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Biomedical subjects

A Balogh

Publications and source records attributed to A Balogh.

At least 19 recordsLinked to original sources
PubMed2002

Pyogenic liver abscess -- 20 years' experience. Comparison of results of treatment in two periods.

BACKGROUND AND AIMS: Our aim is to give an audit of our experience over the past two decades in the form of a retrospective study. PATIENTS/METHODS: In two equal periods between 01.01.1982 and 31.03.2001, 56 patients (37 males and 19 females) with pyogenic liver abscess were treated. Image-guided percutaneous drainage was performed in 22.2%/20.6% of the patients; the remainder were treated with open drainage with or without biliary tract reconstruction and liver resection. For antibiotic perfusion of the liver an umbilical vein cannula was inserted in 40.7%/24.1%. Microbiological findings, types of therapy, complications and mortality, etiology, patient characteristics, symptoms, and laboratory data were investigated. The results in the two groups were compared and analyzed statistically. RESULTS: The most common cause of abscess, biliary disease, was seen more often in the second period. Solitary liver abscesses were more frequent. The only characteristic biochemical finding was an elevated alkaline phosphatase level. There were more positive cultures in the second period (70.4%/79.3%), and the number of Escherichia coli or Enterobacter aerogenes infections also increased. In the first period the mortality was 18.5%, whereas in the second no patients were lost. CONCLUSION: We suggest the importance of individualized therapy based on an early and exact diagnosis. The first treatment step should be image-guided drainage, but under well-defined circumstances open drainage can also be performed with good results.

Adult↗
PubMed2002

Documentation and evaluation of adverse drug reactions (ADR)--contribution from a poison information center.

The Department of Clinical Pharmacology in Jena is a pharmacovigilance center in a study on intensified spontaneous adverse drug reaction reporting. Physicians specialized in clinical pharmacology screen admissions to the Department of Internal Medicine for possible adverse drug reactions. Because of the collaboration between the Pharmacology Department and the nearby Poison Information Center (PIC) in Erfurt the question occurred whether the latter might contribute to adverse drug reaction monitoring. We compared the ADR registered by the intensified spontaneous reporting system in 1999 with those of the PIC during the same period. Each symptom observed was regarded as 1 case. Every suspected drug was also treated separately. The symptoms were classified using adverse reaction terminology. The drugs were classified according to the WHO Anatomical Therapeutic Chemical (ATC) classification index. The causality assessment was based upon bibliographic data and the method of Bégaud et al. [1985]. Only possible, probable or very probable ADR were compared. The PIC registered mainly psychiatric and nervous system disorders sedation and extrapyramidal disorders were the most frequent reactions - unlike the pharmacovigilance study which registered primarily gastrointestinal and heart rate disorders. The PIC registered mainly drugs used in the therapy of disorders of the central nervous system, i.e. mostly psycholeptics and drugs acting on the alimentary tract, mostly anticholinergics. Drugs for the therapy of sensory organs disorders were frequent owing to the systemic and local adverse drug effects of anticholinergic mydriatics. The PIC and pharmacovigilance centers can benefit from co-operation. The PIC provides easy access to qualified drug information and is thus a useful tool in ADR evaluation. Although the number of adverse reactions assessed was small, their evaluation revealed problems in drug usage which would not otherwise be reported. The evaluation has enlarged the pool of ADR data which is the basis for signal detection.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

Temporal evolution of the electric field accelerating electrons away from the auroral ionosphere.

