[Changes in the treatment of choledocholithiasis]. / A choledocholithiasis kezelésének megváltozása.

UNLABELLED: The therapeutic approaches to gallstone disease and bile duct stone changed dramatically in the last decade by spreading of endoscopic and laparoscopic methods. The authors have reviewed the most frequent curing methods of bile duct stone recently. They examined patients treated for gallstone and common bile duct stone in Surgical Department and Gastroenterological Department of their hospital. Retrospective study was performed to evaluate the issue of treatment for gallstone disease in addition to common bile duct stone (CBDS) and papillary stenosis in the last six years from 1993 to 1998, in the era of laparoscopic cholecystectomy (LC). There was formed a control group from similar patients of these two departments, between 1986-1991, in the six-year period before the laparoscopic era. The postoperative complications and perioperative mortality were analysed in present period compared with the outcome of control group. RESULTS: 734 patients were treated by sequential endoscopic laparoscopic approach or open operation between 1993-1998: 632 endoscopic sphincterotomy (EST), from which 236 LC followed the preoperative EST, 102 open choledochotomy were performed. Overall complications were 4.4% and mortality was 0.9% (EST plus LC plus open operations.) The control group made up of 534 patients underwent a treatment of choledocholithiasis: 196 EST and 338 open choledochotomy were achieved. Complications were 10.6% and mortality was 1.9%. The authors statistically evaluate the retrospective results. They conclude that there is a significant difference in the complications rate between the two groups, but the decrease of mortality is not significant. The mean hospital stay is 6.5 days in the recent group and this value was 13.4 days in the control group. Saving of hospital cost is 62,100 Ft for one patients. The authors think that this sequential approach results in a safer and more effective treatment of cholecysto-choledocholithiasis than the former period's.

[Bouveret syndrome diagnosed by endoscopy]. / Endoscopos vizsgálat során felismert Bouveret-syndroma.

The case of a 74 years old woman suffered from a gallstone disease for 5 years is reported. In the background of the upper abdominal pain and vomiting, which necessitated her hospitalization, a large-size gallstone penetrated into the duodenal bulb and obstructed pyloric channel was found by endoscopic examination. The upper duodenal ileus was verified during the operation, gastroduodenotomy and cholecystectomy were performed, and the 7 x 4 cm size gallstone was removed. After a complications free period the asymptomatic patient went home. Our above reported case is a preoperatively, endoscopically diagnozed Bouveret's syndrome.

Differentiation of glomerular and non-glomerular haematurias on basis of the morphology of urinary red blood cells.

Haematurias present serious problems in differential diagnostics. Although no clear-cut instructions exist, patients with haematuria are usually directed to urological surgeries or inpatient departments. Here they are routinely checked by a number of invasive techniques (cystoscopy, i. v. urography, aortography etc.) before the urological nature of haematuria can be ruled out. The suspicion of a glomerular disease being in the background of haematuria emerges only if it is accompanied by a marked proteinuria. Our department deals with kidney diseases since decades. The routine light microscopic examination of haematuric urinary samples called attention to the fine differences between erythrocyte morphology in glomerular and other haematurias. The present paper is an account of morphological studies of red blood cells carried out in haematuric urinary samples of 120 histologically verified glomerulonephritis and 80 other cases.