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Osteoporosis (OP) is one of the most common debilitating conditions in the population over the age of 50. Its pathomechanism is still not fully understood. Nowadays, in elderly population, the most common approach to control bone loss is blocking osteoclastic activity by administration of antiresorptive drugs. Such drugs are also used for the management of metastatic bone cancer, hypercalcemia of malignancy, and other conditions with elevated osteoclastic activity. Bisphosphonate therapy is the first choice, but recently monoclonal antibody to RANKL (receptor activator for nuclear factorkappa B ligand), has also been used; each with distinct mechanism of actions. Bisphosphonates irreversibly adhere to bone minerals, and during bone remodelling, osteoclasts internalise and metabolise matrix-bound bisphosphonates. Subsequently, they damage cytoskeletal organization and ruffled border integrity, resulting in the eventual osteoclast apoptosis. On the other hand, denosumab blocks osteoclast neogenesis by neutralizing RANKL, which is necessary for osteoclast precursor differentiation into mature osteoclasts. Thus, bisphosphonates acts on mature osteoclasts, while denosumab hinders osteoclast formation from its precursors. Although their antiresorptive actions are different, recent case reports and controlled clinical studies indicated that administration of either of these may be associated with development of osteonecrosis of the jaw (ONJ). The fact that ONJ is associated with both bisphosphonates and denosumab convincingly suggests that osteoclast suppression is essential in the pathomechanism of ONJ. The evidence-based, cause-related therapy for MRONJ still remains missing. Many alternative therapeutic approaches has recently been tested and published, amongst them, using recombinant human parathyroid hormone (rh-PTH, teriparatide) may become a promising treatment modality

The recently introduced 2017 World Workshop on the Classification of Periodontitis, changed several definitions and diagnostic approaches. Those were summarized and published in the Hungarian scientific media last year. One of the key elements of the new classification is to make a paradigm change and new perspectives in the understanding of the whole plaque related periodontal diseases. For plaque related periodontitis, the new classification incorporated stages and grades of disease, aiming to describe not only disease severity and extent but also its complexity and the contributing risk factors. Therefor it was wise to formulate evidence-based clinical guidelines for practitioners how manage advanced (stage II–III) periodontitis. The EFP Work Groups based on their panel discussions has recently published a very detailed guideline in the J. Clinical Periodontology (2020; 47: 4–60). Those recommendations cover the whole course of comprehensive periodontal treatment. The aim: of the Hungarian summary of the EFP protocol is to briefly summarize the 55 pages EFP S3 Level Clinical Practice Guideline (S3 CPG) for the Hungarian dentists and scholars. Results: The S3 CPG for the management of stages I, II and III periodontitis used a pre-established stepwise approach to therapy based disease stages. Consensus was achieved on recommendations covering incremental, interventions in all steps of therapy. Treatment planning is focusing on – a) behavioural changes, and supragingival biofilm, gingival inflammation and risk factor control; – b) supra- and sub-gingival instrumentation, with and without adjunctive therapies) different types of periodontal surgical interventions; and – d) the necessary supportive periodontal care to extend benefits over time. Those major elements of periodontal care is briefly summarized in this Hungarian version. Conclusion: This S3 guideline summarizes according to the available evidence at the time of publication the available and most effective methods to treat periodontitis and to maintain periodontal health.

Periodontitis is one of the most common human chronic inflammatory diseases and about 11% of adults develop its clinical signs. Untreated periodontitis ultimately leads to inflammation and destruction of the periodontium leading to the loss of the teeth. Periodontitis is considered as a dental focal infection. The foci can influence other diseases in different areas of the body through different pathways. Diseases and conditions such as cardiovascular disease, diabetes mellitus, rheumatoid arthritis, gastric ulcer, pregnancy complications and respiratory diseases such as aspiration pneumonia and chronic obstructive pulmonary disease (COPD) have been proven to be affected by the condition of the periodontium. COPD is an inflammatory disease characterized by progressive deterioration of pulmonary function and increasing airway obstruction, including chronic bronchitis and emphysema. It has a worldwide prevalence in adults at the age of 40 years or older in about 9%–10%, and it is currently the third leading cause of death worldwide. In addition, the incidence and mortality of COPD are continually increasing. An observational study found that 97% of a COPD cohort had at least one other comorbidity, with 50% having at least four. This impacts the health care costs of COPD patients with multiple comorbidities that are 4,7 times higher than those with no comorbidity. As periodontitis and COPD are both chronic, progressive conditions characterized by neutrophilic inflammation with subsequent proteolytic destruction of connective tissue, it has been proposed that they share common pathophysiologic processes. Several mechanisms have been proposed to explain the association of periodontal disease and COPD. As summarized by the European Federation of Periodontology and American Academy of Periodontology (EFP/AAP), COPD inflammatory status may be modified either by aspiration of bacteria from the oral cavity and/or haematogenous dissemination of inflammatory mediators and plaque organisms from periodontal pockets. The present review of literature aims to investigate the potential connection between periodontal disease and COPD.

