Therapeutic tactics in the treatment of acute necrotizing pancreatitis.

BACKGROUND/AIMS: The authors analyze the possibilities for the delay of surgery with special consideration regarding percutaneous peripancreatic drainage in the treatment of acute necrotizing pancreatitis. METHODOLOGY: In addition to intensive care therapy, 61 patients were also given antibiotic prophylaxis, and early nasojejunal enteral feeding was commenced. In a total of 22 cases where peripancreatic fluid was found, percutaneous drainage was performed. Septic necrosis, sepsis, multi-organ failure not resolving with conservative treatment, gastrointestinal perforation, and bleeding were the indications for operation. Only 9 patients underwent surgery within one week and in 40 patients delayed (more than 7 days) necrectomy was performed. Following surgery, closed omental bursa rinsing was performed. RESULTS: Five patients were cured with only conservative therapy and 7 others were cured under the influence of percutaneous drainage. In 15 patients it was possible to delay surgery using percutaneous drainage with combination of conservative treatment. A total of 39 reoperations occurred due to septic focus, bleeding, colonic necrosis and gastric perforation. The average days of nursing care was 43.3 (3-120). Mortality was 16.4% (10/61 patients). CONCLUSIONS: The number of early operations can be reduced with the use of antibiotic prophylaxis, nasojejunal feeding and percutaneous drainage.

[Successful surgical removal of adrenocortical carcinoma growing into the inferior vena cava and the right atrium]. / A vena cava inferioron keresztül a jobb pitvarba terjedo mellékveserák sikeres mutéti eltávolítása.

The authors discuss a case of a 47-year old female, who underwent a left adrenalectomy for adrenocortical carcinoma. A few months later the tumour locally recurred and spread through the inferior vena cava into the right atrium. The tumour thrombus almost completely occluded the lumen of the inferior vena cava resulting in significant hepatic congestion, ascites and oedema of the lower extremities. The whole tumour thrombus was successfully removed through the right atrium under visual control using extracorporeal circulation in deep hypothermic (20 degrees C) circulatory arrest. The locally recurred tumour from the site of the left adrenal gland was also removed a month later. The histological examination revealed moderately differentiated adrenocortical carcinoma with a proliferation rate higher than 10%. Thereafter, patient underwent adjuvant oncological therapy and she has been disease free in the last one year. Clinical data suggest that tumour thrombus of various origin that grow into the inferior vena cava can be safely removed using extracorporeal circulation (with or without cardiac arrest), and in such cases, when the primary tumour is resectable, the prognosis is relatively good.

[Adenomatoid malformation as peripheral round shadow in lung]. / A tüdoben perifériás kerek árnyék formájában jelentkezo cysticus adenomatoid malformatio.

The authors present a case report of a 17 years old female patient who had a peripheral round shadow on the chest X-ray. After the operation the histological examination verified cystic adenomatoid malformation. The cystic adenomatoid malformation is an abnormal growth of the terminal bronchiolar structures. It is a rare disease, but often associates with other developmental abnormalities. It is important in the differential diagnosis to separate this disease from other cystic pulmonary lesions or sequestration. It is usually recognized in antenatal period or early childhood, but rarely in adulthood. It is possible that there is a connection between the adenoid malformation and lung cancer.

New reconstructive surgery of remnant pancreas in cases of cancer of Vater's papilla.

BACKGROUND/AIMS: The radical surgical procedure for treatment of the carcinoma of papilla of Vater is the pancreatoduodenectomy. The mortality rate of the surgery highly decreased in the last decade, nevertheless there are complications related to the complication of anastomosis of the remnant pancreas. METHODOLOGY: The authors introduce a new reconstructional procedure to decrease the complications. After the removal of the pancreatic head and body an end-to-side anastomosis was performed between the pancreatic duct and a Roux-en jejunal loop. The second anastomosis of the procedure was an end-to-side choledochojejunostomy, the third was an end-to-side duodenojejunostomy. The duodenojejunostomy is about 40 cm from the pancreatic anastomosis, keeping food far from the pancreas with the help of peristaltic waves. This method was applied in 6 patients. RESULTS: It was found that the new reconstructional procedure had generally favorable results without complication. CONCLUSIONS: This method of reconstruction allows for spontaneous closure and safe drainage of potential insufficient pancreaticojejunostomy. The recovered patients support future favorable usage of this new reconstructional surgical procedure.