Biomedical subjects

J Sándor

Publications and source records attributed to J Sándor.

At least 19 recordsLinked to original sources

PubMed2001

[Mortality of breast cancer and frequency of mammography in Hungary].

The Hungarian breast cancer mortality is above the European average. Because of the lack of effective primary prevention, the control has to be based on the improving results of treatment which is much more successful in the case of early detected cancers. Beyond the patients collaboration and the application of the recommended diagnostic protocols, the population based screening programs have high importance in achieving earlier diagnosis. This study aimed to describe the regional differences of mammography's application as an indicator of diagnostic and screening performance. The records of the outpatient services' reports containing the code for native X-ray examination of the breast were analysed in the period of 01/07/1998 to 30/04/2000. The age specific and the age standardised relative frequencies of mammographical examination were determined for the Hungarian counties and Budapest. The observed age specific frequency of mammography for the whole country was 17, 21, 11 and 4% for the age group of 40-49, 50-59, 60-69 and 70-74 years, respectively. The lowest observed values were 10 times smaller than the highest ones in every studied age group. The age standardised relative frequency of mammographical examination was higher than the national average in Tolna (2.52), Borsod-Abaúj-Zemplén (1.48), Zala (1.41), Baranya (1.33), and Csongrád (1.27) counties and in Budapest (1.35). The described data demonstrates that the Hungarian practice of mammography is far from acceptable considering the frequency of application. On the other hand, it was also explored that serious geographical differences exist within the country. It seems that there are providers that can achieve relative successes in diagnosing the breast cancers in as early stage as it is possible. The evaluation and utilisation of the experiences of these providers could increase the efficacy of interventions organised to improve the Hungarian epidemiological status of breast cancer.

Adult↗

PubMed2001

Plasma concentration of myeloperoxidase enzyme in pre- and post-climacterial people: related superoxide anion generation.

Neutrophil granulocytes are involved in the pathogenesis of atherosclerosis also through their free radical generation. The aim of the study was to test how extracellular levels of myeloperoxidase (MPO; a granulocyte enzyme playing role in free radical production) change by age and what effect this change has on the production of the free radical superoxide anion by neutrophils. We also wanted to examine whether the antioxidant effect of different steroid hormones is realized through the MPO. Plasma myeloperoxidase concentrations of healthy blood donors were quantified by ELISA. Superoxide anion production was measured by photometry. Myeloperoxidase concentration was significantly lower in plasmas obtained from older women and men than in those from younger subjects. Adding the MPO inhibitors 4-aminobenzoic acid hydrazide (ABAH) and indomethacin to the granulocytes, the generation of superoxide anion increased and the decreasing effect of the steroids on superoxide production was inhibited. Incubating the neutrophils with the product of the reaction catalyzed by MPO itself (hypochlorite anion), we found significant decrease in superoxide generation. According to our results MPO seems to diminish the production of superoxide anion and so probably has an antioxidant ability. Therefore, its lower plasma levels may contribute to the increasing incidence of atherosclerosis and other free radical mediated disorders in old people. Thus, after further studies MPO might become one of the indicators of cardiovascular risk and the scavenger capacity in general.

Adult↗

PubMed2001

[Stomato-oncological screening examinations: possibilities for early diagnosis]

The dramatic increase in the mortality of lip- and oral cancers in Hungary in the last decades points to the importance of primary and secondary prevention. Stomato-oncological screening examinations belong to the latter category, and might represent useful tools in the early diagnosis and treatment of oral carcinomas and precancerous lesions. The aim of the paper is to review the methods, results and effectivity of stomato-oncological screening examinations in Hungary. Between 1962 and 2000 nine screening examinations were performed: one on a population sample, one in an industrial setting, four connected to X-ray lung-screening examinations (one with the help of a mobile unit), one on voluntary persons, one on high risk people (homeless), one in general medical practice. Among these, in the last five years, in the course of the stomato-oncological examination of 17325 individuals, oral carcinoma has been found in 0.12%, and oral precanceroses in 2.63%. Although the general dentist is obliged by law to perform a stomato-oncological examination on the patients appearing in the practice, unfortunately, about 50-to-90% of the population does not visit a dentist regularly. The regular examination of these - high risk - groups by the help of the above methods, including the help of general medical practitioners is highly recommended.

Journal Article↗

PubMed2001

[Surgery without boundaries].

