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Recent guidelines recommend routine pulse oximetric monitoring during endoscopy, however, this has not been the common practice yet in the majority of the local endoscopic units.To draw attention to the importance of the routine use of pulse oximetric recording during endoscopy.A prospective multicenter study was performed with the participation of 11 gastrointestinal endoscopic units. Data of pulse oximetric monitoring of 1249 endoscopic investigations were evaluated, of which 1183 were carried out with and 66 without sedation.Oxygen saturation less than 90% was observed in 239 cases corresponding to 19.1% of all cases. It occurred most often during endoscopic retrograde cholangiopancreatography (31.2%) and proximal enteroscopy (20%). Procedure-related risk factors proved to be the long duration of the investigation, premedication with pethidine (31.3%), and combined sedoanalgesia with pethidine and midazolam (34.38%). The age over 60 years, obesity, consumption of hypnotics or sedatives, severe cardiopulmonary state, and risk factor scores III and IV of the American Society of Anestwere found as patient-related risk factors.To increase the safety of patients undergoing endoscopic investigation, pulse oximeter and oxygen supplementation should be the standard requirement in all of the endoscopic investigation rooms. Pulse oximetric monitoring is advised routinely during endoscopy with special regard to the risk factors of hypoxemia.Bevezetés: A nemzetközi irányelvek az endoszkópos vizsgálatok végzését rutinszerűen pulzoximetriás monitorozás mellett javasolják, a hazai gyakorlatban azonban ez a vizsgálóhelyek többségében még nem érvényesül. Célkitűzés: A szerzők objektív adatokkal alátámasztva kívánták felhívni a figyelmet a hazai gyakorlat megváltoztatásának szükségességére. Módszer: Multicentrikus, prospektív, 11 vizsgálóhely részvételével végzett vizsgálatban összesen 1249 (közülük 1183 szedációban és 66 a nélkül történt) endoszkópos vizsgálat során végzett pulzoximetriás monitorozás eredményeit értékelték. Eredmények: 239 esetben, az összes eset 19,1%-ában észlelték a vizsgálat során az oxigénszaturáció 90% alá csökkenését, leggyakrabban ERCP (31,2%) és jejunoscopia során (20%). A hypoxaemia vizsgálatfüggő kockázati tényezőjének bizonyult a vizsgálat időtartama, valamint a pethidin (31,31%) és a pethidin és midazolam kombinációban végzett (34,38%) sedoanalgesiás premedikáció, betegfüggő kockázati tényezőnek pedig az időskor, az elhízás, nyugtató-altató hatású szerek szedése, továbbá a súlyos kísérő cardiopulmonalis társbetegség, illetve az Amerikai Anaesthesiologiai Társaság III. és IV. fizikális státus szerinti kockázati fokozata. Következtetés: A betegek biztonsága megköveteli, hogy pulzoximéter és oxigénszupplementáció lehetősége minden endoszkópos laboratóriumban rendelkezésre álljon. A pulzoximetria rutinszerű alkalmazása javasolt endoszkópia során, különös tekintettel a hypoxaemia kockázati tényezőire. Orv. Hetil., 2013, 154, 825–833.

Mannose-binding lectin (MBL) is a pattern-recognition molecule of the innate immune system and may be involved in the pathogenesis of inflammatory bowel disease (IBD). Our aim was to assess the prevalence of MBL deficiency in a cohort of patients with paediatric-onset IBD and study whether it is associated with the clinical manifestations, serum antibody formation, or genetic factors.This prospective study included 159 paediatric patients (mean age: 14.0 years) with IBD [107 patients with Crohn disease (CD) and 52 patients with ulcerative colitis (UC)]. Furthermore, 95 controls were investigated. Serum samples were determined for MBL by enzyme-linked immunosorbent assay (ELISA) and for serologic markers [autoantibodies against Saccharomyces cerevisiae (ASCA) and perinuclear components of neutrophils (pANCA)] by indirect immunofluorescent assay. NOD2/CARD15 variants were tested by polymerase chain reaction/restriction fragment length polymorphism.The MBL serum concentration was significantly lower in IBD patients(both with CD and UC) compared to controls (IBD, p=0.007, CD, p=0.04, UC p=0.004). Prevalence of low MBL level (500 ng/mL) was significantly higher in both CD and UC groups compared to controls (p=0.002 and p=0.006). Furthermore, low MBL level was associated with isolated ileal involvement (p=0.01) and MBL deficiency (100 ng/mL) with male gender (p=0.004) in patients with CD. We failed to confirm any correlation between MBL deficiency and serum autoantibodies or NOD2/CARD15 variants.Our results suggest that low MBL associated with paediatric-onset IBD and ileal CD may be considered an additional marker of the IBD pathogenesis.

