Biomedical subjects

F Jakab

Publications and source records attributed to F Jakab.

At least 37 records · Page 2Linked to original sources

PubMed1997

Jejunal nutrition.

Contrary to the past experience of forced parenteral nutrition nowaday's the enteral [jejunal] nutrition enjoys priority. It is not questionable, that well adjusted and controlled application of fluid, ion, fat, carbon hydrate, amino acid promoted convalescence. The experiences of the Authors supports that enteral nutrition through technically proper outperformed jejunostomy does not increase complication rate and beside well controlled food administration provides the physiologic stimules of food, the method is relatively easy and cost effective. For this reason the Authors initiated jejunostomy at the end of larger interventions such as Akyama procedure, total gastrectomy, multivisceral interventions, pancreatectomy, operations for massive gastrointestinal bleeding and finally reoperations with extreme negative N-balance and with the chance of inability of oral feeding for several days.

Abdomen↗

PubMed1997

Experiences with ethanol infiltration of the liver metastases of colorectal tumors (preliminary study).

With the aid of improvement in imaging technique and with the ability of detection of hepatic tumours, the successful treatment of primary and secondary hepatic tumours using surgical methods has gained importance. Metastasectomies were performed in 16 cases at our department in 1996. In 6 cases atypical resections and/or infiltration with 96% ethanol were performed. In 3 instances ethanol infiltration into the metastases were accomplished during the resection, in 4 cases--when metastases were discovered 1-4 year after the resection of the primary tumours--the same method was used during the relaparatomy. 96% ethanol was injected directly into the metastatic tumours during operations. The early ultrasonograph examinations proved the total destruction of the metastases in diameter of 1-3 cm, and partial necrosis of the large (d = 3-8 cm) tumours. Two patients were lost from the follow up. Five patients are still alive after 2-8 months of the ethanol infiltration. In one patient after the ethanol infiltration of metastases /d = 3-5 cm/ in 6 segments of the liver we observed the dissemination of the tumour.

Aged↗

PubMed1996

[Organizational difficulties in liver transplantation].

Author overviews the evolution of liver transplantation from the point of view of organization in North America, in Europe and in Hungary partly on the basis of his own experience. It can be stated, that in North America the liver transplantation has become the universal method for the treatment of end-stage liver diseases, only after 20 year long period since the beginning. This first 20 years could be characterized by the monopoly of few giant transplant centers. This period was different and shorter in Europe due to integration run by Eurotransplant and Council of Europe. In Hungary the need and hope for a well organized, functioning liver transplant programme has become reality after difficult long period. Individual efforts, organizations, scientific-, clinical-, experimental work are being regarded valuable experience, because due to this effort some liver patients can live with good quality of life, the results are included to the present programme, on the other hand this accumulated knowledge can serve as a basis for further transplant activity.

Humans↗

PubMed1996

A new method to measure portal venous and hepatic arterial blood flow in patients intraoperatively.

The intraoperative measurement of the afferent circulation of the liver, namely the hepatic artery flow and portal venous flow was carried out upon 14 anesthetized patients having carcinoma in the splanchnic area, mainly in the head of the pancreas by means of transit time ultrasonic volume flowmeter. The hepatic artery flow, portal venous flow and total hepatic flow were 0.377 +/- 0.10; 0.614 +/- 0.21; 0.992 +/- 0.276 l/min respectively. The ratio of hepatic arterial flow to portal venous flow was 0.66 +/- 0.259. There was a sharp, significant increase in hepatic arterial flow (29.8 +/- 6.1%, p < 0.01) after the temporary occlusion of the portal vein, while the temporary occlusion of hepatic artery did not have any significant effect on portal venous circulation. The interaction between hepatic arterial flow and portal venous flow is a much disputed question, but according to the presented data here, it is unquestionable, that the decrease of portal venous flow immediately results a significant increase in hepatic artery circulation.

Abdomen↗

PubMed1996

Changes in hepatic hemodynamics due to primary liver tumours.

