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Background/aims: Surgical technique and experience are considered as significant determinants of the successful treatment of recto-sigmoid malignancies., Methods: Two hundred patients operated on between 2005 and 2009 were prospectively followed with an average of 39.8 months. Patients with rectosigmoid or rectal cancer were included, either with primary resection or resection after neoadjuvant therapy. The primary aim was to assess the average survival in the two groups; secondary outcomes were stage specific survival and the incidence of loco-regional recurrence and distant metastases. Intra- and postoperative complications, operating time, onco-pathological specimen quality and length of stay were also analysed., Results: During the follow-up comparable rates for 3-year survival and recurrence rates were found without statistical difference. Hospital stay in the laparoscopic group was significantly shorter and the mid-term survival rates were also better in the more advanced stages. Incisional hernia rate was significantly lower in the laparoscopic group., Conclusions: The results of laparoscopic rectal and recto-sigmoid resections were not inferior, and - in some aspects - they were even better compared to open procedures. Adding the properties of the minimally invasive technique (shorter recovery, reduced surgical stress reaction) this should be the preferred method of operative approach.

Introduction: Minimal invasive surgery of the adrenal gland is a "gold standard" procedure worldwide. Authors compare operative data to a historical control group retrospectively analyzing an almost 15 years period., Material and Methods: Between 1997 and 2011, 175 transabdominal laparoscopic adrenalectomies were performed with the lateral approach. On the left side, a new "suprasplenic" approach was introduced with the superior mobilization of the spleen, and transection of the short gastric vessels. For larger lesions (above 7 cm) hand assisted laparoscopic method was applied., Results: Average operative time of laparoscopic surgery was 77 minutes, compared to 115 minutes of open surgery. The average size of the tumor was 3.1 cm in the laparoscopic, and 4.9 cm in the open group. The largest tumors were similar in both groups, however the rate of smaller sized lesions was higher in the laparoscopic one. Conversion was required in 15 cases (8.6%) mostly due to bleeding. Complication rate was 10.8% in the laparoscopic and 24.6% in the conventional group. Hospital stay was significantly shorter with the laparoscopic technique (4.5 vs. 8.1 days). Among laparoscopic cases unexpected primary malignancy was reported in 3 cases (1.7%)., Conclusions: The laparoscopic technique is the procedure of choice in case of benign adrenal tumors, which offer many advantages. Most metastasis localized to the adrenals can also be removed laparoscopically with expertise and self-restraint, without oncologic compromise. To assure the quality of pre- and postoperative care, cooperation with an endocrinologist is indispensable.

The prediction of graft rejection can play an important part in graft survival. Analysis of immune reactions has shown that graft rejection shares mechanisms with recurrent abortions during pregnancy. Progesterone-induced blocking factor (PIBF), a mediator of progesterone that blocks natural killer cell activity in peripheral blood, produces antiabortive effects. The aim of this study was to examine the PIBF concentration in the urine of transplanted recipients. The study included 116 white adults (70 men and 46 women) of median age 49.3 years, who had undergone kidney transplantations. The median duration after transplantation was 3.46 years. The average period between renal disease and our measurement was 12.3 years, and the median interval between graft rejection and our study was 1.75 years. Urine samples were used to measure PIBF concentrations by an enzyme-linked immunsorbent assay. PIBF urinary concentrations decreased significantly in patients who experienced ≥1 rejection episode (31.8±2.2 ng/mL) compared with those without any episode (22.7±1.2 ng/ml; P<.01). Moreover, the urinary PIBF level was significantly lower among patients who had increased creatinine and urea nitrogen levels in blood samples (P<.05 and P<.01, respectively). Decreased PIBF values in kidney transplant patients followed previous rejection episodes. A close negative correlation was observed between urinary PIBF concentrations and blood levels of creatinine and urea nitrogen. These findings suggested that PIBF detection may predict graft rejection in transplant recipients., (Copyright © 2011 Elsevier Inc. All rights reserved.)