The bright night-time aurorae that are visible to the unaided eye are caused by electrons accelerated towards Earth by an upward-pointing electric field. On adjacent geomagnetic field lines the reverse process occurs: a downward-pointing electric field accelerates electrons away from Earth. Such magnetic-field-aligned electric fields in the collisionless plasma above the auroral ionosphere have been predicted, but how they could be maintained is still a matter for debate. The spatial and temporal behaviour of the electric fields-a knowledge of which is crucial to an understanding of their nature-cannot be resolved uniquely by single satellite measurements. Here we report on the first observations by a formation of identically instrumented satellites crossing a beam of upward-accelerated electrons. The structure of the electric potential accelerating the beam grew in magnitude and width for about 200 s, accompanied by a widening of the downward-current sheet, with the total current remaining constant. The 200-s timescale suggests that the evacuation of the electrons from the ionosphere contributes to the formation of the downward-pointing magnetic-field-aligned electric fields. This evolution implies a growing load in the downward leg of the current circuit, which may affect the visible discrete aurorae.

Journal Article↗
PubMed2001

[The state of cancer surgery at the turn of the millennium].

Surgery remains the method of choice for the treatment of stage I and II cancer disease, it has proved to be curative in 40% of these cases. The role of surgery in the complex multimodality treatment of tumorous diseases is changing, depending on the type and stage of the disease and on the effectivity of the adjuvant therapeutical modalities. In general, surgery has not lost its significance in the treatment of cancer during recent decades. The author presents precise definitions and a homogeneous terminology for the basic concepts of oncological surgery. Changes in the surgical strategy and other factors influencing the surgical radicality are analysed. New methods contributing to the development of cancer surgery and to the improvement of the survival rate and the postoperative quality of life are surveyed. The roles of regional lymphadenectomies, metastasectomies, extended resection and organ-saving methods in the up-to-date treatment of tumorous diseases are discussed.

Combined Modality Therapy↗
PubMed2001

[Quality indicators of hospital care: evaluation of patient care in acute myocardial infarction].

In the international hospital accreditation programs there is an increasing emphasis on involving performance indicators. The inpatient mortality rate of AMI patients and the usage of thrombolytic therapy are very common, evidence based indicators of these programs. The authors goal was to analyze the applicability of these indicators in the evaluation of the Hungarian hospital care. In Hungary, there is a data collection system on every inpatient case. This database was used to determine the above mentioned two indicators for 1997 and 1998. They calculated by hospital group level, by institutions and by geographic areas crude rates and rates adjusted for age and gender, and for severity using the different DRGs of AMI patients. In these two years the inpatient mortality rates of AMI patients were 20.4% and 21.7%, and the usage of thrombolytic therapy were 9.9% and 11.8%, respectively. Using indirect standardization methodology in the usage of thrombolytic therapy, they found high differences among the counties compared to the national average, the range was 51-199%, and among the institutions 0-306%, respectively. It is clear, that there are huge differences in the curative processes and in the inpatient mortality rates of AMI patients among the hospitals. The differences are developed by chance, there are no close connections either to hospital groups, or to geographical locations. Because of the difficulties of risk adjustment, they suggested that indicators were suitable for benchmarking. It is necessary to implement in the national quality criteria system different indicators for evaluating the patient care, to develop programs for auditing the best and worst hospitals and to introduce standards for assuring the validity of the basic data.

Aged↗
PubMed2001

[Multidisciplinary therapy of colorectal cancer].

A multidisciplinary program for the treatment of colorectal cancer is described. The main objective of the authors has been to define uniform up to date guidelines based on recent progress in the treatment of colorectal cancer. Preoperative diagnostic procedures are summarized which advance determination of clinical stage and prognosis. These information essentially determine care. Sequences of surgical methods, preoperative and postoperative radiotherapy and medical treatments are discussed according to tumor stages. Guidelines for surveillance following active treatment and recommendation for the screening of population at high risk for colorectal cancer are presented.

Algorithms↗
PubMed2001

The effects of pregnancy and lactation on bone mineral density.