Surgery at the turn of the century and at the millennium is characterised by an extremely rapid development. There are no boundaries anymore among the different branches of medicine, in different anatomical regions of the human body, between the living human and the artificial tissues, between the reality and the virtual reality. Nanotechnology and robotics offer new possibilities for minimally invasive procedures. By the introduction of telepresence surgery there are no more surgical limits among countries and continents, between Earth and Space as well. A new chapter in history of medicine is the Cyber Surgery. The future has already arrived. Even in this new world we have to follow the ethical requirements summarised in the Hyppocrates Oath.

Ethics, Medical↗

PubMed2000

Intraabdominal abscess managed successfully via the laparoscopic approach.

A rare complication of laparoscopic fundoplication-an intraabdominal abscess located between the fundus and the caudate lobe of the liver-is described. A 41-year-old man had undergone a laparoscopic Nissen-Rossetti fundoplication for longstanding gastroesophageal reflux disease. On the 5th postoperative day, the patient's general condition became worse, and he developed intermittent-remittent fever (40 degrees C), an elevated white blood cell count (WBC), and an accelerated sedimentation rate. Evidence of leakage was excluded by Gastrografin swallow. The diagnosis was finally revealed by means of ultrasound and computed tomography (CT) scan, which showed an intraabdominal fluid collection with an air cap of ~10 cm in diameter situated between the diaphragmatic crura, the caudate lobe of the liver, and the gastric fundus. The location did not allow semi-invasive management of the abscess, such as ultrasound or CT-guided puncture and drainage. On the 8th postoperative day, a laparoscopic exploration was performed utilizing the previous port sites. The adhesions were easily dissected, and evacuation of ~300 ml of white, dense fluid, and lavage and drainage were performed without intraabdominal dissemination of pus. The patient was discharged on the 12th postoperative day free of symptoms. Microbiological examination of the pus showed the presence of Peptostreptococcus. The patient remained symptom free. At 8 weeks postoperatively, barium swallow, endoscopy, 24-h pH monitoring, and stationary manometry of the esophagus yielded normal results. Because there was no direct evidence of leakage at the fundus, the development of the abscess was concluded to be due to the use of deep transmucosal stitches rather than seromuscular ones to create the wrap. The nonabsorbable multifilament suture material passing through the entire gastric wall could have facilitated bacterial contamination of the operative field.

Abdominal Abscess↗

PubMed2000

Surgery in Hungary.

After providing data on the geography and demographics of Hungary, the 1100 years of Hungarian history are briefly surveyed. The introduction, development, and present state of medical education and, in particular, surgical education, including specialty training, are discussed. Attention is devoted to the organization of the surgical community and of surgical manpower in the country. Various disease patterns and their influence on surgical practice are discussed. Attention is also devoted to health care provision and research activity. Finally, the future of surgery, especially general surgery, is outlined.

Curriculum↗

PubMed2000

Allelic polymorphism of GSTM1 and NAT2 genes modifies dietary-induced DNA damage in colorectal mucosa.

Typically, cancer is caused by the interaction of genetic and environmental factors. In colorectal carcinogenesis, diet and nutritional habits are the most important external risk determinants. Allelic polymorphisms of certain metabolizing enzymes may have an influence on cancer risk by modifying the concentration of active carcinogenic compounds in the body. In the present study we investigated the interaction between nutritional and genetic susceptibility factors in human colon carcinogenesis. Healthy volunteers were divided into four groups, based on allelic polymorphisms of N-acetyltransferase 2 and glutathione-S-transferase M1 enzymes. Comet assay was used to determine the level of DNA strand breaks in exfoliated colorectal mucosal cells, following a 2-day vegetarian diet, and after switching to a 2-day 'high-meat' diet. The 'high-meat' diet statistically significantly increased the amount of single-strand breaks in rapid acetylators and among individuals with a GSMT1 + genotype, while it caused only a slight and not significant increase in the other groups. Our study emphasizes the importance of using susceptibility markers in cancer epidemiology, since environmental effects are strongly modified by these genetic factors.

Alleles↗

PubMed2000

Reproductive rights in Hungarian law: a new right to assisted procreation?