There is increasing evidence that nonmelanoma skin cancers (NMSCs) are the most frequently observed tumors in transplant recipients. The incidence of posttransplantation NMSC was determined using our dermatologic screening program. Included in the study were 116 white adults (70 men and 46 women; median age, 49.3 years) who had undergone kidney or combined kidney-pancreas transplantation, with follow-up from September 2008 to December 2009. All patients underwent a full skin examination for NMSC, and completed a standardized questionnaire. Screening resulted in detection of 16 NMSCs in 11 patients out of 116 (9.5%). Lesions were equally distributed by sex, and were detected at a median of 4.1 years posttransplantation. Histologic analysis verified 13 basal cell carcinomas and 3 squamous cell carcinomas (ratio, 4:1). The incidence of NMSC was significantly greater in patients who received cyclosporine immunosuppression therapy (16 vs 1; P < .05), had experienced 2 or more painful sunburns before transplantation (10 vs 11), or worked outdoors (10 vs 11). These data indicate the relevance of skin cancer surveillance in transplant recipients. Our results correspond to international statistics except for the ratio of basal cell carcinoma to squamous cell carcinoma. Further studies are needed to elucidate the reasons for this difference., (Copyright 2010 Elsevier Inc. All rights reserved.)

Introduction/aims: Prostheses use for lower limb amputees is difficult, while the socket is hard, the prosthesis is heavy. Drawbacks of conventional prosthesis are mainly associated with the socket, therefore osseointegration technique is a promising solution, since it doesn't require a socket. Our aim was to introduce this technique in Hungary and extend indication for vascular patients., Methods: The method includes two operative and one rehabilitation phases: during first operation a titanium screw is fixed into the femoral bone marrow cavity, this connects to an abutment, which also penetrates the skin, making a direct connection between the femur and the prosthesis during the second intervention. During rehabilitation the patient makes loading exercises and learns to walk with new prosthesis., Results: This method was launched in Hungary in 2005. Two female amputees were operated on initially, their second surgery was performed in 2006 (when titanium screw was applied in the male patients, as well). Incorporation of titanium screw was exquisite, and rehabilitation was successful. One of our male patients died eight months after his first operation due to myocardial infarction., Conclusion: Based on our experiences, the osseointegration technique facilitates rehabilitation of vascular patients for prostheses use. Adequate follow-up and stable vascular diseases are not contraindications, although further clinical trials are needed to determine its indication.

Background: In spite of the increase in radicality and extended resections, the prognosis of gastric cancer is very poor. Surgical resection is the only effective therapy. The morbidity and mortality of surgical interventions decreased during the last years., Method: The aim of this study was to evaluate the prognostic effect of different factors on survival of gastric cancer. A retrospective study of 483 patients with gastric cancer was performed. Data were collected from January 1993 to December 2002. There were 380 resections, 267 (70,2%) total gastrectomies, 93 (24.8%) distal resections and 20 (5.2%) proximal resections. Epidemiological factors, tumour and treatment related parameters were analysed. Kaplan-Meier method was used to assess survival and Cox regression analysis to evaluate the effect of prognostic factors on survival., Results: The rate of R0 resections was 73.4% for total gastrectomy, and 73% for distal gastrectomy. The five-year overall survival of the entire population was 26.08%, 36.2% of the resected patients and 69.05% of curative resections. In concordance with literature findings, radicality of resection, depth of tumour invasion and lymph node metastases proved to be the most powerful independent prognostic factors., Conclusion: Prognosis of gastric cancer can be remarkably improved by a complete resection of the tumour and its lymphatic drainage, even if extension of the resection is needed.

Based on extensive randomized, multicenter studies, the recent trend in inguinal hernia surgery has been towards using a mesh-based tension-free repair, and Lichtenstein method is considered to be the procedure of choice. Based on above mentioned concern a prospective, multicenter study was conducted. In 15 centers, between March of 1999 and 2000, 1434 patients were included in this trial. Lichtenstein hernia repair was associated with less postoperative pain, lower complications rate,faster recovery, and lower recurrence rate compared with suture repair made under tension. Both the attitude and practice has been changed thoroughly in Hungary and the Bassini repair seems to be replaced by the Lichtenstein procedure. Mesh implantation increased from 1% (1998) to 34% (2005). The study has largely contributed to the national spread of this operation and has doubtlessly verified the advantage of data processing through the internet.

