Intramural duodenal hematoma complicating acute necrotizing pancreatitis.
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Acute Disease↗
Biomedical subjects
J Tóth
Publications and source records attributed to J Tóth.
The impact of radiotherapy on the incidence and time of occurrence of local recurrence in early-stage breast cancer after breast conserving therapy.
There is still little information on the delay of local recurrence after conservatively treated and irradiation breast cancer. To evaluate the impact of radiation therapy (RT) on the incidence and on the time of occurrence of ipsilateral breast tumor recurrence (IBTR), we reviewed the treatment results in 415 women with UICC Stage I or II unilateral breast cancer. All underwent breast conserving surgery (BCS) and full axillary dissection between 1983 and 1987. Out of them 309 patients were irradiated and 106 were not. The median dose of RT was 50 Gy in five weeks to the whole breast. Systemic therapy, when it was given, consisted of 6-cycles of CMF for node positive premenopausal women and 20 mg tamoxifen for three years for postmenopausal women. The median follow up time was 120 months in survivors. The 10-year actuarial IBTR rate was 36.6% for the nonirradiated and 9.1% for the irradiated women (p = 0.0000); 48.6% for patients treated with CMF and 4.2% for those treated with CMF plus RT (p = 0.0051); 29.0% for patients treated with tamoxifen and 7.9% for those treated with tamoxifen plus RT (p = 0.0318). The patient's age and the presence of an extensive intraductal component (EIC) were both highly associated with the likelihood of tumor recurrence in the treated breast. Patients under 41 years of age had an actuarial 10-year IBTR rate of 75% without RT and 17. 1% with RT (p = 0.0006). Women with an EIC positive tumor had an IBTR rate of 88.9% when RT was not given and 27.2% when RT was given (p = 0.0003). In invasive lobular cancer, irradiated patients had a IBTR rate of 2.3%, compared to 53.2% for nonirradiated patients (p = 0.0008). RT resulted in a significant delay in the appearance of IBTR (p = 0.0250) and the median time was increased by 20.0 months. We conclude that RT has the property of not only preventing but also delaying IBTR. In invasive lobular tumors the risk of IBTR is very high when RT is omitted, but BCS plus radiation therapy is effective treatment. Patients wih EIC positive tumor are at high risk of IBTR even when a median dose of 50 Gy is given to the whole breast.
Adult↗
[The role of intraoperative gamma-probe-guided sentinel lymph node biopsy in the treatment of malignant melanoma and breast cancer].
In the treatment of malignant tumors regional lymphadenectomy is used for two purposes. It is used partly for staging the regional lymph nodes which is a significant and independent prognostic factor and determines the need for adjuvant oncologic treatment and partly for achieving locoregional disease control. Removal of tumor-free lymph nodes by regional lymph node clearance is unnecessary according to our current knowledge. Since the sensitivity and specificity of non-invasive clinical examinations are insufficient in predicting the nodal status the histological study of the regional lymph nodes cannot be abandoned. A new and minimally invasive surgical procedure, the mapping and removal of the first tumor draining lymph node, the sentinel node provides the possibility of pathological nodal staging without performing formal lymphadenectomy. Mapping of the sentinel node can be performed by the use of a radioisotope and intraoperative hand-held gamma-probe or a vital blue dye or a combination of these two. This latter method was used by the authors in 73 patients (25 with malignant melanoma and 48 with breast cancer). Sentinel lymph node biopsy was performed successfully in 92% of patients with melanoma and 90% of patients with breast cancer. In three breast cancer patients the sentinel node inaccurately predicted the axillary status as negative, but is was in 93% accurate in predicting the histologic nodal state. According to our preliminary experiences intraoperative gamma-probe guided sentinel lymph node biopsy is considered a feasible procedure in both malignant melanoma and breast cancer. More experiences are needed before introducing this method in the routine clinical practice.
Biopsy↗
[Our experience with Transjugular Intrahepatic Portosystemic Shunt (TIPS)].
