[Comparison of outcome of rigid and self-expanding stents for palliation of malignant dysphagia]. / A malignus eredetu dysphagia palliatív kezelésére használt merev és öntáguló sztentek eredményeinek összehasonlító vizsgálata.

INTRODUCTION: Between 1984 and 2019, 1005 rigid prostheses and 423 self-expanding stents were inserted for palliation of malignant esophageal stenosis. OBJECTIVE: The aim of this study was the comparison of the treatment results using the two types of prosthesis. METHOD: Retrospective analysis has been performed comparing the characteristics and treatment results of the two patients groups referring to the technical success of the procedures, procedure-related complications, change in the quality of life, and survival time. RESULTS: A comparison of average ages, duration time of dysphagia, quantity of weight loss, and the progress of the malignancy proves that palliation with self-expanding stents made it possible to treat more patients in worse condition. The number of complications in the patient group treated with stents was significantly higher at 29.3%/20.9%. Endoscopic intervention was performed to treat complications in 68.6% of cases with rigid prostheses and in 53.2% of patients treated with stents. Relevant improvement of dysphagia and the patients' quality of life was observed in 97% of those who were treated with a rigid prosthesis and in 91.3% of those who were treated with self-expanding stents. The survival time in the group of patients treated with stents was significantly shorter by 4.3/5.4 months than in the other group. CONCLUSION: The use of self-expanding stents in palliative treatment of malignant strictures have brought significant changes in everyday practice with increasing the possibilities. The treatment results were not improved by their application as much as the worse condition of the patient group worsened them. Orv Hetil. 2022; 163(49): 1952-1961.

Oesophagus stricture caused by late metastasis of breast cancer / Emlodaganat nyelocsoszukületet okozó késoi áttéte

Oesophageal strictures due to mediastinal metastases from breast cancer mean a significant diagnostic and therapeutic challenge, since they are relatively rare, difficult to identify and detect. In our case, slowly progressive dysphagia developed 19 years after mastectomy. During dilatation of the stricture, which was thought benign first, the oesophagus was perforated. We were compelled to perform an acute transhiatal oesophagectomy with orthotopic replacement and gastric bypass. The treatment method we applied under pressure of necessity differed from our routine protocol at many points, nevertheless, it resulted in the recovery of the patient. Histopathological tissue analysis of the resected oesophagus helped to discover the real pathological reason: mediastinal breast cancer metastasis causing circular and almost complete occlusion.

Reconstruction with hypopharyngo-gastrostomy after esophagus extirpation due to spontaneous esophageal perforation. / [Nyelocso-perforatio miatt végzett oesophagusexstirpatio rekonstrukciója hypopharyngogastrostoma képzésével].

Despite the significant improvement in surgical and intensive care therapy, esophageal perforation is still a severe, life-threatening condition. As the underlying causes, the accompanying disorders, the localization and the extent of the inflammation vary, the surgeon may sometimes encounter unexpected situations. A 58-year-old female developed necrotizing mediastinitis due to esophageal perforation as the result of incarcerated thoracic hernia of the stomach, therefore, we had to perform esophagus extirpation and cervical esophagostomy. During the reconstruction of the intestinal tract, we found shrinkage of the complete esophageal stump with unknown cause. The gastric sleeve was joined to the hypopharynx. Insufficiency was solved with conservative therapy. The patient regained partial swallowing ability after complex dysphagia treatment. Hyophapharyngo-gastrostomy done due to non-malignant disease is extremely rare in the literature, however, it can be a surgical technique of choice if required as in our case. It should be followed by rehabilitation done by a team, with emphasis on dysphagia treatment. Orv Hetil. 2020; 161(18): 756-760.

Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios as Prognostic Markers of Survival in Patients with Head and Neck Tumours-Results of a Retrospective Multicentric Study.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) may be useful for drawing conclusions about the survival of head and neck squamous cell carcinoma (HNSCC) patients. METHODS: Clinical data of 156 patients managed for HNSCC at two head and neck surgery centres were analyzed retrospectively. We studied the relationships between survival and PLR as well as NLR. RESULTS: With regards to 5-year survival, the difference between the two groups with PLR values lower or higher than the threshold was statistically significant (p = 0.004), and we found the same for disease-free survival (p = 0.05), and tumour-specific mortality (p = 0.009). Concerning NLR, the difference in tumour-specific survival was statistically significant (p = 0.006). According to the multivariate analysis, NLR values higher than the threshold indicated an enhanced risk for overall as well as for tumour-specific mortality. CONCLUSION: In HNSCC patients, a high NLR may be considered as an independent risk factor for 5-year overall survival.

The Esophageal Adenocarcinoma Epidemic Has Reached Hungary: A Multicenter, Cross-Sectional Study.

