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Biomedical subjects

A Nowak

Publications and source records attributed to A Nowak.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Cystic hepatic malignant tumors].

Non-parasitic hepatic cysts are common finding at abdominal sonography and in vast majority they are benign lesions. We report two cases of cystic liver neoplasms, namely the biliary cystadenocarcinoma and malignant hemangioendothelioma. In both cases, despite slow development of the tumour the presence of cyst considerably delayed diagnosis and hindered surgical treatment. We believe that more aggressive approach in "atypical" hepatic cysts could improve prognosis in such cases.

Adult↗
PubMed1994

[Per-rectal scintigraphy of the portal system with pertechnetate TC-99M: effect of propranolol on portosystemic collateral circulation in patients with cirrhosis. Part II].

Propranolol can reduce portal hypertension, therefore is recommended in prevention of variceal bleeding in patients with liver cirrhosis. However, in certain patients with cirrhosis portal hypotensive effect of propranolol cannot be obtained, and the reason of this finding is unknown. In 28 patients with cirrhosis the effect of seven days administration of propranolol on collateral blood flow from inferior mesenteric vein was examined by means of per-rectal portal scintigraphy. Portosystemic shunt index was significantly reduced by propranolol by 17.4 +/- 4.8%. This reduction was observed in cirrhotics classified to A and B, but not C Child-Pugh. These data suggest that propranolol increases vascular resistance in portosystemic circulation which depends on severity of liver failure. This mechanism opposes reduction of portal pressure.

Adult↗
PubMed1994

[Per-rectal scintigraphy of the portal system with pertechnetate TC-99M: clinically useful examination of patients with chronic liver disease.Part I].

Per-rectal portal scintigraphy with Tc-99m pertechnetate is a method to evaluate portosystemic shunting (shunt index) in inferior mesenteric vein. In this study the shunt index was estimated in patients with chronic liver disease in relation to the severity of liver injury, portal hypertension and incidence of oesophageal varices. Shunt index was elevated in patients with non-cirrhotic liver disease as compared with healthy normals (34 +/- 6% vs 8 +/- 2%; p < 0.0005). Moreover, patients with cirrhosis had the shunt index of 65 +/- 4% which was higher than in other groups. There was no correlation of the shunt index to the Child-Pugh classification, hepatic venous pressure gradient and varices size in the cirrhotic patients. Conversely, the shunt index differentiated variceal bleeders from non-bleeders (80 +/- 4% vx 59 +/- 6%; p < 0.005). These data show that peripheral collateral circulation develop in response to mild elevation of portal pressure, but its hemodynamic efficacy to alleviate portal hypertension seems to be unremarkable. High shunt index might reflect elevated risk of bleeding from varices.

Adult↗
PubMed1994

[Peak fibrinogen level as a prognostic indicator in acute biliary pancreatitis].

Early prediction of acute pancreatitis outcome is based on clinical classifications, but their complexity is limiting factor. The aim of this study was prospective, dynamic evaluation of plasma fibrinogen (Fb) concentration in acute pancreatitis and testing preselected, single Fb value as predictor of pancreatic and systemic complications. Serial measurement of Fb was done in 64 patients with acute biliary pancreatitis. Peak concentration of Fb was 5.93 +/- 1.08 g/L and was found 5-8 days following onset of the disease. The peak concentration differentiated patients with mild and complicated course of pancreatitis (5.68 +/- 1.00 g/L vs 6.31 +/- 1.10 g/L; p < 0.05), with the 67% sensitivity and 72% specificity. Similarly, Ranson's score distinguished mild from complicated form of pancreatitis (1.7 +/- 1.1 vs 2.6 +/- 1.3 points; p < 0.01), with the 58% sensitivity and 73% specificity. These data indicate that peak Fb concentration is useful as a single prognostic factor in acute biliary pancreatitis.

Acute Disease↗
PubMed1994

Portal shunting in inferior mesenteric vein in cirrhosis: correlation with hemorrhage from esophageal varices.

