Hepatic eosinophilic infiltration in primary sclerosing cholangitis.
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Adult↗
Biomedical subjects
A Nowak
Publications and source records attributed to A Nowak.
The role of ultrasonography in the detection and management of adnexal masses during the second and third trimesters of pregnancy.
OBJECTIVE: Our purpose was to determine the effect of routine second-trimester and third-trimester ultrasonographic examinations on the prevalence of detectable and operable adnexal disease. STUDY DESIGN: The study group consisted of 7996 pregnant women between 13.0 and 42.8 weeks' gestation. The size and architectural pattern of any detectable adnexal masses were noted. RESULTS: A total of 328 of the 7996 (4.1%) women in the study group had 335 ultrasonographically detectable adnexal masses; 309 of the masses were unilocular or had a single thin septation and 26 were architecturally complex. Of the ovarian cysts 252 of 309 (81.6%) had a mean diameter < 3.0 cm; 60% of the 252 patients in this subgroup had serial ultrasonographic examinations; 43 of the unilocular cysts resolved, and 17 have persisted for up to 2 years. There is a statistically significant trend toward decreasing frequency of ovarian cysts with increasing gestational age (chi2 for linear trend; P < .00001). Eighteen of the 7996 had an exploratory laparotomy (1 operation per 444 deliveries) during pregnancy or in the postpartum period. In addition, 1 patient had a paratubal cyst excised at the time of postpartum bilateral tubal ligation. Pathologically confirmed lesions included 8 benign cystic teratomas, 3 mucinous cyst adenomas, 2 paratubal cysts, 2 corpus lutea, 1 serous cystadenoma, 1 follicular cyst, 1 endometrioma, and 1 ovarian fibroma. CONCLUSION: Ovarian cysts are found in 4.1% of second-trimester and third-trimester obstetric ultrasonographic examinations. Most ultrasonographically detectable cysts are < 3.0 cm in diameter and usually resolve. The frequency of exploratory laparotomy for adnexal disease is not significantly different from that in reports before the widespread use of obstetric ultrasonography.
Adnexa Uteri↗
Arch length changes from 6 weeks to 45 years.
The purpose of this study was to evaluate, on a longitudinal basis, changes in maxillary and mandibular arch length over a 45-year period. Subjects were drawn from two pools of normal individuals. Twenty-eight male and 33 female infants were evaluated longitudinally at 6 weeks, 1 year, and 2 years (before the eruption of the deciduous dentition). Fifteen males and 15 females from the Iowa Facial Growth Study were evaluated at 3, 5, 8, 13, 26, and 45 years. Arch length measurements were obtained independently by two investigators. Intra- and interexaminer reliabilities were predetermined at 0.25 and 0.5 mm, respectively. The greatest incremental increases occurred during the first two years of life. Arch length continued to increase until 13 years in the maxillary arch, and until 8 in the mandibular. Then significant and consistent decreases occurred in both arches mesial to the permanent first molars.
Adolescent↗
Randomized comparison of 1-hour topical method vs. amoxycillin plus omeprazole for eradication of Helicobacter pylori in duodenal ulcer patients.
BACKGROUND: A novel 1-h topical method eradicated Helicobacter pylori in 96% of dyspeptic patients. The eradication rate of amoxycillin/omeprazole therapy varies from 0 to 93%. AIM: To compare both methods in patients with endoscopically proven duodenal ulcer. METHODS: Eighty patients (59 males, 21 females; median age 43 years) were randomized into two therapeutic groups. The first group (group A) was treated with a 6-week course of ranitidine 300 mg/day, then omeprazole 20 mg b.d. with pronase 36000 units/day for 2 days, followed by 1-h topical therapy with a solution of bismuth, metronidazole, amoxycillin and pronase. The second group (group B) consisted of patients treated with omeprazole 20 mg b.d. and amoxycillin 2 g/day for 2 weeks, followed by a 4-week course of ranitidine 300 mg/day. Eradication of H. pylori was assessed by urease test, histology, a polymerase chain reaction and a 13C-urea breath test, all of which were performed 4 weeks after discontinuation of the antibacterial treatment. RESULTS: Eradication rates in groups A and B were 2.5% and 35% in an intention-to-treat analysis, respectively. Side-effects were encountered in 40.5% and 12.5% of subjects in groups A and B, respectively. Treatment tolerance was rated as poor by 54% of patients in group A and 2.5% of patients in group B. CONCLUSIONS: Both treatment regimens, the 1-h topical method and amoxycillin with omeprazole, have low eradication rates in patients with duodenal ulcer. In addition, the topical treatment is characterized by a high rate of side-effects and poor tolerance. Based on the results of our study, neither method can be recommended for eradication of H. pylori in patients with duodenal ulcer.
