A new type of rendezvous: introduction of laparo-endoscopy in selected patients.

OBJECTIVE: The aim of this work is to demonstrate the introduction of laparo-endoscopy and to investigate the year-long experience with its use. PATIENTS AND METHODS: In a subgroup of patients with cholecystolithiasis, concomitant lithiasis of the common bile duct may also be present. When the preoperative endoscopic cholangiopancreatography, performed as a result of a suspected choledocholithiasis, was unsuccessful, a "rendezvous" ERCP, laparo-endoscopy, is performed. After a survey of the international literature on the method, and a description of its technique, the authors give a review of the cases of their own 10 patients, which were all successful. RESULTS: These findings emphasise the advantages of the new method in a certain subgroup of patients over the conventional, sequential approach (preoperative ERCP followed by laparoscopic cholecystectomy), and also give technical hints obtained during their performance of the operations up to now. CONCLUSIONS: These results underline the importance of team work that involves the cooperation of a gastroenterologist, a surgeon and an anaesthesiologist in the indication, organisation and implementation of the intervention.

[Epstein-Barr virus genome positive lymphoepithelioma-like carcinoma of the stomach]. / A gyomor Epstein-Barr-vírusgenom pozitív lymphoepitheliomaszerú carcinomája.

EBV is associated with a high number of tumours and non-tumourous conditions. The rare lymphoepithelioma like carcinoma of the stomach,--just as similar tumours of foregut origin (thymus, lung, salivary gland)--are frequently EBV genom positive with the expression of only a few genes (EBV nuclear antigen 1, EBV encoded ribonucleoproteins/EBER/, latency I). On the basis of the clinicopathological analysis of two cases and literature data the authors point out the male predominance and the relatively favourable prognosis of the patients, furthermore the frequent cardial-subcardial localization of these tumours. Since the frequent non-lymphoepithelioma like stomach tumours,--adenocarcinomas,--show EBV genom positivity in about 1% of the cases, it is concluded that the characteristic lymphoepithelioma like histological pattern is not a sine qua non condition of EBV genom positivity. It may also be assumed, that the CD8 and TIA 1 cytotoxic lymphocytes are not virus but tumour cell specific, however not efficient, perhaps not activated. The low level of apoptotic tumour cells supports this assumption. In one of the cases a double tumour, a genom positive lymphoepithelioma like carcinoma and a genom negative adenocarcinoma, adjacent to each other was seen which speaks in favour of common carcinogenetic factors and shows that microscopic neighbourhood is not a necessary condition in viral association. The origin of the possible oncogenic effect of EBV in the absence of the transforming gene products latent membrane protein 1 and EBNA 2 in genom positive stomach carcinomas is uncertain. The significance of the presence in both cases of CD 5+ tumour cells is not clear, the study of further cases is indicated.

[Myocarditis simulating myocardial infarction]. / Szívinfarktust utánzó myocarditis.

Acute myocarditis caused by infectious mononucleosis simulated myocardial infarction, initially the quantitative and qualitative blood picture was normal. Repeated blood and serological studies confirmed the diagnosis, which was altered by acute porphyria caused by infection. In each case of young patients with myocardial infarction and in older patient with coexisting infectious symptoms, myocarditis must be considered. Since the cardiac manifestation may precede the infectious disease symptoms, repeating the necessary examinations may be mandatory.

The antiabortive effect of progesterone-induced blocking factor in mice is manifested by modulating NK activity.

Immunologic effects of progesterone are mediated by a protein named the progesterone-induced blocking factor (PIBF), which inhibits NK activity and displays an antiabortive effect in mice. Our previous data provide indirect evidence for the importance of PIBF in the maintenance of normal gestation. This study was aimed at investigating whether neutralization of endogenous PIBF production influences pregnancy outcome and if so, what are the mechanisms that participate in this process. Syngeneically pregnant Balb/c mice on Day 8.5 of pregnancy were injected ip with 0.3 mg/kg of RU 486 or with 0.5 mg of rabbit anti-PIBF IgG alone, or together with anti-NK monoclonal antibodies. Mice treated with the same amount of normal rabbit serum or untreated mice of similar gestational age were used as controls. On Day 10.5 the ratio of living and resorbed embryos and NK activity of the spleen cells were determined. In mice treated with anti-PIBF the ratio of resorbed fetuses was significantly higher than that in untreated controls. In RU 486-treated mice we also observed significantly increased resorption rate, which was associated with the inability of spleen cells to produce PIBF. Both anti-PIBF treatment and that with progesterone receptor blocker resulted in increased splenic NK activity. There was a positive relationship between NK activity and the rate of resorptions. All the above effects were corrected by simultaneous treatment with anti-NK or anti-NC (natural cytotoxic) antibodies. These data allow the conclusion that PIBF contributes to normal gestation in mice and that the effect of PIBF is manifested via blocking NK and/or NC activity.