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Biomedical subjects

J Meszaros

Publications and source records attributed to J Meszaros.

At least 19 recordsLinked to original sources
PubMed2005

Infectious complications after simultaneous pancreas-kidney transplantation.

Simultaneous pancreas-kidney transplantation (SPKT) improves long-term survival of insulin-dependent diabetes mellitus patients with diabetic nephropathy. The increasing success of SPKT is a result of improved surgical technique, better organ preservation, potent antirejection therapy, and effective use of antibiotics to prevent and treat infectious complications. However, morbidity and mortality following SPKT remain high mainly owing to infection. From 1988 to 2004, the 51 patients who underwent SPKT were 32 women and 19 men of mean age 34 +/- 4 years old with diabetes and end-stage renal disease. The mean duration of diabetes mellitus was 23 +/- 4 years. The incidence of HCV and HBV infections were 19.6% and 13.7%, respectively. Preoperative work-up included identification and elimination prior to surgery of potential sources of infection. All patients prior to SPKTx had been treated by dialysis (26 +/- 20 months). The kidneys were always placed into the left retroperitoneal space first; at the same time the pancreatic grafts were prepared on the back table. The reconstruction of the superior mesenteric and the splenic arteries was performed using a Y graft of donor iliac artery to the common or external donor's iliac artery. The pancreas was transplanted intraperitoneally to the right iliac vessels. The portal vein was sutured to the common or external iliac vein and the arterial conduit of donor iliac artery. In 20 of the patients, bladder drainage and in 31, enteric drainage was used for the pancreatic juice exterioration. Patients received immunosuppression with a calcineurin inhibitor (tacrolimus or cyclosporin), mycophenolic acid or azathioprine, and steroids. Antibody induction (alternatively anti-IL-2 monoclonal antibody or ATG) was used in last 38 patients. Antibacterial (tazobactam) and antifungal (fluconazole) as well as antiviral (gancyclovir) prophylactic treatment was given to all patients for 7 to 10 days after transplantation. Thirty-eight recipients are alive, 26 with function of both grafts; 8 with functioning kidney grafts; and 4 with nonfunctioning grafts on dialysis treatment from 1 to 14 years after transplantation. Thirteen patients (24.5%) died during the first year after transplantation. Infectious complications were the main cause of death. Systemic infections accounted for the death of five patients and CNS infection for death of another five patients. Three patients died with functioning grafts due to cardiopulmonary disorders (myocardial infarction, pulmonary embolus) early in the postoperative period. A total of 102 infections were diagnosed in 51 patients during the posttransplant course. Twenty-one episodes of CMV infection (systemic 20, duodenal site 1), 73 bacterial infections (systemic 13, pulmonary 13, urinary tract 15, intestinal 8, wound 23), and 8 fungal infections (central nervous system 5, gastrointestinal tract 3). Some patients had more than one type of infection. Overall mortality in the investigated group was 24.5%. Infectious complications were the main cause of death (77%), including systemic infection (38.5%) and CNS infection (38.5%). The predominant etiology of the systemic infections was bacterial. The etiology of CNS infections was fungal. In conclusion, infectious complications are the main cause of morbidity and mortality following SPKT. The early diagnosis of infection, particularly fungal complications, is necessary. The administration of broad-spectrum prophylactic antibiotics, antifungal, and antiviral agents is recommended.

Adult↗
PubMed2001

[Use of the Etest method for antimicrobial susceptibility testing of obligate anaerobes].