Adult↗
Cardiovascular effects of ephedrine, caffeine and yohimbine measured by thoracic electrical bioimpedance in obese women.
Low caloric diet is a commonly accepted treatment in obesity. However, owing to moderate results, a pharmacological support has been proposed. As some efficacious drugs activate overall sympathetic activity, they might modify functions of the cardiovascular system. Three groups of subjects were studied: (1) nine obese women receiving only a standard hypocaloric diet; (2) nine obese women receiving a standard hypocaloric diet and ephedrine (2 x 25 mg) with caffeine (2 x 200 mg); (3) nine obese women receiving a standard hypocaloric diet and ephedrine (2 x 25 mg) with caffeine (2 x 200 mg) and yohimbine (2 x 5 mg). The cardiovascular state was evaluated by thoracic electrical bioimpedance, automatic sphygmomanometry and continuous ECG recording. In each patient, the haemodynamic study was performed twice: at rest, i.e. before treatment; and after 10 days of treatment. On the same days in each patient, the haemodynamic tests were performed during physical exercises (handgrip stress and cycloergometer exercise). Caffeine and ephedrine had no haemodynamic effect in resting patients. These two drugs led to an increase in ejection fraction during cycloergometer exercise. Addition of yohimbine increased diastolic pressure and heart rate but decreased ejection fraction and stroke index during rest. We also observed that addition of yohimbine decreased ejection fraction during the handgrip and cycloergometer exercise and increased cardiac load during dynamic exercise. Pharmacological supplement of ephedrine and caffeine to a low caloric diet modified the cardiovascular system weakly, but the addition of yohimbine to this regimen attenuated cardiac performance during rest and handgrip and increased cardiac work during dynamic exercise.
Adrenergic alpha-Antagonists↗
Biliary pancreatitis needs endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy for cure.
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Biliary Tract Diseases↗
Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy.
There are two situations when antibiotic prophylaxis is recommended. The first is associated with procedures known to be followed by high rates of bacteraemia, involving organisms prone to cause endocarditis. These include oesophageal dilatation, variceal sclerotherapy and laser therapy in the upper gastrointestinal tract. As bacteraemia following these procedures is usually harmless in average risk patients antibiotic prophylaxis is recommended only for a patient with a lesion susceptible to endocarditis or one who is at increased risk of symptomatic bacteraemia due to neutropenia or immunosuppression. In most cases parenteral amoxycillin and gentamicin is recommended plus metronidazole for neutropenic patients. Vancomycin or teicoplanin replace amoxycillin in a case of allergy. The second situation concerns procedures with a high incidence of local infection or which may lead to serious sepsis. These include therapeutic retrograde cholangiopancratography and percutaneous endoscopic gastrostomy where antibiotic prophylaxis is recommended even in average risk patients. Several antibiotics are recommended including oral ciprofloxacin or parenteral gentamicin or quinolone for ERCP and amoxycillin for PEG or cephalosporin or ureidopenicillin for both.
Adult↗
[Use of Polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis complex from patient materials].
The polymerase chain reaction (PCR) and direct culture were applied for detection of Mycobacterium tuberculosis complex in samples obtained from patients with suspicion of pulmonary and extra-pulmonary tuberculosis. In the reaction of amplification IS6110 was applied as a target region, and PCR reaction products were of the size of 123 bp and 317 bp. A total of 278 samples (158 sputum, 36 urine, 25 pleural effusion, 23 bronchial washings, 8 blood, 4 stomach washings, 3 cerebrospinal fluid, 2 fragments of skin, 2 pleural effusion, and 17 others samples) from 181 patients were tested. Mycobacterium tuberculosis complex was detected by PCR in 144 out of 278 samples and by culture in 68 of 278 samples. The PCR test enabled a rapid and sensitive diagnosis particularly in a number of samples which were negative on culture.
Blood↗
Glucosamine in serum of patients after myocardial infarction subjected to rehabilitation training.