OBJECTIVE: Certain patients with portal hypertension develop large esophageal varices, whereas others have small varices, or none. Our objective in this study was to determine whether this variability depends upon the amount of blood derived by peripheral portosystemic collaterals. METHODS: Esophagogastroscopy to determine presence and size of esophageal varices, and pre-rectal portal scintigraphy to assess portosystemic shunt index (PSI) in inferior mesenteric vein were performed in 45 cirrhotics and 17 patients with pre-cirrhotic liver disease. RESULTS: Patients with cirrhosis had higher PSI than normal controls (67 +/- 4 vs. 8 +/- 2%; p < 0.0001) and pre-cirrhotic patients (vs. 34 +/- 6%; p < 0.0001). Neither variceal size nor PSI was correlated with Child-Pugh classification or hepatic venous pressure gradient. PSI was not related to the presence of varices or their size. On the other hand, patients with variceal hemorrhage had elevated PSI, compared with non-bleeders (80 +/- 4% vs. 59 +/- 6%; p < 0.005). CONCLUSIONS: This study shows that portosystemic collaterals in the inferior mesenteric vein do not prevent the formation of large varices. Furthermore, the magnitude of blood flow through peripheral collaterals might reflect the risk of variceal hemorrhage.

Adult↗
PubMed1994

Effect of cigarette smoking on gallbladder emptying and filling in man.

OBJECTIVE: The effect of cigarette smoking on gallbladder (GB) emptying and refilling after a fatty meal was examined in 10 healthy volunteers (four women and six men, mean age 27.6 yr). METHODS: On three different days, the subjects underwent in randomized order: a control test without smoking (C), or they smoked two cigarettes during the early (0-20 min; S0-20), or late (20-40 min; S20-40) phase of the meal-induced GB emptying. GB volumes were measured ultrasonographically before the meal and at 10, 20, 30, 40, 60, 90, 120, 150, and 180 min postprandially. Two-way ANOVA was applied for statistical assessment of the results. RESULTS: The fasted GB volumes amounted to 15.7 +/- 1.8 cm3 (C), 15.0 +/- 1.7 cm3 (S0-20), and 18.4 +/- 2.3 cm3 (S20-40), F2;18 = 1.524, NS. Maximum GB emptying was observed until 60 min after the meal, with a nadir of the GB volume amounting to 7.3 +/- 1.3 cm3 (C), 6.6 +/- 1.2 cm3 (S0-20), and 7.1 +/- 1.1 cm3 (S20-40). No significant difference was found between the stimuli tested when absolute GB volumes were considered: F2;180 = 2.725, NS. Analysis of the GB emptying-refilling curves normalized for the fasted GB volume revealed that a significant inhibitory effect was produced by smoking two cigarettes during the late phase of GB emptying on the subsequent GB refilling: F2;162 = 11.066, p < 0.001 for the whole curve, and F2;72 = 7.126, p < 0.005 for the refilling phase. A significant contrast was found next between S20-40 and the control day (p < 0.001 whole curve; p < 0.005 refilling phase only), as well as between S20-40 and S0-20 (p < 0.001 whole curve; p < 0.025 refilling phase only). CONCLUSION: We conclude that smoking two cigarettes does not disturb the fatty meal-induced GB contraction in healthy humans. Subsequent GB refilling is delayed if smoking takes place during the late phase of the postprandial GB contraction.

Adult↗
PubMed1993

[A rare complication of percutaneous endoscopic gastrostomy: metastasis of adenocarcinoma of the stomach in the area of the gastric stoma].

A percutaneous endoscopic gastrostomy (PEG) was placed by the "pull technique" in a 67-year old patient before initiation of palliative radiation therapy of a gastric adenocarcinoma invading the distal esophagus. A tumor metastasis developed in the peristomal area and around the gastrocutaneous fistula tract; it was most likely caused by implantation of tumor tissue adhering to the PEG tube. This complication of PEG placement appears to be very rare.

Abdominal Neoplasms↗
PubMed1993

[A case of uterine foreign body present for many years].

