[New approach to the management of gastrointestinal tumor]
Semmelweis Orvostudomanyi Egyetem, Sebeszeti Tanszek, Budapest.
The author summarizes the changes recently developed in the treatment of gastrointestinal tumors. He gives a detail analysis of stages of malignant diseases as well as he demonstrates the newest opinion about the lymphadenectomy, tumor resection, and new therapy modalities of liver metastases.
[Study of viral infections among hospital personnel]
Lehel F. Csajbokne BM. Hangyal Z.
Josa Andras Korhaz-Rendelointezet, Higienes Osztaly, Nyiregyhaza.
The authors examined the hepatitis B and C virus infections among health-care workers. Laboratory examinations involving one third (830 people) of the staff found HBV infections symptomless at 101 people (12.2%), 11 people 1.3%) became HBsAg carriers. 13 people (1.56%) had HCV antibody. 4 people remained HCV carriers (0.5%). From 19 workers infected by hepatitis between 1989-96, 2 people remained HBsAg carriers. In a well prepared vaccination programme 871 volunteers were vaccinated (49% of hospital workers). Hepatitis viral infections of hospital employees, results of their laboratory examinations, the date, the number of their vaccinations and their health condition can be followed in the computer registration of the hospital.
[Determination of the upper margin of superficial esophageal cancer by intraoperative endoscopic examination and toluidine blue staining]
Szanto I. Altorjay A. Kiss J. Voros A. Nagy P.
Haynal Imre Egeszsegtudomanyi Egyetem, Sebeszeti Klinika, Budapest.
Authors describe a new application of intraoperative endoscopic examination. At operation it is difficult to define the border of a superficial esophageal cancer. The female patient aged 69 years was operated on because of squamous cell cancer. During the operation endoscopic examination was done and the esophageal mucosa was stained with 1% toluidine blue solution. The squamous cancer stained blue. The upper border ot the tumour was determined so that the esophageal wall was palpated from the outside with a probe and the same time the manipulation was being watched on the monitor of the videoendoscope. Subtotal esophagectomy and lymphadenectomy were performed. Authors claim that by the intraoperative use of endoscopic staining the risk recurrence in an anastomosis may be diminished and leaving behind of multifocal carcinoma may be eliminated.
[Minimally invasive surgery in the management of Mirizzi syndrome]
Rozsos I. Behek S. Magyarodi Z. Szanto L.
Kaposi Mor Megyei Korhaz, I. sz. Sebeszeti Osztaly Kaposvar.
An impacted gallstone in the cystic duct or in the Hartman's pouch with subsequent inflammation and edema resulting in extrinsic compression of the common hepatic or common bile duct with obstructive jaundice is known as Mirizzi's syndrome. The Mirizzi syndrome presents a difficult surgical challenge because of the dense adhesions and edematous inflammatory tissue cause distortion of the normal anatomy in Calot's triangle, leading to a great risk of bile duct injury. Therefore, a controversial issue the surgical strategy for the treatment of Mirizzi's syndrome since the introduction of laparoscopic cholecystectomy. The present study was undertaken to elucidate the applicability of microlaparotomy cholecystectomy in the management of Mirizzi's syndrome. Between December 1990 and December 1996 we operated on 16 patients for Mirizzi's syndrome. In 14 of these patients had type I of Mirizzi's syndrome, the remaining 2 had type II of this syndrome. In 13 of these patients the gallbladder were removed using 3-4 cm single microlaparotomy incisions. In the remaining 3 patients using 5.5 cm, 8 cm as well as 12 cm long incisions for the removal of the gallbladder, and placement T tube because of stenosis of the common hepatic duct, suture repair of the choledochal defect as well as choledochoplasty. In 12 of these patients the microlaparotomy cholecystectomy were done within 7 days of the onset of the obstructive cholecystitis. The postoperative stay of these patients were uneventful and they were discharged home 3 days after surgery. We conclude that early operation of the obstructive cholecystitis with Mirizzi's syndrome eliminates the serious stricture and fistula formation of Mirizzi's syndrome.
[Fatal acute liver damage caused by a therapeutic dose of paracetamol]
Kadas I. Konczol F. Illes T.
Pecsi Orvostudomanyi Egyetem, Igazsagugyi Orvostani Intezet.
