[Types and management of perforations occurring during endoscopic retrograde cholangiopancreatography]. / Az endoszkópos retrográd cholangiopancreatographia során kialakult perforációk típusai és kezelésük.

The authors discuss the incidence of perforation related to endoscopic retrograde cholangio-pancreatography, which is relatively uncommon (0.3-1%) among other types of complications. Perforations can be classified into three types based on their forms and locations. Having reviewed the literature the authors conclude that the most common type is periampullary perforation and the less frequent one is peritoneal perforation. The former usually heals after conservative treatment, while the latter needs an operation. The authors emphasize the important prognostic role of timely diagnosis and surgical treatment if alarming signs (peritoneal, septic) are present. Known predisposing factors, when the procedure needs more careful attention, are also summarized (postoperative status, needle knife papillectomy, intramural contrast media, long lasting examination). After reviewing their own cases, the authors establish that the incidence of perforation in their own centre was four per thousand (10/2400), out of which nine were periampullar and one peritoneal type. In 6 cases operation was necessary, and there was no mortality. The authors conclude that individually tailored therapy can largely reduce the 30-40% mortality rate reported in earlier studies.

[Laparoscopic endoscopy: a new type of combined technique for select patients]. / Ujfajta randevú, azaz a laparoendoszkópia bevezetése válogatott beteganyagban.

The authors report a new method which was introduced last year in their unit. In a significant part of cholecystolithiasis, choledocholithiasis also exists. The diagnosis is sometimes fairly difficult, in these cases newly developed imaging methods (magnetic resonance cholangiopancreatography, endoscopic ultrasonography) can help. In cases of choledocholithiasis, when preoperative endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful, laparoscopic endoscopy can be performed. Authors describe this method as well as discuss the international literature, and review the cases of their own ten cases with this method. They emphasize the advantages of the new method in a certain subgroup of patients against the traditional sequential approach (preoperative ERCP than laparoscopic cholecystectomy) and also share their technical experiences. Finally, they underline the importance of the team work which supposes the cooperation of the gastroenterologist, surgeon and anesthesiologist in the indication, organization and implementation of the intervention.

[Endoscopic management of postoperative biliary injuries]. / Posztoperatív epeúti sérülések endoszkópos megoldása.

The postoperative complications of the biliary tract, such as leakages and strictures, traditionally had been managed surgically, but from the 90s they are usually treated via endoscopic route. These complications occur most frequently after laparoscopic surgeries. Whenever biliary leakage is suspected, close collaboration between endoscopists and surgeons is needed. Immediate visualization of the biliary tract by ERCP is mandatory to confirm the diagnosis and to locate the exact site of the lesion. Various endoscopic techniques have been proved effective in treating post-cholecystectomy biliary leaks. The crucial point is to equalize the duodenal and the biliary pressures, allowing flow of the bile into the duodenum, advancing the healing of the lesion. This can be achieved with a simple endoscopic sphincterotomy or endoscopic sphincterotomy with subsequent insertion of a plastic stent. These methods seem to be equally suitable; however, for greater lesions stent placement is advisable. For strictures multiple stenting is the effective method, and the long standing effects also seem to be good.

[Whipple's disease. Do we think of it enough?]. / Whipple-kór. Vajon gondolunk-e mindig rá?

UNLABELLED: Whipple's disease is a chronic, systemic, relapsing bacterial illness, which is always fatal without treatment, and means a diagnostic challenge for both clinicians and pathologists. It occurs in Caucasian, white, middle-aged men in 80 % of the cases. CASE REPORT: The authors present three cases, and review the etiology, clinical features, presumed pathomechanism and the possibilities of treatment. CONCLUSION: Several immune-mechanisms have been discussed in the background of Whipple's disease, but their primary or secondary role is yet undetermined. First of all, this is a gastrointestinal disease; however, extraintestinal symptoms may be present many years before the final diagnosis. The histological hallmark for the diagnosis is the presence of numerous macrophages in the duodenal mucosa showing periodic acid-Schiff (PAS)-positive inclusions, and the polymerase chain reaction. The choice of antibiotics and the length of the treatment is empiric, but in most cases there is an immediate response to therapy. Relapses are common, especially the involvements of central nervous system.

