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The importance of veterinary interventions has been longstanding in animal farming. The intensification of farming methods, recurrence of infectious diseases and food quality concerns have made veterinary practices and expertise even more relevant. By engaging recent literature on more‐than‐human political economy, this paper explores how veterinary interventions, through political economic and biosecurity practices, become productive economic forces in intensive animal farming and the wider agri‐food production. Empirically, the article focuses on the challenges of buffalo farming in the 'mozzarella landscape' in Southern Italy, and it draws from multi‐sited and multispecies ethnography of water buffalo farming and mozzarella cheese production in the Campania region. One of the main elements of my fieldwork is a seven‐week‐long internship on a buffalo farm where participant and direct observation has been conducted. From a theoretical perspective, the article aims to bring the concept of veterinary bioeconomy to the forefront of animal geographies and political ecology. [ABSTRACT FROM AUTHOR]

Information on the annual International conference organized by Great Britain's Royal Geographical Society (RGS) that held at its headquarter in London, England from August 27-29, 2014 is presented. Topics discussed includes transnational education, economic crises, environmental justice and urban political ecology. The meeting was attended by various people including Katherine Gibson, Uma Kothari and Patiricia Noxolo of the Society.

Esophageal cancer is the most common cause of esophageal resections. Esophageal replacement is still a significant challenge for surgeons, because complications can be expected in over 50% and death also occurs between 4-7%. Complications can be divided into early and late categories and into general and specific complications. From a surgical point of view, early and late specific complications are the most important aspects. Between 1993 and 2012, 540 esophageal resections were performed due to malignant tumors at the Department of Surgery, Medical Center of the University of Pécs. Stomach was used for replacement in 445 cases, colon in 38 cases, and jejunum in 57 cases. The anastomosis with stomach replacement was located to the neck in 275 cases and to the thorax in 170 cases. The colon was pulled up to the neck in each case. There were 29 cases of free jejunal replacements located to the neck, and 28 cases with a Roux-loop reconstruction located to the thorax. In the case of gastric replacement, anastomotic insufficiency developed in 55 cases, graft necrosis occurred in 8 cases, and early anastomosis stricture developed in 30 cases. These numbers are 3 conduit necrosis and 2 strictures in cases of colonic replacements. There was one anastomosis failure in the case of a thoracic jejunum replacement. Also one conduit necrosis was observed in the free jejunal neck transplantation group. Among late special complications, dysphagia is the most important, the causes of which were found in the order of frequency: anastomotic stricture, conduit obstruction, peptic and ischemic stricture, foreign body, local recurrence, functional causes, new malignant tumor in the esophageal remnant after resection and malignant tumor emerging in the replaced organ. Causes may overlap each other, and their treatment may be conservative, endoscopic or surgical. Surgical treatment is usually the last option to restore the ability to swallow and can present a significant challenge even to experienced centers. Orv Hetil. 2023; 164(7): 243-252.

Oncology has evolved to a great extent over the last quarter of century. The significant success is multifactorial, including primary and secondary prevention, the development of diagnostics, new methods of chemo-and radiotherapy, and the integration of basic research results into practice. From the point of view of surgery, the establishing and widespread practical application of the principles of preoperative oncotherapy played a major role in this development. Between 1997 and 2005, 44 patients with gastric cancer and 102 patients with borderline resectable or irresectable esophageal cancer received perioperative treatment at the Department of Surgery of the University of Pecs. The response rate was above 50% in both groups and complete pathological remission was achieved in 3 patients with gastric cancer and 17 patients with esophageal cancer. Based on our own experience and literature data, the development of seven new principles in surgical oncology were observed as the result of a very successful preoperative oncologic treatment. The desired free resection margin was reduced to the millimeter dimension in many cancer cases. Thus so-called organ-preserving procedures were made possible. Regarding the prognosis, the stage after the treatment became determinant. Complete histopathological remission could also be achievable in patients with oligometastases. In the case of a complete remission, the watch and wait tactics emerged as an option. Along the preoperative treatment of resectable colorectal liver metastases, there is no need to strive for complete remission. The treatment order of the primary tumor and its metastases can be reversed. Based on the improving results of oncology treatments, a reduction in surgical activity in the treatment of cancer patients is expected.

