Biomedical subjects

A Bálint

Publications and source records attributed to A Bálint.

At least 19 recordsLinked to original sources

PubMed2005

Cytopathogenicity markers in the genome of Hungarian cytopathic isolates of bovine viral diarrhoea virus.

Since genetic recombination is a major factor in the evolution of the cytopathogenic (cp) bovine viral diarrhoea virus (BVDV) biotypes, in this study the cytopathogenicity markers were investigated in the genomes of two cp BVDV strains recently isolated from mucosal disease (MD) cases in Hungary. In the genome of strain H4956, a Jiv-like insertion was found similar to those described in reference strain NADL and in other BVDV 1, BVDV 2 and border disease virus (BDV) strains. The 133 amino acid Jiv-like sequence is inserted at nucleotide position 4984 (amino acid position 1533), 9 nucleotides upstream of that of strain NADL. The insertion showed 96% amino acid sequence identity with the cellular Jiv protein. In the genome of cp BVDV strain H115/PCR, an ubiquitin-containing duplication was found. The duplicated sequence started at nucleotide position 7978 (amino acid 2531) in the NS4B gene. The duplication contained a complete ubiquitin monomer of 76 amino acids and the complete NS3 gene starting at nucleotide position 5153 (amino acid 1589), which corresponds to the first N-terminal amino acid of NS3. The duplication was located further downstream of the known ubiquitin-containing genomic regions of cp BVDV strains, and it consisted of the shortest inserted nucleotide sequence. The insertions and duplication of strains H4956 and H115/PCR further confirmed that recombinations occurring at positions A and B are the most common mechanisms leading to the development of BVDV cytopathogenicity.

Amino Acid Sequence↗

PubMed2001

Sequence analysis of the membrane protein gene and nucleocapsid gene of porcine reproductive and respiratory syndrome virus isolated from a swine herd in Hungary.

Porcine reproductive and respiratory syndrome virus (PRRSV) was isolated from blood samples taken at a pig farm in Hungary from pigs showing clinical signs of the disease. The virus (ABV 32) was identified as belonging to the European genotype by using type-specific monoclonal antibodies. This was confirmed by comparing the sequence of the membrane protein gene (ORF 6) and the nucleocapsid gene (ORF 7) with the American VR2332 and the European LV genotype reference strain, respectively. Analysis of the amino acid sequence of the ORF 6 and ORF 7 of ABV 32 revealed five amino acid changes in both ORFs when compared with LV, of which two changes in ORF 7 were only found in the Spanish isolates. Additionally, the ORF 7 sequence was compared with corresponding sequences of a total of 21 other European strains. Phylogenetic analysis using the PHYLIP package confirmed the close relationship between the Hungarian and the Spanish isolates. Of all the isolates analysed, ABV 32 and LV were the least related.

Amino Acid Sequence↗

PubMed2001

[Hand-assisted laparoscopic technique (HALS) in colorectal surgery (Case reports and review of the literature)].

Hand-assisted laparoscopic surgery (HALS) is a new technique in which the surgeon's hand is introduced to the abdominal cavity through a mini-laparotomy, while pneumoperitoneum is maintained. We describe the technique of HALS used successfully in the treatment of two patients of colorectal disease. We describe current literature and our initial clinical experience. Our conclusion is that, besides colorectal surgery, HALS technique may prove useful for other abdominal procedures as well; however its real value should be estimated in prospective randomized trials.

Aged↗

PubMed2001

[Antireflux procedures at our unit (1990-1999)].

UNLABELLED: A retrospective analysis was carried out to evaluate the changing attitude of antireflux surgical practice of the authors. Between 1990 and 1994 24 antireflux procedures were performed. Laparoscopic antireflux surgery was introduced in 1995. Since then 41 laparoscopic and 23 open repairs have been performed. Indication for surgery was always based on thorough preoperative examination protocol including functional tests of the esophagus. Each patients had undergone endoscopic and X-ray examinations. The patients are under continuous follow-up surveillance. During the postoperative follow-up studies more than 2/3 of the patients (61 patients) agreed to carry out the functional tests postoperatively. RESULTS: The demographic data of patients of the two study periods proved to be comparable. The length of history was 10.5 years in the first group, while it was 8.9 years in the second group. In both groups the surgical repair caused significant reflux control confirmed by decrease of reflux index and number of reflux episodes furthermore by increase of resting lower esophageal sphincter pressure. Actually 4 recurrences are known in the first group and 2 in the second group. One of the 4 recurrences observed in the first period was treated by redo surgery. The patients having recurrences in the second period can easily be managed by medical therapy. There was no mortality and severe morbidity during the study periods. Few patients reported mild temporary dysphagia. CONCLUSIONS: In a given proportion of reflux patients the individually planned and perfectly performed antireflux surgery offers an acceptable definitive treatment option. The availability of endoscopic surgery enhances this trend, which can be seen all over the world. An increase can be seen in the number of procedures: nearly three times more patients were operated on during the second period. The early clinical results of laparoscopic antireflux procedures are good enough. Good long-term results can be expected if we accept and apply the basic technical principles determined during the open surgery era.

