[A case of congenital cystic intrahepatic bile duct dilatation (Caroli syndrome) treated with hepato-lobectomy]. / Mit Hepato-Lobektomie operierter Fall einer congenitalen, cystischen, intrahepatischen Gallengangserweiterung (Caroli-Syndrom).

The authors report a successful hepatolobectomy of Caroli's disease (segmentally dilatated intrahepatic bile ducts). They also give a survey of congenital and acquired bile duct dilatations, with a view to differential diagnosis and medical treatment. When Caroli's disease is suspected, echography and ERCP can be a valuable diagnostic aid. The definitive cure i. e. the elimination of the anatomical basis of recidive cholangitis, can only be achieved by the resection of the liver containing the dilated intrahepatic bile ducts. Postoperative administration of antibiotics and anticholelithic drugs can help the liver to full recovery.

[Cases of multiple tumors in our clinic]. / Többszörös daganatos esetek osztályunk anyagában.

Between 1989 and 1994, 719 patients had been treated with tumours at the Department of Surgery, Teaching Hospital of Semmelweis University Medical School, Budapest, Multiple tumours were found in 53 cases (7.37%), 49 of these being duplex and four triplex form. In men colorectal carcinoma was the most frequent while in women synchrone and metachrone breast cancers. Simultaneous breast tumors were most often found in senior patients (mean age 72.7) and metachrone ones at younger age (first tumor at 54.8 and the second one at 65.4 years of age, the following time being 10.6 years). Colorectal and gynecological tumours appeared with breast cancer in 5 cases. Regional colorectal tumours developed in five patients after radiotreatment of the pelvis. Familiar accumulation of colorectal cancer occurred in 4 cases. Lynch syndrome developed in 2 patients. The role of genetical factors is known in this group of illness, and they need to be screened. In this study the metachrone cancer in women occurred most frequently and only these patients received oncological treatment. The more effective treatment is supposed to enhance the number of multiplex tumours in which etiological factors also can play a role likewise mutagen effects of the first cancer therapies. The importance of collecting and processing these data is to referre to those risks, which should be considered in our everyday diagnostic work and postoperative care in these groups of patients.

[Comparative study of superoxide production of monocytes in primary biliary cirrhosis]. / A monocyták szuperoxid termelésének összehasonlító vizsgálata primer biliaris cirrhosisban.

Monocytes appear to play a role in immunological abnormalities observed in primary biliary cirrhosis (PBC). Monocytes not only produce fibroproliferative factors, such as IL-1, TNF, and PDGF but also produce superoxide anion which can directly damage tissues, and thus may lead to fibrosis. The aim of this study was to compare the superoxide production in monocytes obtained from 12 control persons, 9 patients with non biliary cirrhosis, 6 untreated PBC patients, 6 patients with gallstones under urso- and chenodeoxycholicacid (Lithofalk) treatment and 32 PBC patients under ursodeoxycholicacid (UDCA) therapy. Monocytes were isolated and the production of superoxide anions with and without phorbol-myristate-acetate (PMA) stimulation was determined. In two occasion, the monocytes from control patients were preincubated with 10, 50, 100 microM UDCA. Unstimulated monocytes from PBC patients under UDCA therapy produce an average 43% more and the PMA stimulated monocytes an average 42% more superoxide than monocytes from the control or from the other cirrhotic patients. The UDCA preincubation did not influence the superoxide production of monocytes obtained from control patients. These findings suggest that the increased activity of monocytes may also play a role in liver damage and fibrosis in PBC.

[Diffuse intestinal malignant lymphoma]. / Diffuz intestinalis malignus lymphoma.

The authors describe a patient with malignant lymphoma presenting with clinically severe malabsorption due to diffuse involvement of the small intestine and with intestinal obstruction. The histologic diagnosis was based on the association of (1) diffuse involvement of the small intestine showing lymphoid tissue expansion and (2) a non-classified form of highly malignant lymphoma. After surgical resection of a stenotic part of the small intestine, abdominal irradiation therapy was done, and the patient improved.

[Familial occurrence of carcinoid of the small intestine]. / Vékonybél-carcinoid familiaris elöfordulása.

The case of a 41 year old woman has been reported, whose "flush" syndrome was caused by a carcinoid tumor originated from the jejunum. The patient's father had to be operated for intestinal carcinoid tumor several times. The occurrence of different forms of carcinoid tumors, especially in the gastrointestinal tract, has been discussed in connection with the diagnostic approaches and therapeutical possibilities. The authors considered the case interesting for publications, because carcinoid is a rather rare tumor, and one cannot find its familiar occurrence in the available literature.

[A case of adult Gaucher disease]. / Felnöttkori Gaucher-kór esete.

The authors describe a case of an adult patient having Gaucher's disease, who had hepatosplenomegaly and pancytopenia. The diagnosis was established by the low level of leukocyte beta-glucosidase and by histology of bone marrow, liver and spleen. The patient had no bone pain, but MRI described characteristic lesions of the femur. Serum acid phosphatase was characteristically elevated. The hypersplenism was reduced after splenectomy. The patient has a daughter with central nervous system dysfunction. Her chromosome examination is normal, but she has lower leukocyte beta-glucosidase activity too. She may have a Gaucher's disease of type II, the acute neuropathic form.

[Experience with intravenous metronidazole administration in the preoperative care of surgery of the large intestine]. / Erfahrungen mit intravenöser Metronidazolgabe bei der Vorbereitung zu Dickdarmoperationen.

Peroperative intravenous administration of Metronidazole reduces significantly septic complications in surgery of the colon, especially in combination with intravenous Gentamycin. Intravenous Metronidazole was also successful in cases of septic shock.

