[Rare side effects in management of hyperthyroidism. Case report]. / A hyperthyreosis kezelésének ritka mellékhatásai.

The authors present the case history of a patient suffering from hyperthyroidism. The diagnostic procedures revealed the presence of propylthiouracyl induced vasculitis with renal involvement, that recovered completely after the withdrawal of propylthiouracyl and corticosteroid treatment. Thereafter, the patient was treated with thiamasol, that caused agranulocytosis with fever. After transient litium carbonate therapy a succesful thyreoidectomy was performed. Cumulative serious side effects of antithyroid drugs are rare. This case highlights some of the challenges and complications encountered in the management of hyperthyroidism.

[The tip of the iceberg: multiple cutaneous sebaceous tumor in colon cancer. Muir-Torre syndrome--case report]. / A jéghegy csúcsa: multiplex faggyúmirigy-eredetu bortumor coloncarcinomában. Muir-Torre-szindróma.

Muir-Torre syndrome is a rare genodermatosis with autosomal dominant inheritance. The syndrome is considered to be a subtype of the hereditary nonpolyposis colorectal cancer (or Lynch-syndrome). In two-third of the cases, it develops as the consequence of germline mutations in mismatch-repair genes--most commonly MutS Homolog-2 and MutL Homolog-1. Its diagnosis can be established if at least one sebaceous tumor (sebaceoma, sebaceous adenoma, epithelioma, carcinoma or basal-cell carcinoma with sebaceous differentiation) and/or keratoacanthoma and at least one internal neoplasm are present. Here the authors present the history of a 52-year-old man with multiple sebaceous carcinomas on his back. Immunohistochemical analysis showed the lack of MutL Homolog-1 protein expression in the tumor cells. Detailed clinical workup in order to identify internal malignancy found malignant coecum tumor. Histopathological evaluation of the sample from the right hemicolectomy revealed mid-grade adenocarcinoma with MutL Homolog-1 and postmeiotic segregation increased-2 deficiency. The detection of the cutaneous sebaceous carcinoma and the application of the modern diagnostic methods resulted in identification of the associated colorectal cancer in an early stage; hence, definitive treatment was available for the patient.

[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.

[Statins and gastrointestinal cancers]. / Statinok és az emésztorendszeri daganatok.

The antitumour effect of statins has already been proven in animal experiments and human cancer cell lines in several gastrointestinal cancers. The chemopreventive mechanism is not completely clarified but the enhancement of oxidative stress, increased autophagy, altered expression of pro- and antiproliferative proteins and their influence on intracellular signaling pathways may play a role. Randomized studies, however, failed to confirme the expected results obtained from experimental studies. The goal of this review is to summarize the data available in the literature regarding the chemopreventive effects of statins on several gastrointestinal cancers. Results of clinical trials suggest that 10-20 mg statin daily has no or minimal antitumour effect. Chemopreventive effect of hydrophilic statins could not be detected but it seems to be significant in the case of hydrophobic statins. There are only few data available on the long-term daily use of 30-40 mg statins. Further long-term evaluation of the effect of statins regarding gastrointestinal cancers is needed, and an analysis of compound- and dose-related subgroups would be beneficial. Chemoprevention with statins cannot yet be accepted as standard medical practice. Use of statins as chemopreventive agents cannot be a substitute for regular oncological screening or surveillance.

[The role of endoscopic ultrasound in the diagnosis and therapy of gastrointestinal disorders]. / Az endoszkópos ultrahang alkalmazása a gastrointestinalis betegségek diagnosztikájában és terápiájában.

Endoscopic ultrasound is one of those diagnostic methods in gastrointestinal endoscopy which has developed rapidly in the last decade and has became exceedingly available to visualize the walls of the internal organs in details corresponding to histological layers, or analyze the adjacent structures. Fine needles and other endoscopic accessories can be introduced into the neighbouring tissues under the guidance of endoscopic ultrasound, and diagnostic and minimally invasive therapeutic interventions can be performed. The endoscopic ultrasound became more widely available in Hungary in recent years. This review focuses on the indications, benefits and complications of diagnostic and therapeutic endoscopic ultrasound. We recommend this article to gastroenterologists, surgeons, internists, pulmonologists, and to specialists in oncology and radiology. This recommendation was based on the consensus of the Board members of the Endoscopic Ultrasound Section of the Hungarian Gastroenterological Society.

Similarities in serum acylcarnitine patterns in type 1 and type 2 diabetes mellitus and in metabolic syndrome.