Adolescent↗

PubMed2000

Intraabdominal abscess managed successfully via the laparoscopic approach.

A rare complication of laparoscopic fundoplication-an intraabdominal abscess located between the fundus and the caudate lobe of the liver-is described. A 41-year-old man had undergone a laparoscopic Nissen-Rossetti fundoplication for longstanding gastroesophageal reflux disease. On the 5th postoperative day, the patient's general condition became worse, and he developed intermittent-remittent fever (40 degrees C), an elevated white blood cell count (WBC), and an accelerated sedimentation rate. Evidence of leakage was excluded by Gastrografin swallow. The diagnosis was finally revealed by means of ultrasound and computed tomography (CT) scan, which showed an intraabdominal fluid collection with an air cap of ~10 cm in diameter situated between the diaphragmatic crura, the caudate lobe of the liver, and the gastric fundus. The location did not allow semi-invasive management of the abscess, such as ultrasound or CT-guided puncture and drainage. On the 8th postoperative day, a laparoscopic exploration was performed utilizing the previous port sites. The adhesions were easily dissected, and evacuation of ~300 ml of white, dense fluid, and lavage and drainage were performed without intraabdominal dissemination of pus. The patient was discharged on the 12th postoperative day free of symptoms. Microbiological examination of the pus showed the presence of Peptostreptococcus. The patient remained symptom free. At 8 weeks postoperatively, barium swallow, endoscopy, 24-h pH monitoring, and stationary manometry of the esophagus yielded normal results. Because there was no direct evidence of leakage at the fundus, the development of the abscess was concluded to be due to the use of deep transmucosal stitches rather than seromuscular ones to create the wrap. The nonabsorbable multifilament suture material passing through the entire gastric wall could have facilitated bacterial contamination of the operative field.

Abdominal Abscess↗

PubMed2000

[Laparoscopic repair of abdominal wall hernias using an intraperitoneal onlay prosthetic patch of expanded polytetrafluoroethylene (eptfe)].

The surgical treatment of ventral abdominal wall hernias is still an unsolved problem despite considerable number of conventional methods. Mesh to replace or reinforce the defect by anterior approach has marginally reduced the recurrence rate, but not the infection rate. The authors describe the technique of laparoscopic repair of abdominal wall hernias using an intraperitoneal onlay prosthetic patch of expanded polytetrafluoroethylene (ePTFE) in two cases. Postoperative complications and the advantages of this technique and other published laparoscopic procedures are discussed and compared to the open ventral repairs. It is concluded that laparoscopic prosthetic ventral hernioplasty is a feasible and safe method. It appears to have less morbidity, especially with regard to the infection rate and recurrences, when compared to the open approach. However, authors believe that prospective randomized trials will be needed for further evaluation.

Aged↗

PubMed1999

[Result of Panzytrat 25000 therapy following total gastrectomy].

Thirteen patients who had undergone total gastrectomy because of gastric cancer in 11 cases and gastric lymphoma in 2 cases (6 female, 7 male) at the 3rd Department of Surgery, Semmelweis University, Medical School have been followed up. The length of follow up period varied between 7.5 months and six years. Vitamin B12 substitution was applied in each case (300 micrograms/month). In 6 cases early temporary iron substitution was necessary. Regular pancreatic enzyme substitution (pancreatin) was used during meals in these patients. At the beginning Kreon (Chinoin) or Neo-Panpur (Egis) treatment was applied. Since April 1996 the patients have been treated by Panzytrat 25,000 (Knoll) which has higher enzyme content comparing with the previous ones. Following gastrectomy the digestion and absorption improved due to pancreatic enzyme substitution and the body weight increased. The serum albumin and cholesterol levels elevated significantly, while the serum uric acid levels did not changed. The iron absorption improved, patients did not require iron substitution later, except two cases. One of them needed transitoric and the other continuous iron substitution. Side effects were recorded in six cases. One of the 13 patients stopped application of Panzytrat 25,000 because of epigastric pain among other side effects (2 epigastric pain, 2 hyperuric state, 2 frequent discharge of stool) and returned to well tolerated Neo-Panpur.