Data regarding the afferent circulation of the liver in patients with primary hepatocellular carcinoma are controversial, we have carried out measurement of hepatic arterial and portal venous flow intraoperatively by transit time ultrasonic volume flowmetry. In patients with primary hepatocellular carcinoma the hepatic artery flow increased to 0.55 +/- 0.211 compared with the control value of 0.37 +/- 0.102 1/min. (p < 0.01). The portal venous flow decreased from 0.61 +/- 0.212 l/min. to 0.47 +/- l/min. P < 0.01). Due to the opposite changes in the afferent circulation the total hepatic blood flow did not change significantly, compared with controls. The ratio of hepatic arterial flow to portal vein flow increased to 1.239 +/- 0.246 in patients with hepatocellular carcinoma, which is double of the control value (0.66 +/- 0.259 l/min). After resection this ratio did not change. The resection did not alter hepatic artery or portal venous flow significantly, although the total hepatic blood flow decreased significantly (p < 0.01). On the basis of our early results it is possible that the ratio of the two circulations may be to deel measured with doppler ultrasound and provide diagnostic information.

Adult↗

PubMed1996

The relationship between portal venous and hepatic arterial blood flow. I. Experimental liver transplantation.

The relationship between the changes in portal venous and hepatic arterial blood flows, in the liver is a much disputed question, it has tremendous significance in the practice of transplantation, and an explanation has been available since 1981, when Lautt published the so-called "adenosine washout theory". According to our earlier observations the decrease of portal pressure or flow consistently led to an increase in hepatic artery flow. At the same time changes in hepatic artery flow or pressure seemed to produce only inconsistent effects on the portal circulation. In the present experiments liver transplantation (OLTX) was carried out on mongrel dogs by Starzl's method. Electromagnetic flow probes were placed on the hepatic artery and the portal vein before removal of recipient's liver, and after completion of all vascular anastomoses to the newly inserted liver, during the recirculatory phase of OLTX. The flow probes were connected to a Hellige electromagnetic flowmeter, portal venous and systemic arterial pressures were also recorded. The control HAF was 241 +/- 23 ml/min, the average PVF was 517 +/- 47 ml/min before removal of the recipient's liver. In the recirculatory phase of HAF increased, by 71 +/- 12% (p < 0.001). The PVF decreased in most animals after OLTX. The decrease was in average -40.2 +/- 3.5% (p < 0.001). The THBF calculated by adding the HAF and PVF showed a small, but not significant decrease recirculation. The systemic arterial pressure decreased slightly and portal vein pressure rose in most animals after OLTX. There was a substantial increase in portal inflow resistance and prehepatic arteriolar resistance and a decrease in hepatic artery resistance. The decrease of PVF after OLTX can be explained by progressive fluid accumulation in the liver parenchyma and increased sinusoidal and portal inflow resistance. The prolonged and continuous increase in hepatic artery flow during the recirculatory phase of OLTX may be due to the decrease of portal flow. The exact mechanism, by which a change in portal flow leads to arteriolar dilatation, can be most probably explained by the "adenosine washout theory" of Lautt.

Animals↗

PubMed1995

The interaction between hepatic arterial and portal venous blood flows; simultaneous measurement by transit time ultrasonic volume flowmetry.

Intra-operative measurement of the afferent circulation of the liver, namely hepatic artery and portal venous flow was carried out in 14 anesthetized patients with carcinoma of the splanchnic area, mainly in the head of the pancreas, by means of transit time ultrasonic volume flowmetry. The hepatic artery flow, portal venous flow and total hepatic flow were 0.377 +/- 0.10; 0.614 +/- 0.21; 0.992 +/- 0.2761/min, respectively. The ratio of hepatic arterial flow to portal venous flow was 0.66 +/- 0.259. There was a sharp, significant increase in hepatic arterial flow (29.8 +/- 6.1%, p < 0.01) after the temporary occlusion of portal vein, while the temporary occlusion of the hepatic artery did not have any significant effect on portal venous circulation. The interaction between hepatic arterial flow and portal venous flow is much in dispute, but, as the data presented here show, there is no doubt that the decrease in portal venous flow immediately gives rise to a significant increase in hepatic artery circulation.

Blood Flow Velocity↗

PubMed1994

The afferent circulation of the transplanted liver during the recirculatory phase in dogs.