BACKGROUND: The epidemiology of esophageal cancer has changed dramatically over the past 4 decades in many Western populations. We aimed to understand the Hungarian epidemiologic trends of esophageal squamous cell cancer (SCC) and adenocarcinoma (AC). METHODS: We performed a cross-sectional study using data from esophageal cancer patients diagnosed between 1992 and 2018 at eight tertiary referral centers in four major cities of Hungary. We retrospectively identified cases in the electronic databases of each center and collected data on gender, age at diagnosis, year of diagnosis, specialty of the origin center, histological type, and localization of the tumor. Patients were grouped based on the two main histological types: AC or SCC. For statistical analysis, we used linear regression models, chi-square tests, and independent sample t tests. RESULTS: We extracted data on 3,283 patients with esophageal cancer. Of these, 2,632 were diagnosed with either of the two main histological types; 737 had AC and 1,895 SCC. There was no significant difference in the gender ratio of the patients between AC and SCC (80.1 vs 81.8% males, respectively; p = 0.261). The relative incidence of AC increased over the years (p < 0.001, b = 1.19 CI: 0.84-1.54). AC patients were older at diagnosis than SCC patients (64.37 ± 11.59 vs 60.30 ± 10.07 years, p < 0.001). The age of patients at the diagnosis of primary esophageal cancer increased over time (p < 0.001, R = 0.119). CONCLUSIONS: The rapid increase in the relative incidence of AC and simultaneous decrease of the relative incidence of SCC suggest that this well-established Western phenomenon is also present in Hungary.

[Cases of migration of swallowed foreign bodies from the gastrointestinal tract]. / A gastrointestinalis traktusból migrált, lenyelt idegen testek esetei.

Migration of swallowed foreign bodies from the gastrointestinal tract is a rare phenomenon compared with the total number of ingestions. In the reported two cases, the serious septic condition indicated urgent surgical intervention. We found a piece of wire swallowed a few months earlier in the right lobe of the liver and the retroperitoneum in case one, and a piece of wire in the pericardium, which migrated from the stomach through the left lobe of the liver, in case two. Abscesses and phlegmonae were found in the retroperitoneum and then in the femoral region requiring a reoperation in case one, and in the liver and pericardium in case two. After the evacuation of abscesses, both patients made full recovery. Diagnostic difficulties and therapeutic challenges served the reasons to present these cases. Orv Hetil. 2019; 160(42): 1677-1681.

[Diverticulosis and diverticulitis of the vermiform appendix. Report of a case and review of the literature]. / A féregnyúlvány diverticulosisa, diverticulitise. Esetismertetés és irodalmi áttekintés.

Diverticulitis of the vermiform appendix is a rare disease with clinical features often similar to conventional acute appendicitis. The importance of appendiceal diverticulosis is the fact that it can lead to an early and a higher incidence of perforation and therefore a higher mortality rate, in contrast to acute appendicitis alone. In this study we present the clinicopathology, diagnosis and therapy of the disease with a review of the literature. A 65-year-old woman presented to the emergency department with a 48-hour history of intermittent pain in the right iliac fossa. Abdominal ultrasound raised the possibility of acute appendicitis but because of the relative asymptomatic state of the patient, the lack of fever and rebound tenderness we started observation. After 2 days with episodic abdominal pain, the patient was taken to the operating theatre for laparoscopic exploration. Intraoperatively, multiple diverticula were noted on the appendix and appendectomy was performed. Histopathological examination revealed diverticulosis and inflammation of the appendiceal wall. Due to the possible complications, the difficult preoperative diagnosis and its frequent association with appendiceal neoplasm, appendiceal diverticulosis requires special attention. For asymptomatic cases, incidentally diagnosed intraoperatively or discovered by radiology prophylactic appendectomy is recommended. Orv Hetil. 2018; 159(19): 768-772.

Thrombocytosis of Liver Metastasis from Colorectal Cancer as Predictive Factor.

There is increasing evidence that thrombocytosis is associated with tumor invasion and metastasis formation. It was shown in several solid tumor types that thrombocytosis prognosticates cancer progression. The aim of this study was to evaluate preoperative thrombocytosis as a potential prognostic biomarker in isolated metastases, in patients with liver metastasis of colorectal cancer (mCRC). Clinicopathological data of 166 patients with mCRC who had surgical resection between 2001 and 2011 were collected retrospectively. All primary tumors have been already resected. The platelet count was evaluated based on the standard preoperative blood profile. The patients were followed-up on average for 28 months. Overall survival (OS) of patients with thrombocytosis was significantly worse both in univariate (HR = 3.00, p = 0.03) and in multivariate analysis (HR = 4.68, p = 0.056) when adjusted for gender, age, tumor size and surgical margin. Thrombocytosis was also a good prognosticator of disease-free survival (DFS) with HR = 2.7, p = 0.018 and nearly significant in multivariate setting (HR = 2.26, p = 0.073). The platelet count is a valuable prognostic marker for the survival in patients with mCRC.