[Intravenous glutamine and early nasojejunal nutrition in severe acute pancreatitis -- a prospective randomized clinical study]. / Intravénás glutamin és korai nasojejunalis táplálás együttes alkalmazása súlyos acut pancreatitisben -- prospektív randomizált kettos vak kontrollált klinikai vizsgálat.

INTRODUCTION: Severe acute pancreatitis (SAP) is still one of the great challenges in gastro-intestinal surgery. According to recent studies, intravenously administered glutamine with total parenteral nutrition may be beneficial in the prevention of infectious complications and may reduce mortality rate. However, it has not been investigated yet, whether i.v. glutamine is able to achieve the same effect with early enteral nutrition as well. OBJECTIVES: The objective of our prospective randomized double-blind study was to explore the effects of intravenously administered glutamine with early nasojejunal nutrition in severe acute pancreatitis. PATIENTS AND METHODS: Forty-five patients with severe acute pancreatitis (with a Glasgow score at least 3 and/or a CRP level above 150 mg/ml on admission) were randomized into two groups. Group Glutamine (n = 24) was given 0.5 g/kg/die glutamine intravenously, while the control group (n = 21) received normal amino acid solution in the same quantity for 7 days. Nasojejunal nutrition was introduced 48 hours after admission in case of all patients, and their management was the same in every other aspect, too. The primary end-points of the study were the rate of pancreas-specific infectious complications and organ failure, and the secondary end-points were the necessity for radiological and surgical interventions, length of hospital stay and mortality rate. RESULTS: In group Glutamine, infected acute peripancreatic fluid collections (APFC) were detected in 4 patients, 2 patients had post-necrotic pancreatic/peripancreatic fluid collections (PNPFC), 2 patients had infected pseudocysts and 2 patients had walled-off pancreatic necrosis (WOPN). Ten patients were cured by ultrasound assisted puncture or drainage successfully. No surgical intervention was necessary. In the control group, 4 patients had infected APFC, 2 patients had infected PNPFC, infected pseudocysts and infected WOPN were diagnosed in 3 cases. Radiological intervention was effective in 9 cases, but 3 patients needed surgery. Three patients died of multi-organ failure, thus the mortality rate of the control group was 14%, while the mortality rate of the Glutamine group was zero. The mean hospital stay of the Glutamine group was 10.6 days, which is significantly shorter than the mean hospital stay of the control group, which was 15.9 days (p = 0.00104). DISCUSSION: The results of the Glutamine group are better in every end-points, however, statistically significant difference was detected in one parameter only, the length of hospital stay.

Solid pseudopapillary neoplasm of the pancreas--proposed algorithms for diagnosis and surgical treatment.

PURPOSE: The incidence of solid pseudopapillary neoplasm (SPN) of the pancreas is rising. Although the evidence for proper management is accumulating, we still lack diagnostic and therapeutic guidelines. In this paper, therefore, we propose an algorithm for diagnosis and treatment of this rare type of tumor. METHODS: A literature search was carried out on "Medline" and "Pubmed" databases to identify studies investigating the clinicopathologic features, pathogenesis, diagnostic, and differential diagnostic pathways, and surgical and adjuvant treatment options. Evidence from relevant published literature was completed with data of six patients treated with SPN in our institution. RESULTS: This study included case series and retrospective reviews only, since no higher level of evidence exists in the relevant literature. The articles emphasized that preoperative diagnosis is desirable to set up a precise plan for surgical treatment. Further, an R0 organ-sparing resection for primary SPN and an en bloc resection of locally advanced SPN are advised, while resection of synchronous as well as metachronous distant metastases is strongly advocated for this rare type of pancreatic cancer. The role of adjuvant chemo- or radiotherapy still needs to be defined. Finally, a diagnostic and therapeutic algorithm is devised in this paper to aid proper management of SPN. CONCLUSION: Current recommendations for treatment of SPN of the pancreas rely mainly on case series as single institutional experiences and retrospective reviews. Although the level of evidence is relatively low, the way of management discussed above is likely to provide an excellent prognosis in typically young patients with SPN.