The objective of this case presentation is to present a case of a phenytoin associated gingival fibromatosis in a 14 years old girl and the results of its comprehensive periodontal-orthodontic therapy. An attempt was also made to summarize the literature background of the clinical features and mechanism of drug induced gingival overgrowth. The gingival overgrowth is a common side effect, following the long term administration of anticonvulsant drugs, calcium channel blockers, and immunosuppressant drugs (phenytoin, nifedipine, and cyclosporine) to control epilepsy, hypertension, and organ transplant rejection respectively. The pathogenic mechanism has been intensively studied by numerous authors but it is still not totally understood. It is common in the pharmacological action of the three chemically totally different molecules that they suppress the cation channels (Na+, Ca++) in in the fibroblasts that control the active folic acid uptakes. The folic acid has a key role in controlling the MMP enzymes expression by the gingival fibroblast. Nevertheless alteration in the expression of different pro and anti-inflammatory cytokines have also been documented. Those molecules also have a direct stimulatory effect on the gingival fibroblast to synthesize excessive amount of collagen. In the presented case our patient had severe postnatal complications and at the age of three developed epilepsy (grand mal) that was difficult to control and finally at the age of 8 neurologist decided to administer phenytoin. The patient showed up at the Periodontal Department of Semmelweis University at the age of 14 complaining of severe gingival enlargement, speech difficulties and complicated tooth eruption. After initial motivation a series of external and internal bevel gingivectomy as well as apically repositioned flap surgeries were performed to remove the fibrotic gum, to assist permanent tooth eruption and re-establish the normal morphology of the gingiva. Originally patient had an Angle Class II malocclusion but due to the fibrotic gingiva the normal tooth eruption was also severely hampered. The orthodontic therapy was provided by the Department of Pediatric Dentistry and Orthodontics of Semmelweis University. The Angle class two malocclusion and the buccal position of the upper front teeth were corrected with bimaxillary fixed orthodontic appliances and after another three years the than 19 years old patient’s periodontal and dental condition as well as her self-esteem has been finally restored.

The basic objective of the first part of this report is to summarize the updated classification of the periodontal manifestations of systemic diseases and conditions affecting the course of periodontitis and also the developmental and acquired conditions with direct negative effects on the periodontal attachment apparatus irrespective of the presence or absence of dental biofilm. Case definitions and diagnostic considerations are also presented. According to the new classification the periodontitis associated with diabetes or tobacco smoking (now considered a dependence to nicotine) are not regarded as a distinct diagnosis within the group of systemic diseases, rather as important modifying risk factors of tissue destruction. The importance of the gingival phenotype, has been recognized and a new classification for gingival recessions was proposed. There is no evidence that traumatic occlusal forces lead to periodontal attachment loss, or gingival recessions. The term biologic width was replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue. The infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and periodontal attachment loss. The second part covers the first evidence based classification for peri-implant diseases and conditions. The definitions of peri-implant health, peri-implant mucositis, periimplantitis, and soft- and hard-tissue deficiencies were provided. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. There is strong evidence that plaque is the etiological factor for peri-implant mucositis. The main clinical characteristics of periimplant mucositis is bleeding on gentle probing, and swelling that might cause an increase in probing depth. Peri-implantitis is a plaque-associated inflammation of the peri-implant mucosa associated with progressive loss of supporting bone. Its characteristic clinical signs: bleeding on probing, suppuration, increased probing depths, soft tissue recession and radiographic bone loss. The healthy keratinized mucosa around the implants are essential for the long term stability of the implants and also for patient’s comfort.

The Hungarian Educational System, the Higher Education also Teacher Education have been constantly changing over the past decades. According to the results of international and domestic examinations, there is an increasing need for new standards and approaches, in the entire Public Education, especially Teacher Education sector. The purpose of our study was to examine the key aspects of the mentoring process in physical education. We were trying to identify those special factors and identify new trends in the area of physical education. What is the role of these factors in the process of professional development of a teacher.