We performed a prospective study of bone mineral density (BMD) in 38 women during their first full-term pregnancy until 12 months postpartum. BMD measurements at lumbar spine [L2-L4 (LS)] and forearm [distal 33% (RD) and ultradistal (RUD) region of the radius] were made within 3 months before conception, after delivery, and at 6 and 12 months postpartum. In mid-pregnancy the DXA examination was carried out only at the forearm. Patients were grouped according to duration of lactation as group I, II or III (0-1, 1-6, 6-12 months respectively). During pregnancy there was a significant difference between baseline and delivery (p< 0.001) in the LS, RUD and RD BMD values. In group I there was no statistically significant difference in LS BMD between visits following pregnancy. The RUD BMD loss was recovered by 6 months postpartum (PP6). Group II showed continuous bone loss from delivery until PP6 at LS and RUD. In group III the LS BMD loss continued throughout the lactation period. The RUD BMD dropped (4.9%) until PP6 then increased by 3.0% as measured at 12 months postpartum (PP12). There was no significant change in RD BMD in any of three groups during lactation. At LS bone loss between delivery and PP12 correlated well with the duration of lactation (r = -0.727; p<0.001). We suggest that calcium needed for fetal skeletal growth during pregnancy was gained from maternal trabecular and cortical sites and that calcium needed for infant growth during lactation was drawn mainly from the maternal trabecular skeleton in our patients. The effect of pregnancy and lactation on the maternal bone mass was spontaneously compensated after weaning.

Absorptiometry, Photon↗
PubMed2001

Systematic errors of planar arm movements provide evidence for space categorization effects and interaction of multiple frames of reference.

Healthy humans performed arm movements in a horizontal plane, from an initial position toward remembered targets, while the movement and the targets were projected on a vertical computer monitor. We analyzed the mean error of movement endpoints and we observed two distinct systematic error patterns. The first pattern resulted in the clustering of movement endpoints toward the diagonals of the four quadrants of an imaginary circular area encompassing all target locations (oblique effect). The second pattern resulted in a tendency of movement endpoints to be closer to the body or equivalently lower than the actual target positions on the computer monitor (y-effect). Both these patterns of systematic error increased in magnitude when a time delay was imposed between target presentation and initiation of movement. In addition, the presence of a stable visual cue in the vicinity of some targets imposed a novel pattern of systematic errors, including minimal errors near the cue and a tendency for other movement endpoints within the cue quadrant to err away from the cue location. A pattern of systematic errors similar to the oblique effect has already been reported in the literature and is attributed to the subject's conceptual categorization of space. Given the properties of the errors in the present work, we discuss the possibility that such conceptual effects could be reflected in a broad variety of visuomotor tasks. Our results also provide insight into the problem of reference frames used in the execution of these aiming movements. Thus, the oblique effect could reflect a hand-centered reference frame while the y-effect could reflect a body or eye-centered reference frame. The presence of the stable visual cue may impose an additional cue-centered (allocentric) reference frame.

Adult↗
PubMed2001

Bone mineral density, biochemical markers of bone turnover, and hormonal status in men with systemic lupus erythematosus.

The aim of this study was to evaluate bone mineral density (BMD), biochemical markers of bone turnover, and hormone levels in men with systemic lupus erythematosus (SLE). BMD at L2-L4 lumbar vertebrae (LS), left proximal femur neck, and radius at the ultradistal and mid-33% region was measured by dual-energy X-ray absorptiometry in 23 men with SLE (mean age, disease duration, and cumulative corticosteroid dose were 45.6 years, 11.9 years, and 33.410 g, respectively) and 40 healthy, age- and sex-matched controls. Biochemical markers of bone turnover, parathyroid hormone and 25-hydroxyvitamin D (25-OH-D), testosterone, and dehydroepiandrosterone sulfate (DHEAS) levels were measured. There was no difference in BMD between the SLE and control group. The prevalence of osteoporosis was 17.4% (4 out of 23), found at LS. Biochemical markers of bone turnover were within the reference range. There was a high prevalence of hypovitaminosis D (65.2%), hypotestosteronism (62.5%), and hypodehydroepiandrosterone sulfate (100%). There was no correlation between BMD and duration of disease, corticosteroid doses, SLE Disease Activity Index (SLEDAI), SLE Collaboration Clinics/American College of Rheumatology (SLICC/ARC) damage index, or markers of bone turnover. Bone-specific alkaline phosphatase (BSAP) (r, -0.500; P=0.018) and DHEAS (r, -0.511; P=0.013) correlated with the daily corticosteroid dose. Despite corticosteroid therapy, bone mass in men with SLE was not decreased.

