[Association of brownish polyposis and diverticulosis in the sigmoid colon -- a case of mucosal prolapse syndrome]. / Barnás polyposis és diverticulosis együttes elofordulása sigmabélben -- Mucosalis prolapsus syndroma esete.

The authors present a case of a 48 year-old man, who was diagnosed with several brownish sigmoid polyps of 1-2 cm size and diverticulosis on colonoscopy. Subsequently, laparoscopic sigmoid resection was carried out due to lower gastrointestinal bleeding. Histological examination revealed diverticulosis associated with polyposis. This rare entity is known in the literature as prolapse-type inflammatory polyp, which is a type of mucosal prolapse syndrome. The brownish discolouration was caused by hemosiderin deposition.

[Rectus sheath hematomas caused by acenocumarol overdose]. / Acenocumarol-túladagolás okozta rectus abdominis bevérzések.

Acenocumarol is widely used in long-term anticoagulant treatment. Overdose of this drug may result in suffusions in various parts of the body. In three cases, we observed suffusion in the rectus sheath, which is an unusual site of hematomas. At early stage, the lack of discoloration of the abdominal wall may lead to problems in differential diagnosis. Chronic anticoagulant treatment in a patient's history in combination with a palpable abdominal mass facilitate the correct diagnosis. In addition, high INR also makes hemorrhagic complications more likely. In simple cases, suggestive past medical history, abdominal palpation, INR and ultrasound examination can be sufficient to make a diagnosis. However, in more complicated cases, further assessment by CT is required to set up the diagnosis; while, in a further case discussed in this article, we could only establish an accurate diagnosis with laparoscopy. Decreased plasma prothrombin levels were always normalized with vitamin K.

[Modified mesh implantation technique in traditional femoral hernia repairs]. / A hálóbeültetés technikájának módosítása hagyományos megközelítésu combsérvmutétek esetén.

Mesh implantation techniques are increasingly common in groin hernia repairs in Hungary. The mesh can be inserted via the traditional Lichtenstein technique or laparoscopic methods. We modified the traditional operation technique to reduce the incidence of femoral hernia recurrence. The medial and wider part of the mesh was slid in the preperitoneal space under Cooper's ligament and Lotheissen's sutures were fixed 1.5 centimeters from the edge of the mesh. Thus, in the case of a possible suture insufficiency, the probability of hernia recurrence is reduced due to the adhesion between the mesh and the surrounding tissue.

[Changes in epidemiology, etiology, diagnostics, and therapy of acute appendicitis]. / Változások az akut appendicitis epidemiológiájában, etiológiájában, diagnosztikájában és terápiájában.

The frequency of acute appendicitis has fallen in the last three decades in developed industrialized countries. From 1961 to 1991 the number of appendectomies performed annually in Hungary decreased significantly. Since 1991 the numbers are essentially unchanged. Appendix lumen obstruction was formerly believed to be crucial in the etiology of the illness, while today mixed aerobic, anaerobic bacterial infection is considered more important. The inflammation process - according to immunogenetic differences - may lead to recovery or tissue necrosis and perforation. To date, no methods are known that could timely distinguish spontaneously healing or conservatively treatable appendicitis from those resulting in tissue necrosis, although routine usage of abdominal ultrasound technique is added to the clinical picture's modern diagnostic arsenal. The operative method for removing the appendix also has changed. Experience has confirmed that laparoscopic appendectomy is usually more favorable in the treatment of acute appendicitis than traditional surgery.

[Diagnostic and therapeutic difficulties of left lower quadrant abdominal pain]. / Bal alhasi fájdalom diagnosztikai és terápiás nehézségei.

A patient presented with left lower quadrant abdominal pain and a lumbar hernia after pyeloplasty. In her history, diverticular disease, lumbar vertebral arthropathy, total abdominal hysterectomy and total left hip prosthesis were found. Due to the lack of special CT maneuvers and techniques (Valsalva, MDCT), laparoscopy provided a clear diagnosis finally. Closure of the hernia with absorbable sutures provided a temporary solution only. A Composix mesh was used therefore, but this resulted in postoperative neuropathic pain. This complication was treated with removal of the tacks and adhesiolysis.