A clinical case of a perennial presence of fragments of fetus skull is presented in the article. Patient was treated symptomatically for 5 years for irregular menstrual cycles. Only USG examination and a probationary biopsy explained the exciting cause. It became evident that a perennial presence of a foreign body in uterus need not induce dramatic clinical symptoms.

Adult↗
PubMed1993

[Test of using plasmid DNA profile analysis for identification of Acinetobacter species].

The analysis regarded 32 strains of Acinetobacter genus isolated from a variety of samples from human and animal sources (hospital environment, nonhospital source, water, burns). The genus Acinetobacter is heterogeneous and has a complex taxonomy. For this reason, plasmid profile analysis has been used as a method of identification to study the genetic diversity of natural populations. Strains having an identical plasmid profile were pooled in the same plasmid group. According to these criteria, 32 isolates were grouped in 11 classes. Within the 11 plasmid groups, 2 were found in A. baumannii, 3 in A. lwoffii, 2 in A. johnsonii, 3 in A. haemolyticus and 1 in A. junii. Most frequently isolated species of Acinetobacter from burns was A. baumannii (11 out of the 13 isolates). Plasmid profile analysis of those strains revealed a presence of only one plasmid group. Plasmid profile analysis of Acinetobacter strains can be an useful technique for characterizing isolates in epidemiologic studies as a complementary method. It can be used directly as a very rapid and convenient technique to type Acinetobacter strains.

Acinetobacter↗
PubMed1993

[Complications after extracorporeal shock wave lithotripsy (ESWL) and methods of management of such cases].

The authors presented the complications which occurred in patients after extracorporeal shock wave lithotripsy (ESWL), and discussed the methods of management of such patients. It was found that the most common complications were: renal colic, fever, "calculus route", and, less frequently, subcapsular and perirenal haematomas. In most patients conservative treatment was adequate. Some of these patients required admission to hospital and proper specialized management.

Colic↗
PubMed1992

Penetration of tinidazole into skin blister fluid following its oral administration.

Plasma and skin blister fluid concentrations of tinidazole following a single oral dose of 2 g drug, and after multiple doses of 0.25 g every 12 h, were determined. Skin blisters were produced by direct application of 0.25% cantharidin ointment to the skin. The maximum concentration in plasma of about 36 mg.l-1 was observed after about 2 h, whereas in skin blister fluid the peak occurred after about 6 h and was 30 mg.l-1. The half-life in plasma was slightly shorter than in blister fluid at 17 and 19 h, respectively, but the difference was not significant. The penetration of tinidazole into cantharidin-induced skin blister fluid, defined according to Wise as the ratio of the AUCs in blister fluid and plasma was 1.00. During routine treatment with tinidazole (0.25 g every 12 h), the concentrations in plasma and blister fluid collected before and 3 h after the morning dose exceeded the minimal inhibitory concentrations for susceptible pathogens. The results provide a pharmacokinetic basis for the proven efficacy of tinidazole in the treatment of protozoal and anaerobic infections.

Administration, Oral↗
PubMed1992

[Manometric evaluation of the effects of intravenous administration of glucagon, buscopan and papaverine on the contractile activity of the sphincter of Oddi].

Endoscopic manometric technique was used to investigate the effects of spasmolytic drugs on the sphincter of Oddi (s.O.) motility. 41 patients were randomly divided into 4 groups. In every patient the characteristics of the s.O. was monitored before and during 5 min. period after i.v. administration of: 20 mg buscopan, 1 mg glucagon, 40 mg papaverine or 2 ml of 0.9% NaCl solution. After buscopan administration the amplitude and frequency of phasic contractions of the s.O. were decreased as well as a baseline pressure in the s.O. Glucagon reduced frequency and amplitude of phasic contractions of the s.O. without influencing the baseline pressure. Papaverine reduced only frequency of phasic contractions. Physiological saline caused no change in pressure characteristics of the s.O.

Adult↗
PubMed1991

Effect of nifedipine on interdigestive gallbladder volume and postprandial gallbladder emptying in man.