Introduction: Cervical oesophagus represents a critical location for squamous cell carcinoma, which usually requires extensive surgery (pharyngo-laryngo-oesophagectomy). In the last decade, neoadjuvant chemo-radiotherapy was reported to be beneficial in the treatment of locally advanced squamous cell oesophageal cancer., Methods: Between November 1997 and January 2012, 55 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy, where the tumour was localized in the upper third. Patients received preoperative irradiation of 3960 cGy in 180 cGy fractions and simultaneously Cisplatin and 5-FU chemotherapy. Restaging was carried out after four weeks and patients considered operable were underwent surgery., Results: In patients with cervical oesophageal cancer 35 of 55 (64%) underwent oesophageal resection or pharyngo-laryngectomy. In 16 out of 35 resected specimens (46%) complete histopathological remission (pCR) was observed. Perioperative mortality and anastomotic leaks were the same: 5/35 (14%). R0 resection rate was 82% and the 2- and 5 years survival rates were 41% and 18%. In 19 cases a larynx preserving pharyngo-oesophagectomy was performed and a free jejunal graft was used for reconstruction after a pharyngo-laryngectomy in 11 cases., Conclusion: The high rate of pCR (46%) confirmed that upper third oesophageal cancer has superior sensitivity to multimodal treatment. In 30 cases neoadjuvant chemo-radiotherapy was able to achieve tumour regression and render pharyngo-laryngo-oesophagectomy unnecessary.

Introduction: Various plastic surgery techniques were applied for oesophageal reconstruction in complicated cases. Myocutaneous flaps that are suitable to cover soft tissue defects of the neck may also be transferred and used for partial defects of the cervical oesophagus or securing a vulnerable suture line. Application of microsurgical techniques may also be useful in certain situations., Patients and Methods: Pectoralis major myocutaneous flap was used in 5 cases in our department between 1998 and 2012. Microsurgical techniques were used in 38 cases of esophageal reconstruction, which were 34 free jejunal grafts and 4 supercharged colon grafts., Results: 23 patients underwent primary reconstruction after pharyngolaryngectomy, while 15 patients had secondary reconstruction after failed previous operations or recurrence. When more experienced was gained free jejunal grafts were used for the cervical as well as thoracic oesophagus. Three grafts were lost, two of them were due to anastomotic thrombosis and one was due to severe MRSA wound infection., Conclusion: Complicated cases of oesophagus reconstructions may be successfully treated by the cooperation of oesophagus and plastic surgeons, which may result in an acceptable complication rate.

Introduction: The authors report their experience with central pancreatectomy and also summarize relevant literature data., Material and Methods: Central pancreatectomies were performed in 7 patients for benign or low-grade malignant pancreatic neoplasms, or pancreatic rupture in one patient. Most frequently applied anastomosis was between the distal part of the pancreas and a Roux-en-Y limb, while the proximal cut surface was closed with sutures, and the suture line was covered with a limb., Results: There were three complications (37%), but reoperation didn't need to be performed and none of the patients died. We did not detect any deterioration in the exocrine or endocrine function during the follow-up period., Conclusions: Central pancreatectomy is a safe procedure with excellent functional results, if both the indication and the applied technique are chosen appropriately.

Background/aims: A single-centre experience gained by middle segmental pancreatic resection and a brief survey of technique and indications are reported., Methodology: During the past 7 years 7 middle segmental pancreatic resections were performed for benign and low-grade malignant pancreatic lesions and in 1 case for pancreatic trauma. The preferred method was anastomosing the distal remnant to a Roux-en-Y limb, closure of the proximal cut end with sutures and in the last 4 patients covering this suture line with the limb., Results: There were 3 complications out of 8 cases (37%) and the surgical morbidity rate was 12%. It did not come to reoperation and lethal outcome. During the follow-up time both the endocrine and exocrine functions remained normal in all patients., Conclusions: Middle segmental pancreatic resection could be carried out with an acceptable morbidity rate. However the proper indication and surgical technique are important factors in achieving advantageous results.

