to fill out an online, anonymous survey. The data of the survey filled out by 40 surgical departments were analyzed separately for the surgeries of the right colon, the left colon, and the rectum. Results: Based on the results, there is a high heterogeneity concerning the mode of the bowel preparation: in case of the right colon 7 different combinations, in case of the left colon and rectum 3-3 different combinations of bowel preparation methods are used. Conclusions: In the current domestic practice there is a high heterogeneity regarding the modes of the bowel preparation before the elective colorectal surgery, which are presumably based mainly on individual experience. The methods of the bowel preparation used by the majority of the surgical centers are not in accordance with the current international recommendations. A preparation of a Hungarian consensus document in this topic would be beneficial.

The role of indocyanine green fluorescence in sentinel lymph node biopsy for breast cancer / Az indociánzöld-fluoreszcencia hasznosítása az emlorák miatt végzett orszemnyirokcsomó-biopsziában.

Összefoglaló. Bevezetés: Napjainkban az orszemnyirokcsomó felkeresésének legelterjedtebb módszere a radioizotópos és kék festékes kettos jelölés, emellett azonban több más jelölés is alkalmazható. Az indociánzöld-fluoreszcencia ígéretes nyirokút-térképezési módszer, mely a találati arányát tekintve - irodalmi adatok alapján - összevetheto a radioizotópos módszerrel. Módszer: Osztályunkon 2020. 03. 31. és 2020. 04. 15. között 10, emlorák miatt operált betegünknél alkalmaztuk az indociánzöld és a kék festékes kettos jelölés módszerét az orszemnyirokcsomó felkeresésére. Eredmények: A 10 operált betegünknél összesen 17 orszemnyirokcsomót azonosítottunk és távolítottunk el. 16 orszemnyirokcsomó jól festodött indociánzölddel (találati arány: 0,94; 95%-os konfidenciaintervallum [CI ]: 0,73-0,99), míg kék festékkel 9 jelölodött (találati arány: 0,53; 95%-os CI: 0,31-0,74). A szövettani feldolgozás során összesen 2 orszemnyirokcsomó bizonyult áttétesnek, ezek közül 1 kék és fluoreszcens volt, 1 pedig csak kék festékkel jelölodött. Következtetés: Kezdeti, kis esetszámnál nyert tapasztalataink alapján az indociánzöld jelölés emlorák során végzett orszemnyirokcsomó-biopszia esetén jól használható kettos jelölési módszer részeként, kék festékkel kiegészítve. A módszer találati aránya, valamint fals negatív aránya irodalmi adatok alapján nem különbözik szignifikánsan a radioizotópos jelölés módszerétol. Orv Hetil. 2021; 162(8): 293-297. INTRODUCTION: The current practice in sentinel lymph node biopsy for breast cancer is the radioisotope and blue dye dual labelling technique, however, other mapping methods are also available. Indocyanine green fluorescence is one of the best alternatives of the standard technique, with detection rates comparable to those of the radioisotope method. METHOD: Between 31. 03. 2020 and 15. 04. 2020, a total of 10 sentinel lymph node biopsies for breast cancer were performed using the indocyanine green fluorescence and blue dye dual technique. RESULTS: 17 sentinel lymph nodes were detected and removed in total, from which 16 showed explicit fluorescence activity (detection rate: 0.94; 95% confidence interval [CI]: 0.73-0.99), whilst 9 where blue (detection rate: 0.53; 95% CI: 0.31-0.74). During histopathological examination, 2 sentinel lymph nodes proved to be metastatic, from which 1 was fluorescent and blue, the other was blue only. CONCLUSION: Regarding our early experience based on a small number of patients, indocyanine green fluorescence, used together with blue dye as part of a dual technique, is a usable method for sentinel lymph node mapping. Based on data from the literature, the detection rate and the false-negative rate of the indocyanine green fluorescence method shows no significant difference from the radioisotope mapping technique. Orv Hetil. 2021; 162(8): 293-297.

Experimental assessment of three electrosurgical tissue-sealing devices in a porcine model.