Female↗

PubMed1999

Surgical aspects of gastro-esophageal reflux disease--indication for surgery. An update.

Gastro-esophageal reflux disease is regarded as the single most common foregut disorder mainly in Western countries. The pathophysiological background of the disease is multifactorial. The primary aim of the management of gastro-esophageal reflux disease is relieving heartburn and healing esophagitis. The therapeutic objectives are alleviating symptoms, preventing complications and avoiding recurrence. Besides the effective medical treatment nowadays we possess the minimal invasive anti-reflux surgery which gives comparable, even better results than medical therapy does, in cases of patients who are suitable for anti-reflux surgery. The key question is the appropriate patient selection. In order to achieve the most adequate patient selection, diagnostic tools like endoscopy, radiotherapy, esophageal body and sphincter manometry, 24-hour esophageal pH monitoring and occasionally 24-hour bile exposure monitoring and gastric emptying studies are mandatory to carry out preoperatively. On the basis of the results of these tests the tailored concept of anti-reflux surgery can be applied. The importance of experienced surgeon should be pointed out, too.

Antacids↗

PubMed1999

Laparoscopic gastric surgery. Early experiences.

In the Department of General Surgery the authors performed 12 elective laparoscopic gastric operations for gastric pathologies. The indications for the procedures were recurrent or therapy resistant and complicated peptic ulcer in 9 cases, benign gastric tumors in 2 cases and early gastric cancer in 1 case. Operative procedures were the next: posterior truncal vagotomy with anterior lesser curve seromyotomy (5 patients), total truncal vagotomy with gastrojejunostomy (2 patients), total truncal vagotomy with pyloroplasty (1 patient), total truncal vagotomy with antrectomy and Billroth-II reconstruction (1 patient), resection of benign gastric tumor by the transgastric approach (1 patient), Billroth-II resection for benign gastric tumor (1 patient), wedge resection of gastric wall for early gastric cancer (1 patient). Intraoperative gastroscopy was used for location of the lesion in 4 of 12 cases. Apart from delayed gastric emptying (2 cases), patients recovered without any problem. The mean hospital stay was 5.7 days. Early experiences with laparoscopic gastric surgery has shown that there are certain important advantages to the approaches. They hold the promise of less pain, less immobility, quicker alimentation, shorter hospitalization, less wound and respiratory complications and an earlier return to normal activities.

Anastomosis, Surgical↗

PubMed1998

Role of different bombesin receptor subtypes mediating contractile activity in cat upper gastrointestinal tract.

Mammalian bombesin-like peptides, gastrin-releasing peptide (GRP) and neuromedin B (NMB) are known to increase the motility of different segments in the gut. The present study was carried out to identify the bombesin receptor subtypes mediating the contractions induced by exogenous bombesin-like peptides in muscle strips isolated from cat esophagus, fundus, and duodenum. Both GRP-10 and NMB evoked concentration-dependent contractions in circular strips of esophagus and fundus and in longitudinal strips of the duodenum. These contractions were tetrodotoxin- and atropine-resistant. The potency of NMB in esophageal strips was 33 times higher than that of GRP-10. The NMB-preferring receptor antagonists D-Nal-Cys-Tyr-D-Trp-Lys-Val-Cys-Nal-NH2 (SSocta) and D-Nal-cyclo[Cys-Tyr-D-Trp-Orn-Val-Cys]-Nal-NH2 (BIM-23127) shifted the NMB and GRP concentration-response curves to the right, while the GRP-preferring receptor antagonist [D-Phe6]Bombesin(6-13)-methyl-ester (BME) did not affect the response to the peptides. Isolated muscle strips from the cat fundus and duodenum showed a higher sensitivity to GRP-10 than to NMB. In both segments, BME shifted the GRP-10 and NMB concentration-response curves to the right, while SSocta had no effect. The antagonism of BME was competitive on duodenal but not competitive on fundic muscle. We conclude that the direct myogenic action of GRP-10 and NMB in the esophagus is mediated mainly via NMB-preferring receptors, while GRP-preferring receptors are responsible for the contractile responses to bombesin-like peptides in feline fundus and duodenum. Our data suggest that the GRP receptor population located on fundic muscle might be nonhomogeneous.

Animals↗

PubMed1998

Referral patterns and motivation for anti-reflux surgery of patients suffering from gastroesophageal reflux disease.