Background: Significance of pancreatic autoantibodies determined by using exocrine pancreas (PAB) and antibodies against recombinant pancreas antigen (rPAB), as well as the importance of autoantibodies against goblet cells (GAB), is not known in pediatric patients with inflammatory bowel disease (IBD). Our aim was to determine the complex analysis of PAB, rPAB, GAB, antibodies against Saccharomyces cerevisiae, and perinuclear components of neutrophils in pediatric patients with IBD. Moreover, association with NOD2/CARD15 and disease phenotype was determined. Methods: A total of 152 pediatric patients (median age 13.9 years) with IBD (103 patients with Crohn disease [CD] and 49 patients with ulcerative colitis [UC]) and 104 controls were included. Serum autoantibodies were determined by indirect immunofluorescence assay. NOD2/CARD15 variants were tested by polymerase chain reaction/restriction fragment length polymorphism. Results: The presence of PAB and rPAB was significantly higher in CD (34% and 35.9%) and in UC (20.4% and 24.5%) compared with pediatric control cohort (0% and 0%, P < 0.0001). In addition, GAB positivity was significantly increased in patients with UC in comparison with CD and controls, respectively (UC, 12.2%; CD, 1.9%; controls, 1.9%; P ¼ 0.02). Specificity of PAB and rPAB was 100%; however, sensitivity was low. The combination of PAB and/or antibodies against Saccharomyces cerevisiae/perinuclear components of neutrophils improved the sensitivity of serological markers in CD (87.4%) and in UC (79.6%); specificities were 89.3% and 93.2%, respectively. Pancreatic autoantibodies (PAB, rPAB) and GAB were not related to clinical presentation, medical therapy, or need for surgery in CD or in UC. Conclusions: Pancreatic autoantibodies and GAB were specific for IBD, but the sensitivity was limited as well because there was lack of correlation with clinical phenotype. Combinations of these antibodies have shown increased sensitivity; therefore, it may be recommended in the diagnostic procedure of IBD.

BACKGROUND Obscure gastrointestinal bleeding (OGIB) that cannot be established applying traditional endoscopic methods represents 5 % of all gastrointestinal bleedings. Earlier, in cases of recurrent, overt bleedings the surgeons had to perform a laparotomy "blind" without diagnosis. The aim of our retrospective study was to analyse the effectiveness of surgical therapy in patients with OGIB investigated with capsule endoscopy (CE). METHODS During 36-month period at two workplaces capsule endoscopy studies were evaluated in 61 patients with OGIB who had undergone non-diagnostic panendoscopy and colonoscopy. CE findings were divided into three groups according to the bleeding source: definitive bleeding source (48), uncertain bleeding potential (5) and negative findings (8). Surgical therapy was initiated in 18 cases with definitive bleeding sources. RESULTS The mean age of 7 male and 11 female patients operated on was 63.4 (+/- 10.69) years. The period between the first clinical symptoms and the date of the operation was an average of 18.2 (+/- 26.11) months. During this period patients were hospitalized in an average of 6 (+/- 7.96) cases. In 17 cases (94 %) the surgical and pathological findings justified the definitive bleeding sources detected by CE. In one case of bleeding angiodysplasia with negative pathological findings the follow-up period without recurrent bleeding justified the validity of CE results and the success of surgical therapy. CONCLUSIONS CE offers a high impact on the surgical results in patients with OGIB. Through our CE examinations the correct localization of the bleeding sources always provided a reasonable support to perform an optimal small bowel resection.

A coeliakia olyan autoimmun enteropathia, amelyet a genetikailag prediszponált egyénekben a gabonafélék gluténje indít el. A betegséget sokáig gyermekkori betegségnek tartották, mivel a klinikai tünetek a glutén étrendbe való beépítésekor jelentkeztek. A coeliakiára specifikus szerológiai markerek elterjedése megváltoztatta a kórkép epidemiológiájával és tünettanával kapcsolatos ismereteket. A diagnosztika nehézsége abból adódik, hogy a gluténszenzitív enteropathiás betegek több mint 50%-ának tünetei atípusosak, és az extragastrointestinalis manifesztációjú coeliakiában szenvedő betegek 90%-ának nincs gastrointestinalis tünete. Jelenleg a coeliakia diagnosztikája a specifikus autoantitestek kimutatásán és a duodenum szövettani értékelésén alapszik. Kezeletlen betegek esetén a felső standard endoszkópia során a nyombélben jól láthatók a boholyatrophia makroszkópos eltérései (Kerking-redőzet elsimulása, a nyálkahártyán áttűnő érrajzolat, a mucosa mozaikszerű rajzolata vagy granuláltsága és a fésűfogszerű redőzet kialakulása). A kapszulás endoszkópia (CE) a hagyományos endoszkópos módszerekkel szemben a teljes vékonybél noninvazív, fájdalmatlan vizsgálatát teszi lehetővé. A vizsgálatok során a vékonybél-nyálkahártya 8:1 arányú nagyításban válik láthatóvá, ami gyakorlott vizsgáló számára lehetővé teszi a boholyatrophia megítélését. Az első tapasztalatok alapján úgy tűnik, hogy a standard felső endoszkópia és a kapszulás endoszkópia szenzitivitása és specificitása azonos coeliakiában. A CE előnyét a felső endoszkópiával szemben a vékonybél teljes értékelhetősége jelenti, mert így a betegség kiterjedése és súlyossága is megítélhető. Hátránya a hisztológiai mintavétel hiánya. Bizonyítottan coeliakiában szenvedő betegek esetében, „alarm” tünetek jelentkezésekor a CE „first line” módszerként javasolható.