BACKGROUND/AIMS: In type 1 diabetes (T1D), type 2 diabetes (T2D) and metabolic syndrome (MetS), the associated complex metabolomic changes in the involvement of carnitine metabolism in total carnitine ester level has already been documented; here we extended the investigations to the individual acylcarnitines. METHODS: The fasting serum acylcarnitine concentrations were determined in 49 T1D, 38 T2D and 38 MetS patients and 40 controls by isotope dilution electrospray ionization tandem mass spectrometry. RESULTS: The acylcarnitine profiles of the 3patient groups shared elements with the controls. Considerably higher levels of almost all short-chain acylcarnitines (p < 0.05) and lower levels of some long-chain acylcarnitines were detected in T2D and MetS patients. The amounts of C3 and C4 carnitine were higher and most of the medium-chain and long-chain acylcarnitine levels were lower (p < 0.05) in T1D and MetS patients than in the controls. In T1D and T2D, the levels of C3 and C4 acylcarnitines were markedly elevated and some long-chain acylcarnitines were lower than the controls (p < 0.05). Moreover, significantly lower concentrations of free- and total carnitine were observed in T1D patients (p < 0.05). CONCLUSIONS: Profound alterations were detected in acylcarnitine profiles in the 3 patient groups. Similarities in the patterns suggest different degrees of involvement of the same metabolic systems in a systems biology approach.

[A rare form of adrenal Cushing's syndrome]. / Ritka etiológiájú Cushing-szindróma.

The authors present the case history of a 74-year-old male suffering from aortic coarctation. His endocrine evaluation was initiated because of severe hypokalemia. The diagnostic procedures revealed the presence of Cushing's syndrome caused by bilateral macronodular adrenal hyperplasia. Because of the high risk of surgical treatment due to his cardiac condition, the patient was treated with the steroid biosynthesis inhibitor ketoconazole, which resulted in a clinical and biochemical regression of hypercortisolism. After interventional treatment of the aortic coarctation the physical and cardiac condition of the patient showed a significant improvement, indicating that despite an old age, surgery offered a valuable tool for management of the disease. To the best knowledge of the authors, the coexistence of aortic coarctation and bilateral macronodular adrenal hyperplasia has not been previously reported. Orv. Hetil., 154(50), 1999-2002.

[Role of pulse oximetric monitoring during gastrointestinal endoscopy. Prospective multicenter study of the Gastroenterology Working Group of the Veszprém Regional Committee of the Hungarian Academy of Sciences (VEAB)]. / Az endoszkópos vizsgálatok pulzoximetriás monitorozásának jelentosége. Az MTA VEAB Gasztroenterológiai Munkabizottságának prospektív multicentrikus vizsgálata.

INTRODUCTION: Recent guidelines recommend routine pulse oximetric monitoring during endoscopy, however, this has not been the common practice yet in the majority of the local endoscopic units. AIMS: To draw attention to the importance of the routine use of pulse oximetric recording during endoscopy. METHOD: A prospective multicenter study was performed with the participation of 11 gastrointestinal endoscopic units. Data of pulse oximetric monitoring of 1249 endoscopic investigations were evaluated, of which 1183 were carried out with and 66 without sedation. RESULTS: Oxygen saturation less than 90% was observed in 239 cases corresponding to 19.1% of all cases. It occurred most often during endoscopic retrograde cholangiopancreatography (31.2%) and proximal enteroscopy (20%). Procedure-related risk factors proved to be the long duration of the investigation, premedication with pethidine (31.3%), and combined sedoanalgesia with pethidine and midazolam (34.38%). The age over 60 years, obesity, consumption of hypnotics or sedatives, severe cardiopulmonary state, and risk factor scores III and IV of the American Society of Anestwere found as patient-related risk factors. CONCLUSION: To increase the safety of patients undergoing endoscopic investigation, pulse oximeter and oxygen supplementation should be the standard requirement in all of the endoscopic investigation rooms. Pulse oximetric monitoring is advised routinely during endoscopy with special regard to the risk factors of hypoxemia.

[Hyperbaric oxygen therapy in outpatient care]. / A túlnyomásos oxigénkezelés és helye az ambuláns ellátásban.