The aim of this study was to evaluate Etest usefulness for antimicrobial susceptibility testing of obligate anaerobes and to compare the activity of five antibacterial drugs against clinical strains of anaerobes. One hundred strains of obligate anaerobes were tested: 2 reference strains (B. fragilis ATCC 25285 and B. thetaiotaomicron ATCC 29741) and 98 clinical strains isolated from patients of the Infant Jesus Clinical Hospital--Center for Trauma Treatment in Warsaw during the last three years (1997-1999). Strains of seven genera of obligate nonsporeforming anaerobes (Bacteroides, Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus, Propionibacterium and Actinomyces) and strains of two sporeforming species (C. perfringens and C. difficile) were examined. The MIC values were determined by the gradient diffusion method Etest (AB BIODISK, Sweden). Wilkins-Chalgren solid medium supplemented with 5% of sheep blood was used. Test plates were incubated at 35 degrees C for 48 hours in glove-box (85% N2, 10% H2, 5% CO2). The MIC values for each strain and antimicrobial agent, and the MIC ranges for bacteria of the same species were established. Ten strains resistant to clindamycin, ten resistant to piperacillin, and ten resistant to imipenem were detected. Seven strains were resistant to metronidazole and two strains to piperacillin combined with tazobactam. Tazobactam restored the susceptibility of eight strains to piperacillin. Obtained results confirm that Etest method is useful for antimicrobial susceptibility testing of obligate anaerobes. Older (clindamycin and metronidazole) and newer (piperacillin, piperacillin/tazobactam and imipenem) antimicrobial agents revealed high and comparable activity against clinical strains of obligate anaerobes. The percentage of strains susceptible to tested antimicrobials was > or = 90. These antimicrobials may be still useful in the empiric treatment of infections caused by medically important anaerobes.

Anti-Bacterial Agents↗
PubMed2000

[Susceptibility to selected coagulase-negative chemotherapeutic agents of methicillin resistant staphylococci isolated from clinical materials in 1997-1998].

The study was aimed at assessment of the sensitivity of methicillin-resistant coagulase-negative staphylococci isolated from clinical material in 1997/1998 to selected chemotherapeutic agents. The investigated material comprised 96 methicillin-resistant coagulase-negative staphylococci from hospital and ambulatory infections isolated during the period from April 1997 to May 1998. Species affiliation was determined by classical identification methods and commercial diagnostic tests for identification of staphylococci. Methicillin resistance was determined by agar disk-diffusion method and screening. Sensitivity to chemotherapeutics was determined by agar disk-diffusion method and agar dilution methods. All the investigated strains were sensitive to nitrofurantoin, furazolidone and vancomycin. To teicoplanin--the second glycopeptide antibiotic--84% strains were sensitive, whereas the percentages of resistant and moderately sensitive strains amounted to 5.2% and 10.4%, respectively. 85% and 82% of coagulase-negative staphylococcal strains were sensitive to fusidic acid and mupirocin. Considerable differences were noted with respect to sensitivity to aminoglycoside group antibiotics. About 35% of strains were sensitive to gentamicin, and 90% sensitive to netilmicin. Ca. 40% of coagulase-negative staphylococci were resistant both to cotrimoxazole and trimethoprim, which, in view of 98% resistance to the second component of cotrimoxazole, may be associated with the activity of only one of the components of the drug--trimethoprim.

Coagulase↗
PubMed1999

[Not Available].

By the end of World War I the Hungarian Psychoanalytic movement was strong and deeply integrated into the cultural and intellectual life of Budapest. The city was ready to be the center of the European psychoanalysis. The paper discusses how Budapest lost its growing eminence as a center, but because of the political-social changes in Hungary in the years 1918-1920. The paper will examine the two waves of Hungarian emigration between the world wars, the first in the early twenties to the Weimar Republic, and then in the thirties, to the United States and Australia. These movements of important Hungarian psychoanalysts, account both becoming weaker of the Budapest School and at the same time its influence in other countries. The author highlights the outstanding role of the American Psychoanalytic Association's setting up the Emergency Committee on Relief and Immigration in saving the lives of many European colleagues. America was open to European psychoanalysis at that time and in return immigrants facilitated the development of modern psychotherapy and psychoanalysis. The influence of Vienna, Budapest and Berlin can be traced in contemporary psychoanalytic culture in the United States. The documentation for this paper was researched in Washington, D.C., New York and London, supported by fellowships and grants from the Woodrow Wilson International Center and the Soros Foundation.

Emigration and Immigration↗
PubMed1986

[Wound healing of the corneal posterior surface in animal experiments].