Three electrosurgical tissue-sealing devices (EnSeal ETSDRC-01, LigaSure LS1500 and Thunderbeat TB-0535PC) were compared regarding sealing time (ST), maximum working temperature (WTmax) and the total (MTZtotal) as well as the collateral microscopic thermal injury zone (MTZcollat) using laparoscopic handpieces 5 mm in diameter on four types of tissue (liver, mesentery, cross striated muscle and spleen) in an in vivo porcine model. LigaSure had the lowest mean ST in spleen, mesentery, muscle and liver, followed by Thunderbeat and EnSeal with significant differences between all types of tissues and devices. The significantly lowest mean WTmax was obtained for EnSeal in mesentery, muscle and liver. LigaSure and EnSeal operated at the lowest temperature in spleen without a significant difference between them. Thunderbeat produced significantly higher temperature peaks in all cases. The lowest mean MTZtotal was caused by LigaSure and EnSeal in spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Nevertheless, Thunderbeat produced the significantly lowest mean MTZtotal in the liver. EnSeal produced the lowest mean MTZcollat in the liver, followed by LigaSure and Thunderbeat showing significant differences. EnSeal and LigaSure produced the lowest mean MTZcollat in the spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Based on the results of this study, Thunderbeat seems to be more invasive to tissue integrity (even without the activation of the ultrasonic scissor function) than EnSeal or LigaSure, that operate at lower temperatures and were found to cause negligible collateral thermal damage.

[The importance of the extracapsular extension of the sentinel node metastasis in the surgical treatment of breast cancer]. / Az orszemnyirokcsomó extracapsularis áttétének jelentosége az emlorák sebészi kezelésében.

Introduction: The introduction of sentinel node biopsy (SNB) has led to a significant decrease of axillary lymph node dissections (ALND). The importance of the extracapsular extension (ECE) in the sentinel lymph node (SN) remains unclear. Method: The data of 635 patients with T1-T2N0M0 invasive breast cancer who underwent SNB between 2014 and 2018 were retrospectively analysed. 25% of the SNB patients (158) had metastasis in the SNs. These patients were grouped based on the presence or absence of ECE. The main objective of our study was to analyse the occurrence of massive (>3) node metastasis in the case of ECE negative and ECE positive patients, where ALND was performed. Results: There were 91/158 patients (58%) in the ECE negative group and 67/158 patients (42%) in the ECE positive group. ALND was performed in 42% of the ECE negative and in 69% of the ECE positive patients. There were no significant differences in the mean age of the patients; size, histological type and grade of the tumours, presence of lymphovascular invasion and proportion of hormone and HER2 receptor positivities. In the ECE negative ALND group, pN1 involvement was 82%, pN2+pN3 involvement represented 18% of cases. In the ECE positive ALND group, pN1 involvement was 60%, pN2+pN3 involvement was found in 40% of cases. The presence of ECE was associated with greater axillary disease burden. These results show a significant difference (p = 0.038). Conclusions: ECE of the SN is an important predictor for non-sentinel lymph node involvement. These data suggest, when ECE is confirmed, it is a further factor to be considered in deciding about ALND.

Negative pressure wound therapy of Corynebacterium jeikeium associated granulomatous mastitis.

We present the first Corynebacterium associated therapy resistant granulomatous mastitis successfully treated with negative pressure wound therapy (NPWT). Our patient had received five different courses of antibiotic therapy, and three surgical explorations before NPWT was introduced and resulted in healing. For a successful treatment, the use of targeted antibiotic therapy, steroid therapy and in case of progressive disease, wide excision is required. When this results in a large wound cavity, NPWT seems an effective and innovative option.

[Early clinical experience with postoperative monitoring of a patient after laparoscopic splenectomy combined with spleen autotransplantation. A case report]. / Minimálisan invazív módszerrel végzett, lép autotranszplantált beteg posztoperatív követésére alkalmazott képalkotó eljárásokkal nyert kezdeti tapasztalataink. Esetismertetés.

We performed splenectomy combined with spleen autotransplantation after blunt abdominal trauma by minimally invasive technique at the County Teaching Hospital in Kecskemét. In case of advanced post traumatic spleen injury, spleen autotransplantation (Furka's spleen chips) is a well-known method to try to avoid postsplenectomy syndrome. During the operation, when in situ preservation of the spleen is not possible, chips of spleen tissue are transplanted into the omentum. Function of the transplanted spleen tissue was monitored by scintigraphy. We describe two different types of spleen scintigraphy to check the viability of spleen chips.