A 16-year-old boy undergone on an "anterior release" surgery for severe scoliosis, since fever developed in the postoperative phase, a total dose of 3500 mg paracetamol was given during a 3-day period. Four days after the end of antipyretic medication, the patient became confused and icteric, later unconscious, and within 24 hours died from fulminant hepatic failure. Autopsy revealed a confluent centrolobular (zonal 3) liver cell necrosis definitely characteristic for paracetamol hepatotoxicity. The case history may illustrate that paracetamol may cause liver injury even in therapeutic doses, if certain risk factors are present. Such factors are malnutrition and starvation, that causing depletion of hepatic glutathione, can result in enhanced susceptibility to toxicity of the drug. Authors emphasize, that in the case they presented, the young patient was malnourished and in the postoperative period fasting, and only a moderate calorie intake was given via parenteral nutrition. All these circumstances may well explain the unexpected fatal complication.
[Gastrointestinal tuberculosis--an almost forgotten clinical picture]
Kisfaludy N. Schneider F. Fauszt J. Faludi S.
Fovarosi Onkormanyzat Uzsoki Utcai Korhaz, Patologia Osztaly, Budapest.
Incidence of gastrointestinal tuberculosis increases in the western world. Exact epidemiological data about this rare extrapulmonological disease are not available in Hungary. Three advanced cases with intestinal tuberculosis have been reported, all of them recognised during surgery due to complications. The clinicopathological correlations are briefly reviewed, and the importance of early diagnosis is emphasized.
[Abdominal trans-sphincter resection of teh anus: new possibilities in the surgical management of deep rectal cancer, with preservation of the anal sphincter]
Istvan G. Berki I. Kiss S. Faller J.
Fovarosi Onkormanyzat Szent Janos Korhaza, Sebeszeti Osztaly es Semmelweis Orvostudomanyi Egyetem, Sebeszeti Tanszek, Budapest.
The last decade has brought marked changes in the surgical treatment of rectal cancer: as the indication of the sphincter-saving procedures was extended, the rate of the abdomino-perineal excision has decreased even in the case of tumours of the distal third of the rectum. However, even with the use of the modern stapling devices, the anterior resection and colo-anal anastomosis may not always be feasible by the traditional abdominal approach. In these cases the sphincter-saving resection can be performed by a particular approach, the abdomino-transsphincteric technique. The authors present this seldom used operation. From the 1-st of January 1994 to the 31-st of August 1996 14 abdomino-transsphincteric resections have been performed. The mean age of the patients was 62.2 (38-81) years. The lower edge of the tumours was situated at 6.3 (5-8) cm from the anal verge. The anastomosis was performed by the double stapling technique in 8 and by hand suture in 6 cases, its distance from the anal verge was 3.2 (3-4) cm. A colon J-pouch was used in 3 cases and a diverting colostomy was performed routinely. One patient died in the postoperative period and a reoperation (abdomino-perineal excission) was performed because of left colon necrosis: Anastomotic leakage was observed in one case. By the time of the present study, 11 patients have had their colostomies closed. The continence is acceptable in every case and all the patients experience a better subjective quality of life, than it was while wearing the colostomy. The use of this technique has helped to avoid a permanent colostomy in 21 out of 33 cases operated on for cancer of the distal rectal third in the reviewed period.
[Extracorporeal membrane oxygenation in neonatology: review of the use of the method]
Morava E. Gill W. Pierce M.
Department of Pediatrics, Tulane Medical Center New Orleans, USA.
Extracorporeal life support and extracorporeal membrane oxygenation characterize the use of mechanical devices for temporary support of heart and lung function. The mechanical circuit consists of a blood pump (heart), membrane oxygenator (lung: which accomplishes both carbon dioxide removal and oxygen delivery), heat exchanger and a servo-control module. Venous blood is drained from the right atrium through the right internal jugular vein, and returned oxygenated through either the right common carotid artery (venoarterial bypass), or into a large vein (venovenous bypass). All patients treated must be free of coagulopathies, as all patients are anticoagulated. Neonatal candidates should be older than 34 weeks gestational age and weigh more than 2000 grams. As of March, 1997 twenty six patients have been treated with extracorporeal life support at Tulane Medical Center with an overall survival rate of 62%. Twelve neonates with either meconium aspiration or pneumonia have been treated with a 100% survival. Six children with congenital diaphragmatic hernia have been unsuccessfully treated.
[Observation in two cases of Whipple disease]
Barta Z. Szabo GG. Illes A. Szegedi G.