Noha az 1990-es évek első felében felbomlott az akadémiai közgazdászok sok évtizeden át örök érvényűnek hitt közmegegyezése a minimálbér szükségképpen negatív foglalkoztatási hatásáról, a túlságosan magas minimálbért minden közgazdász foglalkoztatáscsökkentő hatásúnak jósolja. Tanulmányunkban a magyar minimálbér-szabályozást e hatás szempontjából vizsgáljuk és értékeljük.

A Társadalmi Riport – a TÁRKI tanulmánykötet-sorozata – 1990 óta kétévente bemutatja a magyar társadalom legfontosabb változásait. A 2014-es kötetben szereplő 28 tanulmány átfogó képet nyújt a társadalom, a gazdaság és a politika fontosabb jelzőszámairól és trendjeiről az egyes területek szakértőinek elemző értékelésével. A 2014-ben megjelent kötet újdonsága, hogy öt, a szerkesztők által felkért magyar értelmiségi egy-egy esszében külön is jelezte, hogy mit tart a magyar társadalom legfontosabb problémájának, véleményükkel segítettek tájékozódni abban, hogy hol is tartunk, merre haladunk. Az előszó ezúttal – műfaji korlátait meghaladva – részletesen ismerteti a kötet főbb megállapításait, közlésével kedvet kívánunk ébreszteni az írások alaposabb tanulmányozásához.

A tanulmány értékeli, hogy az elmúlt évek gazdaságpolitikája mennyire szolgálta a tudásalapú növekedés kibontakozását, és javaslatot tesz innovációpolitikai súlypontokra. A tudásalapú növekedés kritériumának a piacon a GNI részeként realizált tudásalapú extrajövedelmet tekinti. Úgy ítéli meg, hogy a kis- és középvállalkozások alacsony K+F és innovációs aktivitásának legfőbb oka a hazai tudástartalommal fejlesztett termékek piacra jutásának korlátozott volta (a termelési szerkezet és államháztartási kereslet túlzott importorientáltsága), ezért a vállalkozási K+F ráfordítások lényeges növekedése csak a hasznosulási feltételek javulásnak eredménye lehet. Az originális innovációk piacának építése, ami a kutatás-fejlesztésnél költségesebb és hosszabb feladat, jelenleg a TTI-politika figyelmén kívül esik. A hasznosításra szolgáló K+F támogatási források esetében a kormányzat eltért a források kiszámíthatóságának, a keresletvezérelt támogatáspolitikának az innovációs törvényben meghatározott elvétől, elmaradt a programok és projektek értékelése. Ilyen és hasonló okok miatt a TTI-politika súlyos hitelvesztést szenvedett. A tanulmány a tudásalapú növekedés fő szegmensének a kis- és középvállalkozások réspiaci pozíciójú originális innovációit tekinti, amelyeknek a globális piacra jutását a hazai referenciapiacok megteremtésével, demonstrációs projektekkel kell segíteni.

Oral candidiasis is the most common oral opportunistic infection caused by a yeast, Candida albicans. As Candida albicans is a member of the normal oral flora and its prevalence is around 40% among humans, the pathogenesis is still not clear. The aims of the publication were, to make an attempt to overview the potential systemic and local risk factors of this opportunistic infection and also to summarise its clinical manifestations in the oral cavity. Several local and systemic factors are known that can convert the saprophytic yeast to active pathogenic state. Oral candidiasis is divided into primary and secondary infections. Candida can adhere and penetrate the epithelial lining of the oral mucosa. The local predisposing factors facilitate the adherence and growth of the yeast, while systemic predisposing factors negatively affects the innate and adaptive immune system that control the growth of the yeasts. Several clinical manifestations can be distinguished. There are acute and chromic forms. The most severe form is the acute pseudomembranous candidiasis (thrush). It is a true primary infection that mostly affects severely compromised subjects. Its chronic forms mostly present in patients infected with human immunodeficiency virus (HIV). AIDS patients can be affected by a therapy resistant long term pseudomembranous Candida infection. The other clinical forms of disease are erythematous candidiasis, chronic plaque-type and nodular candidiasis. The most common clinical form is the so called denture stomatitis. Also some other Candia associated oral diseases – like median rhomboid glossitis and cheilitis angularis are recognized. The clinical diagnosis is relatively simple based on its characteristic clinical signs and subjective symptoms. The laboratory confirmation of the Candida infections is more difficult, as the Candida genus is part of the normal flora. Cytological smear techniques and culturing are the most common laboratory techniques. The disease management is complex and sometimes is really challenging. It is important to identify and if it is possible eliminate the predisposing factors. The most commonly used antifungal drugs belong to the groups of polyenes or azoles. It is because the majority of oral fungal infections affect only the superficial layers of oral mucosa the first choice of therapy should be the topical application of the antifungal drugs, because the majority of antifungal drugs have several systemic side effects.