The authors report the case of a colon adenocarcinoma developed on the neck at the anastomosis of the skin tube and colon 44 years following a corrosive oesophageal injury. This patient suffered a moderately severe oesophageal, stomach and laryngeal injuries due to drinking hydrochloric acid 44 years ago. He underwent serial laryngoplasties, then needed a tracheostomy, oesophagectomy, pyloroplasty and ileocolon transposition. An antethoracal oesophagus formation was performed with ileocolon and skin tube amendment. 44 years later an ulcerated adenocarcinoma developed in the transposed colon, which was resected and the ability to swallow was reinstated by the transplantation of an isolated jejunal segment using microvascular anastomosis.

Aims: To evaluate the efficacy of duodenal switch operation for patients with duodeno-gastroesophageal reflux disease., Methods: Four female patients with therapy resistant epigastric pain and biliary regurgitation were enrolled in the study. In all cases, abnormal duodeno-gastric reflux was confirmed by 24-hour Bilitec monitoring. The average age of the patients was 41.75 years (range 32-53) and three of them had a cholecystectomy in the past. Importantly, all patients had previously undergone fundoplication, which had to be repeated in one of them due to recurrent symptoms. More recently, a duodenal switch procedure was performed in these four patients. Their mean follow-up time was 24.25 months (range 21-30)., Results: Duodenal switch was performed without any perioperative complications. A good clinical outcome was found in all patients on their follow up; however, an abnormal acidic exposure was found in one case on 24-hour oesophageal pH monitoring., Conclusion: Recurrent epigastric complaints developing after anti-reflux surgery in patients with a previous diagnosis of gastroesophageal reflux disease might be due to an abnormal duodeno-gastric reflux. Previous cholecystectomy may increase the risk of biliary reflux. Duodenal switch procedure can be applied with good results in patients with therapy resistant abnormal duodeno-gastric reflux confirmed with Bilitec monitoring.

Aim: The aim of this study was to compare the efficiency of the preoperative combined chemo-radiotherapy in the treatment of locally advanced squamous cell carcinoma in different locations of the oesophagus., Methods: Between 1997 and 2005, 102 patients with locally advanced (T3-4) squamous cell oesophageal cancer received preoperative chemo-radiotherapy. In 40 cases, the tumour was localised in the upper-third (Group I), while in 62 cases, in the middle-third of the oesophagus (Group II). Survival rates of patients receiving neoadjuvant therapy were compared with a historical control group. In addition, Group I and Group II were compared to each other, as well., Results: survival rate was significantly better after neoadjuvant therapy (p:0.0042) Resection was performed in 70% of the patients from Group I, and in 50% of those complete pathological remission (pCR) was observed. The perioperative morbidity and mortality rates were 43% and 14%, respectively. As far as Group II, 69% of the patients underwent oesophageal resection, with a perioperative mortality of 18% and morbidity rate of 62%. pCR was observed only in 7% of the cases. The median survivals (21 and 22 months) and the R0 resection rates (82 and 84%) were similar in the two groups. The pCR subgroup showed a significantly better survival rate., Conclusion: In this study, we demonstrated that preoperative chemo-radiotherapy increases survival in locally advanced oesophageal cancer. A significantly higher rate of complete response was observed in patients with upper-third oesophageal cancer. It seems that this group has superior sensitivity to multimodal treatment; therefore, our results support a new prognostic factor in oesophageal cancer treatment.