The transjugular intrahepatic portosystemic shunt is a relatively new interventional procedure for the treatment of portal hypertension. It helps to stop the hemorrhage from varices. Decreases the risk of rebleeding and the quantity of ascites. 32 patient underwent the intervention from the May of 1995 until October of 1998. Majority of cases belong to Childs'B and C type. In the anamnesis there were 24 alcoholic cirrhosis. Shunt patency, complications and survival were analyzed. TIPS was successfully placed in 27 patients (84%). Portocaval pressure gradient decreased from 22 mmHg to 10.3 mmHg. There was no treatment related mortality. The average follow up was 14 months. In two patients the stents are patent for 36 months. Two stents became stenotic and there were nine occlusions within three years. Hepatic encephalopathy occurred in two cases. The TIPS is a safe, alternative interventional radiological therapy in the cure of portal hypertension without the mortality and morbidity of an open surgical procedure. By the use of TIPS the portosystemic gradient decrease successfully and can be ruled.
Adult↗
[Brachytherapy of the tumor bed after breast conserving surgery: new radiotherapeutic option in the management of early breast cancer].
PURPOSE: To initiate fractionated, interstitial high dose rate brachytherapy of the tumour bed as the sole radiation modality after breast conserving surgery. PATIENTS AND METHODS: In 41 cases of selected stage I-II breast cancer the tumour bed was marked with titanium clips during breast conserving surgery. The tumour bed was implanted with flexible plastic catheters to deliver postoperative radiotherapy. In 8 cases 7 x 4.33 Gy (30.3 Gy), in 33 cases 7 x 5.2 Gy (36.4 Gy) interstitial 192Ir high dose rate brachytherapy was given to the clipped area. Irradiation of the whole conserved breast was omitted. The radiation side effects were assessed by mammograms and MRI-examinations. RESULTS: At a median follow up of 17 (4-36) months neither distant nor regional failure was observed. Local recurrence was detected in 1/41 (2.4%) case. G2 radiation side effects were observed in 2/21 (9.5%). CONCLUSIONS: Postoperative sole brachytherapy of the tumour bed with careful patient selection and adequate quality assurance seems to be a feasible alternative to whole breast teletherapy. Sole brachytherapy shortens the time of radiotherapy from 5-6 weeks to 5 days, and reduces the costs of treatment. The skin and volume sparing effect of interstitial irradiation may decrease the side effects of radiotherapy.
Adult↗
Calculation of the BET Compatible Surface Area from Any Type I Isotherms Measured below the Critical Temperature.
It may occur in practice that the nitrogen isotherm should be measured at 77 K only in order to determine the Brunauer-Emmett-Teller (BET) specific surface area [as(N2, 77)]. This fact has given cause for an elaborate method to calculate the value of as(N2, 77) from Type I isotherms measured on any adsorbents at any temperature. Since Type I isotherms are measured most often in practice the proposed method makes it possible to calculate the value of as(N2, 77) from isotherms of adsorptives which are the actual topics of the investigations. Thus, in these cases the determination of nitrogen isotherms at 77 K can be omitted. The proposed method is based on the Tóth (T) equation and on its modified and extended forms. In these equations are present the parameters chim, chio, and t with the following physical meanings: chim and chio are integral constants originating from the Gibbs equation integrated between definite limits of pressure and coverage and t is a parameter characterizing the heterogeneity of the adsorbents. The parameters chim and chio assure the thermodynamic consistence of these relationships. It is proven that the parameters (chim)1/t and (chio)1/t depend only on the structure of adsorbents (micro-, mezoporous, or smooth surfaces). These parameters, calculated from Type I isotherms measured under the critical temperature of the adsorptives, are the bases of the calculation of the BET compatible surface areas. Copyright 1999 Academic Press.
Journal Article↗
Separation of the First Adsorbed Layer from Others and Calculation of the BET Compatible Surface Area from Type II Isotherms.