There are many cases when a dentist has to decide to prepare single crowns or to connect the abutment teeth. When missing teeth have to be replaced with fixed bridges there is no choice, abutment teeth must be connected. However teeth should be connected based only on careful consideration, because the crowns casted in one piece may decrease the interdental embrasure space and compress the interdental papilla. Therefore the periodontal aspects of crown preparation must be followed. During planning, tooth preparation, impression taking, model and crown preparation, and also during cementation the embrasure area must be respected and the proximal surfaces of the crowns has to imitate the original tooth morphology, and provide access for cleaning for the patient. Otherwise patients cannot clean the proximal surfeces of the neighbouring crowns and gingivitis, periodontitis may develop. The article summarises the problems of primary splinting and the guidelines to be kept in cases when two neigbouring teeth must be connected by crowns.

The new classification of periodontitis made several changes and updated the AAP 1999 classification system. A universal periodontitis diagnosis has been introduced for the case definitions of all plaque related periodontal diseases. That replaces the previous periodontitis scheme that distinguished “chronic” and “aggressive” periodontitis. All biofilm related periodontal disease under a single category as “periodontitis” are further characterized based on a staging and grading system. Staging expresses the severity of disease at the first clinical examination and also the expected complexity of disease management. The grading evaluates pathobiological features of the disease, the estimated rate of the progression of periodontitis based on the analysis of patient’s dental and medical histroy, the risk factors. The risk factors for the further diseases progression and all the factors that might hamper the predictability of therapy should also be evaluated. The periodontal state or the planned invasive periodontal therapy should also be assessed as a potential risk factor for systemic diseases. The new classification system maintained with some modification the 1999 AAP’s classification of Necrotizing Periodontal Diseases (NPD), characterized by typical clinical signs of pain, spontaneous bleeding and papilla necrosis. It is still a distinct category of periodontitis in compromised patients mostly with altered host immune responses. All Endo-periodontal lesions are the consequence of a pathological communication between the pulp and periodontal tissues. This can occur in an acute or a chronic form, and can be further classified according to the clinical signs and symptoms that determines the prognosis and predictability of its management. Periodontal abscesses are acute lesions with localized accumulation of pus within the connective tissues of the periodontal pocket-wall. Its main characteristic is the rapid onset with immediate tissue destruction and the possibility of systemic dissemination.

The major goal of this review article is to summarize in Hungarian language for the Hungarian dental community the new periodontal classification system elaborated by the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions organized by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP). The consensus reports have been presented on the conference, held in Chicago on November 9 to 11, 2017, and 19 review papers and four consensus reports covering relevant areas in periodontology and implant dentistry were published in the J Clin Periodontol. 2018;45:45(Suppl 20); issue. This volume summarizes the updating of the AAP 1999 classification of periodontal diseases and conditions. The new classification of periodontal and peri-implant diseases was based on the recent achievements of periodontal research and made an attempt to update and improve some definitions of the previous classification. The two relevant improvements of the present classification are to formulate correct definitions for the different stages of periodontal health and also included the peri-imlplant conditions and disease in the new comprehensive classification system. Although several major and minor changes have also been implemented. The first part of the Hungarian version of the classification includes the summary of the AAP-EFP papers on periodontal health and gingivial disease. The second part will deal with the diseases and conditions of the periodontal attachment apparatus and peri-implant conditions.

Weaning performance of 2857 purebred calves (660 male and 2197 female) born from 1498 cows mated with 78 sire were analised in seven farms. Genetic- and environmental variance and heritability, breeding value of weaning weight (VS), preweaning daily gain (SGY) and 205-day weight (KVS) were calculated. Farm, year of birth, season of birth, sex, number of calving as fixed, while sire as a random effect was treated. Data were analyzed with SPSS 9.0 and Harvey’s (1990) Least Square Maximum Likelihood Computer Program. The environmental factors examined had an effect on all traits. The overall mean value and standard error (SE) of VS, SGY and KVS were 208±3.31 kg, 887±15.66 g/day and 199±14.774 kg, respectively. The heritability of the investigated traits was 0.24, 0.25 and 0.25. The results of the examination show that the 205-day weight was increased to seventh calving. The male calves were hevier than females, the difference was 22 kg (10,5%).

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The incidence of colon cancer in Hungary shows a continuous increase. Improvements in the chances of survival are mostly dependent on early diagnosis and prevention. The state of the art multidisciplinary treatment of colon cancer also needs focused attention. Next to the ever evolving oncology, surgical resection still remains the indispensable foundation in the treatment of colon cancer. In our article we put an emphasis on the modern principles of surgery. We aim to overview current standards and future initiatives. The lecture that this article is based on was held at the third national event of the Oncologic Section of the Hungarian Surgical Society.