Small intestinal stromal tumors acccount for approximately 35% of all gastrointestinal stromal tumors. Gastrointestinal bleeding is considered as one of the main clinical symptoms for SISTs. Capsule endoscopy has brought revolution in small bowel diagnostics, as it is considered the best method of visualisation of the entire small intestine. Besides, it is well tolerated by patients and is accompanied by a low number of complications. It is also indicated as the first diagnostic method in gastrointestinal bleeding of obscure origin, following negative upper endoscopy and colonoscopy. Case report: 2 patients (a male and a female, aged 58 and 69, respectively) presented with obscure gastrointestinal bleeding have been examined by capsule endoscopy after negative upper endoscopy and colonoscopy. Videorecords have been assessed in both cases by two independent experts. The capsule reached the Bauchin-valve in both cases during the 8 hours of the testing time and the entire small bowel was clearly visible. – Based on the capsule endoscopic images, for one of the two cases a tumor has been reported as the background of the small intestinal bleeding. In the other case we could mark the location of the bleeding, while we were unable to ascertain the type of the actively bleeding lesion during the test. In order to determine the accurate bleeding source double-balloon enteroscopy was performed in the second case. After surgery the histological and immunhistochemical tests have justified the presence of spindle cell GISTs. Taking into consideration the Fletcher-classification, for the tumor size and the mitotic index, both cases can be classified as a GIST of low malignant potencial. Conclusions: An early diagnosis and application of a definitive therapy become possible by using capsule endoscopy, therefore the chance of survival of the patients might be increased.

Az angiodysplasiák a gastrointestinalis traktus leggyakoribb vascularis anomáliái és a vérzésből eredő mortalitás jelentős tényezői. Az obskúrus gastrointestinalis vérzések (OGIV) hátterében megközelítőleg 40%-ban vékonybél-angiodysplasiák állnak, és ebben a betegcsoportban a leggyakoribb vérzésforrást jelentik. Kialakulásuk oka ismeretlen, valószínűleg dominálóan szerzettek, és korral összefüggő degeneratív folyamatok eredményezik őket. Diagnosztikájuk nehézsége egyrészt multiplex megjelenésükből, másrészt kicsiny nagyságukból adódik. Az eddig elvégzett kapszulás endoszkópos (CE) vizsgálatok azt igazolják, hogy manifeszt vérzés során elvégzett CE szenzitivitása lényegesen jobb, mint lezajlott vagy okkult vérzés esetén. Esetismertetés: 61 éves, 13 éve antikoaguláns terápiában részesülő nőbeteg vizsgálatát végeztük el tisztázatlan eredetű, ismétlődő gastrointestinalis vérzés miatt negatív felső endoszkópiát és kolonoszkópiát követően kapszulás endoszkópiával. A vizsgálat során a gyomor antrumában típusos angiodysplasiát és a jejunum felső harmadában aktív vérzést észleltünk látható vérzésforrás nélkül. Következő diagnosztikus lépésként szelektív mezenteriális angiográfiát végeztünk a diagnózis pontosítására, és egyidejűleg radiológiai intervencióra is sor került. Következtetés: A kapszulás endoszkópia megváltoztatta az OGIV-betegek diagnosztikáját, és negatív felső endoszkópiát és kolonoszkópiát követően elsődleges diagnosztikus eljárássá vált. A vizsgálat kellő időben történő alkalmazása esetén a CE jelentősen lerövidítheti a diagnosztikus ténykedések idejét, definitív terápiát eredményezhet, és számos alacsony diagnosztikus értékű és költséges vizsgálat takarítható meg. A vékonybél-angiodysplasiák sikeres terápiája ma is nehéz; a radiológiai intervenció jelenti a legkisebb megterhelést a beteg számára.