Debreceni Orvostudomanyi Egyetem, III. Belgyogyaszati Klinika.
The authors survey the literature of Whipple's disease and present two of their patients. They assure that Whipple's disease in either associated with or is a result of an immunopathological clinical picture, but it is else possible that assumed pathogen, the Tropheryma whippleii itself alters the immune system. In the case of their female patient with active disease they showed the rearrangement of the bcl-2 gene [t(14; 18)] in her peripheral blood lymphocytes, while in their male patient in remission this could not be proved. During the observation, in their female patient insulin dependent diabetes mellitus (IDDM) developed. In connection with these cases, the authors draw the attention to the varied symptoms which are characteristic of autoimmune disease, and to the immunoserological laboratory differences in particular the rearrangement of the bcl-2 gene.
[Severe genital mycoplasma infection following cesarean section]
Patai K. Fuzi M. Kanjo AH. Sipos M. Paulin F.
Semmelweis Orvostudomanyi Egyetem Budapest, II. Szuleszeti es Nogyogyaszati Klinika.
Authors report a serious case of post-caesarean delivery endometritis caused, probably exclusively, by genital mycoplasmas: Ureaplasma urealyticum and Mycoplasma hominis. The initial treatment of the patient with various penicillins, ceftriaxone, gentamicin, metronidazole and nystatine proved ineffective. Subsequently, as microbiological tests turned out positive for genital mycoplasmas, a therapy of doxycyclin was introduced and a full recovery could be attained. Authors' experience is consistent with the observation of American scientists that U. urealyticum is an important pathogen in post-caesarean delivery endometritis. Since the carriage of U. urealyticum in women is frequent in Hungary, it is suggested that microbiological investigations related to sectio caesarea always include tests for genital mycoplasmas.
[Successful treatment of hepatocellular carcinoma with All-trans-retinoic acid]
Egyed M. Nyaradi A. Boros B. Viski A. Kelle M. Puskas A. Kocsis T. Horvath G.
Kaposi Mor Megyei Korhaz, Kaposvar, Belgyogyaszati Osztaly.
A 44-year-old female patient was admitted to our department with diagnosis of malignant lymphoma. The abdominal USG and CT showed multiple liver lesions with partial portal vein thrombosis, moderately increased alfa-fetoprotein (AFP), ASAT, ALAT (2x normal value), serology was negative for HBV and HCV. Liver transplantation was suggested but refused because of portal vein thrombosis. ATRA (45 mg/m2/day orally) was given on the basis of the assumption that HCC and acute promyelocytic leukaemia share similar oncogenic pathway (alter the RAR alpha and beta receptors). She was gained 15 kg-s and has resumed her work as a teacher for the last 20 months. Abdominal CT showed a complete regression of the intrahepatic tumour.
[The role of jejunal feeding in the treatment of acute necrotizing pancreatitis and in recurrence of chronic pancreatitis with severe necrosis]
Hamvas J. Pap A.
II. Belgyogyaszat, Fovarosi Szent Imre Korhaz Budapest.
Acute necrotising is the most serious form of pancreatic inflammatory diseases leading to multiorgan failure and high (15-20%) mortality. The poor nutritional and metabolic condition of the patient and secondary bacterial translocation further rise the mortality. A recently introduced method of continuous nasojejunal feeding putting the pancreas into rest with basal pattern of secretion resulted in lower mortality rate by using adequate nutrition into the second loop of jejunum bypassing duodenopancreatic stimulations via an endoscopically placed feeding tube. The better nutritional and immunological states of the patients, the restored absorption and intestinal motility promote the recovery of pancreatitis, prevent bacterial translocation, resulting in time and in financial spares. Although surgery is occasionally inevitable because of progression of pancreatitis, nasojejunal feeding improves the general condition of patients more efficiently than parenteral nutrition and makes the scheduling of the operation optimal. The authors retrospectively analyse the results of treatment in 56 patients suffering from acute necrotising pancreatitis, as well as in 30 patients with chronic pancreatitis accompanied with more than 20% of necrosis in the pancreas and admitted to their gastroenterological medical department during 5 years. The effect of parenteral nutrition were less beneficial than that of jejunal feeding regarding the mortality and the necessity of operative interventions. Chronic pancreatitis with severe necrosis behaved similarly to the acute necrotising pancreatitis. The continuous nasojejunal feeding seems to be a promising new method for acute necrotising pancreatitis preventing complications and severe catabolic state of the disease by a cost--effective manner.