The results obtaining with breast reconstruction surgery are not always satisfactory for the patients. Reconstruction with pure latissimus dorsi flap is useful option and due to endoscopic harvest large scar on the back can be avoided. The skin sparing mastectomy and even the sentinel lymph node biopsy or lymphadenectomy can be performed using a single incision in the axilla. Also the immediate reconstruction with endoscopically assisted harvest of the latissimus dorsi muscle flap in selective cases can be done using the same incision. The patient reported high satisfaction with the aesthetic and functional results due to preservation the breast shape and the absence of any scarring on the back.

Introduction: In some surgical wards residents start to do laparoscopic operations using both hands, while in other places they only use their dominant hand, and only start to use both hands later. There are no data at the moment about which method is more effective., Methods: We divided 20 students with no laparoscopic experience into 2 groups: one group practised one hand at a time (1K), the other group used both hands (2K) during the 5 days. On the last day both groups had to do every exercise with one hand and two hands as well, then they had to do 3 new exercises, which needed both hands. We measured the time taken, and gave points for the videos taken inside the training box based on OSATS. For statistical analysis we used t-tests, p < 0.05 being significant., Results: On the first day, there was no significant difference between the 1K and 2K groups considering the time taken (518/500 s) and the OSATS points (87/84; 54/55 points). Both groups improved in the mean time and points (1K: 52%, 77% 2K: 50%, 70%) as well, but there was no significant difference between them. In the case of new exercises on the last day, there was no difference between mean time (1K: 425 s, 2K: 411 s) and points (53/59 and 56/52), but there was a significant difference considering the points given for bimanuality., Conclusion: Based on our study, we cannot exactly state that the bimanuality needed for expert laparoscopic surgery would be easier to learn with immediately practising with both hands.

The Hartmann procedure - primarily - was introduced for the treatment of cancerous diseases of sigmoid colon and rectum. In the last few years it was performed in cases with complicated inflammation of the left colon, colon cancers with bowel obstruction or perforation, or in the case of insufficiency of the anastomoses, or in urgent operations after traumatics bowel injuries, when making the anastomosis is at very high risk. Later on the restoration of the continuity of the GI tract can be done traditionally (by laparotomy) or laparoscopically. We present our experiences with the above technique, and also compare our results with traditional open surgeries in our patients.

Introduction: A technique of reconstructing the inguinal ligament using pedicled fascia lata flap is described., Presentation of Case: A 66-year-old woman was referred with massive incarcerated left inguinal hernia, following acute surgery on a femoral vein leasion and numerous attempts at repair and subsequent recurrences. There was complete absence of the left inguinal ligament. The inguinal ligament was reconstructed using a strip of fascia lata, pedicled on the anterior superior iliac spine. This was transposed to cover the external iliac vessels, and sutured to the pubic tubercle. The musculoaponeurotic abdominal wall was reconstructed with 15×13 cm sheet of polypropylene mesh, placed preperitoneal and sutured to the remaining abdominal wall muscles and to the neo-Pouoart ligament., Discussion: Complete destruction of the inguinal ligament is rare but can occur following multiple operative procedures or trauma. Published reports of inguinal ligament reconstruction have been performed using synthetic mesh. The use of autologous tissue should reduce the risk of erosion into the neurovascular bundle, seroma formation, and enhance integration into surrounding tissues., Conclusion: This new technique for autologous reconstruction of the inguinal ligament provides a safe alternative to the use of synthetic mesh in the operative armamentarium of plastic and general surgeons. This is the first reported case in Hungary.

Massive localized lymphoedema (MLL) is a relatively frequent complication in obesity. MLL is present as a giant swelling and associated with characteristic skin changes. Due to the pathologic and morphologic similarity to sarcoma, MLL is also called "pseudosarcoma". MLL can degenerate into angiosarcoma without surgery. We present a case of MLL of the mons pubis in a 54-year-old man with a BMI of 48.6.