Bevezetés és célkitűzések:A portalis hypertensio következtében kialakult vékonybéleltérésekről kevés irodalmi adat ismert. Retrospektív, összehasonlító vizsgálatukban a szerzők a kapszulás endoszkópia diagnosztikus eredményeit, valamint az észlelt elváltozásokat elemezték cirrhosis hepatisban szenvedő betegekben tisztázatlan eredetű gastrointestinalis vérzés esetén.Betegek és módszer:11 cirrhosis hepatisban és portalis hypertensióban szenvedő beteg és 22 májbetegségben nem szenvedő kapszulás endoszkópiás vizsgálat eredményeit hasonlították össze felső panendoszkópiával és kolonoszkópiával nem tisztázott eredetű gastrointestinalis vérzés esetén. A filmeket két egymástól független vizsgáló értékelte. A kapszulás endoszkópiával vizsgált betegeket átlagosan 19 (1–42) hónapig követték.Eredmények:Két centrumban 48 hónap alatt 7 férfit és 5 nőt vizsgáltak, a betegek átlagéletkora 66,2 (±7,6) év volt. Az első klinikai tünet észlelésétől a vizsgálatig eltelt idő átlagban 15,7 (±14,9) hónap. A betegek ez idő alatt 2,8 (±1,3) alkalommal kerültek kórházi felvételre; egy beteg esetében átlagosan 7,9 vizsgálat történt a kapszulás endoszkópiát megelőzően. Mind a 11 betegnél vérzésforrást diagnosztizáltak kapszulás endoszkópia során a vékonybélben. 7 betegben (63%) két definitív vérzésforrást észleltek. Az összes beteg esetében portalis hypertensióval összefüggő elváltozásokat találtak (8 esetben angiodysplasia, 2 esetben portalis hypertensiv enteropathia és 1 esetben bélvaricositas igazolódott). A követés során az újravérzések aránya 27,3%-os volt; a kontrollcsoportban 18,2%-os.Következtetések:Portalis hypertensióban obskúrus gastrointestinalis vérzés esetén a kapszulás endoszkópia eredményes vizsgáló eljárás negatív panendoszkópiát és kolonoszkópiát követően. A vékonybélvérzések hátterében leggyakrabban multiplex angiodysplasiák állnak, és gyakoriak a többszörös vérzésforrások ebben a betegcsoportban.

Despite new cultivation methods, the proportion of conventionally cultivated land is still very high in Hungary.Although these technologies demand more time, labour and fuel, they are still attractive to users because they require less professional skill and simple machinery. In Hungary, conventional tillage methods usually lead to soil deterioration, soil compaction and a decrease in organic content. These side effects have caused gradually strengthening economic and environmental problems.The technologies for those plants which are dominant on Hungarian arable lands use (winter wheat, maize, sunflower and barley) need to be improved both in the interest of environmental protection and the reduction of cultivation costs.The Department of Land Use at Debrecen University is cooperating with KITE Sc. to carry out soil tillage experiments at two pilot locations to prove tillage technologies already used in the USA.The aim of our examination is to adapt new technological developments and machinery, and to improve them on Hungarian soil for local environmental conditions. With these improved machines, the field growing of plants could be executed by less manipulation and better suited to economic and environmental needs. The most significant task is to investigate and improve the conventional cultivation replacing, new soil-protecting tillage technologies, and to apply no-till and mulch tillage systems.On the basis of the experiments’ survey data, we established that the looseness and moisture content of the soil using reduced tillage is more favourable than after using conventional technologies. The results of no-till and shallow spring tillage are behind those of winter plough or disk ripper cultivation in corn yield and production elements.To preserve moisture content in the soil, the ground clearing and sowing while simultaneously performing no-till method presents the most favourable results. The surplus moisture gained using no-till technology is equal to 40 mm precipitation.Regarding the yield of winter wheat we established that the tillage methods do not affect plant yield. Both disk ripper and conventional disc cultivation showed nearly the same harvest results (5.55 or 5.5 t/ha), where the difference is statistically hardly verifiable from the no-till method. From the individual production of corn and the number of plants planted in unit area, calculated results prove that no significant difference can be detected between the production of winter plough and disk ripper technology. Although the yield achieved with the no-till method is less than with the previously mentioned technologies, the difference is only 9-10%. We received the lowest production at shallow spring tillage.Evaluations have shown a 1.1 t/ha (13%) difference in the yield of maize, between winter tillage and the disk ripper method, in this case the traditional method resulted in higher yield. In winter tillage, the yield of maize was 1.9-2.1 t/ha (23-25%) higher than in the case of direct sowing and cultivator treatments. No significant difference could be noted between the yields of direct sowing and cultivator treatments.Our research so far has proved the industrial application of reduced tillage methods in crop cultivation technologies.

The spectrum of serological markers associated with inflammatory bowel disease (IBD) is rapidly growing. Due to frequently delayed or missed diagnoses, the application of non-invasive diagnostic tests for IBD, as well as differentiation between ulcerative colitis (UC) and Crohn’s disease (CD), would be useful in the pediatric population. In addition, the combination of pancreatic autoantibodies and antibodies against Saccharomyces cerevisiae antibodies/perinuclear cytoplasmic antibody (pANCA) improved the sensitivity of serological markers in pediatric patients with CD and UC. Some studies suggested that age-associated differences in the patterns of antibodies may be present, particularly in the youngest children. In CD, most patients develop stricturing or perforating complications, and a significant number of patients undergo surgery during the disease course. Based on recent knowledge, serum antibodies are qualitatively and quantitatively associated with complicated CD behavior and CD-related surgery. Pediatric UC is characterized by extensive colitis and a high rate of colectomy. In patients with UC, high levels of anti-CBir1 and pANCA are associated with the development of pouchitis after ileal pouch-anal anastomosis. Thus, serologic markers for IBD can be applied to stratify IBD patients into more homogeneous subgroups with respect to disease progression. In conclusion, identification of patients at an increased risk of rapid disease progression is of great interest, as the application of early and more aggressive pharmaceutical intervention could have the potential to alter the natural history of IBD, and reduce complications and hospitalizations.