[Rectum tumor diagnosed by subcutaneous emphysema of the chest]. / Mellkasi subcutan emphysema révén diagnosztizált rectumtumor.

BACKGROUND: Various benign and malignant thoracic or abdominal diseases can cause subcutaneous emphysema on the chest, pneumomediastinum or pneumopericardium. To date only 7 cases have been reported on perforation of the sigmoid colon or the rectum presenting with these rare symptoms. METHODS: We report a case of a 72-year-old woman who presented with thoracic and cervical subcutaneous emphysema, pneumomediastinum and pneumopericardium. Further examination revealed that this was caused by a rectal tumor causing large bowel obstruction and a consequent perforation of the transverse colon. Due to the patient's old age, poor health and the special anatomic situation after previous laparotomies, she presented with atypical symptoms. CONCLUSIONS: Subcutaneous emphysema of the chest, pneumomediastinum and pneumopericardium are uncommon symptoms and can be a real challenge in diagnosis. Especially in old patients with significant past medical history, life-threatening conditions present misleadingly with vague clinical symptoms. In case of these patients it is important to remember that even cardiopulmonary symptoms such as pneumomediastinum, pneumopericardium or subcutaneous emphysema of the chest can be signs of severe diseases in the abdomen.

[Endproducts and receptors of advanced glycation and lipoxidation (AGE, ALE, RAGE) and chronic diseases from the perspective of food and nutrition]. / Az elôrehaladott glikáció és lipoxidáció végtermékei és receptoruk (AGE, ALE, RAGE), valamint a krónikus betegségek kapcsolata a táplálkozás szemszögébôl.

BACKGROUND: Chronic diseases as well as complications to acute and chronic disease are repeatedly associated with accumulation in the body of glycated and lipoxidated proteins and peptides. These molecules are strongly associated with activation of a specific receptor called RAGE and a long-lasting exaggerated level of inflammation in the body. METHODS: PubMed reports in excess of 5000 papers plus about 14000 articles about the related HbA 1c , most of them published in the last five years. Most of available abstracts have been read and circa 800 full papers studied in detail. RESULTS: RAGE, a member of the immunoglobulin superfamily of cell surface molecules and receptor for advanced glycation endproducts, functions as a master switch, induces sustained activation of NF-kappaB, suppresses a series of endogenous autoregulatory functions and converts long-lasting pro-inflammatory signals into sustained cellular dysfunction and disease. Its activation is associated with high levels of dysfunctioning proteins in body fluids and tissues, and strongly associated with a series of diseases from allergy and Alzheimer to rheumatoid arthritis and urogenital disorders. Heat-treatment, irradiation and ionisation of foods increase the content in foods of AGE/ALE. CONCLUSIONS: Some processed foods are much like tobacco smoking great contributors to accumulation of glycated and lipoxidated molecules in the tissues. Change of life style: avoidance of foods rich in deranged proteins and peptides and increased consumption of antioxidants, especially polyphenols counteracts such a development.

[Solid pseudopapillary neoplasm of the pancreas]. / A pancreas solid pseudopapillaris tumora.

Solid pseudopapillary neoplasms (SPN) of the pancreas are rare tumours with low malignant potential, usually affecting young women. Due to its relatively low incidence, there are no international guidelines published on diagnosis or treatment. The aims of our study were to summarize our clinical experience of SPN in a Hungarian Surgical Centre and to discuss the relevant international literature. The clinical data of four patients treated between 2004 and 2007 in the Petz Aladár County Teaching Hospital (Gyôr, Hungary) were analyzed retrospectively. All patients were women with age of 17-49 years. In all cases SPN was diagnosed preoperatively on the basis of CT-findings and the diagnosis was confirmed by postoperative histology. After an organ-preserving radical resection of the tumour, all patients have remained disease free with an acceptable quality of life so far. Our data suggest that CT-scan is adequate to establish the preoperative diagnosis of SPN. Surgical resection should be carried out with the required radicality, but organ preservation is advised in order to provide a relatively good quality of life.