[Angioneurotic edema and hypocomplementemia in patients with thyroid cancer]. / Angioneurotisches Odem und Hypokomplementämie bei Schilddrüsenkarzinom.

The combination with a malignant tumour of angioneurotic oedema (ANO) elicited by a disturbance of the complement system was studied. After surgical removal of the tumour the pathologic complement component level may become normal and the angioneurotic oedema may disappear. In the reported case an angioneurotic oedema, the disturbance of the complement component and scintigraphic deviations of the thyroid suggested the presence of a thyroid carcinoma. After thyroidectomy the ANO disappeared and the complement component returned to normal. This case draws attention to the possibility that, beside lymphoproliferative and autoimmune diseases and cancer of the rectum, carcinoma of the thyroid may also be in the background of angioneurotic oedema.

[Perineal neoplasms]. / Perineale Neoplasmen.

The literature on perineal neoplasms is reviewed and their incidence, the method and effectiveness of their surgical treatment analyzed. The prognosis of perineal neoplasms is tragic: according to published data 50% of the patients die within two, 92% within four years. The benign or malignant nature of perineal tumours can be judged only on the basis of histological tests. Attention is drawn to the necessity of the early surgical removal of perineal tumours. In the case of a 66-year old woman the histological diagnosis was gelatinous adenocarcinoma. To the best of the knowledge of the authors no similar case has been reported in the literature.

Role of human adipose tissue in the production and metabolism of steroid hormones.

Radioimmunological methods have been employed for the simultaneous determination of dehydroepiandrosterone, androstenedione, testosterone, oestrogens (oestradiol + oestrone), progesterone, 17 alpha-hydroxyprogesterone and cortisol in human adipose tissue and peripheral blood to compare the hormone pool of adipose tissue with that in the general circulation. Extremely high steroid concentrations in the adipose tissue and hormone pool in the fat of obese subjects were observed. For adipose tissue/serum steroid ratios, the highest values were obtained for dehydroepiandrosterone and the lowest ones for cortisol. A preliminary study showed a great accumulation of steroids in adjacent adipose tissue of breast tumors. Striking differences were observed in the adipose tissue steroid concentrations between benign and malignant mammary tumors. The present findings revealed that blood hormone determinations may be insufficient to consider the steroid hormone availability in various endocrinopathies or steroid responsive tumors, especially when the endocrine state of extremely obese subjects is observed.

Comparison of histochemical and biochemical methods in the evaluation of estrogen and progesterone receptor level in human breast cancer. A study of 118 cases.

Unselected surgical specimens from 118 cancerous breasts of female patients were studied by histochemistry for the presence of cellular estrogen (ER) and progesterone (PR) receptors. The receptor tracers used were 17 beta-estradiol-6-carboxymethyl-oxim-bovine serum albumin - fluorescein isothiocyanate and 11 alpha-hydroxyprogesterone-hemisuccinate-bovine serum albumin-tetramethylrodamine isothiocyanate conjugate (Fluoro-CepTM). Out of 118 carcinomas 77 (67%) proved to be positive in the ER and 79 (66%) in the PR test. The histochemical results were compared with the results of the biochemical assay in 70 cases. A positive correlation was found in 57 cases.

Effect of lentinan on superoxide dismutase enzyme activity in vitro.

The effects of lentinan on enzyme induced lipid peroxidation, xanthine-xanthine oxidase-induced cytochrome c reduction, and on the superoxide-dismutase (SOD) enzyme activity and expression of human lymphocytes and erythrtocytes were studied. Lentinan in low concentration decreased SOD activity of lymphocytes and erythrocytes from healthy subjects. In higher concentration (10 micrograms/ml) lentinan increased the pathologically low SOD activity of erythrocytes and lymphocytes of patients with cirrhosis of the liver. No significant antioxidant (free radical scavenger) effect has been observed in NADPH-induced and Fe3+-stimulated lipid peroxidation and in xanthine-xanthine oxidase system.

Quantitative and qualitative changes in serum oligopeptide components of patients with end stage malignant tumour disease.

A number of changes in peptide components could be demonstrated in sera of patients with end stage malignant diseases. Total and free alfa amino-N content of such sera was shown to be significantly higher than those in sera of patients with no sign of malignancy. In addition, a significant increase was found in one of the serum fraction obtained by Sephadex G-25 chromatography. This increase was shown to be due to an increase in the amount of one of the isotachophoretically separated serum components of anionic character as well as to the appearance in sera of tumour bearing patients of two additional isotachophoretic components never detected in non tumour bearing patients. Based on their chromatographic behavior as well as on observations made in earlier experiments, the peptide nature of the two isotachophoretic serum components seemingly characteristic of sera of tumour bearing patients is highly probable.

Immunohistochemical distribution of neuropeptide Y and catecholamine-synthesizing enzymes in nerve fibers of the human liver.

The course and distribution of neuropeptide Y (NPY)-immunoreactive (ir) nerves in the human liver was studied using immunohistochemistry. The distribution and density of NPY-ir fibers was compared with tyrosine hydroxylase (TH) and dopamine-beta-hydroxylase (DBH) immunoreactivity, two enzymes which are markers for dopamine- and noradrenaline-synthetizing neurones. NPY-immunopositive nerve fibers were densely distributed in the perivascular plexus of the portal trials, along the vena centralis, as well as close to the sinusoids and hepatocytes. The distribution of perivascular TH-ir and DBH-ir nerve fibers was similar to that of NPY-ir nerves, with the exception of intralobular nerves, where close topographical relations to individual hepatocytes and sinusoids were rarely observed. These results suggest that NPY is present in noradrenergic perivascular nerve fibers; probably of sympathetic origin and also in other parasympathetic, presumably cholinergic nerve fibers around the sinusoids.