Hungary has a mixed record in terms of fulfilling reproductive rights as a whole, but in the context of artificially assisted procreation, it provides reproductive health services far beyond those offered by its neighbors, beyond what is stipulated by the ICPD Programme of Action, and, arguably, beyond the internationally accepted parameters of reproductive rights. Recent legislation on assisted procreation has established important new regulations and formulated a new "right to continuation of infertility treatment" applicable to women who have been widowed or divorced. The new legislation is examined in the context of the international reproductive rights movement, with comparisons to other European countries and with reference to Hungarian attitudes and laws on abortion and surrogacy.

Abortion, Legal↗

PubMed1999

[Prognostic value of the presence of the mutation of the codons 12, 13 and 61 in K-ras oncogene in colorectal cancer].

Despite of extensive and intensive investigations, the predictive and prognostic value of c-K-ras mutation is not unequivocal. There has been reported about investigation the occurrence of mutations in the 88 colorectal cancer patient's specimen using polymerase chain reaction. Age: 61.9 years (27-80), gender 8 male, 42 female. Dukes' stages: 43 at the B, 35 at C, 10 at D. Primary of tumour: 52 colon, 36 rectal adenocarcinoma. Mutation out of one of the three ras-codons was detectable in the 54 cases, more frequently at the stage Dukes' C (p < 0.05). The ras-mutation concerned to more elevated death-rate in the stages Dukes' B and C (p < 0.01). Mean survival time to progression was significantly longer at the stage Dukes' B if mutation had not been detected (p < 0.01). The occurrence of the rate of genetic alteration was significantly more frequent at tumours of right-side colon, than left side (p < 0.02) or rectum (p < 0.05) one's. However, at the age of 41-50 years it was significantly more presented at the cases of rectal cancer (p < 0.01). At the age of 51-60 years mutations were detected among men at higher rate (p < 0.05). The cases of local recurrences concerned by mutation at the codon of 13 (p < 0.05). Occurrence of ras-oncogene is the sign of extremely malignant potential of tumour. This fact manifested itself in the time to progression and mean survival time of patients at same clinical or pathological stage. The higher frequency of genetic alterations at the proximal colon may be the reason of more unfavourable prognosis of the disease localised to this site. Reconstructing the molecular events, the presence of ras mutation can serve as a basis for prognosis of the disease and permit of potentially individualised therapeutic intervention.

Adult↗

PubMed1999

[Epidemiologic study of regional inequalities].

The technological achievements of the recent years and the need for more advanced control of the processes within the health sector have supported the geographical epidemiology to become a distinct branch of epidemiology. The combined application of the simple standardized rates, statistical tests and different corrected risk parameters is able to describe the health status for geographically defined, small populations. Several statistical processes have been elaborated to estimate the number of the false positive results and to evaluate the role of chance in predicting the observed geographical pattern. These data completed with the usual risk measures quantify the risk difference within a broader region and determine the actual risk levels for the investigated small areas. The routine data processing system operating as a part of the public health surveillance identifies the high risk areas (the clusters) and without leaving the framework of routine data handling investigates the association between basic exposure data and health risks producing additional data about the nature of the aggregation of health related events. All the spetially varying etiological factors (environmental effects, social status, traditions, regional features of the health sector etc.) are ready to elicit regional alterations in the health status. The aim of the geographical information system is to cover the consequences of the uneven distribution of these factors. Since these kind of etiological factors play significant role in the generation of the most important public health problems in Hungary, and it is known that the small area inequalities are profound for these health impairments, the more extensive application of geographical information systems is expected to improve the efficiency of the control for public health problems and the performance of preventive medicine.

Data Interpretation, Statistical↗

PubMed1999

Transcranial Doppler-determined pulsatility index in the evaluation of endoscopic third ventriculostomy (preliminary data).

