Experimental assessment of three electrosurgical tissue-sealing devices in a porcine model.

Three electrosurgical tissue-sealing devices (EnSeal ETSDRC-01, LigaSure LS1500 and Thunderbeat TB-0535PC) were compared regarding sealing time (ST), maximum working temperature (WTmax) and the total (MTZtotal) as well as the collateral microscopic thermal injury zone (MTZcollat) using laparoscopic handpieces 5 mm in diameter on four types of tissue (liver, mesentery, cross striated muscle and spleen) in an in vivo porcine model. LigaSure had the lowest mean ST in spleen, mesentery, muscle and liver, followed by Thunderbeat and EnSeal with significant differences between all types of tissues and devices. The significantly lowest mean WTmax was obtained for EnSeal in mesentery, muscle and liver. LigaSure and EnSeal operated at the lowest temperature in spleen without a significant difference between them. Thunderbeat produced significantly higher temperature peaks in all cases. The lowest mean MTZtotal was caused by LigaSure and EnSeal in spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Nevertheless, Thunderbeat produced the significantly lowest mean MTZtotal in the liver. EnSeal produced the lowest mean MTZcollat in the liver, followed by LigaSure and Thunderbeat showing significant differences. EnSeal and LigaSure produced the lowest mean MTZcollat in the spleen, mesentery and muscle without significant differences between them, followed by the significantly higher values of Thunderbeat. Based on the results of this study, Thunderbeat seems to be more invasive to tissue integrity (even without the activation of the ultrasonic scissor function) than EnSeal or LigaSure, that operate at lower temperatures and were found to cause negligible collateral thermal damage.

[A rare case of chest pain]. / Mellkasi panasz ritka oka.

Chest pain is a common symptom in patients who visit Emergency Departments. The main task is to exclude life-threatening diseases such as acute coronary syndrome, pulmonary embolization and dissection of thoracic aorta. The authors present the history of a patient, who had an intense chest pain for 7 hours. In accordance with the diagnostic algorithm of chest pain, ECG, blood collection, chest X-ray and chest computed tomography angiography were performed. Acute coronary syndrome, pulmonary embolization and dissection of the thoracic aorta were excluded, however, chest computed tomography CT revealed a huge hiatal hernia as an incidental finding. An emergency surgical repair was performed and the patient recovered without any complications. The authors emphasize that the diagnostic algorithms focus on the confirmation or rejection of possible life threatening diseases in case of chest pain. However, it should be kept in mind that rarer causes may occur, which may require involvement of the relevant disciplines and multidisciplinary thinking. Orv. Hetil., 2016, 157(36), 1445-1448.

The role of sentinel node biopsy in male breast cancer.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a standard procedure in women with breast cancer. The risk of morbidity related to axillary lymph node dissection (ALND) is similar for men and women with breast cancer and SLNB could minimize this risk. METHODS: Between January 2004 and August 2013, 25 men with primary breast cancer were operated on at the Bács-Kiskun County Teaching Hospital. These were reviewed retrospectively. SLNB was performed following lymphoscintigraphy with intraoperative gamma probe detection and blue dye mapping. RESULTS: SLNB was successful in all 16 male patients (100 %), in whom it was attempted. The SLNs were negative in 4 cases (25 %) and were involved in 12. Intraoperative imprint cytology was positive in 9 of the 12 involved cases (75 %) and resulted immediate completion ALND. In 7 patients, the intraoperative imprint cytology was negative, with 3 false-negative results that resulted in delayed completion ALND. After a median follow-up of 48 months, there was only one axillary recurrence after ALND and none in the SLNB group. CONCLUSIONS: SLNB is successful and accurate in male breast cancer patients too. Although compared to women a larger proportion of men have positive nodes, for men with negative nodes, ALND-related morbidity may be reduced by SLNB. We recommend SLNB in male patients with breast cancer and clinically negative axilla.

[Early clinical experience with postoperative monitoring of a patient after laparoscopic splenectomy combined with spleen autotransplantation. A case report]. / Minimálisan invazív módszerrel végzett, lép autotranszplantált beteg posztoperatív követésére alkalmazott képalkotó eljárásokkal nyert kezdeti tapasztalataink. Esetismertetés.

