[Short history of liver surgery in the Department of Surgery of University of Szeged]. / A májsebészet története a Szegedi Tudományegyetem Sebészeti Klinikáján

Introduction The authors introduce the history of liver surgery in Szeged on the occasion of the 100th anniversary of the Surgery Department's establishment. Material and methods After the initiation of liver surgery in Szeged by Professor Karácsonyi 1982 we are treating not only patients with benign and malignant focal liver diseases but also others with surgery required because of complications of portal hypertension. Patients are presented in two periods. Discussion We operated on 46.5% of the patients with malignant and 53.5% of the patients with benign diseases between 1981 and 1991. The surgical spectrum extended to trisegmentectomy. There were 14% of minor and 9.9% of major complications, the mortality was 3.23% which meets international standards. In the second period, 50.5% of the patients were operated on because of malignant and 46.5% of the patients suffered from benign focal diseases from 1992. Among the patients who had been operated on because of liver malignancy, there were 51% metastasis mostly of colorectal cancer, 22% were hepatocellular, 16% were cholangiocellular carcinoma and in 11% were other malignant tumors. In those patients who had been operated on because of benign focal liver diseases, there were 32% cysts, 25% echionococcus cysts, 26% haemangiomas, 8% adenomas, 7% FNH, and 2% because of others. The summarized mortality rate was 1.3%. There were peritoneo-venous shunt implantations in 126 cases because of therapy-refracter ascites. We performed oesophageal transection with a circular stapler after failed endoscopic haemostasis in 50 cases. Conclusion Chances of liver surgery have been basically widened because of the financial investment that is connected to the Department of Surgery's move to a new building. The liver unit in Szeged today can take care of patients in a full spectrum of liver surgery.

Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years' experience at a tertiary care centre.

BACKGROUND: Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. PATIENTS AND METHODS: We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male-female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient's performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. RESULTS: PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79-20.56), clinical progression (OR 7.62; CI 2.64-22.05) and the need for emergency CCY (OR 14.75; CI 3.07-70.81) were mostly determined by AC severity grade. CONCLUSION: PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

[Surgical treatment of liver metastasis in colorectal cancer with simultaneous liver resection]. / Colorectalis rák májáttéteinek sebészi kezelése szinkron májreszekcióval.

Metastatic liver disease is a challenging and life-threatening situation often with dismal prognosis. Nearly half of the patients with colorectal cancer develop liver metastasis during the course of their diseases. Hepatic resection is the treatment of choice in patients with colorectal liver metastasis. This study was conducted to compare the results of patients undergoing simultaneous liver and colorectal resection for synchronous liver metastasis and of those for whom a colorectal and liver resection was made separately. A retrospective analysis was performed on 1597 patients who underwent surgery because of colorectal cancer between January 1999 and December 2008. The results of the treatment were separately evaluated in case of the 152 patients who had liver metastasis. The proportion of the liver metastasis was 9.52%. The metastases arose in 40.8% from the rectum and in 31.8% from the sigmoid colon. It proved to be inoperable in 109 (71.7%) of the 152 patients who had liver metastasis. Simultaneous liver resection was performed because of synchronous metastasis in 14 (32.6%) cases (Group 1) and two step resection in 29 (67.4%) cases (Group 2). In case of synchronous operations only minor liver surgery was done. The mean size of the metastasis was 2.6 cm in diameter in Group 1 and 4.6 cm in Group 2 (p<0.005). The transfused blood volume was 0.3 U/patient. Only minor complications could be observed in Group 1. The hospitalization was 13.1 days in Group 1 and 11.7 days in Group 2. The mean survival time was 37.3 and 47.9 months (p<0.005). Simultaneous liver resection seems to be a safe procedure on those patients who develop small metastases with a limited number. However, the optimal timing of the liver resection and the identification of patients who will have the greatest benefit in survival still remain obscure.

Surgery of benign liver tumors: indications for treatment: twenty years' experience.

BACKGROUND/AIMS: The aim of this study is to give an audit of the experiences in the Institute of Experimental Surgery, at the University of Szeged, over the past 2 decades in the form of a retrospective study. METHODOLOGY: Between January 1982 and December 2001, 132 patients with benign liver tumor (adenoma: 22; focal nodular hyperplasia: 27; hemangioma: 83) were treated. A total of 112 patients underwent surgery, while 20 asymptomatic cases were merely observed. The mean age, the female/male ratio and the size of the tumor in the adenoma cases were 38.2 years, 20/2 and 7.7cm, while for focal nodular hyperplasia they were 39.4, 24/3 and 6.3cm, and for hemangioma 49.0, 62/21 and 6.5cm. The results were compared and analyzed statistically. RESULTS: Enucleation was performed in 45.4% of the patients, nonanatomical resection in 35.6%, segmentectomy in 7%, lobectomy in 3.8%, extended lobectomy in 1.5%, stitching in 4.5%, exploration in 2.3% and liver transplantation in 0.8%. The mortality was 0.8%. Complications occurred in a total of 23.5% of the cases. CONCLUSIONS: Patients with asymptomatic focal nodular hyperplasia or hemangiomas must be excluded from surgery. Surgery is indicated only when growth or severe complaints are observed. Adenomas must be resected because of the precancerous behavior and the danger of bleeding from a rupture.

