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Biomedical subjects

I Sugár

Publications and source records attributed to I Sugár.

At least 19 recordsLinked to original sources
PubMed2004

[The treatment of gastric tumours in our practice: a five year survey].

Between the 1st of January, 1998 and the 31st of December, 2002 we treated 111 patients for gastric cancer in the 2nd Department of Surgery, Semmelweis University, Budapest, Hungary. The majority of patients belonged to the advanced stages of the disease. In 65% of the cases a partial or total gastrectomy was performed. We combined the operation with D2 lymph node dissection if a R0 resection was possible, in the other cases with D1 lymphadenectomy. Postoperative morbidity rate ranged to 15%, the mortality 5.4%. 74 patients could be followed, 41 are dead and 33 still alive. According to the follow up examination the median survival time is 20.4 months at the moment. We observed a significantly shorter survival time, if vascular or lymphoid vessel invasion was present in the histologic specimen. The study has not been finished and the follow up will be continued.

Adenocarcinoma↗
PubMed2001

[Gastrointestinal stromal tumors in our practice].

The classification of tumours originating from the wall of gastrointestinal organs changed dramatically since of electronmicroscopy and immunohystochemistry were introduced. Previously these tumours were classified as leiomyomas, leiomyosarcomas or schwannomas. With the new methods these disorders can be described in more details and unified, and so the change to provide correct prognosis improved. Still, there are some unanswered questions remaining for the pathologists. In our material in the past 5 year we treated 9 patients because of GIST. Most of them were found in the stomach (6), one developed in the oesophagus, one in the small bowel and another one in the rectum. With describe our patients and look at the related articles literature about this important diseases. Though the incidence is under 1% of patients operated on because of gastrointestinal diseases, we would like to share our experiences in treatment.

Adult↗
PubMed2000

Isolated massive pleural effusion caused by pancreatico-pleural fistula.

BACKGROUND: Massive pleural effusions are uncommon but well-documented complications of chronic pancreatitis, usually caused by the development of a pancreaticopleural fistula. The mechanism of the fistula formation is thought to be rupture of the pancreatic duct or pseudocyst. MATERIAL AND METHODS: In the past 7 years we have treated 5 patients with massive pleural effusion of pancreatic origin in the Surgical Department of Semmelweis University Medical School. 4 patients were males; the average age was 52 years (range: 46-59 years). RESULTS: All 5 patients had a history of alcohol abuse and were admitted to the pulmonary department because of respiratory distress. Other symptoms such as abdominal pain, chest pain, or weight loss were not always present. The diagnosis was confirmed by a markedly elevated amylase level in the aspirated pleural fluid. Abdominal ultrasound, CT scan, and ERCP examinations were carried out in order to determine the cause of the pancreaticopleural fistula. Conservative (nonsurgical) treatment was effective within 3 weeks in only one case. The other 4 patients required surgical management. In 3 cases distal pancreatic resection with splenectomy and cholecystectomy was done. In one case cystojejunostomy was performed. All 5 patients have been cured with complete resolution of their pleural effusions. CONCLUSIONS: Patients with large pleural effusions may have underlying pancreatitis with a pancreaticopleural fistula. It is important to establish this diagnosis because treatment may require operative interventions.

Acute Disease↗
PubMed2000

[Acute gastrointestinal bleeding caused by a rare, benign tumor of the duodenum (gangliocytic paraganglioma)].

Diagnosis and treatment of massive gastrointestinal bleeding is sometimes very difficult problem in a surgical unit. Authors present a case of a 40 years old female with an atypical source of upper gastrointestinal bleeding. The origin of the bleeding was detected only by intraoperative enteroscopy. The source of the bleeding was a very rare benign tumour of the duodenum (Gangliocytic paraganglioma) which involved the papilla of Vater. During the operation resection of the pedunculated tumour was carried out, with choledochal--and Wirsungoplastyc, associated with external drainage of these ducts. According to the literature in preoperative diagnosis of this rare tumour endoscopy, angiography, and EUS are very useful. In case of malignancy, metastases radical operation-pancreatoduodenectomy--is indicated.

Acute Disease↗
PubMed2000

[Splenic rupture: a rare complication of colonoscopy].

Splenic rupture due to colonoscopy is very rare. Only a few cases have been reported previously in the English literature. Authors present their own case and they call attention to the mechanism of this complication. They conclude consequences from the literature.

Aged↗
PubMed1997

The use of modified Baylor score in the prediction of rebleeding in peptic ulcer hemorrhage.

The upper gastrointestinal bleeding is still an everyday problem. 40-50% of these bleedings are originating from peptic ulcer. The rate of rebleeding after initial hemostasis is 30-50%. In this group of patients we can observe the highest morbidity and mortality. The aim of this work is to select those patients who belong to the high risk group from the point of rebleeding. For this purpose we introduced after a retrospective analysis the modified Baylor score. In this scoring system the age, the number and severity of parallel illnesses, the hemostatus by the admittance, the ulcer size and location and the stigmata of recent hemorrhage are taken into consideration. On the basis of this every patient gets a score between 0 and 31. Based on our retrospective analysis we could establish three grades of risk groups: low risk (0-7), middle risk (8-11) and high risk (12 and over). In the low risk group there was no rebleeding. In the middle risk group we observed 4 rebleedings in 19 patients, while in the high risk group there were 32 rebleedings out of 36 cases. As a conclusion we can state, that the modified Baylor score is capable for the selection of high risk patients for rebleeding. With the early elective operations in these cases the high morbidity and mortality can be reduced.

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↗
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↗
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↗
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

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

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↗
PubMed1990

The role of Ca2+ level in liver transplantation.

During orthotopic liver transplantation Ca2+ assessment was made in the recirculation phase and the ultrastructural changes in the liver were studied. It was established that the Ca2+ level decreased progressively. The Ca2+ level in the hepatic vein was lower than the arterial value. The EM studies performed in the recirculation phase did not reveal any cellular damage, only the swelling of the mitochondria was striking. Based on the results, the question was raised whether Ca2+ can have a prognostic role in assessing the viability of the liver.

Animals↗
PubMed1990

Prognostic factors and treatment tactics in the surgery of liver abscesses.

The prognostic factors of 21 patients with pyogenic liver abscess were analyzed. It was stated that survival is unfavourably influenced by hyperbilirubinaemia, the mixed bacterial population, the associated diseases as well as the tumorous process. As a result of portal antibiotic perfusion, there was no difference in the mortality rates of multiple and solitary liver abscesses. Based on the analysis of the prognostic factors, the surgical tactics is developed, i.e. a need for surgical exposure is supported, which imposes three tasks: exposure of the abscess/es, management of the primary process inducing the abscess and introduction of a cannula for portal antibiotic perfusion. Besides some criteria, although the author do not have experience in this field, they suggest the use of percutaneous drainage controlled by echography or CT, basically because of the lower mortality rate.

Aged↗