OBJECTIVES The aim of the study was to evaluate the incidence, baseline disease characteristics, and disease location based on the Paris classification in pediatric inflammatory bowel disease (IBD) in the Hungarian nationwide inception cohort. In addition, 1-year follow-up with therapy was analyzed. METHODS From January 1, 2007 to December 31, 2009, newly diagnosed pediatric patients with IBD were prospectively registered. Twenty-seven pediatric gastroenterology centers participated in the data collection ensuring the data from the whole country. Newly diagnosed patients with IBD younger than 18 years were reported. Disease location was classified according to the Paris classification. RESULTS A total of 420 patients were identified. The incidence rate of pediatric IBD was 7.48/10⁵ (95% confidence interval [CI] 6.34/10⁵-8.83/10⁵). The incidence for Crohn disease (CD) was 4.72/10⁵ (95% CI 3.82-5.79), for ulcerative colitis (UC) 2.32/10⁵ (95% CI 1.71-3.09), and for IBD-unclassified 0.45/10⁵ (95% CI 0.22-0.84). Most common location in CD was L3 (58.7%); typical upper gastrointestinal abnormalities (ulcer, erosion and aphthous lesion) were observed in 29.9%. Extensive colitis in patients with UC (E4, proximal to hepatic flexure) was the most common disease phenotype (57%), whereas only 5% of children had proctitis. A total of 18.6% of patients had ever severe disease (S1). Frequency of azathioprine administration at diagnosis was 29.5% in patients with CD, and this rate increased to 54.6% (130/238) at 1-year follow-up. In UC, only 3.3% received azathioprine initially, and this rate elevated to 22.5% (25/111). Use of corticosteroid decreased from 50% to 15.3% in patients with UC. Rate of bowel resection in patients with CD during the first year of follow-up was 5%. CONCLUSIONS The incidence of pediatric IBD in Hungary was among the higher range reported. This is the first large, nationwide incident cohort analyzed according to the Paris classification, which is a useful tool to determine the characteristic pediatric CD phenotype.

In this paper the pH-equilibrium solubility profiles of ionizable drugs are presented. The aim of the present work was to study the validity of the Henderson-Hasselbalch (HH) relationship in the case of structurally diverse weak bases. In the case of monoprotic bases, namely papaverine, promethazine and propafenone the experimental equilibrium solubility data precisely follow the theoretical HH curve until the limit of salt solubility. The common ion effect on salt solubility was found to be significant at low pHs. Deviation from the HH equation in the case of dibasic quetiapine hydrogen fumarate can be easily interpreted with the formation of different salt compositions. The significance of pH control and the effect of the salt form (e.g., fumarate) was also investigated. It is critical that the pKa value and the intrinsic solubility are accurately determined when the HH relationship is used to predict the pH-dependent aqueous solubility of drugs.

We report a case of a 26-year-old primigravid woman, believed to have HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) syndrome, which turned out to be a thrombotic thrombocytopenic purpura (TTP) bout. At the 40th gestational week, based on the clinical picture of HELLP syndrome, a cesarean section was performed and a dysmature male newborn was delivered. Afterwards, clinical symptoms and laboratory abnormalities persisted. Severe ADAMTS13 deficiency with the presence of inhibitory anti-ADAMTS13 antibodies revealed acquired thrombotic thrombocytopenic purpura bout, which was complicated with bilateral vision decrease due to bilateral retinal detachment. At the first ophthalmological examination, ultrasonography and binocular indirect ophthalmoscopy confirmed the diagnosis of the serous retinal detachment. After the diagnosis of acquired TTP bout, the patient was treated with multiple plasmapheresis and intravenous immunoglobulin with rapid improvement of the clinical and laboratory parameters. The ophthalmologic complications disappeared later without sequelae. At the 18-month examination, substantial visual acuity improvement without serous retinal detachment and full best corrected visual acuity were observed.

A terápiarezisztens, súlyos Crohn-beteg gyermekek kezelésére új lehetőséget nyújt az antitumornekrózis-faktor-α-terápia (infliximab). Jelen vizsgálat célja az infliximabterápia hatékonyságának, mellékhatásainak felmérése hazánkban, a gyógyszer gyermekgyógyászati alkalmazásának engedélyezésétől a 2008. december 31-ig terjedő időszakban. A vizsgált periódusban országosan 23 gyermek részesült infliximabkezelésben. Az indukciós terápia során a betegek 5 mg/ttkg infliximabot kaptak a 0., a 2. és a 6. héten, ahol meghatároztuk a betegség aktivitását jelző mutatót (pediatric Crohn disease activity index). Az infliximabkezelés során kedvező terápiás választ 18 betegnél (81,8%) tapasztaltunk, teljes remisszióba 13 gyermek került (59,1%). A számításokat 22 beteg adatai alapján végeztük. A kezelés 6. hetére a fistulák 70%-a bezárult. A gyógyszerrel összefüggésbe hozható akut infúziós reakció 2 betegnél jelentkezett, egy másik esetben anaphylaxiás reakció alakult ki. Késői mellékhatás három gyermeknél jelentkezett. A vizsgálatunkban részt vett, hagyományos terápiára rezisztens, súlyos Crohn-betegek döntő többségénél az indukciós infliximabterápia hatásosnak bizonyult.

