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Biomedical subjects

A Nowak

Publications and source records attributed to A Nowak.

At least 37 records · Page 2Linked to original sources
PubMed2002

Accuracy of linear endoscopic ultrasonography in the evaluation of patients with suspected common bile duct stones.

BACKGROUND AND STUDY AIMS: Endoscopic ultrasonography (EUS) with radial scanning is an efficient diagnostic tool where there is suspicion of common bile duct (CBD) stones. Little is known about the use of linear EUS in this condition. The aim of this study was to evaluate the diagnostic efficiency of linear EUS in a large group of patients suspected to have bile duct stones, using endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy and exploration of the CBD using a Dormia basket, or surgical choledochotomy with choledochoscopy, as diagnostic "gold standards." PATIENTS AND METHODS: 134 patients with clinical suspicion of CBD stones were included in the study and prospectively evaluated, using EUS, and ERCP with endoscopic sphincterotomy (127 patients), or choledochotomy with choledochoscopy where ERCP was unsuccessful (seven patients). EUS was done before ERCP using an echo endoscope (Pentax FG 32 UA; 5 - 7.5 MHz) and Hitachi EUB 405 ultrasound machine. ERCP was done using the TFJ 100 or TJ 20 Olympus duodenoscope. ERCP was carried out within a mean of 2 days after EUS. The longest time between EUS and ERCP was 3 days. The examiners were blinded to the results of the other method used. RESULTS: CBD stones were found in 91 (68 %) patients at ERCP with ES or at surgery. The correct diagnosis was established by EUS in 85 patients. The remaining 43 patients without CBD stones were correctly diagnosed in 41 cases by means of EUS, giving an accuracy of 94 %, sensitivity of 93 %, specificity of 93 %, a positive predictive value of 98 %, a negative predictive value of 87 %, and a Youden's index of 89 %. CONCLUSIONS: Linear EUS is a fairly reliable method for the evaluation of patients with high suspicion for CBD stones. The usefulness of linear EUS in the evaluation of patients with low or moderate suspicion for CBD stones warrants further study.

Adult↗
PubMed2002

[Combined outpatient alcoholism therapy and occupational rehabilitation on welfare recipients--results of a pilot study].

This study tested the feasibility of outpatient abstinence treatment among alcohol dependent subjects on welfare. Patients had a long history of alcohol dependence and prolonged unemployment. Over a period of six months a total of 250 patients were approached by the social welfare office and asked to participate in the program. The program involved detoxification and a three month combined alcohol treatment and personal job training. Of the 250 persons approached 96 patients (about 40 %) appeared for the initial examination, 19 patients (13 %) finished detoxification and a total of 5 patients completed the program. The majority of a group of patients considered to be highly therapy resistant did not complete the program. Still it was important to demonstrate that a subgroup of patients did successfully complete this program. We consider this pilot project a successful starting point for further development of treatment approaches targeted more specifically at this group of patients.

Adult↗
PubMed2001

Dimension of interaction dynamics.

A method allowing one to distinguish interacting from noninteracting systems based on available time series is proposed and investigated. Some facts concerning generalized Rényi dimensions that form the basis of our method are proved. We show that one can find the dimension of the part of the attractor of the system connected with interaction between its parts. We use our method to distinguish interacting from noninteracting systems on the examples of logistic and Hénon maps. A classification of all possible interaction schemes is given.

Journal Article↗
PubMed2001

A prospective, randomized, placebo-controlled trial of prednisone and allopurinol in the prevention of ERCP-induced pancreatitis.

BACKGROUND AND STUDY AIMS: Acute pancreatitis is the most frequent and difficult-to-avoid complication of endoscopic retrograde cholangiopancreatography (ERCP). Corticosteroids, potent anti-inflammatory drugs, and allopurinol--a xanthine oxidase inhibitor that blocks the generation of oxygen-derived free radicals--may be potentially effective in preventing post-ERCP pancreatitis. The aim of this prospective study was to determine the effect of prophylactic oral corticosteroids and allopurinol on the incidence and severity of procedure-induced pancreatitis. PATIENTS AND METHODS: 300 patients were randomly assigned to receive oral prednisone (40 mg), allopurinol (200 mg), or placebo 15 h and 3 h prior to ERCP. The diagnosis and grading of ERCP complications were based on commonly accepted criteria. Patients receiving prednisone or allopurinol were compared with the placebo group in a search for differences in pancreatitis rates associated with endoscopic techniques. RESULTS: The overall incidence of pancreatitis was 10.7 %, with 12 % in the prednisone group, 12.1 % in the allopurinol group, and 7.9 % in the placebo group. There were no statistical differences in the incidence or distribution of severity grades between the groups, although severe pancreatitis occurred only in the prednisone and allopurinol groups. Multiple cannulations and prolonged manipulations of the papilla of Vater were identified as risk factors for ERCP-induced pancreatitis. CONCLUSIONS: Neither prednisone nor allopurinol showed a beneficial influence on the incidence and severity of post-ERCP pancreatitis.