Hyperbaric oxygen therapy, or high pressure oxygen therapy, is a highly specialised branch of medicine. Applications and results date back to the 1960s and it has been used, researched and developed ever since. During the treatment, patients breathe 100% oxygen in a pressurised chamber. For clinical purposes, as defined, the pressure must equal or exceed 1.4 atmosphera absolute, most of the cases typically higher (2.0-2.5 atmosphera absolute). Oxygen dissolves by pressure in body fluids, transported by circulation to all tissues. Cellular regeneration and tissue processes are induced by both the increased oxygen supply and the intermittent change in tissue partial oxygen pressure associated with treatment. The effect can be used in the treatment of many diseases, usually as part of a complex treatment plan. Additional advantage is that it is a non-invasive and pain-free therapy. Evidence-based indications and general baseline usage are regulated by the European Underwater and Baromedical Society through the European Committee of Hyperbaric Medicine, in accordance with the principles of evidence-based medicine. The authors describe three cases in their publication where hyperbaric oxygen therapy significantly contributed to the success of overall treatment. Orv Hetil. 2023; 164(25): 993-996.

[Predictors of efficacy, mucosal healing and dose intensification during the first year of adalimumab therapy in patients with luminal and fistulizing Crohn's disease. National data from Hungary]. / A klinikai hatékonyság, a nyálkahártya-gyógyulás és a dózisemelés prediktorai az adalimumabkezelés elso évében Crohn-betegségben szenvedo betegekben Magyarországon.

UNLABELLED: Adalimumab is a fully human monoclonal antibody targeting tumor necrosis factor with proven efficacy in the treatment of Crohn's disease in clinical trials. The aim of the present study was to investigate the predictors of medium term clinical efficacy and mucosal healing during adalimumab therapy in patients with Crohn's disease in specialized centers approved for biological therapy in Hungary. METHODS: Data of 201 Crohn's disease patients were prospectively captured (male/female: 112/89, median age: 24 years, duration: 8 years). Previous infliximab therapy was given in 97 (48.3%) patients, concomitant steroids in 41.3% and azathioprine in 69.2% (combined: 26.4%) of patients. RESULTS: Overall clinical response and remission rates at 24 and 52 weeks were 78% and 52%, and 69.4% and 44.4%, respectively. Endoscopic improvement and healing was achieved in 43.1% and 23.6%, respectively. In a logistic regression model, clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, while normalized C-reactive protein at week 12, clinical remission at week 24, frequency of previous relapses and smoking were associated to endoscopic improvement/healing. Dose intensification to weekly dosing was needed in 16.4%. Parallel azathioprine therapy and clinical remission at week 12 was inversely associated to dose escalation to weekly dosing. CONCLUSION: Clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression, luminal disease and smoking are predictors for medium term clinical efficacy/mucosal healing during adalimumab therapy, while parallel azathioprine therapy may decrease the probability for dose escalation.

Incidence, Predictive Factors, Clinical Characteristics and Outcome of Non-variceal Upper Gastrointestinal Bleeding - A Prospective Population-based Study from Hungary.

BACKGROUND AND AIMS: Acute non-variceal upper gastrointestinal bleeding (UGIB) is associated with significant morbidity and mortality. Our aim was to evaluate the incidence, management, risk factors and outcomes of acute non-variceal UGIB in a population-based study from Hungary. METHODS: The present prospective one-year study involved six major community hospitals in Western Hungary covering a population of 1,263,365 persons between January 1 and December 31, 2016. Data collection included demographics, comorbidities endoscopic management, Glasgow-Blatchford score (GBS), Rockall score (RS) transfusion requirements, length of hospital stay and mortality. RESULTS: 688 cases of acute non-variceal UGIB were included with an incidence rate of 54.4 (95%CI: 50.5-58.6) per 100,000 per year. Endoscopy was performed within 12 hours in 71.8%. 5.3% of the patients required surgical treatment and the overall mortality was 13.5%. Weekend presentation was associated with increased transfusion requirements (p=0.047), surgery (p=0.016) and mortality (p=0.021). Presentation with hemodynamic instability or presence of comorbidities was associated with transfusion (p<0.001 both), second look endoscopy (p<0.001 both), re-bleeding (p<0.001 both), longer in-hospital stay (p<0.001 both) and mortality (p=0.017 and p<0.001). GBS was associated with transfusion requirement (AUC:0.82; cut-off: GBS >7points), while mortality was best predicted by the post-endoscopic RS (AUC:0.75; cut-off: RS >5points). CONCLUSIONS: Incidence rates of acute non-variceal UGIB in Western Hungary are in line with international trends. Longer pre-hospital time, comorbidities, hemodynamic instability, weekend presentation, treatment with anticoagulants or non-steroidal anti-inflammatory drugs was associated with worse outcomes.