The endoscopic appearance in portal hypertension is well described in the stomach and the colon, but there is a limited number of data available on small bowel changes. The present retrospective, comparative study was aimed to analyse the diagnostic yield and describe the small bowel findings with capsule endoscopy in cirrhotic patients with gastrointestinal bleeding of unknown origin.Capsule endoscopy findings of 11 cirrhotic patients with portal hypertension and 22 non-cirrhotic patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy, which were then compared.In total, 9A and 2B cirrhotic patients were examined based on Child-Pugh score with a mean age of 66.2 (+/- 7.6) years. Lesions originated to portal hypertension were found in all cirrhotic patients, most frequently multiple angiodysplasias (63.6%), while in the control group multiple angiodysplasias were a seldom finding (18.2%). None of the radiological and endoscopic examinations of the small bowel before capsule endoscopy showed positive findings in cirrhotic patients.Capsule endoscopy is an effective diagnostic method with high diagnostic yield in portal hypertension. Multiple angiodysplasias are the most probable findings as the source of small bowel bleeding in these patients.

Three to six percent of all gastrointestinal tumours and one to two percent of all malignant gastrointestinal tumours develop in the small intestine. These occur more frequently in men than in women and the peak of occurrence is at the age of 50 to 60 years. According to epidemiological investigations to date the most frequently developing primary tumours in the small intestine are adenocarcinomas, carcinoid tumours, lymphomas and small bowel gastrointestinal stromal tumours. Clinical appearance of the tumours is the same, independent of their histological type. Fifty percent of the benign tumours is asymptomatic and is only discovered incidentally at autopsy. In comparison, 80% of malignant tumours is symptomatic. The prognosis of small intestine malignant tumours is very poor as at the time of diagnosis they have already formed metastases in 45-75% and at the time of surgery they are in 20-50% irresectable. The reason for the late diagnosis is on the one hand the non-specific nature of the symptoms, on the other hand, the limited visualisation of the entire small intestine via traditional radiological and endoscopic methods. Capsule endoscopy (CE) revolutionised the diagnostics of the small intestine by enabling non-invasive, pain-free investigation of the entire small intestine. The timely application of CE may replace a range of expensive assays with limited diagnostic value. Initial results indicate a higher prevalence of small intestine tumours than it had been estimated based on earlier epidemiological investigations. The new method provides an early diagnosis, enabling a definitive therapy, eventually significantly improving patient survival.

The hereditary polyposis syndromes and non-polyposis colorectal carcinoma have been considered as scarcely occuring but inheritable dominant autosomal syndromes. The increasing risk of small bowel carcinoma and prevention of obstruction and intussusception have been making frequent and acute surgical interventions inavoidably led to the necessity of screening and surveillance the patients. Earleir the diagnosis of these symptoms was difficult to establish because traditional radiological methods have a low yield for small polyps. Futhermore, small bowel is only partially accessible with traditional endoscopic techniques such as upper endoscopy, colonoscopy and push-enteroscopy. The “wireless” capsule endoscopy has opened the way then for the non-invasive and painless test of the entire small intestine. – Test results have been cumulated to justify the efficiency and safety of capsule endoscopy concerning the syndromes above. This method can be applied safely even consequently to repeatedly performed surgical interventions by low risk of capsule retention. As the results compared of the diagnosed familial adenomatous polyposis and of Peutz–Jeghers syndrome reflect on capsule endoscopy, its diagnostic sensitiveness is stated as significantly higher than the Barium-contrast X-Ray and MR-enterography. Nevertheless, determination of size and localisation of polypus has becoming more problematic when evaluating the test results.

Limited number of data are available on small bowel changes due to portal hypertension. The present retrospective, comparative study was aimed to analyse the diagnostic yield and to describe the findings with capsule endoscopy of cirrhotic patients with obscure gastrointestinal bleeding.Capsule endoscopy findings of 11 cirrhotic patients with portal hypertension and 22 non-cirrhotic patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy were compared. Capsule video recordings were evaluated by two investigators at both workplaces. Patients after capsule endoscopy were followed-up until a mean of 19 (1-42) months.In total 7 men and 5 women were examined at two medical centres in 48 months with a mean age of 66.2 (+/-7.6) years. The average period between the first clinical symptoms and capsule endoscopy was 15.7 (+/-14.9) months. During this period patients were hospitalized in an average of 2.8 (+/-1.3) times and 7.9 examinations were performed per patients prior to capsule endoscopy. A small bowel bleeding source was diagnosed in all 11 patients. Two definitive bleeding sources were observed in 7 patients (63%). Lesions connected to portal hypertension were found in all patients (8 angiodysplasias, 2 portal hypertensive enteropathies and 1 bowel varix). During the follow-up period rebleeding occurred in 27.3% of cirrhotic patients compared with 18.2% rebleeding rate in the control group.Capsule endoscopy is a useful method in patients with portal hypertension and obscure gastrointestinal bleeding after negative upper endoscopy and colonoscopy. Multiple angiodysplasias are often diagnosed in the background of small bowel bleedings, and several bleeding sources frequently occur in these patients.