[Enterobius vermicularis causing symptoms of acute appendicitis]. / Acut appendicitis tüneteit okozó Enterobius vermicularis fertozés.

The authors present a case of enterobiasis of the appendix. Enterobius infection is an uncommon cause of acute appendicitis. Preoperative diagnosis of pinworm infestation is almost impossible unless there is a strong clinical suspicion. Parasites may produce symptoms which resemble acute appendicitis. Careful observation of the appendix stump may lead to intraoperative diagnosis of enterobiasis. A quick diagnosis and appropriate treatment may prevent future complications.

Abdominal surgery performed under general anesthesia increases somatostatin-like immunoreactivity in human serum.

OBJECTIVE: It has been established in animals that somatostatin (SST) is released from pain-activated sensory nerve endings and exerts systemic antinociceptive and anti-inflammatory actions. The aim of this study was to investigate the changes of SST-like immunoreactivity (SST-LI) in human serum before, immediately after and 2 h after surgical operations. METHODS: 25 patients were enrolled in the study. Laparoscopic cholecystectomy, abdominal wall hernia or inguinal hernia operations were performed under combined anesthesia. A 5-ml blood sample was drawn from each patient, the blood was centrifuged and the serum frozen. SST-LI was determined from the defrosted samples by radioimmunoassay. RESULTS: Abdominal surgical operationsinduced a significant increase of SST-LI in the serum. 2 h later it was restored in the cases of laparoscopic interventions but still remained elevated after hernia surgeries. CONCLUSIONS: In this human study we showed for the first time that surgical interventions elevate the endogenous SST-LI in human serum. It is assumed that the released SST is derived from the activated sensory nerves. Since antinociceptive and anti-inflammatory effects of neural SST have already been established in laboratory animals, we presume that this endogenous protective mechanism also operates in humans.

[Simplified economical laparoscopic appendectomy]. / Egyszeruisített, gazdaságos laparoszkópos appendectomia.

The authors give an actual overview of laparoscopic appendectomy literature. They present an operative procedure of laparoscopic appendectomy which is simplified with clipped stump closure. They report on their favourable experiences of the first fifty operations. This procedure is easier and quicker than endoloop's and significantly cheaper than stapler technique. Based on their results, the outlined laparoscopic technique is considered as a valuable alternative of traditional appendectomy.

Purinergic nerves mediate the non-nitrergic relaxation of the human ileum in response to electrical field stimulation.

There has been no direct functional evidence for a purinergic innervation of the human intestinal muscle. In the present study, the relaxant effects of electrical field stimulation (1 or 10 Hz for 20s), ATP, and isoprenaline were studied in organ bath experiments on precontracted circular muscle strips of the human ileum. Non-adrenergic, non-cholinergic relaxations in response to electrical field stimulation in the presence of a nitric oxide synthase inhibitor were significantly reduced by the P(2) purinoceptor antagonists pyridoxal-phosphate-6-azophenyl-2',4'-disulphonic acid (PPADS; 50 microM) or suramin (100 microM). A combination of the two antagonists yielded an approximately 70% inhibition at 1 Hz. The relaxant effect of exogenous ATP, but not that of isoprenaline, was inhibited by PPADS+suramin. It is concluded that purinergic nerves (through P(2) purinoceptors) play a mediating role in the non-nitrergic relaxation in the human ileum.

Anti-lipopolysaccharide antibodies in acute appendicitis detected by ELISA.