Authors replaced the esophagus with anisoperistaltic left colon because they had no other possibilities. In this case twenty-one years ago after an esophageal injury the patient underwent gastric resection, removal of the esophagus and replacement with a skin tube created from a myocutaneous flap. Unfortunately the right colon earlier had been removed after an unsuccessful replacement. Twenty-one years later carcinoma developed in the skin tube therefore the tumour was removed and anisoperistaltic left colon was used as a "new esophagus". The pulled up left colon was supplied by the left colic artery and supercharged by a vascular anastomosis on the neck. Authors would like to present that esophageal replacement with anisoperistaltic left colon is a feasible method if no other therapeutic option remains.

Formerly the treatment of gastrointestinal cancers was exclusively surgical. Though the results were improved by increased radicality, the real progress was achieved by the introduction of multimodal therapy, particularly by the neoadjuvant concept. The basic prerequisite for neoadjuvant treatment is precise staging and risk assessment. According to staging patients can be divided into three categories: (1) Early cancers, confined to the mucosal and submucosal layers, are approached with primary surgery. (2) Systemically metastasized tumors receive merely palliative treatment. (3) Locally advanced cancers are treated by neoadjuvant therapy. Due to neoadjuvant treatment the tumor can be downsized (or downstaged) in some patients. These are the responders benefiting from the therapy, because of the increased RO-resection rate, decreased recurrence rate and improved survival. The non-responders, by contrast have poor prognosis. Neoadjuvant treatment considerably improved the chance for cure for patients with gastrointestinal cancers, thus this method became an evidence based treatment for locally advanced gastrointestinal cancers.

The surgery of metastatic gastrointestinal malignancies comes into prominence nowadays. Positive observations inspire the increase of surgical radicality. Occurrence of peritoneal carcinosis means a very bad prognosis. However, on the base of the literature and our experiences the prognosis can be improved in some well-defined groups of patients. We present the method and opportunity of using peritonectomy and intraperitoneal chemotherapy in connection with two cases. We review the method developed and improved by Sugarbaker and his workgroup. Good results can be achieved by this combined technique in the cases of less invasive tumours, for example pseudomyxoma peritonei and peritoneal mesothelioma. Good result can also be achieved in the cases of more aggressive tumours if they are in resectable stage with not so extensive peritoneal seeding. Surveying the literature we can find encouraging results concerning ovarian cancer, gastric and colo-rectal cancer accompanied by peritoneal seeding.

We performed 26 reconstructions after emergency esophago-gastrectomy for corrosive injury during 13 years (1992-2004). Substernal replacement with pedicled colon graft was performed in 22 patients. Multi-stage operations were performed in 4 patients, two free jejunal grafts were applied after unsuccessful colon replacement. In two patients reconstruction could be completed only with a skin tube. Two patients died in the postoperative period. We do not support one stage reconstruction in corrosive injuries, and we suggest that the ideal time for reconstruction is around two months after esophago-gastrectomy.

Aims: To evaluate the effect of a new laparoscopic procedure, which was developed in our institute for reinforcement of posterior hiatoplasty., Methods: The results of our first 20 patients of this ongoing prospective study are presented. All patients had gastro-oesophageal reflux disease and a hiatus defect greater than 6 cm. The reinforcement of the posterior hiatoplasty was carried out with ligamentum teres hepatis. The ligamentum was dissected with from the abdominal wall, brought behind the oesophagus and stitched to the right and left crura, with two non-absorbable sutures. In all patients a loose Nissen-DeMeester fundoplication was also performed. Patients were followed up with oesophagograms. The mean follow-up time was 12.4 months (range 3-24)., Results: The mean operation time was 115 minutes (range 95-135). Conversion to open procedure was necessary in five patients due to adhesions caused by previous operation. No intraoperative complications were observed. One reoperation was necessary because of a subphrenic haematoma. There was no perioperative mortality. At follow-up two patients had atypical reflux symptoms, but functional tests showed no abnormal gastroesophageal reflux. Oesophagograms showed one recurrence, but the patients was symptom free., Conclusion: On the basis of these preliminary results it seems that laparoscopic reinforcement for the closure of large hiatus hernias with ligamentum teres is a safe, feasible and effective technique.

