[Application of computed tomography and abdominal pressure measurement in the treatment of giant incisional hernias]. / Számítógépes tomográfia és hasurinyomás-mérés alkalmazása az óriás medián hegsérvek kezelésében.

Introduction: Giant abdominal wall defects represent a major challenge for surgeons. CT scan can determine the ratio between the volume of the hernia sac and the abdominal cavity, determining the extent of the disproportion, which is related to the postoperative abdominal pressure value. Aim: Confirmation of the significance of CT examination in postoperative giant abdominal wall defects, effectiveness analysis of the reconstruction method by abdominal pressure measurement. Method: A prospective study is conducted on patients with giant incisional hernias, with preoperatively performed abdominal CT scan. Tension-free abdominal wall reconstruction is realized with retromuscular Prolene mesh and hernial sac. Abdominal pressure is measured during and after surgery. Patients' follow-up is performed through phone after 2-4-6 months. Results: We present our results through three cases. First case: 48-year-old woman presented a giant recurrent incisional hernia and multiple comorbidities. Maximum defect diameter was: 155 mm, hernia volume: 1536.63 cm3, BMI = 43.6. The patient was discharged after seven days. Second case: 51-year-old male patient presented with multilocular giant incisional hernia, BMI = 26,85. Maximum diameter of the two wall defects were 123 mm and 105 mm, their total volume: 406.41cm3. The patient was discharged after five days. Third case: A 67-year-old male patient presented with giant incisional hernia. The abdominal defect size was 100/100 mm (LL/CC), volume: 258.10 cm3, BMI = 23.7. The patient was discharged after four days. Conclusion: The proper surgical technique can be established based on the preoperative CT scan. Abdominal wall reconstruction with retromuscular Prolene mesh and hernial sac provides a cheap, reliable, tension-free technique. The technique's short-term efficacy can be determined by abdominal pressure measuring through the bladder. Orv Hetil. 2020; 161(9): 347-353.

[Traumatic asphyxia with permanent visual loss. Case report]. / Traumás asphyxia maradandó látásvesztéssel.

Traumatic asphyxia is a rare condition that occurs after compressive thoracoabdominal trauma, which is characterized by subconjunctival hemorrhage, cervicofacial cyanosis, edema and petechiae. Serious life-threatening thoracic and abdominal injuries may coexist. After conservatory treatment in most cases complete recovery is achieved, but in isolated cases permanent neurological lesions may occur. We present the case of the 39-year-old male patient who suffered a compressive thoracoabdominal trauma. The physical examination showed the characteristic "ecchymotic mask". After surgical treatment of the abdominal injuries and intensive therapy the patient was discharged with permanent vision loss. The high retrograde venous pressure in the head and neck may be associated with neuronal ischemia, which can lead to irreversible optic nerve atrophy. It is therefore important to carry out an early, routine and complete ophtalmologic examination, especially in the intubated and poorly cooperative patients. Orv Hetil. 2017; 158(22): 864-868.

Clinico-pathological particularities of the shock-related pancreatitis.

Acute pancreatitis can develop in patients with shock due to the underlying diseases, surgical interventions or because of severe hypoperfusion. The aim of our work was to study the histological alterations of the pancreas in patients dying after cardiogenic, hypovolemic or septic shock, to demonstrate the presence and severity of pancreatic injury. We performed a retrospective study which included patients who died and who were autopsied after different types of shock, hospitalized between 2007-2009 in general and cardiac intensive care units. We excluded the patients with known pancreatic diseases. From 223 patients included in our study 39 presented necrotising hemorrhagic alteration of the pancreatic tissue. There were no differences in histological and immunohistochemical findings between the different etiopathogenetic types of shock. None of the patients had characteristic clinical signs for acute pancreatitis. The digestive symptoms, they presented, could be related to the underlying disease or to postoperative state. The common findings in these patients were prolonged and severe hypotension, associated renal dysfunction, leucocytosis, hyperglycemia and hypocalcemia. Pancreatitis can occur in patients with shock, due to prolonged hypoperfusion of the pancreas. It is difficult to diagnose it because clinical signs are altered due to severity of underlying disease or analgo-sedation commonly used in intensive care. We therefore recommend in patients with shock to consider the possible development of ischemic pancreatitis for prompt and efficient treatment.

An immunohistochemical study of colon adenomas and carcinomas: E-cadherin, Syndecan-1, Ets-1.

It is thought that dysregulation of E-cadherin, syndecan-1 (CD138) and Ets-1 is involved in carcinoma development. E-cadherin is an important epithelial cell adhesion molecule; syndecan-1 (CD138) is a regulatory proteoglycan in both cell-cell and cell-matrix adhesion and Ets-1 is a proto-oncogene and transcription factor, which takes part in extracellular matrix remodeling. Our goal was to study the changes in the expression of these molecules during colon carcinoma development and progression. We tested 117 colon adenomas and 149 de novo and ex adenoma carcinomas of the colon, using the Ultravision Polymer system. The positive reaction rate was 100% for E-cadherin, 98.3% for syndecan-1 and 22.4% for Ets-1 in adenomas, while in carcinomas it was 88.5%, 62.4% and 56.3% respectively. We found decreasing expression of E-cadherin and syndecan-1 throughout colon carcinoma progression and an opposite regulation for the Ets-1 protein. Decrease in expression of syndecan-1 is more pronounced in carcinomas compared to E-cadherin. De novo carcinomas have lower E-cadherin and syndecan-1 expression, and higher Ets-1 expression compared to ex adenoma carcinomas. These findings support the hypothesis that there are differences in the carcinogenesis of these tumors.

Morphometric investigation of carotid body in sudden infant death syndrome.

BACKGROUND: The pathomechanism of sudden infant death syndrome (SIDS) has not been clarified yet. The high rate of early progenitor cells in carotid body has been reported as a pathognomic feature for SIDS. AIM AND STUDY DESIGN: The morphometric analysis was done by NIKON Eclipse microscope with a morphometric program Lucia G. SUBJECTS: This study was designed to investigate the structure and developmental state of carotid body in SIDS and non-SIDS cases. A comparison was made between the rates of dark and early progenitor cells. OUTCOME MEASURES: The Kruskal-Wallis test showed a significantly higher number of progenitor cells in the SIDS group than in controls (p=0.0003). RESULTS AND CONCLUSION: In this study on Hungarian SIDS cases we confirmed the observation that infants who died suddenly have an underdeveloped carotid body.