Aged↗
PubMed2001

Does wave VI of BAEP pertain to the prognosis of coma?

OBJECTIVES: The significance of brainstem auditory evoked potential (BAEP) wave VI for the outcome of comatose patients was assessed and compared to the prognostic impact of median nerve evoked somatosensory potential (MSEP) recording. PATIENTS AND METHODS: One hundred sixteen patients in a comatose state due to traumatic brain injury (n = 57) and to intracerebral hemorrhage or tumours (n = 59) were investigated prospectively. Outcome was assessed 3 months after the onset of coma using Glasgow Outcome Score (GOS). Standard BAEP and MSEP recordings were obtained within 24 h after coma onset. The frequency of findings was correlated with outcome by means of non-parametric statistical analysis. Additionally, 27 healthy volunteers were studied to confirm the constant presence of wave VI in normal BAEP. RESULTS: In healthy controls, wave VI was present in 53/54 ears stimulated. Outcome correlation analysis revealed a significantly (p < 0.01) higher frequency of abnormal wave VI in patients with unfavourable outcome (GOS 1-3) irrespective of the underlying pathology. Similarly, abnormal MSEP findings were significantly more frequent in this outcome group. Diagnostic sensitivity for an unfavourable outcome was low for both parameters, whereas specificity and positive predictive value of abnormal wave VI as well as of abnormal MSEP were equally high. CONCLUSION: Abnormal BAEP wave VI bears prognostic information in comatose patients.

Adolescent↗
PubMed2001

High cervical spinal cord stimulation (CSCS) increases regional cerebral blood flow after induced subarachnoid haemorrhage in rats.

The effects of high cervical spinal cord stimulation (cSCS) on regional cerebral blood flow (rCBF) were investigated after experimentally induced subarachnoid haemorrhage (SAH) in rats by the means of (99m)Tc-HMPAO. The experiments were carried out on a total of 24 Wistar rats, divided in three groups [group I: control without SAH, group II: SAH, group III: SAH and cSCS]. (99m)Tc-HMPAO was administered intravenously (group II/group III) 48 hours after induction of SAH. In group III, (99m)Tc-HMPAO was given after 3 hours of cSCS. All animals were sacrificed 30 minutes after application on (99m)Tc-HMPAO. Radioactivities were determined in blood, cerebrum and cerebellum. The ratio cerebrum/blood and cerebellum/blood was calculated to ascertain "extraction rate" in the sample differentially. The following mean values were calculated for the cerebellum/blood ratio: Group I: 1.06, SD: 0.21; Group II: 0.66, SD: 0.21; Group III: 1.00, SD: 0.37. Comparing the mean values a highly significant difference could be found between group II and III (p = 0.007) and between group I and II (p = 0.0019), respectively. Calculations of the cerebrum/blood ratio revealed similar results. After SAH cSCS enhances cerebral and cerebellar blood flow in rats. Possibly, cSCD constitutes a new therapeutic approach in the treatment of disturbed regional cerebral blood flow after SAH.

Animals↗
PubMed2001

Bile-induced adenosine triphosphate depletion and mucosal damage during reflux esophagitis.

