Monthly screening by the ACTO screening test in combination with phone audits offers a new way to test visual acuity, with the Amsler score helping to detect changes in visual function. For patients with visual changes, confirmation by the ophthalmic physician can be achieved in time. Self-assessment cannot replace qualified ophthalmologic examination, but monthly self-controls enhance safety, reduce the number of physician contacts, and improve the detection of visual changes, with the option of immediate ophthalmic retreatment.
Our aim was to improve the outcome of emergency surgeries for colorectal cancer (CRC). Authors compared two periods: 2004-2006 and 2007-2011. Targeted cases were emergency admissions, in which the diagnosis of colorectal cancer is only revealed during work-up or during surgery. No other exclusion criteria were set. Analyzed main endpoints were anastomotic leak, postoperative mortality, resecability. ASA classification and TNM stages were assessed in order to learn morbidity and general condition prior to acute surgery. Considering the experience gained in prior period, in 2007, authors have made a change in treatment strategy. In following years leakage ratio became ten times lower and mortality was reduced by 5%. There is a great chance that fast work-up and preparation for surgery may decrease complications and mortality. The aim would be for CRC patients, is to reach surgery in an early stage of disease as possible, at least before complications develop.
A felnőttkori necrotizáló enterocolitis (adult necrotizing enterocolitis -ANEC) gyakran fatális kimenetelű, fulmináns lefolyást mutató tünetegyüttes, amelyet segmentalisan kialakuló bélelhalás jellemez. A Bell-féle súlyossági beosztás alapján hármas stádiumba tartozó betegüknél a szerzők necrotizáló enterocolitis miatt ismételt műtéteket és vékonybél resectiókat végeztek. Az eltávolított bél szövettani vizsgálata a mucosából kiinduló intestinalis necrosist mutatott, a mesenterialis erek obstructiója nélkül. Az ötödik beavatkozás után a tápcsatorna folytonosságát a megmaradt 30 cm-es terminalis ileum és a duodenum leszálló szára között készített anastomosissal állították helyre. A fent ismertetett, irodalmi ritkaságnak számító kórképben szenvedő súlyos beteg minden várakozást felülmúlva 30 cm-es vékonybéllel szinte teljes életet él gastroenterologiai gondozás mellett.
Kulcsszavak: felnőttkori necrotizáló enterocolitis (ANEC), NOMI (non-occlusive mesenteric ischaemia), pneumatosis intestinalis, portalis gáz, "thumb printing" jel, bélelhalásThe adult necrotizing enterocolitis (ANEC) is a rare condition, frequently fatal, and characterized by a fulminant symptoms and segmental necrosis of the bowel. The authors performed repeated surgeries and small bowel resections on a patient classifi ed to stage number three on Bell scale due to necrotizing enterocolitis. Patholigical examination of the resected bowel showed intestinal necrosis without obstruction of mesenteric vessels. After the fi fth operation the continuity of the gastrointestinal tract was reconstructed by an anastomosis between the remained 30 cm of terminal ileum and descending loop of duodenum. Despite the remaining 30 cm small bowel only, the patient is capable to enjoy almost complete life at support of gastroenterological control.
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