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Biomedical subjects

A Oláh

Publications and source records attributed to A Oláh.

At least 19 recordsLinked to original sources
PubMed2002

Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis.

BACKGROUND: Microbial infection of the pancreatic tissue in patients with severe acute pancreatitis increases the morbidity and mortality rates. Colonization of the lower gastrointestinal tract and oropharynx with Gram-negative, but sometimes also Gram-positive, bacteria precedes contamination of the pancreas. The aim of this study was to determine whether lactic acid bacteria such as Lactobacillus plantarum 299 could prevent colonization of the gut by potential pathogens and thus reduce the endotoxaemia associated with acute pancreatitis. METHODS: Patients with acute pancreatitis were randomized into two double-blind groups. The treatment group received a freeze-dried preparation containing live L. plantarum 299 in a dose of 109 organisms, together with a substrate of oat fibre, for 1 week by nasojejunal tube. The control group received a similar preparation but the Lactobacillus was inactivated by heat. RESULTS: A total of 45 patients completed the study. Twenty-two patients received treatment with live and 23 with heat-killed L. plantarum 299. Infected pancreatic necrosis and abscesses occurred in one of 22 patients in the treatment group, compared with seven of 23 in the control group (P = 0.023). The mean length of stay was 13.7 days in the treatment group versus 21.4 days in the control group (P not significant). CONCLUSION: Supplementary L. plantarum 299 was effective in reducing pancreatic sepsis and the number of surgical interventions.

Acute Disease↗
PubMed2002

The N34S mutation of SPINK1 (PSTI) is associated with a familial pattern of idiopathic chronic pancreatitis but does not cause the disease.

BACKGROUND: Mutations in the PRSS1 gene explain most occurrences of hereditary pancreatitis (HP) but many HP families have no PRSS1 mutation. Recently, an association between the mutation N34S in the pancreatic secretory trypsin inhibitor (SPINK1 or PSTI) gene and idiopathic chronic pancreatitis (ICP) was reported. It is unclear whether the N34S mutation is a cause of pancreatitis per se, whether it modifies the disease, or whether it is a marker of the disease. PATIENTS AND METHODS: A total of 327 individuals from 217 families affected by pancreatitis were tested: 152 from families with HP, 108 from families with ICP, and 67 with alcohol related CP (ACP). Seven patients with ICP had a family history of pancreatitis but no evidence of autosomal dominant disease (f-ICP) compared with 87 patients with true ICP (t-ICP). Two hundred controls were also tested for the N34S mutation. The findings were related to clinical outcome. RESULTS: The N34S mutation was carried by five controls (2.5%; allele frequency 1.25%), 11/87 (13%) t-ICP patients (p=0.0013 v controls), and 6/7 (86%) affected (p<0.0001 v controls) and 1/9 (11%) unaffected f-ICP cases. N34S was found in 4/108 affected HP patients (p=0.724 v controls), in 3/27 (11%) with wild-type and in 1/81 (1%) with mutant PRSS1, and 4/67 ACP patients (all p>0.05 v controls). The presence of the N34S mutation was not associated with early disease onset or disease severity. CONCLUSIONS: The prevalence of the N34S mutation was increased in patients with ICP and was greatest in f-ICP cases. Segregation of the N34S mutation in families with pancreatitis is unexplained and points to a complex association between N34S and another putative pancreatitis related gene.

Adult↗
PubMed2001

The influence of intraoperative complications on adhesion formation during laparoscopic and conventional cholecystectomy in an animal model.

BACKGROUND: The aim of this study was to evaluate the extent of postoperative adhesion formation after laparoscopic and open cholecystectomy. MATERIALS AND METHODS: Qualified surgeons performed 60 experimental laparoscopic cholecystectomies (LC) in dogs with the aim to acquire the laparoscopic technique. To assess the relation between the complications during the operation (bleeding, laceration of the liver bed, or gallbladder perforation) and the formation of adhesions, surviving animals were divided into four groups according to the type of complication occurred. Assessment of the results was made by second-look laparoscopy 4 weeks after LC using the adhesion index (AI; score range, 0-4). The animals then were killed so the extent of adhesion formation could be measured. As a control, open cholecystectomy was performed in 15 dogs without intraoperative complications. The Mann-Whitney rank-sum test and Dunn's method were used for statistical analysis. RESULTS: No adhesion formation or intraoperative complications were registered in the laparoscopic group I. In all the cases wherein bleeding or laceration of the liver bed occurred and was managed with electrocoagulation, adhesions formed. Adhesion formation in these groups was significantly higher than in "ideal LC" or cases of gallbladder perforation alone (p < 0.01). All the animals in the control group developed significantly more adhesions than those in the experimental group (p < 0.05). CONCLUSIONS: It seems that LC has a lower rate of adhesion formation than the conventional open technique. Complications such as bleeding or laceration of the liver bed during LC can enhance adhesion formation. No adhesion formation can be mentioned in relation to gallbladder perforation during LC.

