[A double immunochemical method for detecting faecal haemoglobin and albumin in rectal screening]. / Széklethemoglobin és -albumin kettos immunkémiai vizsgálat colorectalis szurésnél.

Undoubtedly, colonoscopy is the "gold standard" in the diagnosis of colorectal cancers. Sophisticated bowel preparation and risk of bowel perforation and bleeding, as well as the patient's discomfort during examination lead to low compliance in screening. Therefore, alternative non-invasive screening methods tend to come into the fore. In this study we compared the sensitivity and specificity of the double immunochemical FECA test for the haemoglobin + albumin content of the faeces with those of control colonoscopy in the detection of colorectal neoplasms. In a 3-year period 154 patients (69 males and 85 females) were scheduled for colonoscopy with previously collected stool samples. The sensitivity and specificity of the double immunochemical test for faecal haemoglobin + albumin content were determined in colorectal neoplasms of different severity. Colonoscopy served as a control examination. Colonoscopy identified in 77 cases benign lesions, and in 10 cases malignant tumours. The double immunochemical test for faecal blood and protein successfully used in model screening population showed in our present study 52.7% sensitivity and 92.3% specificity for significant neoplastic lesions (high-risk polyps and tumours). When the evaluation was limited to the high-risk polyps, the sensitivity was modified to 45.5% and the specificity to 92.3% and in case of invasive tumours to 90% and 100%, respectively. If only faecal haemoglobin content was measured, the overall sensitivity for polyps of any size and sort was 15.7% which, however, increased to 27.63% if faecal albumin was also measured. Based on relevant literature, the sensitivity of the FECA test for colorectal polyp and cancer is more favourable than that of other FITs. However, the increased sensitivity of the double faecal protein test falls short of the standard colonoscopy. Therefore, in certain cases the latter might be considered as a primary screening method.

Early diagnosis of pancreatobiliary duct malignancies by brush cytology and biopsy.

Two hundred and five preoperative intraductal samplings (brushing and biopsy) were evaluated from 113 patients with biliary or Wirsung duct strictures. One hundred and three strictures could be specified by histology of the operative specimens, autopsy, or by the patients' clinical course. Preoperative diagnostic efficacy depended on the tumor location (it was the best for ampullary and para-papillary tumors), but the average quantitative indices for sensitivity, absolute sensitivity, specificity, positive and negative predictive values, diagnostic accuracy of cytology were 53%, 20%, 100%, 100%, 25%, 59%, respectively. The same values for biopsy were 43%, 34%, 100%, 100%, 36% and 56%. These figures improved after simultaneous cytology and biopsy. Close cooperation with the endoscopist was necessary in cases of negative, inconclusive and dysplastic (27%) samples. Repetition of sampling improved the results by 8%. Among the 26 preoperative false negative cases, sampling-, technical- and interpretative errors occurred in 84%, 4% and 12%, respectively. Revision of samples revealed 4 malignant cases among the false negative cytologic brushings. Reclassification of specimens considering the latest criteria - primary and secondary malignant features, pancreatic intraepithelial neoplasia (PanINs), etc. - resulted in improvement of the diagnostic efficiency.

[Extracorporeal shock wave lithotripsy of pancreatic stones as a part of complex endoscopic therapy]. / Hasnyálmirigy-vezeték-kövek lökéshullám-kezelése, mint a komplex endoszkópos terápia része.

INTRODUCTION: The authors report on ESWL treatment of 29 patients suffering from pancreatolithiasis. PATIENTS/METHODS: The mean age was 46.5 (23-76) years, there were 7 women and 22 men. The etiology of chronic calcifying pancreatitis was alcohol in 24 (82.7%) cases, idiopathic in 3 (10.3%) patients and there was one familiar and one pancreas divisum case. The indication of ESWL was abdominal pain in 27/29 (93.1%) cases. During ERCP pancreatic sphincterotomy was performed and a nasopancreatic catheter was placed for a continuous lavage with isotonic citrate at a rate of 0.5-1 ml/min for a mean of 6 days. The mean number of ESWLs was 2.2. RESULTS: Fragmentation was achieved in 28/29 (96.5%) patients. There were five (17.5%) complications, fever in three cases, one case of acute relapse of pancreatitis, and one hematuria. The mean number of therapeutic ERCPs was 2.32 (0-7). Overall a complete duct clearance was achieved in 62% (18/29) of the patients, partial clearance in 13.9% (4/29) but the ESWL was unsuccessful in 24.1% (7/29) of the cases. Early pain relief occurred in almost every case (28/29). Twenty four (82.7%) patients were followed for 18.7 (2-33) months. Each patient remained symptom free. The average weight gain was 7.6 kg. The exocrine pancreatic function determined by Lundh test in 7 patients had not improved (11.2 vs. 12.2 pathological value in average). Recurrence of pancreatic duct stones was revealed in four (22.2%) cases among the 18 successfully treated patients after 15 (7-22) months. CONCLUSION: The authors conclude that the ESWL treatment of pancreatic stones together with the endotherapy applied is an effective method for painful pancreatolithiasis.