[Severe lead poisoning caused by an ingested fishing weight]
Laszloffy M. Keszei N. Kakosy T. Soos G. Hudak A. Naray M.
Orszagos Munka-es Uzemegeszsegugyi Intezet, Budapest.
Authors describe the case-history of a 17 year old male who accidentally ingested a fishing weight that was retained in the stomach and caused a serious lead poisoning. It is worth mentioning that beside the wellknown symptoms and signs of lead intoxication also the liver was seriously affected. The histologically verified toxic lesion of the liver presumably can be attributed to the large quantities of lead absorbed within a short period. This also explains the appearance of symptoms and signs indicating to encephalopathy beside the young age of the patient. The foreign body could not be removed by means of gastroscopy, therefore a gastrotomy was carried out followed by chelating treatment with i.v. CaNa2EDTA that resulted in complete clinical and laboratory recovery. The case history draws the attention to the importance of the quick removal of the retained lead containing objects out of the gastrointestinal tract.
[Combined therapy of metastatic liver neoplasms: intrahepatic chemoembolization and systemic chemotherapy]
Pajkos G. Szentpetery L. Kristo K. Izso J.
II. Belgyogyaszat-Onkologia, BM Kozponti Korhaz es Intezmenyei Budapest.
Chemoembolisation has been an effective treatment-option for unresectable colorectal liver metastases, however it frequently fails because of tumour progression outside the liver. We conducted a pilot study to assess the toxicity and efficacy of combined regional and systemic chemotherapy for patients having liver dominant disease. Three cycles of chemoembolisation using 50 mg adriamycin, 8 mg mitomycin C, 50 mg cisplatinum admixed with 10 ml of lipiodol were given at 6 weeks intervals. The systemic therapy consisted of 425 mg/m2 5-fluorouracil and 20 mg/m2 leucovorin by intravenous infusion 1-5 days repeated every 28 days. 41 patients were treated for the period 1st January 1994-31st December 1996. Out of these 27 were male, 14 female with a medium age of 62 years (40-78). Primary site of tumour was colon in 30 cases and rectum in 11 cases. 14 patients received prior chemotherapy (5 adjuvant, 9 palliative). Mean follow up time is 18 months (4-36) in this study. 27 partial and 1 complete remissions were achieved at the average response rate of 68%. Mean time of progression was 10.7 months (4-18), overall survival time was 15 months (4-36). Common toxicity was the postembolisation syndrome consisting of abdominal pain, fever, chills, reversible elevated liver enzymes. Four patients had drug-induced cholangiohepatitis. At 15 patients we experienced grade 3, toxicity (5 diarrhoea, 3 mucositis, 2 vomiting, 2 leukopenia, 2 thrombocytopenia, one skin rush). No treatment related death or catheter complications were observed. Although these treatment results are superior to our historical experience, a controlled clinical trial will be acquired to establish this approach.
[Body composition in overweight children, healthy children as well as children with mucoviscidosis, measured by multifrequency impedance]
Madarasi A. Holics K. Ujhelyi R. Czinner A.
Belgyogyaszati Osztaly, Heim Pal Gyermekkorhaz Budapest.
The body composition of a total of 90 children (aged 5-18) were subjected to multifrequency impedance measurement with a Human IM Scan impedance analyser. We compared data of 30 overweight children (17 boys, 13 girls; mean age 11.47 yrs, range: 4-17 yrs), 30 children with cystic fibrosis (12 boys, 18 girls; mean age 12.8 yrs, range: 3-24 yrs) and 30 healthy children (12 boys, 18 girls; mean age 13.4 yrs, range 7-18 yrs). The percentage of fat mass was found to be inversely proportional to total body water. Extracellular water expressed as a percentage of the total body water was significantly higher in overweight children than in the other two groups: (p < 0.01) between children with cystic fibrosis and overweight children, (p < 0.05) between healthy children and overweight children. Extracellular water expressed as a percentage of total body water was lower in children with cystic fibrosis than in healthy children (p < 0.05). The ratios of extracellular mass and body cell mass to body weight were significantly lower in overweight children than in healthy children (p < 0.01) or in children with cystic fibrosis (p < 0.01). The ratio of exchangeable sodium and potassium was lower in all three groups than the normal value given for adults (> 0.87), but in overweight children it was significantly higher than in the other two groups; (p < 0.01) between children with cystic fibrosis and overweight children, (p < 0.05) between healthy children and overweight children. Multifrequency impedance measurement is reliable, fast, non-invasive, easy to carry out, therefore we consider it very useful in determining the body composition of children in various pathological conditions.