A szerzők egy 6 éves gyermeknél jelentkező, letális kimenetelű chronicus intestinalis pseudoobstructio (CIPO) esetét ismertetik. A klinikai tünetek és a képalkotó vizsgálatok ileus képét mutatták mechanikus elzáródás nélkül. Az ápolás során neurológiai tünetek alakultak ki, bal oldali mydriasis, majd grand mal görcsroham laktát-acidosis mellett. A konzervatív kezelés teljes parenterális táplálást, folyadék-elektrolit pótlást, erythromycin és szomatosztatin adását, acidosis korrekciót foglalt magában. A beteg halálát a 48. ápolási napon hirtelen fellépő keringési elégtelenség, szívmegállás okozta. A tisztázatlan eredetű gastrointestinalis és neurológiai tünetek, laktátacidosis alapján mitochondriális myopathia lehetősége merült fel a kórkép hátterében. A postmortem hisztopatológiai vizsgálat viscerális myopathiát bizonyított. A molekuláris genetikai vizsgálatok mitochondriális DNS-mutációt nem igazoltak.

A 10 year-old patient was admitted to our hospital due to severe gastrointestinal bleeding. His symptoms included hematochezia and fainting. Neither emergency upper endoscopy nor colonoscopy had identified the site of bleeding. During the colonoscopy they noticed that fresh blood entered the cecum from the ileum. An urgent capsule endoscopy was performed 8 hours after the patient admission. They placed the capsule with specific endoscopic technique into the proximal duodenum under general anesthesia. During 3,5 hours by the small bowel passage the capsule moved to the ileum and a focal bleeding lesion was detected at this site, suggesting the typical picture of bleeding Meckel's diverticulum. The patient was transfused by 1 unit of blood, with a minimum haemoglobin level 95 g/l. By surgery the ulcerated Meckel's diverticulum was identified and resected. Histopathology showed ectopic gastric mucosa. Surgical resection of the diverticulum resulted complete healing of this patient. The capsule endoscopy diagnosis was prompt, precise, and the all examinations were carried out within 24 hours. Involving urgent small bowel capsule endoscopy into the diagnostic workup of the obscure bleeding patient could considerably shorten the time to achieve a correct diagnosis and allowed the early institution of definitive treatment. By this one could spare a great number of costly alternative investigations with low diagnostic yield.

The major indication of small bowel capsule endoscopy is the diagnostics of obscure gastrointestinal bleeding. The present retrospective study was aimed to analyze the diagnostic yield, positive and negative predictive values and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding.During a 36 month period at two workplaces 66 capsule endoscopy studies were performed in 62 patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy. Capsule video recordings were evaluated by two investigators at both workplaces. Capsule endoscopy findings were divided into 3 groups according to the bleeding source: definitive bleeding source (48 patients), uncertain bleeding potential (5 patients), and negative finding (8 patient). Patients after capsule endoscopy were followed-up until a mean of 20 (1-41) months.A definitive small bowel bleeding source was detected in 78.7% of the cases studied by capsule endoscopy. Definitive bleeding sources included angiodysplasia (28 cases), small bowel Crohn's disease (5 cases), small bowel tumor (5 cases), small bowel stenosis (2 cases), NSAID therapy related ulcer (1 case), non-specific inflammation (1 case) and helminthiasis (1 case) respectively. The positive and negative predictive values of capsule endoscopy studies were 95.8% and 84.6% respectively. In cases with definitive bleeding sources 72% of patients received therapy in accordance with capsule endoscopy findings (surgery in 18 patients, medical treatment modification in 16 patients, chemoembolisation in 1 patient). During the follow-up period 17.7% of the patients had rebleeding.Capsule endoscopy is a useful and effective diagnostic method in cases with obscure gastrointestinal bleeding. Effective therapy may be introduced in accordance with the majority of positive capsule endoscopy results.

Gastrointestinal stromal tumors (GISTs): clinical and pathological features. The gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. With immunohistochemical, electron microscope and molecular examinations they can be clearly distinguished in both their genotype and phenotype from other mesenchymal tumors. GIST tumors express the CD 117 receptor in more than 90% independent of histopathological features and clinical behaviour. This is why it is considered as the most important characteristic. The incidence is 10-20 new cases per 1 million annually. The number of incidents is expected to increase by the establishment of CD117 and other new markers (protein kinase C theta, DOG1). Nowadays the establishment of the expected biological behavior and malignancy can be difficult. The best prognostic factors are the tumor size and the mitotic index. Dominantly, due to the mutation of the c-kit proto-oncogene and PGDFRA gene that the high level tyrosine kinase activity generates resulting uncontrolled proliferation and cell growth. The imatinib mesylate is a selective inhibitor of the KIT tyrosine kinase receptor and it also blocks the activity of the PDGFRA kinase. The therapeutic consequence of this is that the majority of advanced GIST tumors which do not react to conventional radio- and chemotherapy respond well to tyrosine kinase inhibitor treatment. As a result, survival and patient's quality of life can significantly improve.

