Introduction Ectopic gastrointestinal varicosities are defined as dilated portosystemic collateral veins that may localize anywhere in the gastrointestinal tract outside the gastroesophageal region. Ectopic colonic varices can be considered idiopathic when other etiology that related to portal hypertension or portal vein thrombosis have been excluded. Case presentation A forty-five-year-old female patient has been under treatment for histopathologically confirmed ulcerative colitis since the age of 17. In her forties, the patient developed worsening hematochezia leading to severe anemia. Routine colonoscopy was performed which confirmed extensive rectosigmoid varices. A thorough investigation did not confirm any underlying causes, such as portal hypertension or cirrhosis. Discussion The selective percutaneous transhepatic mesenteric angiography, which is recommended as a diagnostic and therapeutic option, was not performed because the interventional radiologists did not consider embolization feasible. Laparoscopic rectosigmoid resection with high ligation of the inferior mesenteric vein led to complete remission of hematochezia. The final histological examination confirmed ectopic rectum and sigmoid varices, and ulcerative colitis was ruled out. Conclusions Lower gastrointestinal bleeding from the colonic varices is very rare, with only a few cases reported in the literature. In the idiopathic form, the prognosis is very good, given the absence of other underlying diseases causing portal hypertension. Ectopic varices present a clinical challenge as they are difficult to diagnose and localize. There are currently no clear guidelines for diagnosis and therapy, and recommendations are based on different case reports. Idiopathic cases can be treated effectively by resection of the affected bowel segment.

Introduction: There have been significant changes in the treatment protocol for rectal tumors in recent decades, greatly reducing the rate of local recurrence and distant metastasis, thereby increasing overall survival. Method: We performed a retrospective processing and statistical analysis of the data of 362 patients with rectal cancer who underwent local neoadjuvant chemoradiotherapy and then underwent surgical treatment between 1 January 2010 and 31 December 2017 at the Institute of Surgery of the University of Debrecen. We compared the response rate and overall survival results of our patients with local neoadjuvant treatment to the outcomes of total neoadjuvant treatment reported by the recent large international studies. Results: We experienced complete pathological regression in 8.6% of our patients. After neoadjuvant therapy, 10.7% of our patients experienced distant metastasis at the time of the operation or within 3 months period thereafter. In our study, the rate of response to the neoadjuvant treatment was a prognostic factor independent of the stage at di-agnosis and recognition. The groups with better response produced significantly better survival results. Conclusion: The total neoadjuvant treatment doubled the number of patients with complete pathological response, and the incidence of distant metastasis was by 7% lower in both recent international studies compared to the local neoadjuvant group. 85% of our patients were T3-4N+ stage at the time of recognition. Given the 10.7% rate of dis- tant metastases detected at the time of surgery or within 3 months in our patient population, we can state that ap- proximately half of our patients would have benefited from the administration of total neoadjuvant therapy which produced better outcomes. Based on this conclusion, we decided to introduce the total neoadjuvant therapy protocol in our department for treatment of patients with advanced rectal tumors.

Elective surgery is one of the main treatment modalities in modern medicine. Approximately 5% of the population undergo elective surgery each year. Traditional preoperative management calls for patients being fasted from midnight of the evening prior to surgery in order to decrease the risk of aspiration. For many years, this practice has been enforced, but over the past decades the scientific basis for fasting has been challenged. Perioperative fasting and surgical trauma contribute to increased postoperative morbidity and length of hospital stay. Preoperative oral carbohydrate loading recommended by the European Society of Anaesthesiology (ESA), Enhanced Recovery After Surgery (ERAS) and European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines has been shown to reduce the development of insulin resistance by approximately 50% on the day after surgery. Moreover, it significantly reduces perioperative discomfort such as hunger, thirst, tiredness, weakness, and inability to concentrate. This clinical trial aimed to determine the efficacy and safety of a food for special medical purposes (FSMP) versus standard dietary management (fasting) in patients scheduled for elective surgery. The study was designed as a randomized, controlled, open-label, single centre clinical trial with an intervention (n=25) and a control group (n=25). Patients ages 18 years and older who were scheduled for elective surgery and required to fast the night and morning prior to surgery were enrolled into the study. The primary endpoint was thirst assessed during the morning of surgery. Secondary endpoints were assessed hunger, assessed feeling of agitation, feeling of fatigue, assessed feeling of weakness, and overall well-being. There was no significant difference (p=0.052) detected between the two groups when assessing thirst during the morning of surgery. There were significant differences between the two populations regarding hunger (p<0.001), feelings of agitation (p=0.012), feelings of fatigue (p<0.001) and overall well-being both before (p=0.001) and after surgery (p<0.001). No significant difference (p=0.398) was detected between the two populations regarding feelings of weakness. In our view, the use of the formula improves the well-being of patients. Our hypothesis is that the consumption of food for special medical purposes in the form of a transparent liquid containing only carbohydrates, instead of fasting before surgery, improves the well-being of patients. Our results suggest that MediDrink OpLoad can be an effective alternative to the standard dietary care of patients undergoing major surgery, and it can positively affect patient well-being.

