[Treatment results of patients with rectum tumor in a city hospital]. / Rectum daganatos betegek kezelésének eredményei egy városi kórházban.

INTRODUCTION: Two hundred and three patients were operated on with rectal malignancy between 2007 and 2014 in our surgical department. METHODS: Of these, patients who had cancer within 16 cm of the anal verge were included. 73 patients received neoadjuvant treatment and 130 patients were treated with primary resection. The specimens were graded by the Dworak and the Rödel regression score system. RESULTS: We found strong response in 45 patients and pathologic complete remission in three patients. 5-years survival was compared in the two groups operated between 2007 and 2009. While the overall survival rates were just the same, we can report that response to neoadjuvant therapy is a strong predictor of disease free survival. The incidence of loco-regional recurrence was lower in patients who received neoadjuvant treatment compared to the ones who underwent primary resection. Postoperative complications, incidence of anastomotic leakage were also analysed. We did not find increase in the postoperative complications in the group of patients with neoadjuvant treatment.

[Limb saving surgery in cases of bone sarcomas]. / Végtagmegtartó mûtétek csontsarcomáknál.

At the Orthopedic Department of Semmelweis University we operate an internationally recognized bone and soft tissue tumor center. Our specialty is the treatment of benign and malignant bone tumors, tumor-like lesions and surgery of soft tissue tumors. Our main aim, taking into account the appropriate oncologic radicality, is to create the conditions for the development of limb saving surgery. Limb saving surgery is an interdisciplinary activity both in diagnosis and in treatment. We have proper pathology, radiology and interventional radiology background for the fast and advanced pathomorphological and radiomorphological diagnosis of different tumors. Using modern chemotherapy, radiotherapy and other advanced cancer treatment protocols rapid access to oncology background is provided for children and adults as well, both primary and secondary bone tumors and soft tissue sarcoma cases of the extremities. The limb saving surgery after removal of the tumor is essentially a reconstructive surgery. Reconstructive surgery in childhood and younger ages mean mainly the biological solutions (vascularized autologus bone grafts and/or homologous bone graft), otherwise in elderly ages implantation of tumor endoprostheses has a greater significance. Furthermore, the final tumor surgery requires experienced abdominal surgeon, vascular surgeon and plastic surgeon to ensure the background as well. The professional background of our clinical practice is based on participating in international conferences and spending several months abroad in different big tumor centers. Over the past 15 years, several international cancer congresses were organized in Hungary by our Department.

[Antegrade colonic enema is a choice for the treatment of faecal incontinence and constipation]. / Anterograd vastagbélátmosás az incontinentia és az obstipatio kezelésének egyik lehetosége.

UNLABELLED: Faecal incontinence and constipation cannot always be treated successfully by conservative or surgical methods. In these cases regular retrograde colonic enema can reduce the symptoms of the patients and can establish pseudocontinence. The authors present a method of colon cleaning which has been used successfully. The method was introduced in clinical practice by Malone in 1990. The antegrade enema is administered through the appendicostomy. In cases, where the appendectomy was performed earlier, a neoappendix was created from the coecal wall and used for the irrigation of the colon. During procedure the patients injected tap water (300-450 ml) through the (neo-)appendicostomy with a thin catheter. After a short time period this was followed by passing of the stool. The procedure was performed on twelve patients, five female, and seven male patients (mean age: 39.2 years). The indications for the procedure were the following: faecal incontinence induced by denervation of the pelvic floor in three patients, sphincter trauma in two patients and congenital sphincter malformation in two cases. In addition, combined symptoms of faecal incontinence and constipation caused by pelvic floor denervation in three patients. Finally, intractable constipation was the reason in two patients. After irrigation, the stool was passed, but the functional result was rather variable. Eight out of twelve patients were satisfied with the result, two patients reported improvement in the constipation, but it failed in one case. In another case, the appendicostomy could not have been used due to surgical complications. The stricture of the (neo-)appendicostomy was observed in two cases. Significant reflux occurred only in one case. CONCLUSION: after adequate patient selection this method can be applied with success.

[Surgical management of inflammatory bowel diseases]. / Gyulladásos bélbetegségek sebészi kezelése.

The development of the medical management of the inflammatory bowel disease (IBD-ulcerative colitis, Crohn's disease) has reduced the number of the acute surgical interventions. Beyond the medical treatment the surgical management, the operative modalities, the pre and postoperative care has gone through a lot of changes. They review the different types of surgical alternatives and debating on the advantages and disadvantages, they put emphasis on the different surgical solutions of the Crohn's disease and that of the ulcerative colitis. Among the applied surgical alternatives to the ulcerative colitis they discuss the traditional proctocolectomy with end-ileostomy, the Kock-reservoir (as continent stoma), as well as the restorative proctocolectomy which is sufficient to preserve the anal continence. Principles of the surgery of the Crohn's disease are discussed according to the localisation of the inflammatory process (small bowel, colonic, rectal, anal channel). Because of the predisposition of relapses and the necessity of the successive surgical therapy, the extensive resections should be avoided.