Acute Disease↗
PubMed2001

The frequency of bile duct crystals in patients with presumed biliary pancreatitis.

BACKGROUND: Previous studies of biliary microlithiasis in acute pancreatitis of uncertain etiology were conducted a few weeks to months after the acute episode. Bile obtained during urgent ERCP (less than 24 hours after admission) was studied for the presence of microlithiasis during the acute phase of acute pancreatitis of suspected biliary origin. METHODS: Fifteen consecutive patients with acute pancreatitis of suspected biliary origin were recruited from a population of 309 patients with acute pancreatitis (5%) treated during the last 4 years. Patients with gallstones on US and/or ERCP and those in whom the etiology of acute pancreatitis was certain were excluded. RESULTS: Microlithiasis (mostly calcium bilirubinate granules) was found in 12 (80%) cases. Despite endoscopic sphincterotomy 3 patients died within 2 weeks because of multisystemic organ failure. Among the 12 remaining patients, 2 (16%) developed gallbladder stones and 1 underwent cholecystectomy for cholecystitis (8%) during follow-up. The average length of follow-up was 30 months. No episodes of acute pancreatitis were noted during follow-up. CONCLUSIONS: In the acute phase of acute pancreatitis of suspected biliary origin, biliary microlithiasis was found in most cases. Endoscopic sphincterotomy appears to protect patients from further episodes of acute pancreatitis.

Acute Disease↗
PubMed2001

[Effectiveness of a micronized purified flavonoid fraction (MPFF) in the healing process of lower limb ulcers. An open multicentre study, controlled and randomized].

OBJECTIVE: To determine the increase in healing rate of venous ulcer in patients receiving a micronised purified flavonoid fraction (MPFF) as supplementation to standard local care. METHODS DESIGN: A randomised, open, controlled, multicentre study. SETTING: Departments of Dermatology and University Outpatients Clinics. PATIENTS: One hundred and forty patients with chronic venous insufficiency and venous ulcers. INTERVENTION: PATIENTS received standard compressive therapy plus external treatment alone or 2 tablets of MPFF daily in addition to the above treatment for 24 weeks. MAIN OUTCOME MEASURE: Healing of ulcers and their reduction in size after 24 weeks of treatment. RESULTS: The percentage of patients whose ulcers healed completely was found to be markedly higher in those receiving MPFF in addition to standard external and compressive treatment than in those treated with conventional therapy alone (46.5% vs 27.5%; p<0.05. OR=2.3, 95% CI 1.1-4.6). Ulcers with diameters <3 cm were cured in 71% of patients in the MPFF group and in 50% of patients in the control group, whereas ulcers between 3 and 6 cm in diameter were cured in 60% and 32% of patients (p<0.05), respectively. The mean reduction in ulcer size was also found to be greater in patients treated with MPFF (80%) than in the control group (65%) (p<0.05). The cost-effectiveness ratio (cost per healed ulcer) in the MPFF group was 1026.2 compared with 1871.8 in the control group. CONCLUSIONS: These results indicate that MPFF significantly improves the cure rate in patients with chronic venous insufficiency.

Aged↗
PubMed2001

[Adolescent endometriosis].

