[Atypical cases of gallstone ileus].
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Biomedical subjects
Publications and source records attributed to J Kiss.
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The therapeutic results and complications of 557 thoracic operations are evaluated. 94.4% of the patients recovered, 2.7% improved and 2.9% died. There appears to be a significant correlation between the therapeutic results, the diagnosis and the type of operation. The 7.0% wound infections were closely related to the age of the patient. The postoperative respiratory complications observed in 11.5% of the cases were in close relation to the diagnosis. The causes leading to respiratory complications and the length of the febrile period are discussed in detail, and the results are assessed in the light of data in the literature.
The role of antibiotics in the therapeutical result and in the postoperative complications was studied after 557 thoracic operations. It was found that antibiotics have no decisive role in the therapeutic result and there was no difference in the incidence of wound infections between the groups treated with different antibiotics. The principles and practice of treatment of would infections and pyothorax are discussed in detail. No relationship was found between the incidence of postoperative respiratory complications and the various drug treatments. Prevention and treatment of postoperative respiratory complications are discussed. The length of the febrile period was independent of the antibiotics applied. Their time of application, the problem of changing drugs and their side-effects after thoracic operations are analyzed.
After a review of the literature on antibiotic prophylaxis in thoracic surgery the authors present their own procedure, and point out the lack of difference between the therapeutic results and the incidence of complications in the groups treated with various antibiotics, and the control groups. Thus, routine prophylaxis is out-of-date, superfluous and even harmful in thoracic surgery. They are against preventive application in every case, but do not claim that antibiotics should never be applied. Pulmonary operations might be considered potentially infected; this, however, is not the same as an indication for prophylaxis. In thoracic surgery, preventive treatment is determined by individual indications and should always be of the aimed type. Antibiotics are dear, but their high price must not prevent their use, though the financial aspects of superfluously performed antibiotic prevention are not negligible.
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After the intramuscular administration of 500 mg oxacillin (oxacillin-chinoin) the serum level and the level of the pulmonary tissue of 15 patients operated on account of different diseases of the respiratory tract were determined by means of the agar diffusion method. In the first hour the serum level showed the average value of 11.8 mcg/ml, the level of the pulmonary tissue was 2.4 mcg/g. 60-120 minutes after the administration the serum level rapidly diminished, the decrease of the level of the pulmonary tissue was smaller, i.e. oxacillin was more rapidly excreted from the serum than from the pulmonary tissue. Taking into consideration the minimum inhibition concentration of oxacillin on the basis of our results we are of the opinion that oxacillin is suitable for the treatment of gram-positive oxacillin-sensitive infections of the lungs.
The synthesis and transport of newly synthesized proteins in dendrites of rat hippocampal pyramid cells were investigated. Labelled leucine was injected into the left lateral ventricle and the hippocampal region was processed for light and electron microscopic autoradiography. To differentiate between the silver grains originating from 'sedentary' or 'migratory' proteins, the radioactivity in dendritic areas free of ribosomes and rich in ribosomes was determined separately. Several conclusions were reached. (1) Protein synthesis in dendrites takes place mainly in the proximal parts although a slight synthetic activity can be observed along the whole dendritic tress as well. (2) Newly synthesized proteins are transported toward the distal dendritic region; the data obtained suggest that cisterns of the smooth endoplasmic reticulum and the microtubular system may be involved in this transport. (3) Two phases of dendritic transport may be distinguished; a fast phase with a rate of 100-200 mm/day and a slow phase with a rate of 2.8-10 mm/day. It also seems probable that the majority of the proteins newly synthesized in dendrites are transported by the slow phase.
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Gentamycin concentration in the serum, pericardial fluid, auricle, valve and papillary muscles of 14 patients subjected to cardiac surgery was determined after intramuscular administration of 80 mg of the drug. Fifty to 140 minutes after administration the mean level in the serum was 6.0 mcg/ml, in the pericardial fluid 0.6 mcg/ml, in the auricle 5.8 mcg/g, while after 120 to 240 minutes in the valve 1.2--9.6 mcg/g and in the papillary muscles 2.0--3.6 mcg/g of gentamycin was measured. Consequently, an efficacious gentamycin concentration can be achieved in the cardiac tissues but not in the pericardial fluid which makes gentamycin excellently suited for the prevention and treatment of the infectious complications of heart operations.
Lincomycin levels in the blood serum and lung tissue were determined in 17 patients after surgical operations because of the lung diseases, the drug being administered in a dose of 500 mg. In 45 to 330 minutes after administration of the antibiotic its concentration in the blood serum and lung tissue was 4.6 +/- 10 lambda/ml(average 7.7 lambda/ml) and 1.4-8 lambda/gm (average 4.4 lambda/gm) respectively. The lincomycin level in the lung tissue amounted to 61 per cent of that in the blood setum. The concentration of lincomycin the lung tissue was several times higher than the minimum level necessary for inhibition of the strains included in the antibiotic antibacterial spectrum. Therefore, lincomycin is an important drug in the treatment of infections of the respiratory tract.
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The authors describe the rare case of bezoar in the oesophagus. Their patient was sent to their Clinics with a diagnosed oesophageal tumor. The exact diagnosis was established by endoscopical examination. The bezoar was removed by endoscope, therefore, an operation was not necessary.
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