Autoradiographic studies using tritiated thymidine as a precursor of DNA synthesis show that the process of wound healing of the corneal endothelium in both rhesus monkeys and rabbits following scarification and cryocoagulation takes place for the most part by means of cell proliferation. After injection of tritiated thymidine into the anterior chamber immediately prior to sacrifice, autoradiographically labeled flat mounts and cross-section preparations of the corneas of 7 rhesus monkeys and 14 rabbits were examined at lesion ages ranging from 4 hours to 10 days. In the monkeys scarcely 10% of the endothelial cells in the areas of the corneal lesions or at their borders were in the S-phase in the autoradiographically labeled flat mounts 24 hours to 3 days after injury, whereas up to 39% of those in the rabbits were seen to be so after 18 hours. In the monkeys one could discern mitoses between the 2nd and 5th days, and amitoses (binuclear cells) were found in 1-day and 3-day animals. In rabbits numerous mitoses could be discerned between the 1st and 5st days, but no multinuclear cells were seen. Healing of the corneal endothelium in the monkeys occurred some-what later and was less pronounced than in the rabbits.

Animals↗
PubMed1982

Anterior bulbus perforation and vitrectomy in the 'minipig'.

Wound healing after experimental anterior eye perforation, including lens, ciliary, body and vitreous, was studied in 12 miniature pigs (minipigs). In half of the eyes, perforation was followed by removal of the damaged lens and suturing of the wound. In the other half, a primary subtotal vitrectomy was performed after removal of the lens. The behaviour of the connective tissue in the wound-healing process was not fundamentally changed by subtotal vitrectomy. In both groups very little fibrous ingrowth into he vitreous structure was observed, suggesting that the pig vitreous has marked antifibroplastic properties. The anatomical and technical features of vitrectomy in the minipig, and the advantages and disadvantages of this animal model are discussed. It appears that the eye of the minipig is ideal for the study of biochemical factors preventing fibrous ingrowth into the vitreous.

Animals↗
PubMed1978

[Mobility measurements and histological studies on endosseous titanium implants under masticatory stress in the mandibles of adult macacas].

Linkow blades were implanted into 5 adult monkeys. Measurements of mobility showed that two weeks after implantation the implant mobility was below the mobility of the control teeth. Fixed bridgework was inserted and after 8-14 months the mobility of implant and control teeth were alike. Inspite of this favourable result, the mobility of the implants, after removal of the bridgework, was higher than that of the controls and of normal values. The histological picture explains this, since all implants showed a sheath of connective tissue which was 5-10 times the dimension of the normal desmodontal space. Inflammatory processes and epithelial growth into depth were observed inspite of the absence of clinical symptoms. There was bony growth through the windows of the implants, but only on two implants could bone sheathing be observed. The conclusion is that Linkow implants should not be used alone for the anchoring of bridgework but only as link supports between long bridge spans or as distal extension of shortened tooth arches. Also, it can be used for the retention of a Dolder bar in mucosa supported dentures.

Animals↗
PubMed1977

Central anticholinergic effects of N-ethyl-2-pyrrolidylmethyl-cyclopentylphenyl glycollate.

The following effects of N-ethyl-2-pyrrolidyl-methyl-cyclopentylphenyl glycollate (PMCG) have been studied: effects on aggressive behaviour in mice and on general behaviour in rats, protective effects against central action of arecoline and nicotine in mice, thermo-regulatory effects in mice, protective action in poisonings with fluostigmine in mice and rats, and effects on bioelectrical activity of the brain in cats. It was stated that PMCG possesses a strong central anticholinergic activity blocking predominantly central muscarinic receptors; PMCG had also strong protective effects in anticholinesterase intoxications. It is suggested that this drug could have antiemotional and antiparkinsonian properties.

Aggression↗
PubMedDate not supplied

Permanent bile duct cannulation in the monkey. A model for studying intestinal absorption.

Our aim has been to obtain an experimental model where the test animal is subjected to the least amount of stress and restraint, and can serve for the repeated sampling of biliary excretion over a prolonged period of time. By using a special end-piece at the outer terminals of the two cannulas the monkeys could be given full freedom after experimentation. During the course of the study it was found that insertion of the cannula into the common bile duct led to the development of collateral pathways for passage of bile around the point of insertion. This adaption reaction for the restoration of a normal bile channel would seem to be characteristic of Rhesus monkeys, for we did not encounter it in similar experiments on dogs and minipigs. The experimental model described is intended to serve for the determination of intestinal absorption of compounds that are mainly excreted via the bile. Results with radioactive ergotamine are presented.

