Biomedical subjects
Publications and source records attributed to A Farkas.
Authors studied the occurrence and clinical outcome of hiatal hernia in 18 patients during a 7-year period. The age of the children from 10 years to 15 years, with a mean age of 12.8 years. Their patients had recurrent abdominal pain, 4 of them had chest pain. 13 patients had macroscopic oesophagitis. Under medically treatment 16 patients has been well. Two cases required surgery. Aetiology of hiatal hernia in children is unknown.
From March 1989 to october 1990, 35 refluxing ureters in 25 children were treated by submucosal injection of Teflon (STING). The overall success rate was 54% after the first injection. The authors detail the procedure and analyse their results which demonstrate that Teflon injection can be safe and effective treatment of vesicoureteral reflux in most cases can replace antireflux surgery.
OBJECTIVE: Our purpose was to determine the effects of labor and fetal hypoxia on the levels of insulin-like growth factor binding protein-1 in the maternal and fetal circulation. STUDY DESIGN: Serum levels of insulin-like growth factor binding protein-1 were determined in maternal and umbilical blood at delivery in two groups. The first group included 43 vaginal deliveries and 23 elective cesarean sections. The second group consisted of 44 women; in 24 the liquor was meconium stained and in 20 it was clear. RESULTS: Levels of insulin-like growth factor binding protein-1 in the neonate were lower in deliveries occurring before onset of labor (p < 0.001), Mann-Whitney U test) and higher in cases with severe meconium staining (p = 0.01). There were no differences in maternal levels of insulin-like growth factor binding protein-1 between subjects in labor and not in labor or those with or without meconium staining. CONCLUSION: The process of labor leads to an increase in fetal levels of insulin-like growth factor binding protein-1. This increase may well be associated with the relative fetal stress that occurs during labor. This suggestion is supported by the finding of the highest levels in labors in which there was thick staining of the liquor.
This exploratory investigation examined the association between maximal aerobic power (VO2max) and blood pressure (BP) and heart rate (HR) reactivity to mental challenge. Adolescent male judo athletes (n = 20) performed a 2-min mental arithmetic. Heart rate was recorded before, during, and after the arithmetic, and BP was recorded before and after the mental challenge. Blood pressure in the immediate stress-recovery period was not related to VO2max, but subjects having a higher maximal aerobic power showed faster HR recovery from mental stress than those having a lower VO2max. Subjects who showed earlier peak HR responses, during the stress episode, demonstrated lower average HR reactivity than subjects who attained the maximal HR response later in the stress period. The relationship between the interval to reach peak HR and the magnitude of reactivity deserves further attention. However, at present these findings should be viewed as tentative because of the uniqueness and size of the sample.
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For the topical employing of nonsteroidal antiinflammatory drugs, some technological problems are to be solved. These were accomplished by the authors by preparing Indosol [indomethacin-TRIS (tromethamine) salt]. pH and osmotic pressure of Indosol eye-drops are similar to that of the tear fluid. The Indosol eye-drops have a great therapeutic efficacy. Indosol eye-drops do not alter tear film break up time (BUT) and do not inhibit reepithelization of the cornea. Indosol eye-drops proved to be useful in the treatment of the anterior segment and the uvea. The most important use is the pre- and post-treatment in intraocular surgery. Indosol eye-drops contribute to the safety of lens-extraction and lens implantation. The great bioavailability was also shown by the high indomethacin level of the aqueous humor after instillation Indosol eye-drops. It does not cause any deleterious side-effects even in long term treatments.