The original version of this article unfortunately contained a mistake. The variants listed in Table 3 of the original version of this article are not in line with the latest HGVS (Human Genome Variation Society) nomenclature (version 19.01).

Introduction: From 2011 to 2014 a total of 760 questionnaires were filled by all the patients hospitalized with confirmed colorectal cancer in the Department of Surgery, University of Debrecen in order to screen for HNPCC. After the recommended pre-screening method, we chose 28 patients for sequencing of the MMR genes to identify individual mutations. We found 5 pathogen mutations responsible for Lynch-syndrome from which 3 mutations were identified as a novel mutation. In two cases we found the hypermethylation of the promoter region of hMLH1 gene. We emphasize the importance of monitoring and follow up of HNPCC patients and their family members through the demonstration of a family tree.

INTRODUCTION:Hereditary nonpolyposis colorectal carcinoma (HNPCC) is an autosomal dominant disease, which shows familial clustering.AIM:We would like to emphasize the importance of monitoring the HNPCC syndrome patients by presenting a case of a proven MMR gene mutation carrier and her family tree encompassing 10 years.MATERIALS AND METHOD:To screen a suspected HNPCC Hungarian family member we are taking thorough family histories. If the diagnosis of HNPCC was further supported by immunohistology and the microsatellite status, sequencing of the MMR genes was carried out.RESULTS:A novel mutation in exon 6 of the hMSH2 gene leading to the deletion of two nucleotide pairs [c.969-970delTC] was detected in our patient. During the 10-year follow-up period of our patient new HNPCC-associated tumors have developed in several family members. Conslusion: Close surveillance of the patient and its family members at risk was effective, although it requires compliance from the subjects. Orv Hetil. 2017; 158(30): 1182-1187.

Absztrakt: Bevezetes: A hereditaer nonpolyposus colorectalis carcinomara jellemző mutaciok (HNPCC) autoszomalis dominans oroklődesmenetet mutatnak. Leginkabb vastagbeldaganatok kialakulasaert felelősek. Celkitűzes: A HNPCC-szindromas betegek szűresenek es kovetesenek fontossagat szeretnenk hangsulyozni egy igazolt MMR-gen-mutaciot hordozo betegunk jelenlegi es 10 evvel korabbi csaladfajanak osszehasonlitasaval. Betegek es modszer: Hazankban előfordulo, HNPCC-re gyanus csaladok kiszűrese erdekeben alapos csaladi anamnezist veszunk fel. Amennyiben az immunhisztokemiai es mikroszatellitainstabilitas-vizsgalatok HNPCC-szindromara utalnak, elvegezzuk az MMR-genek szekvenalasat. Eredmenyek: Betegunknel egy, a hMSH2-gen 6. exon ket bazispart erintő deletioja (c.969–970delTC) igazolodott. Tizeves utankovetes soran betegunknel es rokonainal ujabb, a HNPCC-re jellemző tumorok jelentek meg. Kovetkeztetes: A veszelyeztetett csaladtagok kovetese soran a szekunder prevencio a jol egyuttműkodő betegeknel hatekony volt. Orv Hetil. 2017; 158(30): 1182–1187. | Abstract: Introduction: Hereditary nonpolyposis colorectal carcinoma (HNPCC) is an autosomal dominant disease, which shows familial clustering. Aim: We would like to emphasize the importance of monitoring the HNPCC syndrome patients by presenting a case of a proven MMR gene mutation carrier and her family tree encompassing 10 years. Materials and method: To screen a suspected HNPCC Hungarian family member we are taking thorough family histories. If the diagnosis of HNPCC was further supported by immunohistology and the microsatellite status, sequencing of the MMR genes was carried out. Results: A novel mutation in exon 6 of the hMSH2 gene leading to the deletion of two nucleotide pairs [c.969-970delTC] was detected in our patient. During the 10-year follow-up period of our patient new HNPCC-associated tumors have developed in several family members. Conslusion: Close surveillance of the patient and its family members at risk was effective, although it requires compliance from the subjects. Orv Hetil. 2017; 158(30): 1182–1187.

Abstract: Introduction: Hereditary nonpolyposis colorectal carcinoma (HNPCC) is an autosomal dominant disease, which shows familial clustering. Aim: We would like to emphasize the importance of monitoring the HNPCC syndrome patients by presenting a case of a proven MMR gene mutation carrier and her family tree encompassing 10 years. Materials and method: To screen a suspected HNPCC Hungarian family member we are taking thorough family histories. If the diagnosis of HNPCC was further supported by immunohistology and the microsatellite status, sequencing of the MMR genes was carried out. Results: A novel mutation in exon 6 of the hMSH2 gene leading to the deletion of two nucleotide pairs [c.969-970delTC] was detected in our patient. During the 10-year follow-up period of our patient new HNPCC-associated tumors have developed in several family members. Conslusion: Close surveillance of the patient and its family members at risk was effective, although it requires compliance from the subjects. Orv Hetil. 2017; 158(30): 1182–1187.