Animals↗
PubMedDate not supplied

Use of drotrecogin alpha (recombinant human activated protein C, rhAPC) in the treatment of severe sepsis induced by graft pancreatitis after simultaneous pancreas and kidney transplantation: a case report.

We present our experience with recombinant human activated protein C (rhAPC) to treat a 40-year-old preemptive simultaneous pancreas-kidney transplant (spktx) recipient who developed septic shock due to graft pancreatitis. We diagnosed intra-abdominal septic complications with septicemia induced by multiple pathogens and cardiopulmonary insufficiency. Until the 59th posttransplant day, 21 peritoneal lavages were performed to treat peritonitis and intra-abdominal abscesses. On the 53rd day when septic shock was diagnosed, rhAPC was administered, after which the patient improved, vasoconstrictive agents were reduced, and respiratory insufficiency resolved. The Physiologic and Operative Severity Score for enumeration of Mortality and Morbidity (POSSUM) scale showed a decrease in predicted mortality from 93% to 17% on day 7 after rhAPC initiation. The patient was discharged at 128 days after spktx with good function of both grafts. Administration of rhAPC limited systemic inflammatory response syndrome (SIRS) and may be considered when faced with the dilemma of stopping immunosuppression to save a recipient's life but at the cost of rejection of a functioning graft.

Adult↗
PubMedDate not supplied

Chlamydia pneumoniae infection and ischemic heart disease in hemodialysis patients.

INTRODUCTION: Ischemic heart disease and other atherosclerotic complications are the prominent causes of death among hemodialyzed end-stage renal disease (ESRD) patients and renal transplant recipients. Numerous articles in recent years have raised the possibility of an infective factor, especially Chlamydia pneumoniae, in the development of atherosclerosis and its complications. The aim of this study was to assess the incidence of chronic C pneumoniae infection and its association with ischemic heart disease and atherosclerosis in a population of patients with ESRD awaiting renal transplantation. MATERIAL AND METHODS: The studied group consisted of 164 subjects: 99 ESRD patients (heart disease [HD] group) who were hospitalized for vascular access creation (27), pretransplantation nephrectomy (47), or kidney transplantation (25), and a control group of 65 subjects consisting of 50 healthy blood donors and 15 multiorgan donors. C pneumoniae was detected in vascular wall fragments, kidney biopsy specimens and peripheral blood monocytes using real time polymerase chain reaction (PCR). Serum immunoglobulin IgG and IgA anti-C pneumoniae antibodies were detected using Enzyme-linked immunosorbent assay (ELISA) and a lipid profile (cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides [TG]) was obtained. Data on cardiovascular disease events, smoking history, diabetes, hypertension, cause, and length of renal failure were collected and analyzed. The existence of atherosclerotic lesions was detected using ultrasound (US) Doppler examination of aortic bifurcation. Chronic C pneumoniae infection was diagnosed on the basis of detection of both IgA and IgG antibodies and/or the detection of C pneumoniae DNA in vascular wall fragments or peripheral blood monocytes. After a follow-up of 32 months, data on cardiovascular events and patient history were collected again. RESULTS: Chronic C pneumoniae infection affected 46.5% (46/99) of HD patients and 9% (6/65) of controls (P < .05). Among HD patients, 26.3% (26/99) had ischemic heart disease (IHD) versus 6% in the control group. Among C pneumoniae-infected HD patients, IHD was more frequent (39.1%) than in noninfected HD patients (15%; P < .05). Within the 32-month observation period of the HD group, cardiac pain was observed in 11 (24%; 11/46) infected patients versus 3 (5.7%; 3/53) patients without C pneumoniae infection (P < .05). Exacerbation of previously diagnosed IHD was observed in 8 (44%; 8/18) cases in the C pneumoniae-infected group versus 0 (0%; 0/8) in the uninfected patients (P < .05). CONCLUSIONS: Chronic C pneumoniae infection affects hemodialysis patients more frequently than healthy subjects. Hemodialysis patients with C pneumoniae infection are at the greater risk of exacerbation of existing IHD.