This paper presents results of 3 weeks physical training on glucosamine level in serum of male patients after myocardial infarction (MI) aged between 38 and 61. Patients were randomised in two groups: the training group (n = 21), staying in Cardiac Rehabilitation Department and the control group (n = 11), discharged home for 3 weeks. Each group received identical dietary instructions. The training group performed exercises every day: on bicycle ergometer during 30 minutes (5 times a week), overall-conditioning exercises for 30 minutes daily and 30 to 60 minutes of walking each day. Before administering of the therapy and 3 weeks later all MI patients performed the bicycle ergometer exercise test until the ventilatory threshold was reached. Before that test and 3 minutes after its termination capillary and venous blood samples were drawn. In the capillary blood samples indices of acid-base balance, lactate level, and glucose level were determined. In venous blood samples the serum levels of immunoreactive insulin, C-peptide and glucosamine were determined as well as binding of 125I-insulin to erythrocyte receptors. Obtained results show that administered therapy increased physical fitness and decreased of glucosamine concentration, insulinaemia and insulin resistance.
Adult↗
Arch width changes from 6 weeks to 45 years of age.
The purpose of this study was to evaluate on a longitudinal basis, the changes in intercanine and intermolar widths over a 45-year span. The subjects in this study were from two pools of normal persons: (1) 28 male and 33 female infants evaluated longitudinally at approximately 6 weeks, 1 year, and 2 years of age (before the complete eruption of the deciduous dentition); and (2) 15 male and 15 female subjects from the Iowa facial growth study evaluated at ages 3, 5, 8, 13, 26, and 45. Arch width measurements on maxillary and mandibular dental casts were obtained independently by two investigators. Intraexaminer and interexaminer reliability were predetermined at 0.5 mm. From the findings in the current study, the following conclusions can be made: (1) Between 6 weeks and 2 years of age, i.e., before the complete eruption of the deciduous dentition, there were significant increases in the maxillary and mandibular anterior and posterior arch widths in both male and female infants. (2) Intercanine and intermolar widths significantly increased between 3 and 13 years of age in both the maxillary and mandibular arches. After the complete eruption of the permanent dentition, there was a slight decrease in the dental arch widths, more in the intercanine than in the intermolar widths. (3) Mandibular intercanine width, on the average, was established by 8 years of age, i.e., after the eruption of the four incisors. After the eruption of the permanent dentition, the clinician should either expect no changes or a slight decrease in arch widths. In conclusion, although the dental arch widths undergo changes from birth until midadulthood, the magnitude as well as the direction of these changes do not provide a scientific basis for expanding the arches, in the average patient, beyond its established dimensions at the time of the complete eruption of the canines and molars. Both patients and clinicians should be aware of these limitations.
Adolescent↗
Cardiovascular status after postural change in compensated cirrhosis: an argument for vasodilatory concept.
It seems that hypervolemia and vasodilatation coincide in compensated cirrhosis, but neither rank nor importance of these factors has been fully clarified in adaptive response to postural change. We studied, with gated equilibrium radionuclide angiography and thoracic electrical bioimpedance the hemodynamic status of 19 patients with compensated cirrhosis and 18 healthy subjects in upright and supine positions. In the upright position, the cirrhotic patients were hypotensive and had decreased peripheral vascular resistance despite increased cardiac output. The transition to the supine position was accompanied by a significant fall in the heart rate and an increase in the stroke volume in both controls (92 +/- 22 to 63 +/- 10 beats/min, and 38 +/- 9 to 62 +/- 19 ml/m2, respectively) and cirrhotic patients (101 +/- 20 to 79 +/- 13 beats/min, and 44 +/- 15 to 63 +/- 19 ml/m2, respectively). Besides, the diastolic arterial pressure fell in controls from 89 +/- 9 mmHg to 81 +/- 11 mmHg; p < 0.01, while it remained unchanged in cirrhotic patients (77 +/- 17 vs 82 +/- 13 mmHg). In the supine position, the cirrhotic patients presented tachycardia and left ventricular hyperkinesy (increased velocity of left ventricular filling and emptying). In conclusion, these results show that in compensated cirrhosis the decreased arterial tone and peripheral blood pooling are important factors of adaptive hemodynamic reaction to postural change.
Adult↗
[Bacterial diagnosis of tuberculosis using the PCR technique].