[Late malignant transformation of chronic corrosive oesophageal strictures]. / A nyelocso krónikus heges szukületeiben kialakuló malignus elváltozás.

The number of patients with scar carcinoma of the oesophagus developing on the basis of a corrosive stricture seems to be rising in the past decades. Thirty six patients with this condition were treated surgically in a 20 years period; this is the second largest series in the literature. Patients with scar cancer were 7.2% of all oesophageal carcinoma cases; this ratio is currently the highest of all in the literature. The interval between the burn and the diagnosis of scar carcinoma was 46.1% years; this is higher than the 30-35 years generally described so far. It was 50.9 years in those patients who drank lye before the age of 12, but 14 years less when it happened in adulthood. The long-term survival was excellent: 45.6% of the patients after resection were alive after 5 years and 14.4% after 10 years. The explanation of the good prognosis is that carcinoma develops in a lye stricture and is at first surrounded by a rigid scar which allows only intraluminal growth, so it causes early dysphagia through obstruction. Early dissemination is prevented because of the same reason. One-stage resection and reconstruction is the best way to treat the radically operable patients. In patients with esophageal corrosive stricture in need of operation, both a bypass procedure and resection can be performed, but it should be pointed out that malignancy may develop even years after the operation in the remaining part of the gullet. Total esophagectomy is therefore suggested instead of by-pass.

Levosimendan interacts with potassium channel blockers in human saphenous veins.

The involvement of potassium channels in the venodilating capacity of the inodilator levosimendan in human saphenous vein preparations was investigated. Levosimendan caused relaxation with 50% effective concentration (EC50) of 0.32 +/- 0.04 microM in isolated veins contracted by 5-hydroxytryptamine. Fifteen microM glibenclamide, a blocker of the ATP-sensitive potassium channels (K(ATP)), partially inhibited the relaxing effect of the inodilator. In the presence of iberiotoxin, the selective blocker of large conductance calcium-activated potassium channels (BK(Ca)), levosimendan induced contraction with EC50 of 0.21 +/- 0.06 microM. We presume that levosimendan dilates human saphenous veins by interacting with hyperpolarizing potassium channels (K(ATP) and BK(Ca)).

Liver abscess caused by Stenotrophomonas maltophilia: report of a case.

We report the case of a melioidosis-like abscess of the liver caused by Stenotrophomonas (Xanthomonas) maltophilia infection in a Chinese man living in Hungary. Although this appears to be the first documentation of a liver abscess of this origin in a nonimmunocompromised patient, our case report demonstrates that this common facultative pathogen can also cause liver abscess and sepsis. After repeated negative blood cultures, histological examinations of liver biopsies suggested the possibility of chronic melioidosis, but the microbiological examination performed directly on the same specimen identified a Stenotrophomonas maltophilia infection. Surgical drainage was performed and sulphamethoxazole/trimethoprim therapy was commenced, after which the patient recovered fully. The facultative pathogen S. maltophilia, which most often causes nosocomial infections, may cause severe sepsis and liver abscess. We wish to draw attention to the fact that the antibiotic sensitivity of S. maltophilia is not necessarily the same in vivo and in vitro. This can create difficulties in both diagnosis and treatment.

[Surgical treatment of gastric cancer: new methods and longstanding difficulties]. / Gyomorcarcinoma sebészi kezelése: új lehetôségek és régi gondok.

UNLABELLED: The incidence of gastric carcinoma has been declining and the same tendency is observed in Hungary. The five-year survival rate has been improved due to the fewer postoperative deaths and the more radical operations (e.g. extended lymphadenectomies). METHODS: The authors analyzed the clinical data of 183 patients with gastric carcinoma. Age, sex, histology reports, TNM staging and the surgical interventions are presented. RESULTS: Potentially curative resection could be performed in about half of the patients (92/182). A large proportion of the patients belonged to the locally advanced cancer group (112/182). The ratio of the different TNM stages remained the same year by year in the investigated period despite the improving endoscopic facilities. CONCLUSION: Early diagnosis of gastric cancer is crucial and continuous effort should be made by the surgeons, the gastroenterologist and the general practitioners to identify high risk patients with the use of new, sensitive screening methods.