Case Report: Authors present the case of a 30-year-old female patient, who was admitted to the ICU because of hypertensive crisis accompanied by chest complains, cardiac decompensation, progrediating short of breath and unconsciousness. Despite the quick examinations and the prompt treatment multi-organ failure developed 3 days after admission. Investigations revealed the underlying cause, which was a left-sided suprarenal neoplasm. Hence, multidisciplinary decision was made to carry out a laparoscopic adrenalectomy urgently. The histology examination of the removed neoplasm was pheochromocytoma. In the postoperative period the condition of the patient gradually improved, her symptoms and complains settled, and finally she was discharged in a healthy condition., Discussion: The diagnosis of a pheochromocytoma is a difficult task, the symptoms and complains caused by it can simulate many other illnesses. The acute crisis caused by pheochromocytoma usually can be treated conservatively, but in more severe cases with impending multi-organ failure an urgent operative treatment can be unavoidable. Though the operative risk is relatively high, the correct intra- and postoperative treatment with a quick laparoscopic procedure can be effective.

Case Report: The authors report a case of a 34-year-old woman who had postprandial abdominal pain for years. During the course of her examination lactose intolerance and hiatus hernia was diagnosed. After ineffective conservative treatment CT angiography (CTA) and digital substraction angiography (DSA) was performed and showed significant celiac artery stenosis. Percutaneous transluminal angioplasty (PTA) was unsuccessful as extravasal mechanical compression was present, therefore, laparoscopic decompression and surgical division of MAL fibres were carried out. The postoperative period was characterized by a complete relief of previous symptoms and repeated CTA showed normal blood flow., Discussion: The authors emphasize the importance of the measurement of peak velocity of celiac trunk with Colour Duplex abdominal ultrasonography, the examination has 100% sensitivity and 83% specificity. The Duplex ultrasonography is less expensive than the "gold standard" diagnostic methods like CT and DS angiography, and can lead us to early diagnosis. Laparoscopic surgery is safe and low expense method for celiac artery decompression, however, sometimes it is difficult to reveal the exact reason and thus setting up the proper operation plan.

Current surgical treatment modalities for breast reconstruction include latissimus dorsi mycotaneous flap with immediate permanent breast implant (LDI). The aim of the present study was to analyze reconstruction with LDI in terms of quality of life, cosmesis and patient satisfaction. A chart analysis was carried out with the first ten patients who underwent breast reconstruction with LDI. The patients were interviewed and self-assessment quality of life was administered. They also underwent assessment of satisfaction and cosmesis. The high satisfaction and cosmesis scores in the breast reconstruction group indicate the superior results that can be achieved with breast reconstruction.

Perineal wound healing problems following extended abdomino-perineal resection of ano-rectal cancer represent a great challenge to the surgeon. Perineal soft-tissue reconstruction with a myocutan flap was thought to reduce surgical wound healing complications. A review of the relevant literature was carried out on perineal soft-tissue reconstruction with rectus abdominis myocutan (VRAM) flap following extended abdomino-perineal rectal resection for cancer. The more commonly used neoadjuvant chemo- and radiotherapy as well as extended surgical radicality resulted in increased perioperative risks, therefore combined procedures between the colorectal and plastic surgical teams are inevitable. This case report illustrates the above trend.

Introduction: Laparosocopic splenectomy gradually became the gold standard procedure in the surgical treatment of certain haematological disorders. Operative experience in laparoscopic procedures facilitates the comparison of various techniques., Aim: Two variants in laparoscopic spelenectomy are analysed and presented., Material and Method: Sixteen patients underwent laparoscopic spelenectomy. Anterior- and postero-anterior laparoscopic approaches are compared with respect to clinicopathologic features., Conclusions: Using the postero-anterior technique dissection of splenic hilum is more straightforward, recognition of accessory spleen is easier and the likelihood of intraoperative complications is less. In selected cases of splenomegaly the anterior technique is recommended though.

Background: The present study was designed to provide an analysis of factors for angiogenesis and proliferation., Material and Method: We analyzed tumor tissues from 37 rectal cancer patients with concurrent or subsequent liver metastasis underwent preoperative radiotherapy, surgery and adjuvant chemotherapy. Immunohistochemistry was used for expression of proliferation (staining with anti-Ki67: MIB-1) and for detection of microvessel density (MVD, expressed by CD34). Clinicopathological findings were compared with outcome with emphasis to IHC., Results: A vascular enumeration and pN status and the time of presence of the metastases has shown prognostic role along with the factors above. Increased proliferative activity of the tumor as expressed by MIB-1 staining has no prognostic value, similarly to the localization of tumor, gender, age or grading., Summary: Different prognostic and predictive factors in colorectal cancer have been reported. Higher pN status and tumor vascularisation has been linked to poor prognosis in overall survival and tumor recurrence.