At the beginning of 80-ties new system BACTEC for mycobacteria culture has been introduced. So time of this culture has been shortened to 1-3 weeks. At the end 80-ties Polymerase Chain Reaction (PCR) technique was started and at present it is used in many laboratories in order to get information about genetic material of mycobacteria in different biological samples. Most often insertive factor IS 6110, located in chromosome Myc. tub. complex, is used. DNA amplification occurs in three stages: 1) DNA denaturation. 2) addition of starters (primers): 3) elongation of starter with d NTP synthesis. PCR technique identifies genetic material (DNA) of mycobacterium which is presented in a given biological sample. Positive PCR result not necessarily means that active disease takes place.
DNA, Bacterial↗
[Endoscopic ultrasonography in the preoperative localization of a pancreatic tumor producing insulin (insulinoma)].
Pancreatic endocrine tumors include insulinomas, gastrinomas and some other less frequent neoplasms produce different GI hormones. Preoperative localization of the tumor in patients with evident clinical and biochemical features is usually difficult to obtain in conventional imaging methods. This is due to typically small size of these tumors. Non-invasive methods (conventional ultrasound, computerized tomography, nuclear magnetic resonance, positron emission tomography) and invasive methods (visceral angiography, portal veins catheterization) are often of no use in such condition, as their sensitivity is low. Preoperative localization is of importance for the surgeon, as he can plan his operation for reducing the length of the procedure with obvious consequences. This paper describes for the first time on Polish literature the usefulness of endoscopic ultrasonography in preoperative assessment of insulinoma in one patient. This finding was confirmed during surgery. The operation led to enucleation of two small insulinomas in the head of the pancreas and resulting in complete healing of the patient as found in one year follow up.
Adult↗
Differentiation of seventeen genospecies of Acinetobacter by multiplex polymerase chain reaction and restriction fragment length polymorphism analysis.
The 17 described genomic species (DNA groups) of the genus Acinetobacter, including the type strains of the seven named species, were studied by using a multiplex PCR. The multiplex PCR assay combined two primer sets (rA1 and rA2 for recA gene target; rib1 and rib2 for 16S rDNA sequence) in a single reaction. Restriction analysis with two enzymes (Mbol and Hinfl) of the enzymatically amplified products allowed identification of all genospecies. This technique proved to be a rapid and reliable method for the identification of the Acinetobacter genomic species including the closely related DNA groups (1, 2, 3, 13). The results of this study suggest that the proposed method can be used for the identification of Acinetobacter spp. and as such may help to elucidate the ecology and clinical significance of the different species of this genus.
Acinetobacter↗
Massive loss of bile from the nasobiliary tube.
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Bile↗
Short-term effects of variceal sclerotherapy on portal hypertensive gastropathy.
BACKGROUND AND STUDY AIMS: Obliteration of esophageal varices may modify the mucosal perfusion of the stomach. The relationship between short-term injection variceal sclerotherapy (IVS) and the evolution of portal hypertensive gastropathy (PHG) is insufficiently recognized. PATIENTS AND METHODS: Forty-one cirrhotic patients were treated with hemostatic or secondary preventive IVS. They underwent sclerotherapy at intervals of four to five days until esophageal ulceration, stricture, or a reduction in variceal size developed. On admission and on completing the IVS schedule, an endoscopy score was calculated using a system assigning 0 points for a normal mucosal image, 1 point for reddened, 2 points for a mosaic-like mucosal pattern, and 3 points for a mosaic-like pattern plus red marks in the stomach. All patients received propranolol after the first sclerotherapy session. RESULTS: The total score before IVS was 45 points (1.1 points per patient). After 188 sclerotherapy sessions (2-8 per patient), the score significantly increased to 73 points (1.8 points per patient, P = 0.04). This effect was particularly marked in Child-Pugh class B patients (mean individual rise from 0.7 to 1.9 points, P = 0.01), and negligible in patients with either less or more advanced cirrhosis (Child-Pugh classes A and C). CONCLUSIONS: In patients with cirrhosis, short-term IVS may contribute to the mechanisms of progressive PHG.
Aged↗
[RHnull syndrome--diagnostic and therapeutic problems].
A very rare Rhnull phenotype as a cause of haemolytic anaemia in a female patients was for the first time detected in Poland. The beneficial influence of splenectomy was demonstrated. It was proved that a single transfusion of Rh negative red cell concentrate, because of the lack of Rhnull blood, did not cause any acute adverse reactions. However, a transient, subclinical delayed haemolytic reaction due to the stimulation of anti-c and anti-e was observed.
Aged↗