[Drug therapy of gastroesophageal reflux (a prospective controlled clinical trial)]
Wittmann T. Rosztoczy A. Feher A. Jarmay K. Olah T. Szendrenyi V. Kiss I.
I. Belgyogyaszati Klinika, Szent-Gyorgyi Albert Orvostudomanyi Egyetem, Szeged.
One year follow up(1.5, 3, 6, 12 months) study was established to examine the role of several classes of drugs in the treatment of reflux disease in 40 patients on the basis of objective control parameters (pH-metry, endoscopy, histology). The therapy was initiated, respectively, the different stage of severity (Savary-Miller): in stage 0 sucralfate + domperidone, in stage I and II: ranitidine + domperidone and in stage III-IV omeprazole was introduced. Our results proved that sucralfate + domperidone is curative on reflux oesophagitis in stage 0 cases. In stage I sucralfate and domperidone were effective in 3 of 9 cases, ranitidine + domperidone was optimal in 5 of 9, and omeprazole was required in 1 of 9 patients. In stage II, ranitidine + domperidone was effective only in 4 of 11 patients, and the initial therapy was modified to omeprazole in 7 of 11 patients to find the optimal drug in this stage. In stage III and IV only omeprazole showed curative effect and the doses required were 20 mg in 8 of 13 and 40 mg in 5 of 13 patients. The complaints improved in 34 of 40 patients after 6 weeks treatment, while histological healing of reflux oesophagitis was observed in 12 of 40 cases. After 3 months the endoscopic healing rate was 28/40, but histological healing could be reached after 6 months of optimal treatment in 30 of 40 cases. We can conclude, that the optimal drug selection may result a rapid improvement of complaints, but endoscopic and histological regeneration of the oesophageal mucosa is more graduated with time. The healing process of the reflux oesophagitis requires 3 months. Proton pump inhibitor drugs have an enhanced role in the treatment of gastrooesophageal reflux disease, and our results proved that the efficient and safety treatment of mild form (stage II) of disease requires the administration of proton pump inhibitors.
[Simultaneous occurrence of hereditary angioneurotic edema and Crohn disease]
Farkas H. Gyeney L. Nemesanszky E. Kaldi G. Kukan F. Masszi I. Soos J. Bely M. Farkas E. Fust G. Varga L.
Orszagos Reumatologiai es Fizioterapias Intezet, Budapest Ful-orr-gegeszeti Osztaly.
Hereditary C1 esterase inhibitor deficiency is often associated with immunpathologic disorders. The authors present a case of the rare coincidence of hereditary angioedema (HAE) and Crohn's disease. The history of the patient is analysed along with the familial occurrence of the disease. Characteristic abdominal manifestations of C1 esterase inhibitor deficiency are compared to the clinical signs of Crohn's disease. Differential diagnostic pitfalls are described along with efficatious therapeutic options.
[Computerized speech recognition-based endoscopic findings]
Molnar B. Gergely J. Pronai L. Papik K. Zagoni T. Feher J. Kutor L. Tulassay Z.
II. Belgyogyaszati Klinika, Semmelweis Orvostudomanyi Egyetem, Budapest.
Discrete, Hidden Markov model based speech recognition and phoneme based speech synthesis techniques were applied for gastroscopy reporting and machine control. The authors developed a special program for grammatical analysis of the sentences. Altogether 100 patient findings were grammatically analysed. The sentences were grouped according to the topographical order of the investigation: oesophagus, cardia, fundus, corpus, antrum, pylorus, bulbus, postbulbar section, and the pathological findings: erosion, ulceration, malignancy. Speech samples from 3 deep voiced male investigators were collected. The recognition rate was above 95%. A simulation program was also developed for dictation and controlling of the different equipment (monitor, printer, video, endoscope) in the gastroscopy laboratory by speech recognition. Speech synthesis was applied for the evaluation of understanding. This module artificially synthesizes the answer of the system giving backup for the understood information. With additional developments the discrete word speech 'recognition' achieved the level of routine application in medical reporting. However, ready-to-use developments need the joint activity of speech technology and endoscopy industry with end-user teams.
