Transmesenteriális colon átvezetéses colorectális anasztomózis.

Introduction: A crucial element of colorectal surgery is ensuring a safe anastomosis. In order to avoid the most significant complication - anastomotic leakage - two factors are essential: adequate blood supply and a tension-free suture. After extended resections, the mobilised colon sometimes cannot be connected to the rectal stump without tension. In these cases, transmesenteric placement of the transverse colon may facilitate a tension free anastomosis. Methods: The results of transmesenteric colorectal anastomoses performed at the Surgical Department of the BAZ County Central Hospital and University Teaching Hospital are reviewed and compared with literature data. Results: Eight patients underwent transmesenteric colorectal anastomosis. No anastomotic insufficiency was observed. Intra-operative blood loss, postoperative intestinal passage induction were similar to those expected with conventional anastomosis. Six cases were completed by laparoscopy, two by laparotomy, and two patients have been converted after laparoscopy. Conclusion: Extended left sided colorectal resections may result in inadequate residual bowel length, which could compromise the anastomosis. When the mobilised left colon does not reach the rectum without tension, transmesenterically placed transverse colon can be used. This surgical technique, which can also be performed laparoscopically, represents a safe alternative of achieving a tension-free anastomosis.

[Pulmonary histiocytic sarcoma]. / A tüdo histiocytás sarcomája.

Histiocytic sarcoma is an uncommon hematological malignancy. Its occurrence in the lung is very rare. Due to the small number of cases and the clinical and pathological features of the disease, the diagnosis can be challenging. Its optimal treatment is not yet known, in locally confined cases - depending on the location and size - surgical removal is part of complex oncotherapy. We report the case of a 52-year-old man with a tumor of central localization in the left lung. Pulmonectomy was performed. Histology verified histiocytic sarcoma of the lung. An overview of clinical features of the entity is presented in connection with our case report. Orv Heti. 2023; 164(34): 1350-1357.

[Rare case of primary pulmonary myxoid sarcoma]. / Primer myxoid tüdosarcoma ritka esete.

Mesenchymal tumors of the lungs are rare, mostly aggressive, with a high metastatic rate, representing only 0.013-1.1% of all pulmonary malignancies. Primary pulmonary myxoid sarcoma is an extremely rare type of lung sarcoma and stands as a separate entity in the 2015 WHO classification, characterized by EWSR1-CREB fusion gene. So far, 37 myxoid sarcoma cases have been reported. We offer an overview of the most important characteristics of pulmonary myxoid sarcoma and differential diagnosis, while reviewing the reported cases. We present the case of a 47-year-old patient with pulmonary myxoid sarcoma, who was diagnosed with a right central pulmonary mass, showing rapid endobronchial progression, complicated by empyema. EWSR1 gene translocation could not be detected. During chemotherapy, tumor progression occurred. Molecular genetic examinations revealed MET gene exon 14 skipping mutation, based on which tyrosine-kinase inhibitor treatment was administered. Pulmonary myxoid sarcoma can be classified as a nonvascular, spindle cell entity of mesenchymal tumors, with the characteristic EWSR1-CREB1 gene translocation. The male-female ratio is similar, with a slightly higher incidence in middle-aged women (1.5 : 1). Patients' average age is 44 years; with predilection in the right upper lobe (62%), or endobronchially (85%). Without specific symptoms, diagnosis is often cumbersome. Immunohistochemical methods, typical hystological image and molecular genetic tests confirm the diagnosis. Pulmonary myxoid sarcoma is a rare entity, without specific symptoms. In our case, myxoid sarcoma was complicated by empyema, which was drained. Because of advanced stage, surgical resection was not an option. Radical surgery offers the best results, in inoperable cases therapeutic recommendations for sarcomas are the guiding principles. Our case belongs to the rare group of myxoid sarcomas, where MET activating mutation was detected, making it eligible for targeted treatment. Orv Hetil. 2023; 164(27): 1077-1083.

Evidence-Based and User-Centred Development of an Ecounseling & Learning-System for Parents of Children with ADHD.

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood and adolescence. It is characterized by attention deficit, hyperactivity, and impulsivity as the main symptoms. These can lead to increased stress in everyday life for the entire family. The e-counseling and e-learning application is being developed within the ELSA project to support parents of ADHD-diagnosed children in everyday life. The requirements identified included, for example, advice on children's restlessness or measures against sibling rivalry.

Modern treatment of massive hemothorax / A masszív haemothorax modern kezelése

Introduction and objective: Hemothorax is an umbrella term for pathologies with an extremely wide range of etiology and severity. Most commonly it is of tramuatic origin, frequently iatrogenic (intervention, blood coagulation altering therapy) and rarely unknown. Depending on the cause, volume, and dynamics, it requires a patient-adapted treatment determined by access to certain therapeutical methods. We aim to provide a practical overview of these. Methods: Retrospective analysis of patients treated for haemothorax at the Thoracic Surgery Department of Borsod-Abaúj-Zemplén County Teaching Hospital in the period 1 January 2017­31 December 2021 has been performed. We used the hospital's database to collect data. In this paper, we analyze the cause of hemothorax, method of treatment, the efficacy of chosen therapeutic modality, duration of hospital stay, complication rate, 30-day survival. Results: 77 patients were treated with hemothorax, 57 male, 20 female patients. Average age was 53,4 (23­90, SD:14,9) years. Surgery was performed in 31 cases, with 10 cases needing reintervention. In 7 cases, multimodal approach was chosen, with chest wall stabilization. Average hospital stay: 14 (2­79) days. 30-day survival: 95%. Discussion: Thoracic drainage is our first therapeutic choice. The methods used in the treatment of hemothorax in our practice have been extended with the use of digital subtraction angiography (DSA), which yields immediate and effective bleeding control. We performed video-assisted thoracoscopic surgery (VATS) in increasing numbers. Conclusions: As long as the intensity of bleeding and patient's general status allows it, after drainage, the first therapeutic option ­ when accessible ­ should be DSA bleeding control. In cases which do not resolve after drainage, VATS evacuation of hematoma is a safe method used in the treatment of hemothorax. In the past 5 years, we used thoracoscopy in increasing numbers while treating this entity. Based on our results and the literature, we can safely state that the use of thoracoscopy in the treatment of hemothorax is a safe and reliable option in eligible patients, and the results are comparable with those treated by thoracotomy.

