Surgical strategy in massive colorectal bleeding.

Several pathologic disorders can become a source of severe gastrointestinal bleeding. The most frequently observed entities responsible for massive colorectal bleeding are diverticulae, intestinal angiodysplasias, inflammatory bowel diseases and cancers. In order to choose the bes--surgical method to stop the hemorrhage and cure the disease; it is mandatory to properly identify the origin and location of the bleeding. It is a common experience that the usually advised diagnostic methods often yield disappointing results in urgent cases. The presented case shows that selective angiography can lead to the fastest diagnosis in angiodysplasia and with surgery a definitive result can be obtained.

Pseudoaneurysm and ilio-caval fistula caused by malignant fibrous histiocytoma of the aorta--CT diagnosis and angiographic confirmation.

We report a case of a malignant fibrous histiocytoma (MFH) of the aortic bifurcation, which manifested as a pseudoaneurysm with the formation of an ilio-caval fistula, a complication about which, to our knowledge, nothing has been published previously. Spiral CT, catheter arteriography and venography were complementary in the diagnostic procedure.

Prognostic value of DNA ploidy status in patients with rectal cancer.

BACKGROUND: A retrospective study was performed to measure the prognostic value of DNA ploidy status and proliferative index (PI) for survival in patients with rectal cancer. PATIENTS AND METHODS: Fifty-two patients underwent curative surgery for rectal carcinoma. Ten tumors were in Stage I, 25 cancers were in Stage II, and 17 of them were in Stage III. Using flow cytometry the nuclear DNA content of the tumor cells was measured. RESULTS: There were 25 DNA diploid and 27 DNA aneuploid carcinomas. Aneuploid DNA content did not show higher occurrence in advanced tumors. The mean survival was 59 months in the case of DNA diploid carcinoma, while it was 47 months in the case of DNA aneuploid cancer. The mean PI of the DNA diploid cancers was 8%. The PI of DNA aneuploid tumors was 22%. High PI (PI > 10%) was observed in 32 carcinomas while low PI (PI < 10%) occurred in 20 cases. Patients with aneuploid DNA content and high PI had significantly worse survival compared to patients with diploid DNA content while low PI. Locoregional and distant metastases occurred more frequently in patients with aneuploid tumor. By univariate analysis, tumor size, lymph node involvement, DNA ploidy status and PI all correlated with prognosis. However, multivariate analysis showed that TNM stage and PI were the only significant prognostic factors for survival. CONCLUSION: The survival and disease-free survival of patients with diploid DNA content was better compared to aneuploid cases. The results suggest that DNA ploidy status is important in determining the biological behaviour of rectal carcinomas, although the multivariate analysis did not prove its significant influence. The PI were independent negative prognostic factors for survival.

[New technique for surgical treatment of enterovaginal fistula]. / Enterovaginális sipoly kezelése mucous fistulával.

Enterovaginal fistulas most frequently occur following abdominal tumors, inflammatory bowel disease and radiation therapy. There is a tendency for spontaneous closure, although a surgical intervention is necessary in more than 50% of the cases. Mortality is between 15-25%. The quality of life is significantly worsened by an enterovaginal fistula of a patient already suffering from a malignant disease. To relieve the patient from her distressing situation a mucous fistula was constructed by exclusion of the small bowel loop participating in the formation of the fistula track. Bowel continuity was restored by anastomosis. The patient's quality of life improved significantly. This operation was performed in three cases without complications. We recommend this procedure as an alternative technique to improve our patients' quality of life.

[The importance of recognizing hereditary non-polyposis colonic carcinoma]. / A herediter nonpolyposis colon carcinoma felismerésének gyakorlati jelentósége.

The clinical diagnosis of hereditary nonpolyposis colon carcinoma (HNPCC) can be made in more than 5% of all colorectal cancer cases, depending on the stringency of criteria used. The disease is inherited in an autosomal dominant fashion but penetrance is lower than 100%. The diagnosis must be verified by the demonstration of germline mutations of DNA "mismatch repair" genes. Although yet an exception in our national health practice, these tests are routinely applied in some centers abroad. The recognition of the syndrome is important since these patients can enter a surveillance program and may be cured. The most important pertaining information is summarized through the demonstration of our own case.

Antiinvasive effects of Tiazofurin on liver-metastatic human colon carcinoma xenografts.

The effect of Tiazofurin (TR)-a C nucleoside with significant antineoplastic activity-have been studied on the liver metastasis formation of human colorectal carcinoma xenografts. TR treatment (especially at a dose of 300 mg/kg bwt) produced significant inhibition of metastasis formation in the liver and induced a significant and dose dependent decrease in the serum CEA level. There was not clear connection between the alteration of the weight of the primary tumor bearing spleen and the anti-metastatic activity of TR. In tumor cells derived from tumors obtained from TR treated animals a considerable decrease was observed in the expression of MMP2 metalloproteinase. Furthermore, TR induced a significant dose dependent inhibition of the microinvasiveness of colon carcinoma cells on EHS matrix. Based on the data presented here and published elsewhere, the authors suggest that in the remarkable liver metastasis inhibitory effects of TR modulation and the nonproliferative events of the multistep metastatic cascade plays an important role.

[Quality of life of post-colostomy patients]. / Colostomás betegek életminöségének vizsgálata.