Animals↗
PubMed2001

GRP-receptor-mediated signal transduction, gene expression and DNA synthesis in the human pancreatic adenocarcinoma cell line HPAF.

Bombesin-like peptides have been implicated as growth factors in various human cancers. Human adenocarcinoma cell lines (Capan-1, Capan-2, MiaPaCa-2 and HPAF) were tested to determine whether they express the gastrin-releasing peptide-preferring bombesin receptor (GRPR) and neuromedin B-preferring bombesin receptor (NMBR). Using RT-PCR the highest level of GRP receptor mRNA was found in HPAF cells. NMB receptor mRNA expression moderate in all cell lines investigated. We therefore selected the HPAF cell line to investigate whether bombesin treatment affects intracellular Ca(2+) ([Ca(2+)](i)), cAMP level, DNA synthesis as a measure of cell proliferation, and expression of three transcription factors: c-fos, c-myc and high mobility group protein IY (HMG-I(Y)).Bombesin administration led to an immediate increase in free intracellular Ca(2+) concentration ([Ca(2+)](i)) but did not change cAMP levels. The peptide also enhanced [(3)H]thymidine incorporation in HPAF cells (but not in the other cell lines), an effect that was concentration dependent, reaching 36 +/- 5% stimulation over control values at 24 h with an EC(50) of 2.27 x 10(-12) M. Furthermore, bombesin stimulated c-fos, c-myc and HMG-I(Y) expression in a time-dependent manner: the c-fos mRNA level increased dramatically in the first 30 min of exposure, then returned to basal level within 2 h, while the c-myc and HMG-I(Y) mRNA levels peaked at 2 h and 4h, respectively. All actions of bombesin were blocked by BME (D-Phe(6)-bombesin-(6-13)-methylester), a selective GRP receptor antagonist, but not by the NMB receptor antagonist BIM-23127 (D-Nal-cyclo[Cys-Tyr-D-Trp-Orn-Val-Cys]-Nal-NH(2)). We conclude that HPAF cells express mRNA for GRP receptors and that functional receptors are present in the cell membrane. The occupation of these receptors leads to a sequence of intracellular events involving rapid mobilization of intracellular Ca(2+), expression of c-fos, c-myc and HMG-I(Y) mRNA, and stimulation of cell proliferation. Conversely, although NMB receptor mRNA can be detected, its actual translation to functional receptors does not reach a detectable level.

Adenocarcinoma↗
PubMed2001

[Cholestasis caused by chronic pancreatitis in childhood. Surgical treatment and genetic analysis].

Authors report two cases of childhood chronic pancreatitis, causing severe symptoms and common bile duct stenosis with cholestasis. Both patients had to be operated on. Chronic pancreatitis with calcification led to significant common bile duct stenosis in a 13 years old girl. After ERCP a double bypass procedure was performed (Wirsungo-jejunostomy and hepatico-jejunostomy). During 42 months follow-up the patient remained pain- and symptom-free gaining 16 kilograms. In a 9 years old girl severe stenosis of the intrapancreatic common bile duct and a small duct type chronic pancreatitis with extensive fibrosis was found. Treatment was Roux-en-Y hepatico-jejunostomy. Thirty-four months after the operation she is symptom-free with normal enzyme parameters. Authors report results of genetic investigations performed on registered chronic pancreatitis children and their families in Hungary, including the two operated cases. Two of the 5 patients were hereditary type, despite negative family history. Cationic trypsinogen gene R122H (R117H) mutation were detected in both patients. Chronic non-hereditary pancreatitis is a very rare disease in childhood but may cause severe secondary conditions requiring surgery.

Adolescent↗
PubMed2001

[Experience with the surgical management of Vater's ampulla tumors].

The article reviews our experience about tumours of the papilla of Vater. 30 patients were operated on between 1996-1999. The mean age was 58 years, the leading symptom (73%) was jaundice. In 23 patients preoperative ERCP was successful and was completed in 15 cases with EST, in 8 cases with biliary drainage. In 3 patients--despite benign endoscopic histology--intraoperative frozen section, and in one patient final histology confirmed malignancy. Altogether in 27 patients was malignant transformation of the papilla observed. In 15 cases pylorus-preserving pancreatoduodenectomy (PPPD), in 2 cases local excision (LE), while in 10 patients palliative procedures were performed. Resection rate (PPPD + LE) was 63%, while radical resection (PPPD) was performed in 55.5% of all cases. During 26 months mean follow-up survival rate was altogether 74%, and 80% in radically resected patients. We review the literature, describe the difficulty of histological and describe our experience and practice in the treatment of this rare tumour.