Outcomes of variceal upper gastrointestinal bleeding: A prospective, multicenter, population-based study from West Hungary / A varixeredetu felso gastrointestinalis vérzések elemzése: yugat-magyarországi prospektív, multicentrikus, népességalapú vizsgálat

Összefoglaló. Bevezetés: Az akut varixeredetu gastrointestinalis vérzés napjainkban is jelentos morbiditással és mortalitással jár. Célkituzés: Célunk az akut varixeredetu felso gastrointestinalis vérzések incidenciájának, ellátási folyamatainak és kimeneteli tényezoinek átfogó felmérése volt. Módszer: Prospektív, multicentrikus vizsgálatunk keretében hat nyugat-magyarországi gasztroenterológiai centrum bevonásával elemeztük az ott diagnosztizált és kezelt, varixvérzo betegek adatait. Rögzítettük a demográfiai, az anamnesztikus, a diagnosztikus, valamint a terápiát és a betegség kimenetelét érinto adatokat. Minden beteg esetében kockázat- és predikcióbecslést végeztünk a Glasgow-Blatchford Score (GBS), a pre- és posztendoszkópos Rockall Score (RS) és az American Society of Anesthesiologists (ASA) Score alapján. Eredmények: A vizsgált egyéves periódusban (2016. 01. 01. és 2016. 12. 31. között) 108, akut varixeredetu gastrointestinalis vérzést találtunk (átlagéletkor: 59,6 év). Endoszkópos terápiára 57,4%-ban került sor, 39,8% sclerotherapiában, 18,5% ligatióban részesült. Transzfúziót a betegek 76,9%-a igényelt. A teljes halálozás 24,1% volt. A transzfúziós igény vonatkozásában a legmagasabb prediktív értéku a GBS volt (AUC: 0,793; cut-off: GBS >8 pont). Az ASA-pontszám szignifikáns összefüggést mutatott a transzfúzió-szükséglettel (OR 7,6 [CI 95% 2,7-21,6]; p<0,001), az endoszkópos intervencióval (OR 12,6 [CI 95% 3,4-46,5]; p = 0,033) és trendszeru kapcsolatot a mortalitással (OR 3,6 [0,8-16,7]; p = 0,095). Emellett a nemzetközi normalizált ráta (INR) értéke (p = 0,001) és a szérumkreatinin-szint (p = 0,002) állt kapcsolatban a mortalitással. Az endoszkópos intervenció aránya szignifikáns összefüggésben volt a varix Paquet-stádiumával (p<0,001) és az ASA-pontszámmal (OR = 12,6 [3,4-46,5]; p = 0,033). Következtetés: Nyugat-Magyarországon magas az akut varixeredetu vérzés elofordulási gyakorisága. Az ASA-pontszám és a GBS jó prediktív faktor a betegségkimenetel és a transzfúziós igény vonatkozásában. A megfigyelt magas mortalitás és az endoszkópos ligatio alacsony aránya indokolja a kezelési stratégiák optimalizálását akut varixeredetu gastrointestinalis vérzés esetén. Orv Hetil. 2021; 162(31): 1252-1259. INTRODUCTION: Acute variceal gastrointestinal bleeding is associated with significant morbidity and mortality. OBJECTIVE: Our aim was to evaluate the characteristics and prognostic factors in the management of acute upper gastrointestinal bleeding in a large multi-center study from Hungary. METHOD: This prospective one-year study (between January 1, 2016 and December 31, 2016) involved six community hospitals in Western Hungary. Data collection included demographic characteristics, vital signs at admission, comorbidities, medications, time to hospital admission and endoscopy, laboratory results, endoscopic management, risk assessment using Glasgow-Blatchford Score (GBS), Rockall Score (RS) and the American Society of Anesthesiologists (ASA) Physical Status Score, transfusion requirements, length of hospital stay and mortality. RESULTS: 108 cases (male: 69.4%) of acute variceal gastrointestinal bleeding were registered during the 1-year period. Endoscopic therapeutic intervention was performed in 57.4%. On initial endoscopy, 39.8% of the patients were treated with sclerotherapy and 18.5% had ligation. 76.9% of the patients required blood transfusion. The overall mortality (including in-hospital bleedings) was 24.1%. The GBS predicted transfusions (AUC: 0.793; cut-off: GBS >8 points). The ASA Score was associated with transfusion (OR 7.6 [CI 95% 2.7-21.6]; p<0.001), endoscopic intervention (OR 12.6 [CI 95% 3.4-46.5]; p = 0.033), and showed similar trend with mortality (OR 3.6 [0.8-16.7]; p = 0.095). The increased international normalized ratio (INR) and creatinine levels were associated with mortality (p = 0.001 and p = 0.002). CONCLUSION: Incidence rates of acute variceal gastrointestinal bleeding in Western Hungary are high. The ASA Score, GBS predicted outcomes and transfusion requirements. The observed high mortality rates, coupled with relatively low rates of endoscopic ligation, warrant optimization of management strategies in acute variceal gastrointestinal bleeding. Orv Hetil. 2021; 162(31): 1252-1259.