Due to a better understanding of the pathophysiology of gastroesophageal reflux disease (GERD), as well as the improvements in surgical technique, the number of anti-reflux procedures has increased world-wide during the last decade. This trend has been facilitated by the advent of minimally invasive surgery. Although a great number of publications deal with the indications or selection of patients for surgery, only a few discuss the motivation of patients for choosing surgery rather than long-term medical treatment. In order to evaluate the different elements of motivation of patients suffering from primary gastroesophageal reflux disease, the data of 115 patients who had undergone anti-reflux surgery between January 1990 and June 1997 at the Department of Surgery, Technical University, Munich, were evaluated. As laparoscopic anti-reflux surgery has only been regularly performed since 1994 in our Department, the study period was divided and the two periods (1990-1993 and 1994-1997) were analyzed separately. The data were evaluated according to the referral pattern and the motivation of patients with GERD who chose surgery. In the period from 1990 to 1993, 38.5% of the patients were referred to surgery by general practitioners, 38.5% by internists, 10% by practicing surgeons and 8% by gastroenterologists. In 5% of the cases the patients themselves initiated surgery. The corresponding results for the period from 1994 to 1997 were 29%, 38%, 12%, 8% and 13%, respectively. The most common reason for a patient to choose surgery was moderate or only short-term response to appropriate conservative treatment, which accounted for 98% and 92% of the patients, respectively, during the study periods. This was followed by avoidance of life-long medical therapy and its potential risks in 77% and 85% of the patients. Fear of cancer was reported in 10% and 25%, respectively. In the second period, the option of a minimally invasive procedure was reported as an important factor in 45% of the patients. Although the number of anti-reflux procedures performed per year is increasing and there is also an increasing tendency regarding the application of minimally invasive procedures, the factors leading to referral failed to show significant differences in the two periods. The motivation of patients, however, clearly changed in favour of surgical therapy, mainly because of the availability of a minimally invasive approach.

Adolescent↗

PubMed1997

Complications of laparoscopic cholecystectomy in Hungary: a multicentre study of 13,833 patients.

OBJECTIVE: To report our countrywide experience of laparoscopic cholecystectomy with particular reference to complications. DESIGN: National multicentre retrospective study. SETTING: 71 university departments and public hospitals in Hungary. SUBJECTS AND INTERVENTIONS: 13,833 patients operated on between 1 January 1990 and 31 December 1993. Follow up by questionnaire. RESULTS: 732 patients (5.3%) required conversion to open cholecystectomy, urgently because of intraoperative complications in 204 (1.5%), electively for acute or chronic inflammation or obscure anatomy in 441 (3.2%), for unexpected findings in 72 (0.5%) and for technical problems in 15 (0.1%). There were postoperative complications in 598 (4.3%) but reoperation was indicated in only 154 patients (1.1%). There were bile duct injury in 81 (0.6%) and 199 bleeds (1.4%) which required conversion in 102 patients (0.7%) and reoperation in 38 (0.3%). 36 of the 181 postoperative recognized bile leaks required reoperation (20%). 19 patients died (0.1%). CONCLUSIONS: The morbidity and the mortality of laparoscopic cholecystectomy are better than after the open operation. The 2-6 times higher risk of bile duct injury mentioned in early studies was not confirmed.

Cholecystectomy, Laparoscopic↗

PubMed1997

Transabdominal preperitoneal herniorraphy: technique and results.

As enthusiasm for laparoscopic surgery has grown, laparoscopic approaches to the groin hernia have evolved. The most widely accepted laparoscopic repair employs the placement of a large sheet of mesh in a preperitoneal position to cover potential hernia spaces. Between March 1994 and February 1997 160 inguinal and 3 femoral hernia were operated of an transabdominal preperitoneal (TAPP) polipropylen mesh. 131 patients were operated (128 males and 3 females, ranging in age from 19 to 82 years), 31 (23%) of them had bilateral hernias. Recurrent hernia was the indication in 52 (32%) cases. Average operating time for unilateral repair was 80 minutes and for bilateral repairs was 108 minutes. Postoperative complications included 7 (4.3%) cases of transient neuralgias, 20 (12%) cord/scrotal transient seromas-hematomas and 2 (1.2%) hydrocele. The 5 (3.1%) early recurrences were considered to be caused by technical inexperience and/or too small prosthetic patch. The laparoscopic hernioplasty has definitive advantage: minimal postoperative pain, short hospital stay (average postoperative time of hospitalization 3.1 days) and early restoration of full physical activity (in 1 to 2 weeks). The method should be considered as a potential "best option" in patients with recurrences and bilateral inguinofemoral hernias.

Abdomen↗

PubMed1996

Long-term clinical results of highly selective vagotomy performed between 1980 and 1990.