We performed splenectomy combined with spleen autotransplantation after blunt abdominal trauma by minimally invasive technique at the County Teaching Hospital in Kecskemét. In case of advanced post traumatic spleen injury, spleen autotransplantation (Furka's spleen chips) is a well-known method to try to avoid postsplenectomy syndrome. During the operation, when in situ preservation of the spleen is not possible, chips of spleen tissue are transplanted into the omentum. Function of the transplanted spleen tissue was monitored by scintigraphy. We describe two different types of spleen scintigraphy to check the viability of spleen chips.

[Intraoperative laser doppler flowmetry of the tissue microcirculation of extraperitoneal transplanted omental flaps on dogs]. / Extraabdominalisan átültetett cseplesz lebeny mikrocirkulációjának intraoperativ vizsgálata laser Doppler flowmetria segítségével kutyán.

The aim of this study was to develop a new method to check of the viability of an extraabdominally transplanted omental flap. We performed free omental transplantation to the left lateral neck region in the frame of a formerly published new esophageal resection series on 5 dogs. Intraoperative laser Doppler flowmetry was performed, before and after isolation, after transplantation, and 14 days after the operation. From the 5 transplanted flaps, 4 survived the transplantation. The flap microcirculation deteriorated immediately after the transplantation, but at the time of re-operation the measurements showed similar microcirculation as control tissues, which proves the viability of the transplanted flaps. In our opinion, in dogs for the intraoperative monitoring of viability and microcirculation of free transplanted omental flaps, laser Doppler flowmetry is a feasible method.

[Kidney neovascularization by the greater omentum after pretreatment with omental angiogenic factor]. / A vese neovascularizatiója a nagycseplesz felhasználásával omentális angiogén faktor elokezeléssel.

BACKGROUND: Several diseases may affect the renal artery and the circulation of the kidney. In these cases alternative blood flow should be secured to preserve renal function. There are experimental methods for this, such as omentonephropexy. In this model the new vessels grow into the kidney from the omentum. METHODS: Thirty mongrel dogs were anaesthetized and operated on. The left kidney was exposed, partially decapsulated, then omental angiogenic factor extractum was placed on the renal surface and the greater omentum was fixed there. After 4 weeks the left renal artery was ligated, and further 4 weeks later the right kidney was removed. Hematology tests were performed, urea, creatinine levels were measured and urine samples were tested after each operations. For statistical analysis Mann-Whitney rank sum and Wilcoxon signed rank tests were used. RESULTS: The survival rate was 20%. Significant elevations were observed in serum creatinine and urea levels after each operation, mostly after the third one and in non-surviving animals. Moderate anaemia was also present. CONCLUSION: The efficacy of the neovascularization presented in this study and the survival rate indicate further investigations are necessary in order to explore the mechanism and the dynamics of the vascularization processes.

Changes in microcirculation after ischemic process in rat skeletal muscle.

Laser Doppler flowmetry (LDF) is a good method to investigate tissue microcirculation, but it has many standardization and measuring problems. To exclude these effects, we performed a test using LDF on rat skeletal muscle. In 12 CD outbred anesthetized rats, bilateral femoral vessels and the quadriceps femoris muscle were exposed. The left femoral artery and vein were clamped for 1 h by microvascular clips (ischemic side). On the right side, no other intervention was made (control side). An LDF probe was applied on the medial vastus muscle. Short-term occlusions (2-3 s) were performed before and after the 1-h clamping and on the control side while LDF curves were registered. The halftimes of ascending curves on the ischemic side were significantly elongated vs. the condition before clamping (P = 0.0007) or the control side (P = 0.0017). Microcirculatory changes caused by 1-h ischemia were shown by this simple, quick, and well-reproducible test on rat skeletal muscle.

Transplantation and microsurgical anastomosis of free omental grafts: experimental animal model of a new operative technique in dogs.

Our objective was the elaboration of a new animal model for the free transplantation of an omental flap and the examination of its viability in dogs. The cooled omental flap from the abdomen was freely transplanted to the lateral cervical region, and its blood supply was established with microsurgical anastomoses. The technique was developed in 5 dogs, and short-term survival examinations were later carried out in 3 cases by means of this method. Postoperative viability was assessed by angiography, methylene blue testing, and histology. Of the 3 transplanted grafts, 2 still survived 1 week after the operation. For technical reasons, 1 flap thrombotized. For determination of the viability of the transplanted graft, histology proved best. Vital reactions, including granulation tissue and angiogenesis, were present on the histological slides. The short-term survival of an omental flap can be ensured with microsurgical transplantation in dogs.