Unlabelled: Only surgical resection offers cure in gastric cancer. Curative resection unfortunately is possible only in about every second patient diagnosed with gastric cancer. Neoadjuvant chemotherapy may help to reach R0 resection in patients with locally advanced gastric cancer., Aim: To evaluate the ability of ECF neoadjuvant chemotherapy in locally advanced gastric cancer., Patients and Methods: Between December 1998 and April 2003 twenty-four patients with locally advanced gastric cancer were given neoadjuvant chemotherapy according to the ECF scheme. Before treatment, staging examinations were carried out: endoscopy, barium swallow, chest X-ray, computer-tomography and laparotomy or diagnostic laparoscopy. We treated patients with four three-weeks-long courses of chemotherapy with bolus injection of epirubicin and cisplatin on day 1, and continuous infusion of 5-fluorouracil on day 1 to 21. Twelve weeks long treatment was followed by 4 weeks free of treatment, than staging was repeated to determine response., Results: 45.83% response rate was achieved. One complete response was observed. Ten patients showed partial response, 3 stable diseases and 10 progressive disease were detected. Twenty-one patients were operated on. Sixteen resections were carried out, ten with curative intent. Overall survival and disease free survival in the whole group were 12.19 and 8.66 months, while in patients with R0 resection 20.66 and 18.33 months., Conclusion: Neoadjuvant chemotherapy provides a hope for cure for patient with locally advanced gastric cancer.

The appearance of distant metastases meant in the past, that gastric cancer was incurable. However, experience with colorectal cancer has shown that patients with distant metastasis may have a chance for cure, if metastatic disease can be completely resected. Considering these experiences in the literature it seems that the judgement of gastric cancer has recently changed. It is reasonable to excise late and isolated metastasis in some patients to improve the prognosis. The authors report a successfully treated case of gastric adenocarcinoma with an usual, oesophageal metastasis.

Kidney transplantation is a widely used method for the treatment o fend-stage renal disease. Between September 3, 1993 and December 2002 a total of 300 kidney transplantations were performed at the Department of Surgery at the Medical University of Pécs. In 24 patients simultaneous kidney and pancreas transplantation was performed. The mean age of the 189 male and 111 female patients was 42 years. The HLA B, Dr tissue antigen mismatches was 1.63. The average cold ischemic time was 1199 minutes whereas the average anastomotic time was 43 minutes. Early surgical complications happened to 16 patients. In spite of the immunosuppressive treatment 26 acute steroid resistant rejection have occurred, 9 of which were irreversible. In our opinion the meticulous surgical technique is as important as the postoperative care is. The early and late complications of 300 renal transplants are reviewed by the authors.

In the treatment of gastric cancer R0 surgical resection is the only hope for cure. Unfortunately most patients are first seen when they are in an advanced stage, when the possibility of R0 resection is very poor. In these cases administration of other therapies is justified. In the last decade neoadjuvant combination chemotherapy had been introduced with promising results. ECF neoadjuvant chemotherapy has 60% response rate in irresectable cases. We report about a patient with locally advanced gastric cancer treated with neoadjuvant ECF chemotherapy. The patient reacted with complete response, so following chemotherapy R0 resection could be carried out. We describe different therapies used for patients with locally advanced gastric cancer. Neoadjuvant chemotherapy is a recommended therapeutic modality in locally advanced gastric cancer, because it may have the effect of irresectable disease becoming resectable.

Blast injuries causing pneumatic damage to the oesophagus are very rare. Patients usually present with respiratory distress, subcutaneous and mediastinal emphysema, and may also have pneumothorax. Ruptures need early repair to avoid serious morbidity and potential lethal complications. We report about a successfully treated 47-year-old patient, who has been admitted to our department with compressed air injury of the oesophagus.