Twenty-one iatrogenic ureteral injuries (20 patients) as a result of obstetric and gynecologic operations are presented. All injuries occurred during operations for benign conditions, such as Cesarean section and transabdominal hysterectomy. Pelvic adhesions as a result of repeat Cesarean section, markedly enlarging the uterus at the time of abdominal hysterectomy, and massive hemorrhage during surgical treatment were the main causes of ureteral injury. Nine ureters were transected (eight patients) and 12 ureters had postoperative obstruction. Fistulas occurred between the affected ureter and the vagina (five patients), uterus (one patient) and skin (one patient). The existence and the site of such a fistula is clearly demonstrated roentgenographically using intravenous urograms while a urethral catheter filled with contrast media is inserted into the bladder. Only a few ureteric injuries (two patients) were diagnosed and managed during the initial gynecologic operation. The remainder underwent delayed repair procedures. In most patients, the upper urinary tract was protected by percutaneous nephrostomy. The preferred operation for definitive correction was ureteroneocystostomy using the psoas hitch procedure. Direct localization by difficult dissection of the injured ureteral site was unnecessary with ureteroneocystostomy because this procedure bypasses the site of the injury to the ureter. This procedure can be applied in most injuries to the ureter, distal or proximal, which occur during gynecologic and obstetric operations. Renal salvage was achieved in all instances, with no operative or postoperative complications.
An extensive survey in a highly inbred Arab community documented over 60 cases of male pseudohermaphroditism due to 17 beta hydroxysteroid dehydrogenase deficiency. During a period of 10 years (1981-1991), 16 such patients underwent masculinating genitoplasty. Two children have had a one stage corrective genitoplasty while all others (2 adults, 3 adolescents and 9 children) had staged operations. Cosmetic and functional results are very encouraging in children and adolescents but very poor among adults. Based on our experience and follow-up, we advocate early sex assignment and early masculinizing genitoplasty with preoperative hormonal therapy to male pseudohermaphrodites due to 17 beta hydroxysteroid dehydrogenase deficiency.
We describe our experience in treating 16 established cases of vesicovaginal fistulae in non-irradiated bladders which followed obstetric and gynecological procedures. The fistulae, most of which were large and complex, were successfully repaired surgically after two to three months intervals, using the O'Connor transvesical technique. The advantages of late correction using the transvesical approach in such cases are discussed. Thirteen additional cases of accidental bladder injuries during obstetric and gynecological procedures are presented. These injuries were successfully treated by immediate primary sutures. Our experience shows that bladder injuries mainly occur in women who had previously had a Cesarean section.
Twenty-two severely acidaemic babies (mean umbilical artery pH 7.00), born at term but not requiring resuscitation, were matched for gestational age, mode of delivery and birthweight with non-acidaemic infants. Skin-puncture pH, PCO2 and base deficit were measured at 1 h of age in the acidaemic group. Mean respiratory and heart rates at 30 and 60 min in the two groups were not significantly different. The improvement in pH and base deficit in the acidaemic group correlated with PCO2 at 1 h of age but not with respiratory rates, heart rates or birthweight. However, all four small-for-gestational age infants and one other showed a significantly smaller rise in pH (mean 0.09) compared with the others (mean 0.33). This was associated with a smaller fall in PCO2 and no change in base deficit and these babies were not identified by clinical observations at 1 h of age. Thus, clinical observations of respiratory and heart rates over the first hour of life did not distinguish babies born with severe metabolic acidaemia and did not identify babies who were less efficient at compensating for the acidaemia.
Concentrations of IGF-binding protein-1 (IGFBP-1) were measured by radioimmunoassay in 176 amniotic fluid samples from 9 to 20 and 36 to 42 weeks of pregnancy. Low levels of IGFBP-1 were present at 9 and 10 weeks (median values 35.0 and 45.0 micrograms/l respectively). After 10 weeks, the levels increased by four orders of magnitude to reach a peak at 16 weeks (median 145.2 mg/l). After 16 weeks levels fell. Near term, the levels (median 27.1 mg/l) were lower than in the second trimester. The rapid increase in IGFBP-1 shown by radioimmunoassay was confirmed by Western ligand blotting. The findings suggest that the regulatory role of IGFBP-1 in the growth or differentiation of the fetus or of its surrounding membranes may change as pregnancy advances.