The etiological role of human papilloma virus (HPV) in a number of squamous cell malignant tumours is well known. Squamous cell carcinoma of colon (SCC) is a rare disease with uncertain etiology. Our objective was to detect possible HPV infection in a colon SCC patient. The 94-year-old female patient was operated for an obstructive colon tumour. Histology confirmed SCC. Tumour tissue and the removed lymph nodes were examined with polymerase chain reaction and Southern blot hybridization techniques. From HPV types 16 and 18, which most commonly associated with malignant tumours, the presence of HPV type 16 could be confirmed in the primary tumour and in 4 out of the 9 surrounding lymph nodes (of which 2 were metastatic). HPV-16 infection was detected in a colon cancer patient with SCC histological type in the primary tumour and in surrounding lymph nodes. According to our knowledge, no similar study has been published yet.

Mesenteric panniculitis can develop in every patient after abdominal surgery. The clinical and pathological signs are usually vague, so different therapeutic approaches are recommended at various stages of the disease. While some authors suggest that these stages are different manifestations of the the same disease, others claim that the various stages represent the progression of a single entity. We report a case of a 65 year-old male patient with mesenteric panniculitis and fibrosis, which developed after laparoscopic sigmoid resection first, and required a Hartmann's procedure finally. The disease developed once again after the elective reconstruction of the colon. This time surgical intervention was not possible and he was treated conservatively with intravenous steroids, antibiotics, parenteral nutrition and continuous nasogastric tube. The patient gradually recovered in three weeks time. We report this successful treatment, and review the relevant literature.

The colorectal cancer can be mainly treated by surgery. Metastases are responsible for the poor prognosis. Development of metastases is a difficult, multi-level regulated process with complex molecular interactions. During the past decade, these mechanisms have become better known. Some parts of it had been clarified, others are still targets of the research. Analysis of this system can lead to find substances or methods, which could inhibit the development of metastases. Our aim was an exposition of the factors taking part in the process of development of colorectal metastases.

In the last 2 years 9 patients have been operated on in our surgical department because of colon necrosis which developed after open heart surgery. The symptoms--abdominal distension, circumscript peritonitis in the right lower part of the abdomen--developed 2-4 days after the heart operation. Laparotomies were carried out within 2 days from the onset of symptoms in all but one patient. In 7 patients the necrosis of the right colon, while in 2 other patients extreme dilatation of the colon was found. In 6 patients right hemicolectomy was carried out. One operation was finished without anastomosis with double stomas. In the 2 patients with no necrosis catheter-cecostomy was performed. All patients but one after hemicolectomy with reconstruction died after several reoperations because of suture leak. The other 3 patients were cured. We examined and analysed the pre-, intra- and postoperative circumstances of the heart operations, which lead to the severe complications. We think the cause of the problems was the liberal use of wide spectrum antibiotics with caused severe dysbacteriosis and Clostridium difficile toxicosis in the colon. This condition could lead to a pseudomembraneous colitis which resulted in the colon necrosis.

Internal hernias are very rare. The hernial orifice, sac and content are situated inside the abdomen. Paraduodenal hernias are relatively rare congenital malformations and account about 50 per cent of all internal hernias. The cause of this malformation is the incomplete rotation of the mid-gut. Right and left paraduodenal hernias are different, varying in anatomic structure and embryological origin. In right paraduodenal hernia the small bowel is partially or completely localised behind the mesocolon of the ascending colon, in left paraduodenal hernia behind the mesocolon of the descending colon. That is why the widely used name "mesocolic" hernia is more convenient, because it refers on the pathogenesis of the disorder. The complaints can vary from recurrent atypical abdominal pains to the complete small bowel obstruction, but often there are no complaints. Abdominal CT scan and the barium meal provide the best diagnostic approach for paraduodenal hernias, but it will be recognised very often only at an emergency operation. A case of small bowel obstruction caused by incomplete left paraduodenal hernia discovered after swallowing a foreign body is described with pathogenesis, diagnosis and possible treatments for the disease.

The ultimate goal of the regenerative periodontal treatment is the de novo formation of new connective tissue attachment with the regrowth of the alveolar bone. Clinically it is very difficult to evaluate the nature of clinical healing and prove the occurrence of real periodontal regeneration. The aim of the present study was to compare the clinical and radiographic parameters with the histometric findings following two different periodontal regenerative procedures in humans.