Unlabelled: A case control study is presented reviewing the outcomes of 32 consecutive major tracheal surgeries. The audit is based on our six and half year experience., Material and Methods: There were 11 (neo)esophageal communications, 9 direct injuries (iatrogenic and trauma), 8 endotracheal obstructions and 4 inflammatory processes requiring surgical intervention. Six sutures of the trachea, 13 resections with anastomosis, 2 external fixations and 11 combined esophagotracheal procedures were performed., Results: The 30-day mortality was 12.5% (4/32) with a dominance of the inflammatory cases. The overall mortality was 21.8% due to the late complications of the surgeries for esophagotracheal sinuses. There was no death., Conclusions: Independent factors influencing outcome seemed to be: underlying pathology of the trachea, timing of intervention, nutritional state of the patient, and surgical technique. Tracheal replacement can be considered the key element of further process in this field of thoracic surgery.

Our knowledge of Gastrointestinal Stromal Tumours (GIST) has been broadened in the last few years by the discovery of the key function of c-kit tyrosine kinase mutation in their pathogenesis. A single institution database is presented and a hypothesis is examined regarding probable connection between GIST and other gastrointestinal malignancies. Between 2000 and 2004 20 patients were admitted to our department with GIS tumour. With the addition of three cases detected between 1991 and 2000, and proved to be GIST retrospectively, 23 cases are followed. Mean age was 64.52 years, male to female ratio 11:12. Ten tumours originated from the stomach, ten from small bowel, one from rectum and two from mesenterium. All patients underwent surgery, 16 operations were completed with R0 radicality, one R1 and four R2 resections were performed. Follow-up ranged from 1 to 157 months. Five out of 23 patients died (21.7%), six patients live with metastatic disease, twelve are disease free. Amongst patient-, tumour- and treatment-related factors the prognostic significance of Fletcher's risk and radicality of resection was demonstrated (p<0.05). Significantly more synchronous or metachronous gastrointestinal malignancies were found is this population of GIST patients, when compared to the prevalence of malignancies in normal Hungarian population (p<0.001).

Physical examination, cervical ultrasonography (US) and aspiration cytology are the mainstays of the preoperative diagnostics of papillary thyroid carcinoma. For the staging of suspected malignant cases, cervical and mediastinal CT (MRI for inconclusive results) is indicated before any surgery. The end-result of primary treatment is assessed by total-body iodine scintigraphy and the serum human thyroglobulin (hTG) level. For long-term follow-up, physical examination and the serum hTG level are the most reliable tools (6-monthly), supplemented by cervical US and chest X-ray (yearly), and total-body iodine scintigraphy (2-yearly). If these furnish positive results, further examinations may be indicated. In suspected relapses of hTG non-producing and iodine non-accumulating papillary carcinomas, 201thallium chloride or 99mTc-sesta-MIBI (methoxy-isobutyl-isonitrile) scintigraphy, and positron emission tomography with 18fluoro-deoxyglucose or 11C-methionine may be of help. For estimation of the prognosis (cause-specific survival) of the patients, the MACIS score system of the Mayo Clinic is widely accepted, the patients being divided into low-risk and intermediate/high-risk categories. The recommended standard surgical intervention is near-total thyroidectomy (2-4 g residual glandular tissue left at the upper pole of the less-involved lobe), with a central cervical lymph node dissection for diagnostic purposes. In cases of lymph node dissemination, dissection (radical, modified radical, selective or microdissection) of any of the involved compartments (central, right or left cervical, or upper mediastinal) is indicated for therapeutic reasons, the method of which is depending on the extent of the metastatic involvement. Following adequate surgical intervention, no adjuvant radioiodine therapy is indicated for low-risk cases with a tumour of less than 1 cm diameter. For other low-risk or intermediate/high-risk patients, radioiodine ablation (R0N0M0) or a therapeutic radioiodine dosage (R2N1M1) is indicated. In cases at high-risk of local/regional relapse and in radioiodine non-accumulating tumorous cases, external radiotherapy may be applied. Thyroid hormone medication in a TSH suppressive dose is indicated during the first 5 postsurgical years: the goal is to achieve a TSH level below 0.1 (determined by a 3rd generation assay). If no relapse occurs or the case is a low-risk one, following the 5 years, it is enough to maintain the TSH level in a subnormal range (0.1-0.3).