The effect of two oral doses (10 and 20 mg) of nifedipine versus placebo on the fasted gallbladder volume and on the meal-induced gallbladder emptying was assessed according to a double-blind study protocol in 12 healthy volunteers. Eight subjects underwent three studies (with placebo and with both nifedipine doses), whereas in two subjects the effect of a 10-mg nifedipine dose vs placebo and in two others the effect of a 20-mg nifedipine dose vs placebo was examined. The studies were performed on separate days, and the gallbladder volume was measured by means of real-time ultrasonography. Neither placebo nor 20 mg nifedipine per os elicited any significant change in the fasted gallbladder volume. With 10 mg nifedipine per os a significant increase in the interdigestive gallbladder volume was observed: 22.9 +/- 2.9 cm3 before and 26.2 +/- 3.2 cm3 after the drug receipt (P less than 0.005). A trend towards an inhibition of the postprandial gallbladder emptying was observed with 10 mg nifedipine per os without, however, reaching the level of statistical significance. Following 20 mg nifedipine per os, a marked delay in the meal-stimulated gallbladder emptying occurred, as reflected by a decrease in the gallbladder ejection fraction from 48.1 +/- 4.5% (placebo) to 26.4 +/- 5.0% (nifedipine) (P less than 0.02) at 30 min and from 54.0 +/- 3.6% (placebo) to 33.2 +/- 4.6% (nifedipine) (P less than 0.02) at 40 min after the test meal. We conclude that a therapeutic oral dosage of nifedipine has a significant relaxing effect on the human gallbladder.

Adult↗
PubMed1991

[Endoscopic prosthesis of the biliary tract].

In the years 1987--1989 endoscopic biliary tree stenting was performed in 64 patients. The straight prostheses type Amsterdam 10 or 12 F and double pigtail prostheses were applied. In 36 cases the indication for stenting was malignant stricture of the biliary tree (group I) caused by carcinoma of the ampulla of Vater (n = 12), carcinoma of the head of the pancreas (n = 15), common bile duct and bifurcation tumor (n = 5) and gallbladder cancer (n = 4). In 28 cases the indications were common bile duct stones (group II) where stone size made endoscopic removal impossible and surgery was contraindicated. Normalisation or improvement of elevated serum bilirubin level was observed quite quickly after stenting (it decreased to about 50% of initial value after 7 days). Mean duration of prosthesis patency in group I patients who avoided surgical treatment was 144 days and mean survival time was 220 days. In group II patients mean duration of prosthesis patency was 183 days. Endoscopic biliary tree stenting is an advantageous alternative to surgical palliative++ treatment of obstructive neoplastic jaundice and constitutes an efficient method of treating common bile duct stones in poor operative risk patients.

Adult↗
PubMed1991

[Emergency endoscopic sphincterotomy in acute obstructive cholangitis].

In 45 patients with acute obstructive cholangitis (AOC) endoscopic sphincterotomy (ES) was performed within 24 hours after admission. Criteria for the diagnosis of AOC were as follows: clinical symptoms consisting of fever and chills, right upper abdominal pain, and jaundice (Charcot's triad) with coexisting laboratory data as elevated WBC, ERS, bilirubin level and evidence of obstructive biliary disease confirmed by endoscopic retrograde cholangiopancreatography. The causes of AOC were: in 38 patients (84.5%)--common bile duct stones, in 2 patients (4.5%)--carcinoma of the papilla of Vater, and in 5 patients (11%)--benign stenosis of the papilla of Vater. A rapid clinical improvement was observed in 40 patients after ES. Within 24 hours after ES patients had relief of pain, fever subsided and white blood cell count returned from 11.7 +/- 6.9 G/l to 7.0 +/- 3.0 G/l. Bilirubin level decreased from 101 +/- 86 mumol/l to 77 +/- 68 mumol/l. Endoscopic drainage failed only in 4 patients (9%) who required surgery. One patient (2%)--died. In the treatment of acute obstructive cholangitis urgent endoscopic sphincterotomy should be a method of choice. Surgery should be reserved only for patients in whom ES failed.

Acute Disease↗