BACKGROUND: This study was designed to investigate the role of bile in a large animal model of acute esophageal reflux disease. METHODS: An agar electrode was used to measure the transmucosal potential difference of the esophagus in anaesthetized dogs. The vascular permeability index and the epithelial permeability index of the mucosa were evaluated by means of the Evans blue and the sodium-fluorescein clearance method, respectively. The tissue adenosine triphosphate (ATP) level and the myeloperoxidase activity were determined from tissue biopsies, while the degree of mucosal damage was evaluated histologically on a grade 0-100 scale. Group 1 (n = 8) served as saline-treated control; groups 2 (n = 8), 3 (n = 5) and 4 (n = 5) were exposed for 4 h to canine bile alone, to hydrochloric acid + bile, or to hydrochloric acid alone, respectively. RESULTS: In Groups 2, 3 and 4 the degree of mucosal damage was significantly increased, and a 4-fold elevation in myeloperoxidase activity was observed. The transmucosal potential difference was decreased significantly below the control level, while the vascular and epithelial permeability indices were significantly increased compared with the control values. Bile, but not hydrochloric acid, evoked a significant (40%) decrease in the ATP level of the esophageal tissue. CONCLUSIONS: We propose that mucosal dysfunction, structural damage and leukocyte invasion during hydrochloric acid-induced esophageal injury are exacerbated by bile-induced changes in tissue ATP concentrations during experimental esophageal reflux disease.

Acute Disease↗
PubMed2001

Wheat germ extract decreases glucose uptake and RNA ribose formation but increases fatty acid synthesis in MIA pancreatic adenocarcinoma cells.

The fermented wheat germ extract with standardized benzoquinone composition has potent tumor propagation inhibitory properties. The authors show that this extract induces profound metabolic changes in cultured MIA pancreatic adenocarcinoma cells when the [1,2-13C2]glucose isotope is used as the single tracer with biologic gas chromatography-mass spectrometry. MIA cells treated with 0.1, 1, and 10 mg/mL wheat germ extract showed a dose-dependent decrease in cell glucose consumption. uptake of isotope into ribosomal RNA (2.4%, 9.4%, and 28.0%), and release of 13CO2. Conversely, direct glucose oxidation and ribose recycling in the pentose cycle showed a dose-dependent increase of 1.2%, 20.7%, and 93.4%. The newly synthesized fraction of cell palmitate and the 13C enrichment of acetyl units were also significantly increased with all doses of wheat germ extract. The fermented wheat germ extract controls tumor propagation primarily by regulating glucose carbon redistribution between cell proliferation-related and cell differentiation-related macromolecules. Wheat germ extract treatment is likely associated with the phosphorylation and transcriptional regulation of metabolic enzymes that are involved in glucose carbon redistribution between cell proliferation-related structural and functional macromolecules (RNA, DNA) and the direct oxidative degradation of glucose, which have devastating consequences for the proliferation and survival of pancreatic adenocarcinoma cells in culture.

Adenocarcinoma↗
PubMed2001

[Drug for the treatment of sleep disorders--review].

For the treatment of insomnia/sleep disturbances, drugs are indicated only if non-drug-procedures alone are not sufficiently successful or not successful at all. To facilitate sleep, sedative-hypnotic agents are used clinically. Because of favorable risk-benefit ratio, non-benzodiazepines with benzodiazepine-like action (zolpidem, zopiclon) or benzodiazepines themselves (dependent on their pharmacokinetic profil) are administered in the most cases. Sedative-hypnotic drugs reducing the electric activity of the CNS sufficiently to produce coma and even death are not recommended at present. To assess the clinical relevance of amino acid L-tryptophan for the treatment of insomnia/sleep disturbances, more controlled clinical studies are necessary. The nonprescription antihistamines (Doxylamin, Diphenhydramin) are only suitable for short-term administration in adults. Under certain conditions, antidepressant and antipsychotic drugs can be taken. Because of potential risks, the intake demands caution. Different herbal remedies are recommended, but only for extracts of valerian a sleep-inducing effect can be assumed. Melatonin, an endogenous hormone and tryptophan-metabolite is thought to be involved with the sleep-wake cycle. Therefore the exogenous intake of melatonin may influence vigilance and sleep. This is particularly true for patients with jet-lag symptoms.