Adult↗
PubMed2001

[New surgical method in the treatment of severe hemorrhoidal bleeding caused by decompensated liver cirrhosis].

Authors used a new technique for haemorrhoid surgery performed with PPH (Procedure for Prolapse and Haemorrhoids) instrument to cure bleeding haemorrhoids caused by vascularly decompensated liver cirrhosis. Longo developed the special circular stapler in 1993. The 69 years old female patient underwent continuous medical treatment during the last 10 years due to liver cirrhosis developed as a result of chronic alcoholism. There were two haemorrhoidectomies in her previous history. Haemorrhoidal bleed was in the background of severe haematochesia in July 1999. She was transfused with 38 units of blood at Department of internal medicine. Because no result was expected by further conventional surgery, this new procedure was performed. After uneventful postoperative period the patient was discharged without any complaints. During six months follow-up there was no further bleeding and her quality of life is better.

Aged↗
PubMed2000

Percutaneous video choledochoscopic treatment of retained biliary stones via dilated T-tube tract.

BACKGROUND: Retained biliary stones is a common clinical problem in patients after surgery for complicated gallstone disease. When postoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy are unsuccessful, several percutaneous procedures for stone removal can be applied as alternatives to relaparotomy. These procedures are performed either under fluoroscopic control or with the use of choledochoscopy, but it is also possible to combine these methods. METHODS: Since 1994, we have used the percutaneous video choledochoscopic technique for the removal of difficult retained biliary stones via dilated T-tube tract in 17 patients, applying the technique of percutaneous stone extraction used in urology. While waiting for the T-tube tract to mature and after the removal of the T-tube, the dilatation of its tract was 26-30 Fr. Stone removal was carried out using a flexible video choledochoscope and a rigid renoscope under fluoroscopic control, with the aid of Dormia baskets, rigid forceps, and high-pressure irrigation. RESULTS: We performed 23 operative procedures, and the clearance of the biliary ducts was successful in all cases. There were no major complications or deaths. CONCLUSION: Percutaneous video choledochoscopic-assisted removal of large retained biliary stones via the T-tube tract is a highly effective and safe procedure. Its advantages over other procedures include the ability to visualize the stones and noncalculous filling defects; it also guarantees that the stones can be removed under visual video endoscopic control. It has no problems related to tract or stone size.

Adult↗
PubMed2000

Use of different absorbable sutures for continuous single-layer anastomosis in the gastrointestinal tract. A prospective, randomized study.

BACKGROUND AND AIMS: A prospective, randomized study was designed to test the safety of the single-layer continuous anastomosis technique in gastrointestinal surgery. Results from the use of two different sutures were compared in relation to postoperative complications. MATERIAL AND METHODS: The safety of a single-layer continuous technique using two different types of absorbable suture was studied in 247 anastomoses performed on 183 patients between 1996 and 1997. There were 26 gastric, 117 small-bowel, 32 colonic, 29 pancreatic and 43 biliary anastomoses in the study. In 134 cases, Poliglecaprone 25 (Monocryl, Johnson & Johnson) was used, and in 113 cases Glycomer 631 (Biosyn, USSC). All procedures were carried out by the same surgeon. RESULTS: Anastomosis-related complications were detected in 7 patients (2.8%). Anastomotic failures including minor leakage occurred in 5 cases (2.0%). Reoperation was required in only 1 patient (0.4%), and there were no deaths. No difference was found in the dehiscence rate between the two types of absorbable material (1.5% with Monocryl and 2.6% with Biosyn; p = 0.5). CONCLUSION: Compared with other techniques used for gastrointestinal anastomosis, this technique is safe and easy to apply using either suture material.

Absorbable Implants↗
PubMed2000

[Inguinal hernia repair with mesh plug technique (initial experiences with a new, tension-free surgical method)].

Majority of inguinal hernia repair are performed in Hungary by traditional surgical techniques, reconstruction under tension (Bassini, Kirschner, Shouldice). Hernia surgery underwent a revolutionary change from the 80's. Set out from the United States, tension-free methodologies (Lichtenstein, laparoscopy, mesh plug) have spread worldwide, of which early and late results--especially recurrence rate--are significantly better than the formerly used techniques. Authors introduce the surgical technique of mesh plug hernioplasty and their promising experiences after the first 80 operations.

Adult↗
PubMed2000

[Cardiac tamponade caused by intrathoracic pancreatic pseudocyst].