OBJECTIVE: Endoscopic 3rd ventriculostomy has become the method of choice in the management of occlusive hydrocephalus. The treatment is accompanied by significantly less peri-operative complications than the cerebrospinal fluid shunting procedures previously employed. Close surveillance of patients, however, is necessary to avoid the consequences of raised intracranial pressure that may develop in case of obstruction of the artificial outlet of the 3rd ventricle. The aim of this study was to confirm the value of transcranial Doppler-determined pulsatility index (PI) in the assessment of the patency of endoscopic 3rd ventriculostomy and to elucidate its usefulness in early postoperative recognition of increased intracranial pressure. METHODS: In twenty-two patients suffering from occlusive hydrocephalus, transcranial Doppler sonography (TCD) was performed before, immediately after, and five days after endoscopic fenestration of the floor of the 3rd ventricle. PI was defined with fast Fourier transformation. Mean PI values were determined in both middle cerebral arteries (MCA), over five cardiac cycles. RESULTS: In nineteen cases, PI values showed a significant decrease immediately as well as five days after the intervention as compared to the pre-operative values, and flow-sensitive MRI confirmed the patency of the fenestration in all cases. In one patient the operation failed to produce an effective diversion of cerebrospinal fluid as shown by flow-sensitive MRI, and the pulsatility index was unchanged. In two patients, a significant immediate postfenestration drop in PI was followed by a recurrence of PI to pre-operative levels without any clinical deterioration. CONCLUSIONS: Preliminary results suggest that the transcranial Doppler-determined pulsatility index is a useful non-invasive tool for the evaluation of the patency of the fenestration in the early follow-up of patients who underwent endoscopic third ventriculostomy.

Adolescent↗

PubMed1999

The history and the future of teaching and training of laparoscopic surgery in Hungary.

INTRODUCTION: Laparoscopic biliary surgery was introduced in Hungary at the end of the 1990. A variety of experimental training and teaching courses had been performed in basic techniques and the human field, which was followed by laparoscopic biliary surgery and various advanced fields. AIMS OF THE STUDY: To review the history of teaching and training of laparoscopic surgery in Hungary in both the experimental and the human field, and to draw the consequences of this experience. MATERIAL AND METHODS: In a period of 6 years 704 qualified surgeons received a full hands--on hands experimental training in laparoscopic biliary surgery, laparoscopic advanced surgery, laparoscopic gynaecologic and laparoscopic urology surgery. DISCUSSION: The courses performed in the first and the second phase were of theoretical and practical components. The theoretical knowledge was based with emphasise to the new instruments and equipment, the indications, the new surgical technique. The practical knowledge gave every participant the full time to acquire this new type of surgery. At the end of the courses the successful participants received certificates to shift for training to the human field. Each institution needs to wrestle with issues concerning credentialling in advanced laparoscopic surgery. Like many technical skills, proficiency is maintained through repetition. A philosophy must be developed to determine whether each surgeon will perform this highly specialised type of surgery or whether it will be considered a general skill.

Animals↗

PubMed1998

Biliary tract complications in laparoscopic cholecystectomy. A multicenter study of 148 biliary tract injuries in 26,440 operations.

BACKGROUND: The higher risk of biliary tract injury is considered the most significant disadvantage of laparoscopic cholecystectomy. METHODS: A national multicenter retrospective study was performed to determine the frequency, etiology, and treatment of biliary tract injuries between January 1, 1991, and December 31, 1994. Follow-up was by questionnaire. RESULTS: Some 148 biliary tract complications were observed during 26,440 laparoscopic cholecystectomies. There was no significant correlation found between the number of LCs performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage, but in the 2nd year of practice, the incidence of both complications decreased. In institutes with more conversions, more cases of bile leakage were also observed. A significant positive relationship was found between biliary tract injuries and postoperative bile leaks. There was no significant relationship between usage of intravenous and intraoperative cholangiography and ERCP. In univariant analysis of the type of injury, the primary treatment modality did not affect the outcome of injury or entail the necessity of reoperation. Obscure anatomy leads to significantly more main bile duct injuries. According to multivariant analysis, the outcome is significantly influenced unfavorably by the necessity of repeated interventions and advanced age. CONCLUSIONS: The definitely higher risk of bile duct injury mentioned in early studies was not confirmed.

Adolescent↗

PubMed1996

[New possibility in inguino-femoral hernia repair: laparoscopic herniaplasty].

The development of minimally invasive surgery brought up the challenge: to repair the frequent inguino-femoral hernias laparoscopically. The authors performed 65 laparoscopic hernioplasties in one year: "transabdominal preperitoneal" technique was used in 61 cases und "intraperitoneal onlay mesh" in 4 cases. Fifty-three patients were operated on, 12 of them had bilateral hernias. Recurrent hernia was the indication in 22 patients (34%). The average operating time was 102 and 144 minutes in the unilateral and the bilateral cases, respectively. There was no wound infection, or general complication. Spontaneously dissolving seroma/hematoma of the spermatic cord was noticed and detected by ultrasound in 5 patients (7.7%). The neuralgia caused by the irritation of the nerves of the region in 4 patients (6.1%) disappeared without sequels after treatment with vitamins B. The 2 early recurrences (3.2%), considered to be caused by technical inexperience, these patients were treated successfully with the "intraperitoneal onlay mesh" technique. In the authors' opinion there are definite advantages of laparoscopic hernioplasty, namely the minimal postoperative pain, early mobilization, shorter hospital stay and early restoration of full physical activity (in 1-2 weeks) as well as the known disadvantages of this technique (narcosis, longer operative time, intraperitoneal procedure, higher costs).