Adult↗
PubMedDate not supplied

Chlamydia pneumoniae infection: an additional factor for chronic allograft rejection.

INTRODUCTION: Chronic rejection (CHR) of organ allografts, one of the most significant problems in modern transplantation, is not fully understood. This study sought to evaluate the influence of selected parameters on late kidney transplant function. PATIENTS AND METHOD: The studied group consisted of eighty-six patients who received allogeneic transplants between 1988 and 1999 for leukocyte Chlamydia pneumoniae-DNA, immunoglobulin (Ig)A/IgG anti-C pneumoniae, blood lipids, ischemic damage in the donor and during organ preservation, HLA mismatch, and acute rejection episodes. RESULTS: Eighty-six patients were segregated as 26 patients (30%) with histologically proven chronic graft rejection (CHR[+]) and 59 patients (70%) without (CHR[-]). The presence of C pneumoniae-DNA in peripheral blood leukocytes was significantly more frequent in CHR(+) than CHR(-) group (46% vs 20%). Patients with leukocytes positive for C pneumoniae-DNA more frequently (50%) had CHR than patients negative for C pneumoniae-DNA (22%). CHR(+) patients showed significantly lower HDL levels (47 mg/dL vs 58 mg/dL) and higher triglyceride levels (193 mg/dL vs 148 mg/dL). To study the cumulative effect of differences between the CHR(+) and CHR(-) groups, we applied a multiple binary logistic regression analysis. An econometric model enabled us to calculate the probability of CHR for a given patient taking into account covariates chosen by means of stepwise selection: the presence of C pneumoniae-DNA in blood leukocytes, the use of continuous pulsatile perfusion in hypothermia, myocardial infarction occurrence, and triglyceride concentrations. CONCLUSION: The presence of C pneumoniae-DNA in peripheral blood leukocytes increased the risk of CHR, which may be predicted by a multifactor analysis of chosen parameters.

Adult↗
PubMedDate not supplied

Comparison of 1-year patient and graft survival rates between preemptive and dialysed simultaneous pancreas and kidney transplant recipients.

It is well known that the main decrease in graft and recipient survival rates is observed during the first 12 months after transplantation. Improving results during this period seems to be crucial for the late outcome. The aim of this study was to compare 1-year survival rates of dialyzed and preemptive pancreas and renal graft recipients and their graft function. From November 1999 to January 2005, 42 whole simultaneous pancreas and kidney transplantations (spktx) were stratified into group I (n = 13): recipients who received a preemptive pancreas and kidney transplant versus group II (n = 29): previously dialyzed spktx recipients. The mean time of dialysis for group II was 39 +/- 16.5 months. We assessed 1-year cumulative survival rates for recipients and grafts for each group. The 1-year cumulative survival rate for preemptive graft recipients was significantly higher than that for dialyzed patients before spktx (100% vs 69%; P = .05). For groups I and II 1-year cumulative graft survival rates for kidney grafts were 100% and 89%, respectively, and for pancreatic grafts 84% and 65.5%, respectively. There was a significant improvement in the 1-year survival rate of preemptive spktx recipients compared with patients dialyzed before spktx. However, 1-year pancreas and kidney graft function did not differ significantly between the groups.

Adult↗
PubMedDate not supplied

Prion disease and medical devices.

Prions are novel proteinaceous-infectious agents that have been implicated in transmissible spongiform encephalopathies. It is now generally accepted that noninfectious prion proteins are normally produced by the host and may undergo a conformational change to an abnormal, pathologic form, which appears to be responsible for disease symptoms. Many methods of decontamination and sterilization are claimed to be ineffective against prion proteins. Incidences of iatrogenic transmission of prions due to medical devices have been reported, and the recommended clinical practices when handling suspected cases are reviewed. Recent results with a peracetic acid based sterilant indicate that it may be a safe and effective means of prion inactivation on medical devices.

Animals↗