[Surgery of benign liver tumors: indications for treatment. Personal experience and review of the literature]. / Indokolt-e a jóindulatú májdaganatok sebészi kezelése? Saját tapasztalatok és irodalmi áttekintés.

BACKGROUND AND AIMS: Our aim is to give an audit of our experience over the past two decades in the form of a retrospective study. PATIENTS/METHODS: Between 1 January, 1982 and 15 December, 2001, 133 patients with benign liver tumor (adenoma: 22, focal nodular hyperplasia: 27, hemangioma: 83, lipoma: 1) were treated. A total of 113 patients underwent surgery, while 20 asymptomatic cases were merely observed. The mean age, the female/male ratio and the size of the tumor in the adenoma cases were 38.3+/-10.2 years, 20/2 and 7.7+/-2.4 cm, while for focal nodular hyperplasia they were 39.5+/-12.4, 24/3 and 6.3+/-2.7 cm, and for hemangioma 49.01+/-10.7, 62/21 and 6.5+/-3.6 cm. The results were compared and analyzed statistically. RESULTS: Enucleation was performed in 53.1% of the patients, non-anatomical resection in 24.8%, segmentectomy in 6.2%, lobectomy in 4.4%, extended lobectomy in 1.8%, stitching in 5.3%, exploration in 3.5% and liver transplantation in 0.9%. The overall 30-day postoperative mortality was 0.9% (1/113). Minor or major complications occurred in a total of 27.4%. CONCLUSIONS: Patients with asymptomatic focal nodular hyperplasia or hemangiomas must be excluded from surgery. Surgery is indicated only when growth or severe complaints are observed. Adenomas must be resected because of the precancerous behavior and the danger of bleeding from a rupture.

Endothelin-a receptor antagonist treatment improves the periosteal microcirculation after hindlimb ischemia and reperfusion in the rat.

OBJECTIVES: To examine the microcirculatory changes in the rat tibial periosteum after hindlimb ischemia and reperfusion and to evaluate the effects of endothelin-A (ET-A) receptor antagonist therapy in this condition. The healing and functioning of vascularized bone autografts depend mainly on the patency of the microcirculation, and the activation of ET-A receptors may be an important component of the tissue response that occurs during ischemia-reoxygenation injuries. METHODS: Wistar rats were subjected to 1 hour of hindlimb ischemia and 3 hours of reperfusion. The periosteal microcirculation was visualized by intravital fluorescence microscopy. The leukocyte rolling and adherence in the postcapillary venules and the functional capillary density of the periosteum were determined. Two separate groups were treated with the selective ET-A receptor antagonist BQ 610 or the novel ET-A receptor antagonist ETR-p1/fl peptide at the onset of reperfusion. RESULTS: Reperfusion was accompanied by a significant decrease in functional capillary density and by an increase in the primary and secondary leukocyte-endothelial cell interactions. ET-A receptor inhibition reduced the leukocyte rolling and firm adherence and attenuated the decrease in functional capillary density in both treated groups. CONCLUSIONS: ET-1 plays a major role in microvascular dysfunction in the periosteum during reperfusion. The ET-1-ET-A receptor system might be an important target for tissue salvage therapy in transplantation surgery.

Experience with different methods of treatment of nonparasitic liver cysts.

BACKGROUND AND AIMS: In a search for the optimal management of nonparasitic liver cysts, a study was made of the effectiveness of different methods. PATIENTS AND METHODS: Between 1 January 1982 and 15 December 2001 we treated 132 patients with nonparasitic liver cysts. In 72 patients 31 cysts were treated with enucleation, 60 with deroofing, and 24 with stitching by laparotomy; two liver resections were also performed. In a further 34 patients 36 cysts were treated with deroofing by minimally invasive surgery. In an additional 26 patients 32 cysts were treated with various interventional radiological methods. RESULTS: There was no mortality. The morbidity rate after laparotomy was significant (22.2%). The rate of recurrence after enucleation and deroofing was 6.5% and 13.8%, respectively, but there were no recurrences after stitching and liver resection. The recurrence rate following laparoscopic deroofing was 19.4%, and that following interventional radiological procedures was 50%. CONCLUSIONS: Treatment is required only if cysts are highly symptomatic or if growth is detected. Interventional radiological methods do not prove more favorable than surgery. Laparoscopic fenestration is preferred because of its low morbidity and the short period of hospitalization. Traditional surgical methods should be reserved merely for cases in which laparoscopic deroofing is not feasible.