In acute appendicitis the bowel transmissibility of the intestinal flora increases in relation to inflammation and edema formation. We can therefore observe an immunologic response in patients, which is detectable using different bacteria isolated from the normal intestinal flora. Our aim was to measure this immunologic reaction and to detect the relationship between this response and histologic types of acute appendicitis. Sera from 47 cases, comprising 38 patients suffering from appendicitis and 9 healthy controls, were examined. The sera were taken shortly before appendectomy and 14 days after operation. The antigens were lipopolysaccharides (LPS) extracted from bacteria of normal intestinal flora: Escherichia coli O21, O22, O33, O61, O68, Bacteroides fragilis and an absolute rough mutant: Shigella sonnei Re 4350. Antibodies were detected by ELISA. We showed a direct relationship between severity of appendicitis and registered antibody titer. Both aerobic and anaerobic bacteria play a role in infection in appendicitis. According to our serologic results the synergy of B. fragilis with E. coli from normal flora is more important in the initiation of inflammation, but in the perforation process the role of E. coli seems more important compared to that of B. fragilis.

[Pneumatosis cystoides intestinalis]. / Pneumatosis cystica intestini.

Authors present a case history of pneumatosis cystoides intestinalis with free intraperitoneal gas mimicking abdominal hollow organ perforation. The illness occurred in old immunocompromised man. The diagnosis was based on exploratory laparotomy and supported by abdominal x-ray and ultrasound.

Inhibition of nitric oxide synthesis blocks the inhibitory response to capsaicin in intestinal circular muscle preparations from different species.

Moderate concentrations of the sensory stimulant drug capsaicin caused relaxation in human and animal intestinal circular muscle preparations (guinea-pig proximal, mouse distal colon, human small intestine and appendix) in vitro. With the exception of the guinea-pig colon, the nitric oxide (NO) synthase inhibitor N(G)-nitro-L-arginine (L-NOARG; 10(-4) M) strongly inhibited the relaxant effect of capsaicin. Tetrodotoxin, an inhibitor of voltage-sensitive Na+ channels failed to significantly reduce the inhibitory effect of capsaicin in the guinea-pig colon, human ileum and appendix; it caused an approximately 50% reduction in the mouse colon. The relaxant effect of capsaicin was strongly reduced in colonic preparations from transient receptor potential vanilloid type (TRPV1) receptor knockout mice as compared to their wildtype controls. It is concluded that nitric oxide, possibly of sensory origin, is involved in the relaxant action of capsaicin in the circular muscle of the mouse and human intestine.

Effects of capsaicin on visceral smooth muscle: a valuable tool for sensory neurotransmitter identification.

Studying the visceral effects of the sensory stimulant capsaicin is a useful and relatively simple tool of neurotransmitter identification and has been used for this purpose for approximately 25 years in the authors' and other laboratories. We believe that conclusions drawn from experiments on visceral preparations may have an impact on studies dealing with the central endings of primary afferent neurons, i.e. research on nociception at the spinal level. The present review concentrates on the effects of capsaicin--through the transient receptor potential vanilloid receptor type 1 (TRPV1) receptor--on innervated gastrointestinal, respiratory and genitourinary smooth muscle preparations. Tachykinins and calcitonin gene-related peptide (CGRP) are the most widely accepted transmitters to mediate "local efferent" effects of capsaicin-sensitive nerves in tissues taken from animals. Studies more and more frequently indicate a supra-additive interaction of various types of tachykinin receptors (tachykinin NK(1), NK(2), NK(3) receptors) in the excitatory effects of capsaicin. There is also evidence for a mediating role of ATP, acting on P(2) purinoceptors. Non-specific inhibitory actions of capsaicin-like drugs have to be taken into consideration while designing experiments with these drugs. Results obtained on human tissues may be sharply different from those of animal preparations. Capsaicin potently inhibits tone and movements of human intestinal preparations, an effect mediated by nitric oxide (NO) and/or vasoactive intestinal polypeptide.

[Unusual laparoscopic surgical cases: cholelithiasis in situs inversus totalis, and gallbladder agenesis]. / Különös laparoszkópos sebészeti esetek: cholelithiasis situs inversus totalisban, és agenesia cholecystae.

Organ anomalies and organ system transposition may cause diagnostic and therapeutic difficulties. We report a patient with situs inversus totalis and symptomatic cholelithiasis successfully treated via laparoscopic cholecystectomy. We present a laparoscopic and MR cholangiographic pictures of our patient with gallbladder agenesis.