The relationship between the changes in portal venous and hepatic arterial blood flows, e.g. the interaction of the two vascular systems in the liver always was a much disputed question, although it has tremendous significance in the practice of transplantation, and the explanation has been known since 1981, when Lautt published the so-called "adenosine washout theory" /9/. According to our earlier observations the decrease of portal pressure of flow generally and consistently led to an increase in hepatic artery flow. At the same time, changes in hepatic artery flow or pressure seemed to produce only inconsistent effects on the portal circulation. In the present experiments liver transplantations were carried out on mongrel dogs by Starzl's method /14/. Electromagnetic flow probes were placed on the hepatic artery and the portal vein before removal of recipient's liver, and after completion of all vascular anastomoses of newly inserted liver, e.g. in the recirculatory phase of OLTX. The flow probes were connected to Hellige electromagnetic flowmeter, portal venous and systemic arterial pressures were recorded too. The control HAF was 241 +/- 23 ml/min, the average PVF was 517 +/- 47 ml/min before removal of the recipient's liver. In the recirculatory phase the HAF increased to 414 +/- 39 ml/min, by 71 +/- 12% (p < 0.001). The PVF decreased in most animals after OLTX. The decrease was in average -40.2 +/- 3.5% (p < 0.001). The THBF calculated by adding the HAF and PVF showed a small, but not significant decrease during recirculation. The control THBF was 758 +/- 50 ml or 39.0 +/- 3.1 ml/min/kg. In the recirculatory phase 754 +/- 48 ml/min HBF could be measured, respectively. The systemic arterial pressure slightly decreased, portal vein pressure rose in most animals after OLTX, accordingly there was a substantial increase of portal inflow resistance and of prehepatic arteriolar resistance, decrease of hepatic arterial resistance. The decrease of PVF after OLTX can be explained by a progressive fluid accumulation in the liver parenchyma and increased sinusoidal and portal inflow resistance. The prolonged and continuous increase of hepatic artery flow during recirculatory phase of OLTX may be due to the decrease of portal flow. The exact mechanism, by which a change in portal flow leads to arteriolar dilatation, can be most probably explained by "adenosine washout theory" of Lautt.

Animals↗

PubMed1994

Blood flow measurement in patients with hepatocellular carcinomas.

Since the data regarding the afferent circulation of the liver in patients having primary hepatocellular carcinoma are controversial or missing. Authors carried out the measurement of hepatic arterial and portal venous flow intraoperatively by transit time ultrasonic volume flowmetry. In patients with primary hepatocellular carcinoma the hepatic artery flow increased to 0.55 +/- 0.211 compared with the control value of 0.37 +/- 0.102 1/min (p < 0.01). The portal venous flow decreased from 0.61 +/- 0.212 1/min to 0.47 +/- 1/min (p < 0.01). Due to the opposite changes in the afferent circulation the total hepatic blood flow did not change significantly. The ratio of hepatic arterial flow to portal vein flow elevated to 1.239 +/- 0.246 in patients with hepatocellular carcinoma, which is the double of the basic control value (0.66 +/- 0.259 1/min). After resection this ratio practically did not change. The surgical intervention, that is the resection of the liver did not alter the hepatic artery and portal venous flow significantly, although the total hepatic blood flow has decreased significantly (p < 0.01). The prominent and marked increase in the ratio of hepatic arterial flow may be attributed to the decrease of portal venous flow caused by the primary hepatocellular carcinoma. The decrease of venous flow can be explained most probable by compression and infiltration of the intrahepatic branches of the portal vein. As we pointed out the decrease in portal venous circulation consequently causes increase in hepatic arterial flow.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Complications following major abdominal surgery in cirrhotic patients.

The morbidity and mortality associated with major abdominal surgical interventions in 34 histologically proven cirrhotic patients are analyzed by the authors. The surgical interventions were carried out as urgent, absolute and elective indications. Thirty-seven general and surgical complications were observed following major abdominal surgery in 34 cirrhotics. Seven out of 34 patients died, giving a mortality rate of 21%. Suture-line insufficiency, peritonitis, sepsis and other inflammatory processes turned out to be the most common complications. Statistical analysis showed that the Child criteria, prothrombin level and white blood cell count were useful prognostic factors.

Abdomen↗

PubMed1992

[Clinical aspects and management of a retroperitoneal abscess].

