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Introduction: Idiopathic inflammatory myopathies are a group of clinically heterogeneous diseases, which have been classified by myositis specific antibodies recently. The anti-SRP positive subset of this group is characterized by more severe clinical prognosis than other myositis specific antibody positive types., Aim: Our goal was to compare 16 anti-SRP positive patients in the Division of Clinical Immunology, Department of Internal Medicine, University of Debrecen with 16 antibody negative ones., Method: Muscle strength validated in both groups by the manual muscle test proved to be significantly decreased both before and after therapy (χ 2 = 0.006 and 0.019) in the anti-SRP positive group., Results: Muscle-specific inflammatory laboratory parameters showed significant difference only in case of LDH-levels after therapy. Both groups showed good clinical response to first line steroid treatment, yet the significantly higher rate of second line administration suggests worse therapeutic response of the antibody positive group., Conclusion: Based on these facts we determined poor clinical prognosis and therapeutic response of the anti-SRP positive group. Orv Hetil. 2017; 158(35): 1382-1389.

Unlabelled: From time to time there is a surprise at the end of surgery - even after subtotal resection - when a vocal cord is observed on indirect laryngoscopy to be non-functional. Surgeons are highly individualistic and develop their own special ways of locating and protecting the nerve. The present study has tried to clarify whether relying on palpation alone during surgery is safe enough in each case., Materials and Methods: Between 01.01.2001 and 31.12.2008, 1228 recurrent laryngeal nerve (RLN) were exposed in 702 patients on thyroid surgery. The RLN was found and traced until the laryngeal entry point in all patients. Substernal spreading was noted in 38.6% (271/702), while tracheal compression or dislocation was present in 19.5% (137/702). Recurrent thyroid disease counted for 8.4% (59/702) of all cases. Total thyroid lobectomy was carried out in 82.2% (1009/1228), near-total thyroidectomy in 15.5% (191/1228), and subtotal resection only in 2.3% (28/1228)., Results: Palpation was helpful in 80.7% (991/1228), proved false positive in 8.7% (107/1228), while in 10.6% (130/1228) it did not provide any help in the localization. The palpability of the RLN showed marked discrepancy between the two sides. False positivity was noted with palpation in 3.4% (21/625) and 14.3% (86/603) on the right and left side, respectively. On the other hand, palpation helped localization in 4.8% (29/603) on the left side, while the same figure was 16.2% (101/603) on the right side. Definitive RLN palsy was experienced in 0.8% of all cases (10/1228), whilst transient paresis was encountered in 1.4% (17/1228). Occult malignancy was noticed in 5.6% (39/702)., Conclusions: No indication has been left for subtotal resection. Even if benign multinodular goitre is present, since the clinical and pathophysiological evidences suggest that multinodular goitre affects the entire gland, any surgery that leaves potentially abnormal thyroid tissue in situ carries a risk of recurrent disease. RLN palpatory method is a useful part of thyroid surgery but it is suitable for rough orientation only.

Malignant gastrointestinal stromal tumor arising in a duodenal diverticulum. The authors describe the case of a 74-year-old male patient who was operated on for a GIST found in a large duodenal diverticulum, co-using gastrointestinal bleeding. This diverticulum--including the tumor--was removed by resection the distal part of the stomach and proximal third of duodenum. The histology revealed malignant gastrointestinal stromal tumor (GIST). 6 months after the operation he remained tumor free according to the control examinations. On the basis of new pathologic classification we summarise the signs, the diagnostic and therapeutic possibilities and the histologic characteristics of gastrointestinal stromal tumors.

Introduction: Mediastinal alterations causing esophageal dysfunctions originate from malignant or inflammatory diseases and in a few cases from congenital anomalies., Case Report: The authors report the medical history of a 27-year-old woman whose large (35-40 mm in diameter) cystic lesion was causing compression of the middle third esophagus and dysphagia. Because of subjective complaints resection was made from a right posterolateral "muscle-preserving" thoracotomy. Histological examination verified an intramural, esophageal cyst. After the 7th postoperative day the patient was discharged from the hospital, currently she is without symptoms and complaints., Discussion: In the background of esophageal dysfunctions can be a mediastinal lesion causing external compression. This lesion, in a few cases, is a congenital anomaly, which develops during the separation of the respiratory- and the digestive apparatus. Probably the effect of increased divisional tendency can create the partial duplication of developing organs, i.e. trachea, esophagus. Later these are described as bronchogenic or enterogenic cysts. Literature mentions cases about ciliated columnal epithelium, ventricular mucosa or malignancy covering the inner surface of the cyst. Preoperative examinations are not enough to describe a mediastinal cyst. According to the surgical guidelines a case without complaints is only a relative indication to operate. If it is followed, an occasional malignant transformation will not be recognized, or will be recognized too late., Conclusion: As we know, a mediastinal cystic lesion never regresses. Because of the tendency of malignant transformation, in the absence of operative contraindication, surgical resection is the method of choice even in symptom-free cases.

Ectopic pancreas is an uncommon clinical finding. It is rare for heterotopic pancreas tissue to cause symptoms, however every disease of the pancreas may develop in it. The most common sites for ectopic pancreas are the submucosal layer of the stomach and the small intestine. Symptomatic ectopic pancreas usually causes diagnostic difficulties. Surgical excision is recommended if the patient has complaints. We report the case of a 32-year-old man. We performed subtotal gastrectomy because of a submucosal, antral tumour, that caused gastric outlet obstruction. The histological examination verified ectopic pancreas tissue. The patient recovered without any complications.

Introduction: Epiphrenic diverticulum cannot be considered a primary anatomical alteration, there is a manometrically verifiable motility disturbance in the background., Objectives: To determine the place, type and time of surgical solution in the treatment., Patients: Between 1999 and 2004 seven patients were treated for epiphrenic diverticulum causing complaints. Average age was 61 years, and the leading symptom was dysphagia and regurgitation. Motility abnormalities characteristic of achalasia in four cases, hypertensive LES in three cases, and incompetent and normal LES, and diffuse esophageal spasm in one patient each could be revealed. The size of diverticuli varied between 5-9 cm., Results: In four cases transthoracic diverticulectomy myotomy and partial antireflux plasty, in two cases esophagus resection, and in the case of one patient myotomy and fundoplication was performed. In the removed diverticuli an ulcer and a malignant transformation in one case each was detected. No major complications could be observed. Six patients are completely satisfied with the operation, only one reported well tolerable occasional regurgitations., Conclusion: Even in the era of minimal invasive surgery the traditionally performed, combined - diverticulectomy, myotomy, fundoplication - operative solution should be considered the gold standard. Surgical intervention is justified even for accidentally discovered symptomless patients, due to the considerable potential complications of the disease.