[The role and significance of the most important known cytokines in inflammatory bowel diseases]
Vitalis Z. Altorjay I. Udvardy M.
Debreceni Orvostudomanyi Egyetem, II. sz. Belklinika.
Several theories have already been postulated in connection with the pathogenesis of inflammatory bowel diseases, yet none of them has been approved. Recently increasing attention has been payed to different cytokines, playing central role in the development of inflammatory processes. In the intestinal mucosa of patients suffering from inflammatory bowel diseases increasing amounts of interleukin-1 (IL-1), tumor necrosis factor (TNF) and platelet activating factor (PAF) could be measured. On the other hand, antiinflammatory cytokines seem to be ineffective, or being present in insufficient amount (IL-4 and IL-10 respectively). It is therefore probable, that altered ratios of cytokines, or pathologic regulation of their production lead to progression of inflammation in IBD. Influence of cytokine production may open new therapeutic approach, e.g. IL-10 enema proved to be effective in the treatment of some cases of steroid-resistant ulcerative colitis, while intravenous administration was useful in Crohn's disease. A brief, comprehensive review of our present knowledge about cytokines in IBD is given.
[Surgical trauma induced by laparoscopic cholecystectomy]
Gal I. Roth E. Lantos J. Varga G. Mohamed TJ. Nagy J.
Bugat Pal Korhaz Gyongyos, Sebeszeti Osztaly.
The objective demonstration of improved postoperative recovery suggests that surgical injury induced by the laparoscopic approach is less intense than that after open surgery. Forty-two patients diagnosed as having noncomplicated gallstones were studied prospectively. They were operated on by laparoscopy (LC, n = 21) or open surgery (OC, n = 21). Both surgical procedures induced significant changes of investigated parameters (acute-phase response, free radical mediated reactions, neutrophil functions). Comparison of the results of the two cholecystectomy techniques showed that laparoscopic cholecystectomy induced a significantly less intense acute-phase response, a more attenuated oxidative stress characterising by free radical mediated reactions and that is less disruptive to neutrophil function. The results and the data from the literature suggest that surgical injury causing by the laparoscopic cholecystectomy is less intense than that after open cholecystectomy, which can explain partially the better clinical outcome following laparoscopic versus open procedure.
[Histo-pathological evaluation of response to 6 and 12 months of interferon alpha therapy]
Jarmay K. Karacsony G. Ozsvar Z. Nagy I. Lonovics J. Schaff Z.
I. Belgyogyaszati Klinika, Szent-Gyorgyi Albert Orvostudomanyi Egyetem Szeged.
BACKGROUND AND AIMS: Interferon-alfa (IFN-alfa) has recently been introduced for chronic C hepatitis treatment; however, the response rate is merely 25-50%. The aims of this follow-up study were to compare the efficacy of 6 and 12-month IFN-alfa treatment via liver biopsy scores and to evaluate the correlation with the biochemical response. PATIENTS AND METHODS: 20 chronic C hepatitis patients were studied. 10 patients received IFN-alfa therapy for 6 months, and 10 for 12 months (3 million units three times a week). Liver biopsy material was taken before and after therapy. RESULTS: There was a significant serum alanine aminotransferase (ALT) level improvement in both groups, but a significant histological improvement in necroinflammatory activity (grade) occurred only in the 12-month group. The Chevallier stage scores demonstrated a significant progression in both groups. CONCLUSIONS: 12-month IFN-alfa treatment affords a better response in the liver histology grade and serum ALT level, but not the stage; a normal ALT does not guarantee hepatitis inactivity. Liver biopsies appear indispensable for monitoring the fibrotic changes in chronic C hepatitis.
[An unusual case of morbid weight loss]
Reichardt J. Parlagi G. Kondrai L. Wacha J. Toth K.
II. Belgyogyaszati Osztaly, Jahn Ferenc Korhaz Budapest.
A 47 year old patient was admitted because of 20 kg weight loss and microcytic anaemia. There wasn't any important disease in his medical history. During examinations it has been found microcytic anaemia, hypoproteinaemia, low serum potassium, elevated prothrombin INR value, malabsorption and mild hepatosplenomegaly. After precluding the possibility of malignant disorders and any other chronic diseases, examinations have cleared Whipple-disease.