14 patients with retroperitoneal abscess have been collected by the authors since June 1, 1988. The retroperitoneal abscess of multifactorial origin can be considered as a secondary disease. The physical clinical signs (e.g. psoas rigidity sign, palpable mass, costolumbal sensitivity) play central role in setting up of diagnosis, and these signs were present in more than 75% of the cases. The physical signs generally indicate advanced retroperitoneal abscess, and at the same time the contour of psoas muscle disappears and concavity of lumbal vertebras can be seen on plane abdominal X ray film. The exact diagnosis was achieved in mean 45 days after the on set of complaints, this fact urges, that the up-to-date imaging modalities (US, CT, NMR) should be applied earlier in septic conditions of unknown origin. Retroperitoneal surgical intervention was performed in their patients, in the future the percutaneous drainage procedure has to be considered as first intervention for retroperitoneal abscess. Retroperitoneal abscess secondary to malignant disease has unfavorable prognosis, 2 out of 14 patients with retroperitoneal abscess died, both of them had underlying malignancy.

Abscess↗

PubMed1991

[Complications of abdominal surgery in patients with liver cirrhosis].

The morbidity and mortality of major abdominal surgical interventions in 34 histologically proven cirrhotic patients are analysed by the authors. The surgical interventions were carried out by urgent, absolute and elective indications. 37 general and surgical complications could have been observed following the major abdominal surgery of 34 cirrhotics. 7 out of 34 patients died. Suture-line insufficiency, peritonitis, sepsis and other inflammatory processes turned out most frequently among the complications. The Child criteria, the prothrombin level and white blood cell count proved to be useful prognostic factors by statistical analysis.

Abdomen↗

PubMed1991

Gastrointestinal angiodysplasia.

In the recent four years, 8 cases of gastrointestinal angiodysplasia (a.d.) were observed by the authors. Analysing the conclusions drawn from the patients course of disease, they found a.d. to be the cause of an unknown gastrointestinal bleeding. a.d. can be basically diagnosed by angiography. It is often associated with liver cirrhosis or arteriostenosis. The treatment of a.d. is surgical. The recurrence and repeated appearance of bleeding can be expected even after a thoroughly performed resection.

Adolescent↗

PubMed1991

Complications following major abdominal surgery in cirrhotic patients.

The morbidity and mortality of major abdominal surgical interventions in 34 histologically proven cirrhotic patients are analysed by the authors. The surgical interventions were carried out based on vital absolute and elective indications. 37 general and surgical complications were observed following the major abdominal surgery of 34 cirrhotics. 7 out of 34 patients died, the mortality was 21%. Suture insufficiency, peritonitis, sepsis and other inflammatory processes occurred most frequently among the complications. The Child criteria, the prothrombin level and white blood cell count proved to be useful prognostic factors.

Abdomen↗

PubMed1990

[Gastrointestinal angiodysplasia].

8 cases of gastrointestinal angiodysplasia are reported. It can be stated on the analysis of these cases, that the angiodysplasia can be the cause of unexplained GI hemorrhages, and in the majority of cases the visceral angiography provides diagnostic evidence. The angiodysplasia can be observed frequently in association with liver cirrhosis and aortic valvular stenosis. Surgery is regarded as the best method of treatment. Subsequently the careful resection rebleeding and development of newer angiodysplasia can occur.

Aged↗

PubMed1990

Surface pH and morphological changes of the liver in the recirculation phase of experimental liver transplantation.

Measurement of the surface pH of the liver in the recirculation phase of liver transplantation is an indicator of tissue perfusion. In the recirculation phase there is a close correlation between arterial blood and the surface pH of the liver. The surface pH of the liver and EM study together can be of prognostic importance in establishing the viability of the transplanted liver.

Animals↗

PubMed1990

Inflammatory pseudotumour of the liver.

In view of their own case, authors review the diagnostic and clinical characteristics of the inflammatory "pseudotumours" of the liver. They state that this liver disease is important from the differential diagnostic point of view. The inflammatory pseudotumours should be basically differentiated from malignant tumours in which the imaging procedures and their repetition are significant. Authors review their case in connection with 13 cases collected from the literature.

Aged↗

PubMed1990

Changes in hepatic blood flow in jaundice due to hilar carcinomas, the so-called Klatskin tumours.

The hepatic circulation of patients with hilar carcinoma and icterus was studied by isotope technique. A marked alternation in blood flow was observed, that is that the ratio of the circulation of the hepatic artery and the portal vein became balanced. By elimination of the icterus, the hepatic circulation normalized. This allowed the conclusion that the change in blood flow must have rather been due to the mechanical icterus and the increased pressure of the bile duct than to the tumorous infiltration and therefore the earliest possible elimination of the icterus is urgently indicated.

Aged↗