The psychosomatic care of patients after surgical treatment must comprise the analysis of quality of life with colostomy. Five different parameters were assessed of 100 colostomy patients. Sixty-one percent of our patients had skin irritation problems. Twenty-eight patients applied regular irrigation. Seventy-two percent of these had daily motions, 20% had bidaily, the remaining 8% had irregular bowel movements. Seventeen percent of the nonirrigating patients observed very irritating fecal discharge around the stoma. Embarrassing noises concomittant with bowel movements were observed by 42% and 45% struggled with bad odors. Irrigating patients had hardly any of these problems. For 65% of the patients the idea of having a colostoma meant the greatest psychological burden before the operation. The stress situation culminated in the immediate postoperative period in 10%. Forty percent of those asked were seriously worried about the reaction of their social environment. In 65% a significant decrease of social relations could be observed. Sixteen percent reported an increased social activity after colostomy had been performed. Sixty percent admitted considering the option of suicide at least once. Thirty-five percent revealed to have any kind of sexual problems after colostomy. Eight of our 100 colostomy patients experienced serious adverse reactions from their family members. In eighty percent of the cases family members showed great sympathy although they acted naively. The quality of life of colostomy patients may be best taken care of by qualified stomatherapists, out-patient proctology departments and the ileo-colostomy movement (ILCO).

Modulation of heparan-sulphate/chondroitin-sulphate ratio by glycosaminoglycan biosynthesis inhibitors affects liver metastatic potential of tumor cells.

Previous data have indicated that the proteoglycan (PG) pattern is different on tumor cells with different liver metastatic potential. We selected "conventional" glycosaminoglycan (GAG) biosynthesis inhibitors, beta-D-xyloside (BX), 2-deoxy-D-glucose (2-DG), ethane-l-hydroxy-l,l-diphosphonate (ETDP) and the newly discovered 5-hexyl-2-deoxyuridine (HUdR), to modulate PGs on highly metastatic/liver-specific 3LL-HH murine carcinoma and HT168 human melanoma cells and to influence their liver colonization potential. These compounds all induced remarkable changes in GAG biosynthesis, but to varying degrees: glucosamine labelling was affected mainly by 2-DG, and HUdR and sulphation by BX and HUdR. Furthermore, the ratio of heparan sulphate/chondroitin sulphate (HS/CS) of PGs was increased by ETDP and decreased after treatment by HUdR. In addition to changes in PG metabolism, tumor-cell proliferation and adhesion to fibronectin were affected; BX and 2-DG stimulated cell proliferation and adhesion, while HUdR inhibited both proliferation and adhesion. Most interestingly, HUdR, the most effective inhibitor of HS/HSPG, depressed the formation of liver colonies, while ETDP, the most effective inhibitor of CS/CSPG, stimulated the appearance of liver colonies. These observations indicated that, at least in these experimental systems, tumor cells with a high HS/CS ratio are more likely to form liver metastases; consequently, anti-HS agents could also be anti-metastatic.

[Multiple primary cancer of the colon and rectum]. / A primaer multiplex vastag- és végbélrák.

Data of 33 patients operated on during 13 years because of primary multiple cancer of the colon are presented. The frequency of multiple occurrence was 4.1%. Synchronous tumors were observed in 1.8% (15 patients) and metachronous was (following 410 operations) 4.4% (18 patients). The attention is drawn to the relationship between polyps occurring simultaneously with colonic cancers and the following--metachronous tumors. Careful examinations must cover the period following the acute colon operation, as eliminating the cause of the emergency operation other--synchronous tumors or polyps may remain hidden. The significance of prevention and follow-up examinations in the treatment of metachronous tumors in stressed. It was stated that the malignancy and operability indices of the second tumor detected in this way did not differ significantly from the primary tumors. Preference was given to subtotal colectomy as operative principle in the treatment of metachronous cancers of the colon.

[Essential hypertension caused by a virilizing adrenal tumor]. / Virilisaló mellékvesetumor által okozott "esszenciális hypertonia".

Authors report here an interesting case of a woman who has been treated for essential hypertension for 12 years. Beside the hypertension, an extreme virilization appeared. A large adenoma, originated from the left adrenal gland have been explored behind the clinical picture. After surgical removal of the adenoma, adrenocortical hormones decreased to the normal levels. Systemic blood pressure decreased considerably the virilisation showed gradual involution. The correct treatment of the patient was a decade late, resulting in the development of encephalopathic syndromes.

[Simultaneous occurrence of hyperthyreosis and thyroid carcinoma]. / Gemeinsames Vorkommen von Hyperthyreose und Schilddrüsencarcinom.

The authors report on the morphological and clinical features of occult thyroid carcinomas confirmed by detailed histological examinations following the surgical treatment of hyperthyreotic goiters recurrent after prolonged thyreostatic treatment, as well as on the follow-up data of the patients. Joint occurrence of hyperthyroidism and thyroid tumors was observed in five patients, two of whom showed progressive endocrine ophthalmopathy. In the surgical preparations of three patients, chronic lymphocytic thyroiditis was also diagnosed. On the grounds of postoperative care, the authors draw conclusions of practical clinical significance. They take a stand on the questions of surgical and adjuvant treatment favored by them in the case of the joint occurrence of the two diseases.