[Acute abdominal syndrome caused by benign ovarian tumors]. / Benignus ovariumtumorok okozta akut hasi kórképek.

The acute abdomen is a life threatening condition, its proper diagnosis and treatment is a great challenge until today in surgery. The authors aim to present the diagnostic difficulties in four cases of acute abdomen caused by large benign ovarian tumors. Vast majority of benign ovarian tumors are recognized accidentally through physical examination, X-ray and ultrasonography of the pelvis, abdominal operation is carried out for other reasons or investigations for acute abdominal pain. The case history, physical examination and radiological procedures do not always lead to the correct diagnosis. The authors diagnosed the disease through laparotomy, and an adequate operation was carried out subsequently. Following the operation, all four patients left the hospital in good condition.

[Primary T-cell lymphoma of the small bowel]. / Primer vékonybél T-sejtes lymphoma operált esete.

Primary malignancies in the small intestine are relatively rare. There are no specific methods to find these tumours in early stage. The authors report a case of a primary T-cell lymphoma in the small bowel that caused diagnostic challenges. A 66-year-old woman presenting with abdominal pain and and a palpable mass in the left upper quadrant of her abdomen was admitted into the hospital. Blood tests, endoscopic examinations, ultrasonography and CT scan could not reveal a definitive diagnosis. While a small bowel follow through examination demonstrated an entero-enteral fistula, its exact position could not have been determined. Consequently, an exploratory laparotomy was carried out, and a tumour was found involving the small bowel loops. The involved portion of the small intestine (with the fistula) was resected, and a side-to-side small bowel anastomosis was performed. Histological and immunohistochemical analyses revealed a primary T-cell lymphoma of the small bowel. There was no evidence of metastatic disease at the time of surgery. The patient received adjuvant chemotherapy, but three months later multiple lung metastases were detected. Small bowel malignant tumours cause significant diagnostic difficulties. Therefore, diagnosis and adequate treatment are usually delayed for some weeks. In the future, capsule endoscopy could help in the diagnostic work-up. Nevertheless, surgical exploration and resection of the tumour will be necessary for the correct diagnosis and treatment.

[Primary retroperitoneal enteric cyst in an adult]. / Primaer retroperitonealis enteralis ciszta egy felnottben.

The posterior mediastinum is the usual location of enteric cysts. They can be located at any part of the posterior mediastinum adjacent to the oesophagus, but communication with that structure is rare. Approximately 60 percent of the cysts occur in infants less than one year of age, and symptoms of tracheal or oesophageal obstruction are common. The cysts usually contain clear, colorless mucoid fluid. The authors describe here a successfully treated enteric cyst with an unusual, retroperitoneal location, which presented in an adult.

[Improving results of the surgical treatment of rectal cancer in the Surgical Department of County Hospital, Szekszárd]. / Javuló eredmények a végbélrák sebészi kezelésében a Szekszárdi Megyei Kórház Sebészeti Osztályán.

The authors present that 247 elective rectal operations were performed between 1 January, 1996 and 31 December, 2001 in their surgical department. The examined 6 years were divided into a 4-year and a 2-year period. 148 operations were performed in the first and 99 in the second period. Beside personal changes, methodical and technical modifications were introduced in the second period. Distribution of age and sex was similar, and the groups were comparable. The early postoperative mortality rate decreased from 9% to 4% during the examined time. Due to the double stapling technique, the rate of anterior rectal resections has increased from 40% to 69%, and the rate of abdomino-perineal rectal extirpation has decreased from 43% to 23%. Considerable difference was found in the rate of palliative stoma-creation operations, since the 16% decreased to 8% in the second period, so the quality of life of patients has improved. The operative time, the hospital stay of the patients and the rate of operations with blood transfusion decreased. The different types of postoperative infections decreased due to the new methods.

[Subtotal colectomy for the treatment of obstructive left colon cancer. Follow-up results]. / Szubtotális colectomia a bal colonfél obstruktív vagy stenotizáló tumorainak primer ellátására. Utánvizsgálati eredményeink.

AIM: Subtotal colectomy (STC) involves an extended resection of the large bowel over the splenic flexure. In a period of 8 years, a total of 72 subtotal colectomies (STC) were performed for the treatment of large bowel obstructions or symptomatic stenosis caused by cancer of the left colon. A primary ileocolic latero-terminal anastomosis was made in each case. The aim of study was to evaluate the late results of procedure. PATIENTS AND METHODS: In a non-prospective, non-randomized study of 23 of the total of 72 STC cases, authors investigated the postoperative quality of life, the changes in the intestinal bacterial flora, and signs of a nutritional deficiency or of an accelerated bowel transit. METHODS: 1) H2 excretion test, 2) UDCA-PABA and 3) Schilling test for contaminated small bowel syndrome and bowel transit time, studied by means of a 4) barium meal and 5) radiopaque marker passage, and 6) registration of the number of defecations/day. RESULTS: The laboratory findings were in the normal range in each case. The daily number of defecations gradually decreased during the 3 months after the operation (mean 1.9/day). The lack of an ileocoecal valve did not result in bacterial overgrowth in the small bowel and the investigations did not reveal contaminated bowel syndrome. The oro-anal transit time was reduced in only four cases. Three months postoperatively, no patient had a deteriorated quality of life. CONCLUSIONS: STC offers 1) one-stage treatment for colonic obstruction in emergency surgery, 2) tumour removal with sufficient oncological radicality, and 3) primary reconstruction of the digestive tract, with a safe ileocolic anastomosis even in emergency cases. The follow-up study of 23 of the patients proved that loss of 60-80% of the colon did not cause any symptomatic disturbance of the digestive functions. The quality of life after surgery was normal, the slightly increased number (mean 1.9) of daily defecations was acceptable, and bacterial colonization of the small bowel did not occur.

[Surgical treatment of non-palpable breast tumors]. / Nem tapintható emlódaganatok sebészi kezelése.

METHOD: Between 1997 and 2000 the authors performed 110 fine-wire localized breast biopsies in patients with nonpalpable suspicious lesions. RESULTS: 108 target lesions (98.1%) were accurately excised during the initial surgery. Overall, 56 lesions were malignant, among these cases 50 invasive carcinomas and 6 DCIS were found. Breast conservation was achieved in 48 patients (88.5%), simple mastectomy with axillary lymph node sampling was performed in 8 cases. 86% of the invasive malignant lesions belonged to the good prognostic subgroup of the Nottingham Prognostic Index. CONCLUSION: There in an importance of the close cooperation between radiologist, surgeon, pathologist and oncologist in the treatment of nonpalpable preclinical breast carcinomas.