In the previous paper it has been proven that a BET compatible specific surface area, asc(N2, 77), can be calculated from any Type I isotherm measured below the critical temperature. In this paper it is proven that the same calculation can be performed from any Type II isotherms if the isotherm has a pure monolayer domain. In order to distinguish the mono- and multilayer adsorption the relative free energy of the surface as a function of the adsorbed amount, pir(ns), and the functions psi(pr) and psi(ns) are applied, both defined by the differential expression (ns/pr)(dpr/dns). When the multilayer adsorption becomes the dominant process then the function pir(ns) has a point of inflexion and functions psi(pr) and psi(ns) have maximum values. It has been demonstrated that in most of the Type II isotherms the mono- and multilayer domains can be separated, so the monolayer component isotherm can be calculated by the T (Tóth) equation. Therefore, it is possible to calculate the BET compatible specific surface area discussed in detail in the previous paper. It has also been proven that there are Type II isotherms which describe only multilayer adsorption; i.e., the functions psi(pr) and psi(ns) do not have maximum values. In these cases the Harkins-Jura equation should be applied. Copyright 1999 Academic Press.
Journal Article↗
Sperm collection from shot red deer stags (Cervus elaphus) and the utilisation of sperm frozen and subsequently thawed.
Sperm samples were collected from the epididymides of 11 hunter-killed stags (Cervus elaphus hippelaphus) within 2 to 17 h post mortem in September 1991. Progressively motile spermatozoa were diluted and deep-frozen in tris-yolk extender by a procedure routinely used for bovine semen. The pre-freezing motility of spermatozoa from 6 stags was higher than 80%, while the sperm of 5 animals was found to be unsuitable for dilution. In the post-thawed sperm of six stags 40-50% of the spermatozoa showed progressive motility and the number of viable spermatozoa ranged from 8.6 to 26.7 x 10(6) per 0.25 ml straw. Two years later, three hinds were superovulated by the use of a progesterone-releasing intravaginal device (CIDR type G, Carter, Holt Harvey Plastic Products Group Ltd., Hamilton, New Zealand) for a period of 14 days and with follicle stimulating hormone (Folicotropin inj., Spofa, Prague). Each hind was inseminated artificially 60 h after the withdrawal of CIDR with thawed sperm injected into the uterus via the vagina. Seven days later the uteri were flushed out, as a result of which 3 early blastocysts + 1 ovum, 3 morulae + 4 ova, and 1 morula + 7 ova, respectively, were recovered from the three hinds. Deer embryos were frozen according to a glycerol-based freezing protocol. A further two years later two hinds were oestrus-synchronised with CIDR type G and 300 IU PMSG (Folligon inj., Intervet, NL), and two of the thawed embryos were transplanted into two recipient hinds 7 days after heat. One of these gave birth to a normal stag fawn in June 1996. This was the first deer born in Hungary from embryo transfer. The results obtained indicate that sperm from top stags shot in the course of hunting can prove useful for the preservation of genetic material or in the development of the farmed deer system.
Animals↗
Sole brachytherapy of the tumor bed after breast conserving surgery: a new radiotherapeutic strategy for patients at low risk of local relapse.
The aim of the study was to test the hypothesis, if there were subgroups of early breast cancer patients in which sole brachytherapy (BT) of the tumor bed was a feasible and safe treatment option after breast conserving surgery (BCS). Forty four prospectively selected patients with Stage I-II breast cancer were entered into a protocol of postoperative tumor bed irradiation using interstitial high dose rate (HDR) implants. The HDR fractionation schedules were calculated according to the linear quadratic model. In 8 patients 7 x 4.33 Gy, in the other 36 patients 7 x 5.2 Gy were delivered to the tumor bed with 2 cm margin. The treatment planning was based on the 3 dimensional (3D) reconstruction of the clipped excision cavity, catheters and skin points. A conformal semi-3D dose planning was used. The side effects were assessed by mammograms, MRI- and clinical examinations. At a median follow up of 20 (7-36) months 1 (2.3%) local and 1 (2.3%) regional failure was observed. Distant metastasis did not occur. The cosmetic results were judged to be excellent in each case. G2 radiation side effects were observed in 2 (4.5%) cases. Postoperative sole BT of the tumor bed with careful patient selection and adequate quality assurance seems to be a feasible alternative to whole breast radiotherapy after BCS. Sole BT shortens the time of radiotherapy from 5-6 weeks to 5 days, and reduces the costs of treatment. The skin and volume sparing effect of interstitial irradiation may decrease the side effects of radiotherapy. A randomized study is in progress to define which subgroups of patients should be candidates for BT alone after BCS.