Adult↗

PubMed1996

[Geographic distribution of mortality from myocardial infarct in Baranya County].

The acute myocardial infarction is one of the leading causes of death in Hungary. The geographical epidemiology is able to quantify the possibilities of preventive activities and to ascertain the target groups for intervention. On the basis of the analysis of standardized data from Baranya county, the mortality rate is 3.16 times higher in the settlements of the lower quartile compared to the rate in the settlements or higher quartile. This relative risk is equivalent with 68% of etiologic fraction. The results demonstrate that there are a group of settlements where local factors predominate the etiologic background of the myocardial infarction. The maps determine the actual clusters calling for some intervention. It seems to be very urgent task for the Hungarian public health organizations to fit the routine cluster investigation into the general public health practice since there is a definite demand for doing it.

Cluster Analysis↗

PubMed1996

Long-term clinical results of highly selective vagotomy performed between 1980 and 1990.

A retrospective analysis was conducted of 778 patients who underwent highly selective vagotomy between 1980 and 1990. Surgery was performed for duodenal ulcers without any complications in 485 (62.3%) patients; for duodenal ulcers with complications such as stenosis, bleeding, or perforation in 270 (34.7%); for combined duodenal and ventricular ulcers in 12 (1.5%), and for ventricular ulcers alone in 11 (1.4%). Pyloroplasty was additionally performed in the presence of complications only. The incidence of intraoperative complications proved to be as high as 1.4%, occurring in 11 patients, while postoperative complications developed in 247 patients (31.7%). Although the overall mortality was 0.6% (5 patients), the mortality rate of those patients who underwent surgery for uncomplicated ulcer disease was 0.2% only (2 patients). The patients comprised 554 men (71.2%) and 224 women (28.8%) with an average age of 41.4 +/- 0.7 years. The average duration of duodenal ulcer disease was 9.5 years, and 643 (83.2%) of the patients were able to be regularly followed up for between 3 and 13 years. Recurrence developed in 62 patients (9.6%): in the duodenum in 57 patients (91.9%), and in the stomach in 5 (8.1%). The rate of recurrence according to sex was 9.4% in men and 10.3% in women, being 42 and 20 patients, respectively. The average duration until recurrence appeared was 27.06 +/- 3.44 months. A reoperation proved necessary in 28 of these 62 patients (45.1%). The clinical results were evaluated by means of a modified Visick classification, according to which 81.8% of the patients belonged to groups 1 or 2, 7.9% to group 3, and 10.3% to group 4.

Adult↗

PubMed1995

[The function of the p53 gene suppressor in carcinogenesis].

The alteration of the p53 gene or protein seems to be the most frequent alteration in the human malignancies. It plays a significant role in the regulation of the physiological cell division. The genetic impairments caused by a series of exogenous or endogenous agents induce the activation of the p53 which results in the G1-S arrest to ensure the opportunity for repair to correct the alteration or in apoptosis when the repair is not able to cope with the mutation. Eventually, the p53 is anticarcinogenic because of its genom guarding function. The investigation of the behavior of this gene and protein is fruitful in solving problems of preventive, diagnostic and therapeutic work.

Apoptosis↗

PubMed1995

[Laparoscopic cholecystectomy and cancer of the gallbladder].

Performing a series of 960 laparoscopic cholecystectomies we have removed 3 unsuspected gallbladder cancers. In one case we have observed the development of trocar site abdominal wall metastasis twice. After resection and reresection of the metastases the patient is symptom-free in the 14th month. During laparoscopic cholecystectomy if there is a suspicion of gallbladder cancer we have to manipulate with special care to avoid rupture of the gallbladder. In doubtful cases frozen section is mandatory. If the malignant process extends over the serosal layer--conversion and radical-extended operation is recommended.

Abdominal Muscles↗