Two infants, 7 children and 1 young woman have been surgically treated for ureteral ectopy in the Departments of Paediatrics and of Urology of the Medical University of Pécs over the last 15 years (1974-1989). The girl/boy ratio was 8/2. In girls, who were otherwise toilet-trained with a normal voiding pattern, constant wetting and urinary infection were the leading clinical findings. The site of ureteral drainage was the vestibule in 4 patients, the urethra in 3, the vagina in 1, the prostatic utricle in 1, and it could not be determined in 1 girl. Diagnosis was based on intravenous urography, voiding cystourethrography, ultrasonography, isotope scan, endoscopy and filling up of the bladder with a methylene blue solution. The diagnosis was more obscure when the ectopic ureter drained a poorly functioning kidney. Considering that in ectopy with duplicated system the upper pole renal segment is almost always destroyed, upper pole nephrectomy and proximal ureterectomy are advocated. In 1 neonate with esophageal atresia and tracheo-esophageal fistula ultrasonography detected the ureteral malformation. In 1 girl bilateral single ureteral ectopy was found.
A 12-year-old girl was injured in a traffic accident and suffered fractures of all the long bones of both legs. During the operation she received 10 l of lactated Ringer's solution, 3 l of 0.9% NaCl, and 2 l of 5% glucose, until blood was available, because of difficulty in its cross-matching. Her hemoglobin dropped to 4.9 g%. After the operation a distension of the abdomen was noted. An abdominal tap confirmed ascites. A simultaneous intravenous pyelogram and retrograde cystogram revealed no leakage from the urinary tract. An over-transfusion ascites was diagnosed combined with pulmonary edema. The patient was treated for 2 days in the ICU, until she was transferred to the orthopedic department with no signs of ascites.
A continent urinary diversion was done by bladder augmentation using a cecal-colonic segment in total urinary incontinence in 3 patients aged 13, 16 and 21 years. The distal end of the appendix was brought to the skin. The narrow lumen of the appendix provides a closure mechanism in a low pressure urinary reservoir. A watertight, easily catheterizable urinary diversion might mean that there is no need to implant the distal end of the appendix into the bladder or colon in a submucous non-refluxing fashion as recommended by Mitrofanoff. The intermittent clean catheterization of the augmented bladder via the appendix was carried out at intervals of 3 hrs. 12-24 months after the establishment of urinary diversion the patients are free of complaints, socially fully accepted.
Endoscopic subureteral injection of polytetrafluoroethylene was performed in 115 ureters to correct vesicoureteral reflux. We treated primary reflux in 84 single ureters, 16 duplex ureters and 4 megaureters (grade V), and secondary reflux in 11 ureters associated with neurogenic bladder, uncapped ureteroceles and failed ureteroneocystostomy. Followup evaluation consisted of a voiding cystourethrogram, which was done in the operating room immediately after the endoscopic procedure, ultrasound 1 month postoperatively, and a diethylenetriaminepentaacetic acid renal isotope scan and repeat voiding cystourethrogram 6 months after injection. Grades II to IV primary reflux involving single as well as duplex ureters resolved in 94% and 82%, respectively, of the cases after 1 injection and in 98% and 93% of the cases after 2 or more injections. The severely and chronically dilated ureters did not respond to the treatment.
Paravesical granuloma formation after inguinal herniorrhaphy is a rare complication due to infected suture material. We present 8 cases of large paravesical granulomas masquerading as bladder tumors. Irritable symptoms predominate the symptom complex and accurate diagnosis can be obtained with multiple, sonographically guided, needle biopsies of the mass. An operation results in complete resolution of the symptoms, while nonoperative management may help to improve but not resolve the symptoms.
An experimental model to study the physiology of the obstructed kidney in awake sheep is described. Unilaterally, a kidney was obstructed, and the pressure in the renal pelvis was measured before and after intravenous injection of indomethacin. This experiment study on awake sheep enabled us to compare the clinical behavior of the animal with the recorded objective data, to demonstrate the rapid decrease in pressure in the obstructed renal pelvis. In addition, we observed a decrease in ureteral peristalsis frequency following the injection of indomethacin.