[Experience with CT colonography (virtual colonoscopy) from the view of gastroenterologists]. / CT-kolonográfiával (virtuális kolonoszkópia) szerzett tapasztalataink a gasztroenterológus szemszögébol.

UNLABELLED: Colonoscopy is a golden standard in the diagnostics of intraluminal diseases of the large intestine. Its advantage is the possibility of histological sampling (biopsy) and therapeutical interventions. In case of technical difficulties (stenosis, severe inflammation, diverticulosis, anatomical alterations) or lack of informed consent of the patient double contrast colonography is the routine diagnostic tool for the examination of the entire large intestine. The spread of the use of colon capsule as a novelty is keeping us waiting. A very important criteria is the adjudication of the expansion of the intestinal disease to the surrounding and distant organs. The correct diagnostics are the base of therapy planning. CT colonography as a standardizable imaging method can give information at once about the intraluminal aberrations, the spread to the surroundings and the abdominal status. The rapid, minimal invasive technology without sedation using multidetector CTs makes the method widely applicable. AIMS: The authors search for the locus of CT colonography in the diagnostics of non-malignant diseases of the large intestine, in the screening of colorectal carcinoma and during tumor staging. METHOD: Data of 92 males (mean age: 61.2+/-12.3 years) and 146 females (mean age 61.4+/-12.5 years) were collected after CT colonography had been performed at Zala County Hospital between September 2002 and January 2007. Indications, protocols and results determining further business have been reviewed. RESULTS: The reason of CT colonography was the failure of colonoscopy in 29% of the 238 patients. In 45/238 patients (19%) stricture of the colon, in 23/238 cases (10%) pain, lack of compliance and technical difficulties were the reasons of failure. In 60% of the remaining 23 persons organic intestinal diseases were diagnosed. In 151 cases (63%) the lack of informed consent for colonoscopy was the reason of radiological examinations, pathological aberrations were found in every second patient. Aiming to learn the method, CT colonography was performed after total colonoscopy in 19/238 patients after informed consent. CONCLUSIONS: CT colonography is a useful tool in the algorithm of diagnostics of colorectal diseases in the case of lack of performing total colonoscopy.

[Silent myocardial infarction]. / A néma szívinfarktus.

INTRODUCTION: By autopsies of patients expired from different diseases not rarely chronic myocardial infarction is found, that was known before neither to patient nor to medical attendant (silent myocardial infarction) and is interpreted as incidental finding. AIM: Study of frequency, role in expectation of life, diagnosis and prognosis of silent myocardial infarction in relation to localisation. METHODS: Retrospective study and statistical analysis of 1568 autopsies performed during 10 years. RESULTS: Acute or chronic myocardial infarction was found in 470 cases (30%), acute infarction in 177 cases (37%), 90% of which was diagnosed in vivo and patients died of infarction and its direct complications. In 293 cases (63%) chronic myocardial infarction was found, 109 cases (37%) were known and 184 cases (63%) were silent myocardial necrosis, the ratio of female/male patients was nearly the same (90/94 persons). 97 patients (32%) with chronic myocardial infarction died of cardiac cause - mostly in cardiac failure -, 196 (68%) of extracardiac cause, most of them of stroke, predominantly the patients with inferior infarction. CONCLUSION: Considering the silent causes, the myocardial infarction is more frequent and has better prognosis, than it is known from epidemiological data without autopsies, because 42% of these patients dies of extracardiac diseases, and the continuity of life is not shorter, than by patients without myocardial infarction. Knowledge of silent infarction gives possibility to estimate the physical charge of patients, their treatment and to prevent recurrence.