Anti-Anxiety Agents↗
PubMed2001

[Changes in calcium metabolism after kidney transplantation].

Prospective study was performed to measure the changes in calcium metabolism after kidney transplantation. 139 recipients received calcium substitution (1st group) and 81 patients were treated with alfacalcidol (2nd group). Serum Ca, P, Mg, alkaline phosphatase (AP) and intact PTH levels were determined before transplantation and at 1, 3, 6, 12 and 24 months thereafter in the two groups. Femoral and vertebral bone mineral density was measured with bone densitometer at the same period. The serum Ca level elevated and the serum P concentration decreased significantly in both group. The mean serum Mg and AP concentration changed in the normal range after the transplantation. The intact PTH level decreased significantly in both group at 2 years following transplantation. The intact PTH concentration changed from 17.1 pmol/l to 9.3 pmol/l in the 1st group, and it is decreased from 17.7 pmol/l to 7.9 pmol/l in the 2nd group. Bone densitometry showed osteoporosis in both group. At 12 months and at 24 months after kidney transplantation bone mineral density (BMD) of lumbar spine was 90.8% and 86.9% in the 1st group and 85.3% and 81% in the 2nd group. At the same time BMD of the femoral region was 84.4% and 85.5% in the 1st group and 82.0% and 81.3% in the 2nd group. The BMD did not changed significantly in the 1st compared to the 2nd group. During this period osteonecrosis was diagnosed in 6 patients in the 1st group and in 9 cases in the 2nd group. In conclusion, the serum Ca and P levels were in the normal range after kidney transplantation. The alfacalcidol treatment significantly decreased the intact PTH concentration compared to the calcium substitution. Moderate osteopenia was observed in both groups after the transplantation, despite of the administration of alfacalcidol treatment.

Adolescent↗
PubMed2000

[Surgical treatment of Boerhaave's syndrome].

The authors treated four patients with spontaneous oesophageal rupture between 1995 and 1999. The interval from injury to surgical treatment was less than 24 h in two cases, and longer than 24 h in the other two cases. The surgical treatment was primary closure of the rupture and mediastinal drainage with gastrostomy within 24 h after the onset. Septic complications occurred in lately presented patients. In these cases, the surgical treatment consisted of oesophagectomy, mediastinal drainage and feeding gastrostomy. The alimentary tract was reconstructed with interposed ileocolon eight weeks later. Each patients was fully recovered. The authors underline the importance of early diagnosis which obviously determine the prognosis and the choice of surgical treatment. Primary repair is proposed after early diagnosis, however oesophageal resection is recommended 24 h after the injury.

Adult↗
PubMed2000

[Principles of evidence-based medicine in the surgical treatment of colorectal cancers].

The principles of evidence-based medicine (EBM) are summarized. The surgical activity of the author's team is analysed to answer the question of whether the principles of EBM prevail in their surgical treatment of colorectal cancer. Results of some comparative studies are presented as concerns preoperative preparation, antibiotic prophylaxis, and the development of the suture technique applied. The changes of radicality in the surgery of colorectal cancer are discussed. It is emphasized that three newly developed procedures are routinely used in their practice to enhance surgical radicality and to improve the 5-year survival rate: 1. subtotal colectomy for obstructive left side colonic tumours, 2. total mesorectal excision for middle and lower third rectal cancer, and 3. multivisceral resections for the treatment of advanced colorectal tumours. The advantages of new methods recently introduced in Hungarian colorectal surgery are guaranteed by previous published studies. The team has made efforts to develop new methods and to control the results in routine surgery. Only the surgical practice during the past few years could be influenced by the principles of EBM, but even so the maintenance of surgical standards, the application of results of well-documented reliable studies and efforts to develop new and better methods reflect principles equivalent to those of EBM in colorectal surgery in the past two decades.

Antibiotic Prophylaxis↗