DESIGN: The aim of our study was estimation of frequency of occurrence endometriosis at girls operated from different indications, research of predisposing factors and estimation of selected biophysical parameters. MATERIAL AND METHODS: Material determined 14 of patients in 13 to 21 years old of life operated on account of endometriosis of sexual organs in our Clinic in years 1996-1999. We study the frequency of occurrence of illness, analysis of perceptible clinical reasons, clinical stage of disease using ASF classification. It was analysed according to gynaecological age of girls, periodical complaints, cystical changes in ultrasound investigation. In serum of blood the level of CA125 was analysed with ready sets of firm Abbott. Congenital malformations were classed according to Buttram classification. CONCLUSIONS: On base obtained of results one ascertained, that protracted pain in pelvis not responding to analgesic and antiphlogistic treatment is indication to complex diagnostics with regard of laparoscopy making possible diagnosis of endometriosis. One ascertained also, that sensibilizing of doctors on predisposing factors to formations of endometriosis (congenital malformations, intrauterine device) can contribute to preventive activities.

Adolescent↗
PubMed2001

[Chylous ascites following resection of abdominal aortic aneurysm].

Chylous ascites is an extremely rare complication of abdominal aortic surgery. We report on a case of chyloperitoneum following resection of aortic aneurysm. The diagnosis of lymphatic tear was confirmed by paracentesis which revealed milky fluid characterized by very high content of triglicerydes. Conservative management with a low-fat diet and diuretics resulted in a successful outcome.

Aged↗
PubMed2000

Society of self: the emergence of collective properties in self-structure.

Using cellular automata, the authors show how mutual influences among elements of self-relevant information give rise to dynamism, differentiation, and global evaluation in self-concept. The model assumes a press for integration that promotes internally generated dynamics and enables the self-structure to operate as a self-organizing dynamical system. When this press is set at high values, the self can resist inconsistent information and reestablish equilibrium after being perturbed by such information. A weak press for integration, on the other hand, impairs self-organization tendencies, making the system vulnerable to external information. Paradoxically, external information of a random nature may enhance the emergence of a stable self-structure in an initially disordered system. The simulation results suggest that important global properties of the self reflect the operation of integration processes that are generic in complex systems.

Humans↗
PubMed2000

Fetal compensatory renal hypertrophy with a unilateral functioning kidney.

OBJECTIVE: To evaluate the possibility of fetal compensatory renal hypertrophy with a unilateral functioning kidney. METHODS: A nomogram of renal length was established from 254 normal fetuses. Renal length was also obtained in 14 fetuses with unilateral renal agenesis and 22 fetuses with a unilateral multicystic kidney. RESULTS: Compensatory renal hypertrophy, defined as a renal length > 95th percentile for gestational age, occurred in 16 of 36 cases (44.4%). CONCLUSIONS: Compensatory renal hypertrophy is detectable in utero and may occur as early as 22 weeks' gestation.

Adaptation, Physiological↗
PubMed2000

[Second primary malignant tumor in patients with nasopharyngeal cancer].

Clinical analysis of 90 patients with malignant nasopharyngeal tumors treated in 1985-1996 was performed. The real frequency of second tumors, immunity to second malignant tumor, therapy and genetical factors were described. Second malignant nasopharyngeal tumors occur rarely than in other head and neck tumors (in our material approx. 4%). An attention should be paid to the young age of our patients, mean 46 years.

Adult↗
PubMed1999

[Laparoscopy in the diagnosis and treatment of pathology of sexual organs in girls].

DESIGN: The aim of our study was a clinical analysis of laparoscopies in girls which were performed in the Clinic of Gynaecological Surgery. MATERIAL AND METHODS: Laparoscopic procedures were carried out between 1996-1998. Patients were divided in to three groups: aged under 15, between 15-19 and over 19. 44% of patients from the youngest group had laparotomy. 43.8% of laparoscopic interventions were in aged group 20-24. CONCLUSION: Laparoscopy is very good diagnostic method in gynaecological diseases. It gave enabled operative treatment in 40-43.8% girls.

Adolescent↗
PubMed1999

[Vascular changes of colonic mucosa as a cause of lower gastrointestinal bleeding in patients with liver cirrhosis].

Gastrointestinal bleeding is the common complication of the portal hypertension. Endoscopy is the most accessible diagnostic technique, but the investigation is often limited to the endoscopy of upper gastrointestinal tract. Colonoscopy in the case of bleeding from the colon is often limited by the possibility of good bowel preparation to that procedure. However diagnostic colonoscopy in these cases increases chances for correct diagnosis and application of adequate treatment. Increasing number of gastrointestinal bleeding cases in the last decade causes the necessity of focusing on this problem.

Colon↗
PubMed1999

Upper GI bleeding.

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Acute Disease↗