Authors report on a clinical case of a 41 year old chronic alcoholic male patient who was hospitalized due to dominantly chest complaints and mild abdominal discomfort. Bilateral pleural and pericardial effusions were detected by performed examinations. A large multilocular pancreatic pseudocyst expanded into the thoracic cavity was verified in the background of his symptoms. To resolve cardiac tamponade developed repeatedly successful operation was performed and the patient healed. Authors give a brief summary for the diagnosis and treatment of cardiac tamponade with pancreatic origin.

Adult↗
PubMed2000

[Malignant eccrine poroma presenting as a breast tumor].

Malignant eccrine poroma is a rare malignoma of the skin. Number of the publicated cases less than a hundred. Authors detected a case of rapid progression malignant eccrine poroma on a young female following a short onset of symptoms. According to the case survey of literature is reported.

Adult↗
PubMed2000

[Long-term follow-up results of surgery for chronic pancreatitis].

Authors evaluate the late results of 51 operated patients by decompression or resection procedure for chronic pancreatitis between 1990-94, based on a follow-up period of 86 months. Only 34% of the 47 investigated patients could be classified as "good" results group--it is the half part of the good results of their former study based on 20 months follow-up period. The incidence of late deaths was very high--27.6%. Eighty-five percent of all the lost patients (11 pts) died after the seventh postoperative year. The most threatened group seems to be the alcoholic and insulin-dependent diabetic patients. This combination was the cause of death in third part of the cases. IDDM developed altogether in 9 patients, on average 3.7 years after the operation, namely it was the consequence of the irreversible progressive natural history of disease. The rate of disability is 44%, and it is significantly higher in the resected group than after decompression, just like the late mortality rat. Based on their results authors emphasise that in chronic pancreatitis the short-term (20-36 months) follow-up results may be deceptive, real outcome of the surgical treatment could be expected only after 5 years postoperatively.

Adult↗
PubMed2000

[Correlation of alcohol consumption and pancreatitis in Hungary].

Alcoholic etiology of acute pancreatitis is outstanding high in Hungary. The aim of this retrospective study was to analyse the etiology of patients of 5 years. Between 1990 and 1994 altogether 374 patients were admitted with acute pancreatitis, which is three and half times higher than between 1970 and 1974. From the 374 cases 220 had alcoholic and only 115 had biliary etiology. Altogether in 127 patients developed necrosis, the rate of alcoholic etiology was 80% in this subgroup. During the last two decades the trend of alcohol consumption became one of the most burning question in Hungary. Based on the Jellinek's formula alcohologists estimate the number of alcoholics more than one million. The number of pancreatitis related death multiplied almost four times between 1970 and 1994. The doubling of alcohol consumption was practically simultaneous with the increase of morbidity and mortality of pancreatitis. Hungary shows the most disfavourable distribution of drink varieties among the high-consuming countries in Europe.

Acute Disease↗
PubMed2000

[Early jejunal feeding in acute pancreatitis: prevention of septic complications and multiorgan failure].

Authors evaluate the effect of early jejunal feeding on septic complications and mortality in acute pancreatitis, based on the results of a two-phase, prospective, randomized study. In the first part of the study they compared the conventional parenteral nutrition with early (started within 24 hours) enteral nutrition in a prospective, randomized trial on 89 patients. Forty-eight patients were randomized into the parenteral group "A" (Rindex 10, Infusamin S, Intralipid 10%: 30 kcal/kg) and 41 patients into the enteral group "B" (fed by nasogastric jejunal tube Survimed OPD, 30 kcal/kg). The rate of septic complications (infected necrosis, abscess, infected pseudocyst) were significantly lower in the enteral group (p = 0.08 chi-square test). In the second phase of the study early jejunal feeding was combined with imipenem prophylaxis (Tienam, 2 x 500 mg i.v.) in the necrotizing cases detected by CT scan. According to the results of 92 patients the rate of septic complications (p = 0.03), multiple organ failure (p = 0.14), and mortality (p = 0.13) were further reduced in this group. Authors believe that combination of early enteral nutrition and a selective, adequate antibiotic therapy may give a chance for prevention of multiple organ failure.

Acute Disease↗
PubMed1999

The role of diagnostic laparoscopy in staging of pancreatic cancers.

Authors report elective diagnostic laparoscopy, and the role of this method in evaluating operability of pancreatic cancer. At their department 11 diagnostic laparoscopic procedures of pancreatic cancer were performed during the last 5 years. In 3 cases tumor proved to be resectable despite preoperative imaging results of unresectable condition. On the basis of international literature authors give brief summary of indications, cost and benefit of diagnostic laparoscopy, and its place in the diagnostic algorythm of pancreatic cancer.

Algorithms↗