Biomedical subjects
Publications and source records attributed to A Pintér.
The fibroepithelial polyp is a benign tumour that occurs as a rare intraluminal mass within the urinary tract. Most commonly it is located within the ureter or ureteropelvic junction. The authors present 3 cases of fibroepithelial polyp causing obstruction of the ureteropelvic junction. Dismembering pyelonplasty resulted in disappearance of the hydronephrosis, and the postoperative course was uneventful.
There are only a few reported cases of a pacemaker lead migrating inadvertently into the left atrium or ventricle. An unusual complication of unremoved, unwanted pacemaker lead is presented. The free tip of the lead caused cerebral embolism after perforating the interatrial septum.
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A case of QT duration dependent T wave oversensing mimicking QRS undersensing and pacemaker malfunction is presented. This example indicates that interpretation of pacemaker ECG may be difficult, even in case of VVI pacemaker.
Atrial pacing (AP), despite its beneficial hemodynamic and antiarrhythmic effect, is still an underused mode of stimulation. The main purpose of this study was to evaluate the long-term results of AP. Sixty four patients (pts) with sinus node disease (28 male and 36 female: mean age 54.2; range: 44-88 years), 3.2% of the total implantation at our clinic were treated with AP between 1982-96. Criteria for atrial pacing were: no AV block in the history, no AV-block during carotid sinus massage, Wenckebach point > 130/min, left atrium < 50 mm, left ventricular EF > 40%. The indication for pacing was predominant sinus bradycardia (SB) in 34 pts and tachycardia-bradycardia syndrome (TBS) in 30 pts. Pts with TBS were on antiarrhythmic treatment, while most pts with SB received no antiarrhythmic drugs. All the pts were checked up at every 3-6 month. Sixty-two pts were followed for 3-154 (mean: 67) months, two pts were lost for follow-up. Repeated lead dislodgment occurred in two pts, which made a pacing mode change necessary. Four pts died during the follow-up period for non-cardiac reasons. At the end of the follow-up period the data of 60 pts were available for evaluation (33 pts with SB, 27 pts with TBS). All the pts with SB were in sinus rhythm, and no patient developed AV block by the end of the follow-up period. Seven out of 27 pts with TBS developed chronic atrial fibrillation, 3 out of them suffered a cerebral embolism; the remaining 20 pts were in sinus rhythm, and the number of paroxysmal attacks decreased significantly, which improved their quality of life significantly. Three pts in this group developed a temporary complete AV block, which regressed with decreasing the dosage of antiarrhythmic drugs. Atrial pacing is proved to be a safe and reliable treatment for sick sinus syndrome. Proper patient selection is crucial in preventing the development of AV conduction disturbance. Atrial stimulation had a satisfactory long-term antiarrhythmic effect in pts with sick sinus syndrome (SSS).
Vasoactive intestinal polypeptide (VIP) was either injected intravenously (300 pmol.kg-1) or perfused (1 nmol in 1 min) into the sinus node artery (SNA) in anesthetized dogs to study its effect on subsidiary atrial pacemakers. Isochronal maps were obtained from 128 unipolar electrograms recorded on the epicardial surface of both atria in nine animals. When VIP was perfused into the SNA or injected intravenously, heart rate increased by 29 +/- 16% and 12 +/- 12%, and blood pressure decreased by 16 +/- 15 mmHg (1 mmHg = 133.3 Pa) and 24 +/- 18 mmHg, respectively. No significant change in heart rate (3 +/- 6% decrease) accompanied a similar decrease in blood pressure after an intravenous sodium nitroprusside perfusion. The perfusion of VIP into the SNA as well as the intravenous injection of VIP induced a shift of the pacemaker site to the region of Bachmann's bundle in a third of the preparations, while the pacemaker remained in the sinus node area in two thirds. A perfusion of isoproterenol into the SNA produced a similar heart rate increase (32 +/- 14%, NS vs. VIP), and shifted the pacemaker site rostrally within the sinus node in three of five preparations, or to the region of Bachmann's bundle in two of five preparations. The response to VIP in the location of the pacemaker was significantly different from the response to isoproterenol. Repeated perfusions of VIP into the SNA after 10-, 25-, 40-, and 60-min intervals produced 2 +/- 13% (p < 0.005 vs. the effect of first VIP administration), 14 +/- 12% (p < 0.05), 10 +/- 12% (p < 0.05) and 30 +/- 13% (NS) heart rate increases, respectively, thereby demonstrating a tachyphylactic effect. In conclusion, VIP seems to exert its positive chronotropic effect directly (probably via specific VIP receptors), although the phenomenon of tachyphylaxis may suggest an indirect sympathomimetic mechanisms.
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The authors present a new, unusual side effect due to retained pacemaker lead. The free tip of the lead caused cerebral embolism by perforating the interatrial septum. Transoesophageal echocardiographic study showed the lead crossing the interatrial septum. The total abnormal course of the lead was demonstrated by lateral X-ray picture. Diagnostic and therapeutic approaches regarding retained leads in malposition are also discussed.
A case of both atrial and ventricular stimulation by the sense event marker during external chest wall stimulation of a DDDR pacemaker is reported. This unusual phenomenon might produce pacemaker-mediated tachycardia.