In Vitro and In Vivo Effect of Poplar Bud Extracts on Phytophthora infestans: A New Effective Biological Method in Potato Late Blight Control.

The effect of populin extract from black poplar (Populus nigra) on seven different late blight strains was tested under laboratory and field conditions. The growth rate of hyphae was found to be significantly lower in vitro after 3 and 4 v/v% populin applications. Stain M16 was resistant to populin treatment under lab conditions, however. Both 5% and 10% concentration populin reduced the M16 strain's severity on potato leaves under field conditions and proved to be even more effective than conventionally used fungicides Infinito 687 Sc and Valis M. Higher infection intensity at the 1% level was observed after 24 h using Valis M, and the same trend toward 10% infection remained after 48 and 72 h as well. Low, almost-no-infection intensity was detected after populin 5% and 10% treatment under an open field condition. Altogether, it can be concluded that populin extract can be a low-cost option for growers and an environmentally friendly approach in late blight control.

Primary angiosarcoma of the pancreas mimicking severe acute pancreatitis--case report.

Primary angiosarcoma of the pancreas is an extremely rare neoplasm that often mimicks severe acute pancreatitis. A 58-year-old man was admitted with clinical and laboratory signs of severe acute pancreatitis. Contrast enhanced CT scan demonstrated haemorrhagic necrotizing inflammation of the pancreas involving the pancreatic tail, splenic hilum and small bowels with multiple peripancreatic and free abdominal fluid collection. Percutaneous drainage was performed. After 13 days, laparotomy was indicated because of persistent intra-abdominal bleeding, fever and a palpable, rapidly growing mass in the left upper quadrant of the abdomen. During the operation a necrotic, haemorrhagic mass was found in the pancreatic tail; a frozen section showed malignancy, although the tumour was unresectable. Despite all conservative and surgical therapeutic attempts, the patient died within four weeks after diagnosis. Final histology justified primary angiosarcoma of the pancreas. If a patient with signs of severe acute pancreatitis has fever without elevated PCT, the presence of a malignant tumour of the pancreas should be considered.

[Successful treatment of retrohepatic inferior vena cava injury: report of two cases]. / Retrohepaticus vena cava sérülés két sikeresen operált esete.

UNLABELLED: Authors present two cases of successfully operated patients with retrohepatic inferior vena cava (IVC) injury. In the first case a 79 year old female patient suffered from multiple stab wounds in the area of the 4th segment of the right lung as well as in the retrohepatic region in close proximity to the IVC. At the time of the first surgery the IVC injury was not identified. During a second operation, however, the IVC was isolated from the liver using an anterior dissection of the parenchyma with finger-fracture technique and the injury was oversawn finally. Successful haemostasis of the liver was achieved by packing of the perihepatic space, which was removed three days later. In the second case a 25 year-old male patient had suffered blunt abdominal trauma. He underwent laparotomy and packing on the site of the hepatic injury, which had to be repeated seven more times. Later on, another urgent laparotomy was carried out for recurring intraabdominal bleeding and bile leakage, and cholecystectomy was performed due to gallbladder perforation. Another two days later a further emergency laparotomy was indicated for ongoing intraabdominal bleeding, when the bleeding source - an injury (3 mm in diameter) of the retrohepatic IVC - was oversawn. After relatively long postoperative stay both patients were fully recovered and discharged from hospital. CONCLUSIONS: penetrating injuries of the IVC are associated with high mortality rate of approximately 78%. Proper management of these injuries requires experience in both vascular and liver surgery. Retrohepatic IVC injury needs to be considered in the differential diagnosis of ongoing bleeding in penetrating or blunt liver trauma. Packing of the liver is a reliable haemostatic method if bleeding persists due to division of the liver parenchyma.

[Distal pancreas resection for metastasis of clear cell renal cancer]. / Distalis pancreasresectio világos sejtes veserák metastasisa miatt.

BACKGROUND: Distant spread from renal cell carcinoma is commonly found in the liver and lung. Metastatic involvement of any other gastro-intestinal organ (duodenum, other kidney, adrenal gland) is unexpected. However, clear cell renal carcinoma is known to cause pancreatic metastasis. METHODS: The authors present the case of a successfully operated 82- year-old man, who was operated for a metastatic tumor in his pancreas. 8 years prior to his current hospitalization, a left sided nephrectomy was performed for renal cell carcinoma. The CT scan revealed a tumor localised in the tail of the pancreas. Distal pancreas resection was performed with splenectomy. Histology revealed clear cell renal carcinoma metastasis. CONCLUSIONS: pancreatic tumors are mostly primaries. Renal cell carcinoma generally gives hepatic and pulmonary metastases. However, clear cell renal carcinoma is known to give pancreatic metastasis, too.