Emerging human alveolar echinococcosis in Hungary (2003-2018): a retrospective case series analysis from a multi-centre study.

BACKGROUND: Human alveolar echinococcosis (AE) caused by Echinococcus multilocularis is an underreported, often misdiagnosed and mistreated parasitic disease mainly due to its low incidence. The aim of this study was to describe the epidemiological and clinical characteristics of human AE patients in Hungary for the first time. METHOD: Between 2003 and 2018, epidemiological and clinical data of suspected AE patients were collected retrospectively from health database management systems. RESULTS: This case series included a total of 16 AE patients. The mean age of patients was 53 years (range: 24-78 years). The sex ratio was 1:1. Four patients (25%) revealed no recurrence after radical surgery and adjuvant albendazole (ABZ) therapy. For five patients (31.3%) with unresectable lesions, a stabilization of lesions with ABZ treatment was achieved. In seven patients (43.8%), progression of AE was documented. The mean diagnostic delay was 33 months (range: 1-122 months). Three AE related deaths (fatality rate 18.8%) were recorded. CONCLUSIONS: AE is an emerging infectious disease in Hungary with a high fatality rate since based on our results, almost every fifth AE patient died in the study period. Differential diagnosis and appropriate surgical and medical therapy for AE is an urging challenge for clinicians in Hungary, as well as in some other European countries where E. multilocularis is prevalent.

[Comparison of open and laparoscopic minor liver resections for malignant tumours - based on the experience of the first 50 cases]. / Malignus májdaganatok miatt végzett laparoszkópos minor reszekciók eredményei az elso 50 eset kapcsán.

INTRODUCTION: Laparoscopic resection of liver malignancies is gaining acceptance. Besides the advantages of minimally-invasive techniques, publications so far show no oncologic compromise of laparoscopy. AIM: Our aim was to compare the results of our first fifty laparoscopic minor liver resections with traditional open procedures. METHOD: We investigated laparoscopic and open minor liver resections performed in our institute between 01. 01. 2013 and 31. 03. 2017. Data were analysed retrospectively. Resection of maximum two segments was considered a minor resection. We compared the number of resected segments, intraoperative blood loss, operative time, 30 day morbidity and mortality, hospital stay, R1 resection ratio and resection margin width. RESULTS: During the given period, 123 open and 55 laparoscopic minor liver resections of malignant liver tumours were performed. Open and laparoscopic groups were similar considering age, sex and health status. The ratio of bi-segmentectomies was significantly higher in the open group (p<0.001). Operation time (p = 0.91) and peri-operative transfusion ratio did not differ in the two groups (p = 0.102). 30 day morbidity and mortality were consistent (p = 0.50; p = 0.34), but patients in the laparoscopic group spent shorter time in hospital (p = 0.0001). The average width of resection margins and the ratio of R1 resections showed no difference between open and laparoscopic groups (p = 0.447; p = 0.263). CONCLUSION: Our investigation indicates that in malignant liver tumours, laparoscopic resection significantly shortens hospital stay without oncologic compromise, even though 30 day morbidity and mortality does not show difference. We conclude that laparoscopic minor resection of malignant liver tumours is safe and feasible. Orv Hetil. 2019; 160(3): 104-111.

Laparoscoppal végzett subtotalis gyomorresectio Roux-en-Y szerinti rekonstrukcióval, antralis gyomoradenocarcinoma miatt.

UNLABELLED: A 35-year-old female presented with epigastric symptoms and fatigue. Gastroscopy revealed a 2 cm ulcerated lesion in the antrum region. Biopsy confirmed an invasive intestinal type adenocc. Staging CT and EUS: cT2cN0cM0. Laparoscopic subtotal gastric resection + modified D2 lymphadenectomy was performed with Roux-en-Y reconstruction of the alimentary tract. Mobilisation of the duodenum and stomach was performed with a 5 mm Ligasure. Distal and proximal resection was performed using Endo GIA 60 mm staplers. We performed a modified D1 lymphadenectomy including the region of the coeliac axis, splenic artery and the hepato-duodenal ligament. A side-to-side retrocolic loop gastro-jejunostomy was fashioned using Endo GIA. To transform the loop jejunostomy to a Roux-n-Y setting, the efferent loop of the jejunum was divided using Endo GIA, while the open end of the stomach was sealed with this same stapler line. This way, the loop anastomosis was fashioned into Roux-Y. The end-to-side jejuno-jejunostomy component of the Roux-Y anastomosis was performed through the specimen extraction site with hand-sewn technique. Duration of surgery: 200 min. Blood loss: 100 ml. The postop period was uneventful, and the patient was discharged on day 9. HISTOLOGY: Invasive intestinal type adenocc., 27 mm diameter, pT1bpN0, HER2 2+. DISCUSSION: Laparoscopic subtotal gastric resection with Roux-Y reconstruction is feasable without oncologic compromise and with excellent functional results in early gastric cancer.

[Metastatic malignant melanoma of the oesophagus: case report]. / Melanoma malignum nyelocso-metastasisának operált esete.

We report a case of metastatic malignant melanoma in the oesophagus. 13 years after the wide excision of primary skin melanoma, we found a polypoid tumor in the upper third of the oesophagus. Biopsy result was melanoma malignum. After negative staging we performed transhiatal oesophagectomy with gastric conduit and cervical anastomosis. Metastatic nature of the oesophageal tumor was proven by histology. After uneventful postoperative course, the patient received adjuvant dacarbazine treatment. The patient was is in good condition, and disease free on the 18 month follow-up.