The aim of the paper is to review the four decades' long history of salt fluoridation, and to report on experiments and activities in Hungary in the course of the last three decades, aiming the country-wide introduction of domestic salt fluoridation. Salt fluoridation, as a caries preventive method was first introduced in Switzerland, in 1955, later caries-reducing effects were studied in Columbia, Spain and Hungary. The results of the clinical experiments of K. Tóth performed in Szeged, Hungary, showed after 17 years a caries reduction of about 66%. These results contributed significantly to the introduction of salt fluoridation in several (France, Costa Rica, Jamaica, Germany) countries. Leaders of Hungarian dentistry tried to introduce salt fluoridation since 1972, but due to the antifluoride lobby, and organisational difficulties, the authorization was delayed. However, in the last three years in the course of several discussions and debates within the top-commissions, a positive statement was issued recently by the Hungarian Academy of Sciences on the support for the country-wide introduction of domestic salt fluoridation at earliest possible convenience.
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As a result of the decrease of the medical authority and the increasing power of the lawyers, the relationship between doctors and patients, patients and society has changed. The situation is more complicated in the case of neonates, infants and children who are unable to articulate their rights and wishes. The problem is complex in connection with the fetus because their interest and that of the mothers are often in conflict. The neonatal surgeon--only together with the geneticist, obstetrician and neonatologist--plays and important role in the evaluation of the mentally or somatically handicapped fetuses and neonates. The neonatal surgeon should suggest the termination of a pregnancy, should give his/her expert opinion about the result of the treatment of a malformation or should propose the withdrawal of the intensive care in the case of a critically ill neonate. Fetuses and neonates with congenital anomalies can be divided into 6 groups. 1. potential for total recovery--2. anomaly enabling a nearly normal life--3. malformations requiring permanent supervision and/or medical care--4. somatic rest defect and subnormal mental development--5. serious somatic and mental damage--6. anomal incompatible with life. In the complex evaluation of a fetus or a neonate with congenital malformation the neonatal surgeon--while not forgetting his/her Hippocratic oath--should take into consideration the quantity and quality of the rescued life, possibilities of a long treatment he/she should act according to the law and fulfil the expectations of the society.
Air pollution represents one of the most important environmental health hazards in Hungary. Irritant gases, like SO2 and NO2 levels exceed national and international standards in many settlements. Tata, a small town, situated in a basin, is one of the most polluted areas in Hungary. Longitudinal and cross-sectional studies have been conducted in children in the winter period of 1993/1994, with respect to SO2 and NO2 concentration. Average SO2 levels exceeded the national standard levels and daily peaks as high as 450 micrograms/m were recorded. Excessive NO2 levels were also found but they were not as high as those of SO2. Acute respiratory morbidity, based on a uniform protocol was recorded daily and evaluated on a daily and weekly basis. A statistically significant correlation with SO2 levels was observed in relation to the frequency of acute daily respiratory morbidity. Other health parameters, like pulmonary function, haematology and sensory performance were also tested. Although no statistically significant correlations were observed, the tendency in all parameters demonstrated impairment, in relation with ambient air pollution. Smoking history of the family did not alter significantly the pulmonary functions of other parameters.
The relative rarity of urogenital sinus and cloacal anomalies, the wide range of their anatomical variants furthermore the number of different surgical options makes the successful management of a child with such urogenital abnormality one of the greatest challenges to the paediatric surgeon. Based on their own experience and the literature the authors give a review of embryology, pathology, and diagnosis of urogenital sinus and cloacal abnormality. They detail the new surgical therapy developed by Hendren and Pena which has been adopted in their routine. This therapy has significantly improved the functional outcome and prognosis of these anomalies. Over the past 20 years 25 patients with urogenital sinus and cloacal abnormalities were surgically treated in the author's institute.
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A case of a 38-year-old male with supraventricular paroxysmal tachycardia existing for more than a decade is reported. He has received amiodarone in a daily dose of 800 mg for three years and the tachycardia returned in 1992. New antiarrhythmic drugs were added but no beneficial effect has been achieved and moreover, a case of ventricular fibrillation occurred. The 12-lead ECG performed during tachycardia and the electrophysiological study showed orthodromic AV reentry tachycardia. Laboratory tests performed proved hyperthyreotic state. Attacks of paroxysmal tachycardia were returned and aggravated by the hyperthyreosis induced by amiodarone. Finally, antiarrhythmic drugs were discontinued and methimazol was introduced. Gradually, the patient become asymptomatic within two months. The most important conclusion of the case reported, that the amiodarone induced hyperthyreosis can be subclinical or obscure. Consequently, a regular control of serum thyreoid hormone levels at least twice a year on patients with long term amiodarone administration should be advised.
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.
In the past 15 years five neonates and children have been treated for high vaginal atresia at the Surgical Unit of Department of Pediatrics, University Medical School, Pécs, Hungary. In three of the six patients distal atresia of the vagina was found (Type III). Two of the three were neonates and had a large hydrometrocolpos and the third, a 13-year-old girl, hematometrocolpos. In the fourth patient the vaginal atresia was associated with cloacal and anorectal malformation (Type V). In the fifth there was a duplication of uterus and vagina; however, only one of the two vaginas was atretic. In three patients a pull-through of the vagina was carried out, in one of them according to Pena, in another a transvesical approach, as suggested by Monfort, was used. Following repeated surgeries in the patient with cloacal malformation the vagina was replaced with large intestine. In the case of duplication of vagina and uterus one half of the duplication was removed.