A 23-year-old woman presented with a thyroid mass and total thyroidectomy was performed. Histological examination revealed papillary thyroid carcinoma. In the postoperative period severe hypocalcaemia due to permanent hypoparathyroidism developed. After postoperative telecobalt irradiation and substitutional hormone therapy (200-400 micrograms/day levothyroxin and 0.5-1.5 micrograms/day calcitriol) the patient had two successful pregnancies. The adaptation of the two mature newborns was without any complication. During pregnancy, the patient was treated with increased doses of levothyroxine and calcitriol. During lactation, the hormone substitution doses were decreased to those used in non pregnant stage. The authors conclude that the successful pregnancies were largely attributable to adequate dose-adjustments of levothyroxine and calcitriol based on frequent measurements of thyroid hormones and serum calcium.

Invasive fungal rhinosinusitis is an aggressive, destructive process most commonly affecting immunocompromised hosts with mortality rate of approximately 60-80%.The authors present a child's recovery of orbital phlegmone due to acute exacerbation of chronic fungal pansinusitis. They call the attention to the possibility of ever more frequent fungal sinusitis in our country.Retrospective case report of an 8 years old boy presented with photos.The recovery was promoted by supposing the chance of fungal origin in time. No orbital abscess was found by surgery despite of typical clinical appearance and MRI results. After beginning of antibacterial treatment and functional endoscopic sinus surgery (FESS) the even worsening clinical status of orbital phlegmone raised the possibility of fungal origin, which was verified by mycological examination. The antimycotic treatment, which had been started in time was followed by complete recovery. Due to scarring in the medial rectus muscle, diplopia was the only complication which needs further ophthalmological controls.Supposition and verification of chance of fungal origin is essential in cases of chronic inflammation of paranasal sinus and/or their complications for complex recovery.

A population-based study of 7,049 index patients with multiple congenital abnormalities (MCA) born in Hungary during 1973-1982 was organized by the Hungarian Center for Congenital Anomaly Control. All clinically recognized syndromes and associations which were submitted (2,049) were accepted without any further follow-up. New or supplementary information was requested in the case of unspecified MCA (320). A copy of detailed necropsy records was requested from pathologists in lethal cases (2,022). Following these steps, apparent but not true instances of MCA were excluded (399), and an attempt was made to assign as many of the remainder as possible in 17 well-delineated MCA entities (900). The living index patients with severe MCA were referred where possible to the regional centers for evaluation (864). One hundred and seventy entities were identified, and seven cases were excluded as not representing MCA. In the so-called 3,393 unidentified cases for which no diagnosis was possible, the component abnormalities were tabulated according to their number. The final count was 6,643 cases with MCA, which is equivalent to a birth prevalence of 4.0 per 1,000 total births, and to 10% of recorded cases with congenital anomalies. As a result of this program the proportion of recognized syndromes and associations among children with MCA increased from 29% to 47%. The accuracy of diagnoses has improved, e.g., the occurrence of unspecified cases decreased from 4.5% to 2%. As a result of this study, the number of chromosomal (1,700), Mendelian (557), and teratogenic (104) syndromes and associations (758) was considerably greater than the initial notifications indicated.

Nach einer Literaturubersicht wird ein Schnellverfahren fur die Untergrundkorrektion und die gleichzeitige Auswertung beschrieben. Dies erfolgt mit Hilfe eines mit einem Spektralprojektor projizierten Graphikons, einer Indexlinie verAnderlicher Winkelstellung und mit einer auf den Projektionsschirm gelegten δY- und log c-Skala. Die Genauigkeit des Verfahrens wird unter Berechnung des Ablesungsfehlers und auf Grund praktischer Bestimmungen festgestellt. Die erreichbare Genauigkeit erweist sich als genugend. Die gute Verwendbarkeit der Methode wird an praktischen analytischen Beispielen gezeigt.

The occurrence of specific and nonspecific congenital anomalies was determined in first degree relatives of index patients with congenital diaphragmatic defects who were born in Hungary between 1970 and 1979 and were ascertained through a population-based registry. The cases were grouped into Bochdalek types (N = 156), other types (N = 26), unclassified types (N = 55), and multiple congenital anomalies (MCA) cases including those with congenital diaphragmatic defects (N = 96). The sib occurrence in the Bochdalek type was 0.9% (taking into consideration also the unclassified cases or the total material, it was 0.5% or 0.4%, respectively). Specific familial clusters were not found in other types. Neural tube defects were detected in 1.8% of sibs in the total material and 2.4% in MCA cases.