[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.

Aspirin resistance: focus on clinical endpoints.

INTRODUCTION: Via its antiplatelet effect, aspirin reduces the odds of an arterial thrombotic event in high-risk patients by approximately 25%. However, 10% to 20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term follow-up. Nevertheless, the effectiveness of aspirin has been questioned by the emergence of the concept of aspirin resistance, which has been introduced as an explanation of the fact that a considerable proportion of patients treated with aspirin exhibit normal platelet function. OBJECTIVES AND METHODS: We systematically reviewed all available evidence till March 2008 on prevalence of aspirin resistance and its association with clinical outcome. We also collected articles showing the possible way of treatment. CONCLUSION: Analyzing the data of different laboratory methods aspirin resistance seems to be associated with poor clinical outcome, although currently no standardized or widely accepted definition of aspirin resistance exists. The widely used laboratory methods might not be comparable with each other; therefore, specific treatment recommendations for patients who exhibit high platelet reactivity during aspirin therapy or who have poor platelet inhibition by aspirin are not established.

[Clinical aspects of hepatitis C in women of child-bearing age]. / Fertilis korú nôk hepatitis C-vírus-fertôzésének klinikai vonatkozásai.

It is difficult to define the optimal timing of antiviral treatment in women infected with viral hepatitis C, who have child-bearing potential. Antiviral treatment is strictly contraindicated during pregnancy and the breast-feeding period. Data are conflicting about the question of treatment with modern drugs (peginterferon and ribavirin) before or after pregnancy. The risk of vertical transmission from mother to child is estimated about 5%. The mother's viraemia seems to be the main transmission factor. There is a worse prognosis in nulliparous and postmenopausal women in the natural history of viral hepatitis C. Poor outcome in gestational age, maturity and Apgar score were not associated with hepatitis C virus infection. Combined treatment has frequent gynecological and other side effects. The timing of antiviral therapy in women in child-bearing period is recommended individually.

[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.

Prevalence of SLC22A4 1672T and SLC22A5 -207C combination defined TC haplotype in Hungarian ulcerative colitis patients.

Ulcerative colitis (UC) is a chronic inflammatory disease of the gastrointestinal tract. The aim of this study was to verify the prevalence rate of the haplotype called TC, determined by combination of two functional alleles of OCTN cation transporter genes (SLC22A4 1672T and SLC22A5 -207C combination variants) in ulcerative colitis patients and unrelated healthy controls. The "TC haplotype" has recently been suggested to confer risk for UC. A total of 121 unrelated Hungarian subjects with UC and 110 matched controls were genotyped for the two single nucleotide polymorphisms. The genotypes were determined by using PCR/RFLP assay and direct sequencing. The SLC22A4 1672T allele frequency was 46.7% in the patients with UC and 46.4% in the controls, whereas the SLC22A5 -207C allele occurred in 48.8% of the patients and 51.4% of the controls. The prevalence of the TC haplotype was 19% in the patient group and 22.7% in controls. Since there was no accumulation of the TC haplotype in the patient group, our observation suggests that carrying the TC haplotype is not associated with a higher risk for UC in the Hungarian population.

No association of the cytotoxic T-lymphocyte associated gene CTLA4 +49A/G polymorphisms with Crohn's disease and ulcerative colitis in Hungarian population samples.

AIM: The goal of the current work was to analyse the prevalence of the +49A/G variant of the cytotoxic T-lymphocyte antigen 4 gene (CTLA4) in Hungarian patients with Crohnos disease (CD) and ulcerative colitis (UC). METHODS: A total of 130 unrelated subjects with CD and 150 with UC, and 170 matched controls were genotyped for the single nucleotide polymorphism (SNP). The genotypes were determined by using PCR/RFLP test. RESULTS: The G allele frequency and the prevalence of the GG genotype were 38.1% and 12.3% in the CD group, 40.6% and 18.6% in the UC patients, and 37.4% and 15.9% in the control group, respectively. CONCLUSION: The results of the current study show that carriage of the +49G SNP in heterozygous or in homozygous form does not confer risk either for CD or for UC in the Hungarian population.