Objective: Results of fast absorbing Poliglactin 910/370 suture material were assessed in skin closure following invaginal hernia repairs., Methods: Fifty consecutive patients undergoing invaginal hernia repair were prospectively and randomly assigned in two groups. In Group I, wounds were closed with conventional absorbable subcutaneous Polyglactin 910 (VICRYL, ETHICON) and non absorbable cutaneous Monofilament Nylon (ETHILON, ETHICON) stitches. In Group II, running subcutaneous and intradermic irradiated Polyglactin 910/370 (VICRYL-Rapide, ETHICON) sutures were used. The time of skin closure, the price of the suture material, short and middle term cosmetic results, complications in wound healing and the subjective comfort of patients were noted., Results: The cost of skin closing was similar, while the need for further medical wistis was lower in the VICRYL-Rapide group. The wound healing process and it's cosmetic results were similar. Patients in Group II experienced less discomfort, due to the avoidance of suture removal., Conclusion: The rapidly resorbing suture material (VICRYL-Rapide) is a cost effective choice for closing the skin of invaginal hernia repairs and probably of other clean operations.

The classification of tumours originating from the wall of gastrointestinal organs changed dramatically since of electronmicroscopy and immunohystochemistry were introduced. Previously these tumours were classified as leiomyomas, leiomyosarcomas or schwannomas. With the new methods these disorders can be described in more details and unified, and so the change to provide correct prognosis improved. Still, there are some unanswered questions remaining for the pathologists. In our material in the past 5 year we treated 9 patients because of GIST. Most of them were found in the stomach (6), one developed in the oesophagus, one in the small bowel and another one in the rectum. With describe our patients and look at the related articles literature about this important diseases. Though the incidence is under 1% of patients operated on because of gastrointestinal diseases, we would like to share our experiences in treatment.

Cysteine proteases [Cathepsin B and L (CATB, CATL)] and the serine protease urokinase type plasminogen activator (UPA) with its inhibitor type-1 (PAI-1) are thought to play an important part in colorectal cancer invasion and metastasis. To our knowledge, however, cathepsins and plasminogen activator/inhibitor system have not been evaluated in the same study. The authors using the ELISA method, determined the protease antigen concentrations in colorectal cancer tissue and in normal tissue distant from tumour, in 35 patients with colorectal cancer. They also evaluated the relationship that these proteases may have with the major histomorphological parameters and tumour staging. Significantly higher antigen levels were found: 1. in cancerous tissue vs. tumour free tissue (CATB, CATL, UPA, PAI-1); in colorectal cancer with vs. without metastasis (CATB, CATL, UPA, PAI-1); 3. in poorly vs. well differentiated tumours (CATB, UPA, PAI-1); 4. in advanced Dukes' stages (CATB, UPA, PAI-1). The simultaneous activation of cathepsins and plasminogen activator/inhibitor system in colorectal cancer confirms their role in colorectal tumor biology and particularly in the process of invasion and metastasis. Our results suggest the possible prognostic impact of these proteases in colorectal cancer.

The last decade has brought marked changes in the surgical treatment of rectal cancer: as the indication of the sphincter-saving procedures was extended, the rate of the abdomino-perineal excision has decreased even in the case of tumours of the distal third of the rectum. However, even with the use of the modern stapling devices, the anterior resection and colo-anal anastomosis may not always be feasible by the traditional abdominal approach. In these cases the sphincter-saving resection can be performed by a particular approach, the abdomino-transsphincteric technique. The authors present this seldom used operation. From the 1-st of January 1994 to the 31-st of August 1996 14 abdomino-transsphincteric resections have been performed. The mean age of the patients was 62.2 (38-81) years. The lower edge of the tumours was situated at 6.3 (5-8) cm from the anal verge. The anastomosis was performed by the double stapling technique in 8 and by hand suture in 6 cases, its distance from the anal verge was 3.2 (3-4) cm. A colon J-pouch was used in 3 cases and a diverting colostomy was performed routinely. One patient died in the postoperative period and a reoperation (abdomino-perineal excission) was performed because of left colon necrosis: Anastomotic leakage was observed in one case. By the time of the present study, 11 patients have had their colostomies closed. The continence is acceptable in every case and all the patients experience a better subjective quality of life, than it was while wearing the colostomy. The use of this technique has helped to avoid a permanent colostomy in 21 out of 33 cases operated on for cancer of the distal rectal third in the reviewed period.

The problems of the paradoxical respiration - observed in the case of fenestrated rib fracture - are discussed by the authors. On the basis of the data of the literature and of 348 own cases with covered rib fracture, as well as on the basis of the course and the clinical analysis of the lesion the authors refuse to admit the role of the "pendelluft" and of the mediastinal flutter in the development of circulatory and respiratory disorders occurring in the case of fenestrated rib fractures. In the authors' opinion, there are only quantitative differences between the consequences of the various rib fractures. The thoracal lesion is considered by the authors as functional unity. The treatment is always prescribed according to the degree of the functional disorder and also the classification of the injured patients is to be made on this basis.