A retrospective analysis was conducted of 778 patients who underwent highly selective vagotomy between 1980 and 1990. Surgery was performed for duodenal ulcers without any complications in 485 (62.3%) patients; for duodenal ulcers with complications such as stenosis, bleeding, or perforation in 270 (34.7%); for combined duodenal and ventricular ulcers in 12 (1.5%), and for ventricular ulcers alone in 11 (1.4%). Pyloroplasty was additionally performed in the presence of complications only. The incidence of intraoperative complications proved to be as high as 1.4%, occurring in 11 patients, while postoperative complications developed in 247 patients (31.7%). Although the overall mortality was 0.6% (5 patients), the mortality rate of those patients who underwent surgery for uncomplicated ulcer disease was 0.2% only (2 patients). The patients comprised 554 men (71.2%) and 224 women (28.8%) with an average age of 41.4 +/- 0.7 years. The average duration of duodenal ulcer disease was 9.5 years, and 643 (83.2%) of the patients were able to be regularly followed up for between 3 and 13 years. Recurrence developed in 62 patients (9.6%): in the duodenum in 57 patients (91.9%), and in the stomach in 5 (8.1%). The rate of recurrence according to sex was 9.4% in men and 10.3% in women, being 42 and 20 patients, respectively. The average duration until recurrence appeared was 27.06 +/- 3.44 months. A reoperation proved necessary in 28 of these 62 patients (45.1%). The clinical results were evaluated by means of a modified Visick classification, according to which 81.8% of the patients belonged to groups 1 or 2, 7.9% to group 3, and 10.3% to group 4.

Adult↗

PubMed1992

[Prevention of carcinoid tumor crisis].

A case of the carcinoid tumour of ileum causing hormone producing multiple hepatic metastases was described. Sometimes after feeding and drinking of beer the "flush" and the diarrhoea appeared. Multiple hepatic metastases were established by ultrasound. Two and a half years ago the patient already was examined and treated by another hospital. In this time the origin of the primaer carcinoid tumour was not found and the superselective embolisation of the right lobe of the liver was made which caused a carcinoid crisis. Later the complaints were renewed and once more the patient was examined. The origin of the illness was proved in the lower ileum by CT (computer tomography), angiography and I131 MIBG (metajod-benzyl-guanidin) scintigraphy. Another embolisation of the liver caused a newer carcinoid crisis. The operation of primaer carcinoid tumour was decided because of the danger of carcinoid crisis and ileus. In the perioperative period the patient was protected against carcinoid crisis by Sandostatin (made in SANDOZ, Basel), because the preoperative therapy, the anaesthetics and the surgical manipulation could have caused a carcinoid crisis. In Hungary the authors used for the first time somatostatin in perioperative period to protect the patient against carcinoid crisis.

Carcinoid Tumor↗

PubMed1991

[Experience with the management of pyogenic liver abscesses by percutaneous transhepatic puncture and drainage].

The authors treated forty-two patients with liver abscesses guided by computer tomography or ultrasound percutaneous transhepatic puncture or drainage from January 1 1983, to 1989 December 31. Closed aspiration or drainage was done in 42 patients altogether 56 times. Three patients died (3/42 = 7.2%), postdrainage complications happened in 9 cases (9/42 = 21.4). Operative intervention was necessary in 11 patient after the percutaneous procedure (11/42 = 26.2%). The authors wrote about the technics particularly of the percutaneous puncture or drainage. The authors are considering the method as an effective treatment for pyogenic liver abscesses if the personal and technical circumstances are given.

Drainage↗

PubMed1991

A case of multiple cholangiogenic liver abscess due to residual biliary stone cured by percutaneous drainage controlled by CT and endoscopic papillotomy.

The case of a patient treated for multiple cholangiogenic liver abscess due to residual biliary stone after acute cholecystitis is reported. The multiple liver cyst was cured by percutaneous transhepatic double drainage controlled by CT as well as puncture and aimed local systemic antibiotic treatment. The residual gallbladder stone was removed by endoscopic papillotomy. A similar case has not been reported so far.

Ampulla of Vater↗

PubMed1991

Technique of extensive proximal selective vagotomy.

Based on the experience of 727 operations, the technique of proximal selective vagotomy used by the authors is reviewed in stages. They consider pyloroplasty justified to perform only in complicated cases (bleeding, perforation, stenosis) for preventing complications. Based on their results (mortality rate: 0.68%, recurrences: 6.3%, excellent or good results: 90%), they argue for the operation.

Chronic Disease↗