Efficacy of combined anti-TNF-alpha and surgical therapy in perianal and enterocutaneous fistulizing Crohn's disease--clinical observations from a tertiary Eastern European center.

Background And Aims: Recently, anti-TNF-alpha therapy has increasingly been used in the treatment of perianal Crohn's disease (PCD), but there is only limited data regarding its short- and long-term efficacy.

Material And Methods: The medical records of 68 patients treated with anti-TNF-alpha for PCD were assessed retrospectively. Rate of complex fistulas was 75%.

[Efficacy of tumor necrosis factor-alpha inhibitors in fistulising perianal Crohn's disease].

Introduction: Tumor necrosis factor-alpha inhibitors are increasingly used in the treatment of severe Crohn's disease.

Aim: The aim of the authors was to assess retrospectively the short and long term efficacy of tumor necrosis factor-alpha inhibitors in fistulising Crohn's disease.

Method: Responses to therapy was determined using Crohn's Disease Activity Index, Perianal Disease Activity Index, the rate of complete fistula closure and the additional surgical procedures during biological therapy.

[Clinical and histopathological results after the neo-adjuvant treatment of advanced rectal tumors].

The role of the surgical intervention is decisive in treating colorectal tumors. The neo-adjuvant radio-chemotherapy has improved the efficacy of the treatment of advanced rectum tumors. In order to decrease the size and stage of advanced rectal carcinoma and to increase the rate of resecability, we introduced neoadjuvant radio-chemotherapy.

[The first molecular analysis of a Hungarian HNPCC family: a novel MSH2 germline mutation].

Background: Hereditary nonpolyposis colorectal cancer is an inherited disease characterized by onset at an early age, an excess of synchronous and metachronous large bowel tumors and a variety of extracolorectal malignancies. Basal and squamous cell carcinomas of the skin are not customarily included in the tumor spectrum of the syndrome. The disease is caused by a germline mutation in one of the DNA mismatch repair genes, most commonly MSH2 or MLH1, and typically presents with microsatellite instability and frequent loss of mismatch repair protein expression in the tumor tissue.

[The role of laparoscopy in the surgical treatment of colorectal cancer. Initial results].

The authors have carried out laparoscopically assisted abdomino-perineal rectal resections on a selected group of 8 patients during the past two years. The laparoscopic technique was not accompanied by any complications, while the patients enjoyed the benefits of the procedure. The bowel function of the patients were restored on the 2nd to 3rd day, the mean length of the hospital stay was 8.

[Causes of local recurrence after curative surgery for rectal cancer].

The rate of local recurrence (LR) has been 20-40% after resective surgery for rectal cancer by the traditional - Miles or Dixon - operative technics. The authors performed curative resection in 358 patients with rectal cancer in a 10 year period (01.01.

[Multiple organ resections for the surgical treatment of locally advanced colorectal cancer infiltrating the urinary tract].

The authors present data on 13 patients operated on for the treatment of locally advanced colorectal cancer infiltrating the adjacent parts of the urinary tract. Based on prior diagnostic evidences, every surgical intervention has been indicated as an expected curative resection. All patients of this study underwent a curative resection.

[Subtotal colectomy for the treatment of obstructive left colon cancer. Follow-up results].

Aim: Subtotal colectomy (STC) involves an extended resection of the large bowel over the splenic flexure. In a period of 8 years, a total of 72 subtotal colectomies (STC) were performed for the treatment of large bowel obstructions or symptomatic stenosis caused by cancer of the left colon. A primary ileocolic latero-terminal anastomosis was made in each case.

[Effect of pancreatin replacement on pancreatic function in the postoperative period after pancreatic surgery].

There is evidence that disturbances of exocrine function can persist for several weeks following pancreatic surgery. Active proteases in the duodenal lumen may help to recovery of exocrine function. A placebo-controlled trial of enteric-coated pancreatin (25,000 U lipase; 3 x 1 caps/day) was performed during 2 weeks following pancreatic surgery (resection and drainage operation).

Recurrent phyllodes tumor in a man.

The case of a 35-year-old man with a borderline-type cystosarcoma phyllodes is presented. Four years after the primary excision of the tumor, wide excision of a local recurrence and postoperative radiotherapy were performed. No repeated relapse was observed during a 5-year follow-up.

Different techniques for creating oesophageal anastomoses. A historical review and personal experience.

Unlabelled: Among the surgical techniques used to create a reliable oesophageal anastomosis, mention should be made of the handmade (in one or two layers, wire or Vicryl) and the different stapler anastomoses. 41 oesophageal anastomoses were performed by stapler technique between 4 March 1985 and 4 March 1991. The EEA stapler was used in 15, and the SPTU stapler in 26 patients.

The results and failures of creating a pelvic reservoir in oncology (surgery, urology).

The results of abdominal and pelvic pouch operations are described in surgical and urological material. The lateral ileal pouch (Fonkalsrud) was used in 8 patients with diffuse colonic polyposis and in 4 cases of colitis ulcerosa. The second step of this two-phase operation was completed in 7 patients.

[Laparoscopic cholecystectomy. Initial experiences].

Between February 1991 and July 1991, 74 laparoscopic cholecystectomies were performed. The number of all cholecystectomies during this period was 168. Two surgeons performed the operations.

Comparison of the postoperative changes in the humoral and cellular immune activity in septic and non-septic colorectal cancer patients.

The effect of sepsis on the host resistance of 34 colorectal cancer patients with normal preoperative immune reactivity was studied. A significant change (p less than 0.01) was found in the IgG level of the septic patients (n = 13) when comparing their values with those of the non-septic patients (n = 21), on the third and 7th days postoperatively.

Changes in the tendency of lymphocytes to undergo blastic transformation in the postoperative period, in immune-stimulated and untreated colonic tumour patients.

A study was made of the blastic transformation of lymphocytes in the postoperative period in colonic tumour patients: 23 who had been immune-stimulated by vaccination, and 28 who had not been vaccinated. The immune reactivity decreased significantly in the majority of the cases; however, the deterioration of the immune status affected 68% of the nonvaccinated group, but only 48% of the vaccinated group. The data indicate that the vaccination primarily averted the deterioration of the defence ability in the early postoperative period in patients with a normal preoperative immune activity.

[Experiences with the Soviet SPTU stapler device in colon and rectum surgery].

From 1970-1982, 96 rectal and colonic anastomoses were performed by the stapler device SPTU. The results obtained were at least as good as anastomotic sutures made by hand.

Modern trends in colorectal surgery.

In 39 patients, the 'classical' pretreatment for colorectal surgery (mechanical purgation, laxatives, irrigation and sulfaguanidine administration) was supplemented with the oral administration of 750 mg metronidazole daily for 3 days. This dose was later increased to 1 g daily. The 75 control cases received the same pretreatment as in the test group, with the exception of the metronidazole.

[Relationship of immunological status to infections complicating surgery of the large intestine].

The patients immuno-activity has a well-known importance for the outcome of postoperative complications. The authors evaluated the immuno-activity of 95 patients before selective, radical colorectal surgery: 1) 40% of the patients were anergic compared to healthy controls. 2) The incidence of wound infections was significantly higher in the anergic groups than in normal or hyperergic ones.