Adult↗
[Study of the contractility of the gallbladder by ceruletide infusion cholescintigraphy after litholysis].
Twenty-six randomly selected patients 2-6 years (mean: 3.5) after rapid percutaneous catheteric litholysis at the Radiological Department were investigated by quantitative Ceruletide cholescintigraphy in this pilot study. The average EF of the patients with recurrent gallstones (Group II) was lower (55 +/- 23%) than that of the patients without stones (69 +/- 23%) (Group I). The authors conclude that this scintigraphic method could help not only to select the best method to make patient stonefree but has an important role in forecasting the prognosis of gallstone recovery after litholytic therapy.
Ceruletide↗
["Open abdomen" in the treatment of necrosis in acute pancreatitis].
Eleven cases of acute necrotic pancreatitis had been treated by "open abdomen" at the author's departments. Nine patients survived, but 2 patients had been lost in MOF. Indication, technics and complications are discussed. The author's opinion is, that--on the basis of a suitable indication--"open abdomen" is a good method in the treatment of the necrosis in acute pancreatitis.
Abdomen↗
Clinical renal allograft transplantation in a Dalmatian dog: case report.
A case of successful renal allograft transplantation performed in a two-year-old female Dalmatian dog suffering from end-stage chronic renal failure is reported. A one-year-old male German shepherd with severely injured spinal cord was used as kidney donor. Simultaneous kidney allograft transplantation combined with hypothermic initial perfusion as graft conservation was done, placing the donor kidney into the right iliac fossa of the recipient. The immunosuppression protocol consisted of prednisolone and azathioprine. Regular physical, laboratory, ultrasonographic and scintigraphic examinations were used for assessing both the morphology and the function of the allograft. After a two-week period of hospitalisation the patient was discharged in a remarkably improving condition. The recipient died on postoperative day 45 of respiratory insufficiency resulting from secondary pneumonia and pulmonary oedema. Neither macroscopic nor microscopic abnormalities of the allograft were revealed by necropsy.
Animals↗
Paraintestinal mesenteric abscess and chronic peritonitis in a bull.
A 2-year-old bull was examined because of intermittent anorexia, signs of mild colic, and weight loss of 3 weeks' duration. A tympanitic resonance (ping) could be heard during simultaneous auscultation and percussion of the right paralumbar fossa, and a mass could be felt in the right dorsal quadrant of the abdominal cavity during palpation per rectum. Right flank laparotomy was performed, and intraoperative ultrasonography and ultrasound-guided fine-needle aspiration were used to determine that the mass was an abscess. However, the abscess could not be removed or drained into the colon because of extensive adhesions to other organs. Because the owner refused to pursue continued medical treatment, the bull was euthanatized. At necropsy, the abscess was found to be connected to a caudal mesenteric lymph node through a fistula. Histologic evaluation of the lymph node revealed hyperplastic lymphadenitis, and an alpha-hemolytic streptococcus was recovered from the abscess fluid. The most likely possibility for the findings in this bull were that the lymphadenitis was of hematogenous origin and that the abscess developed as a direct extension of the infectious process, similar to development of mesenteric abscesses in horses with chronic streptococcal infection (i.e., strangles).
Abdominal Abscess↗
[Experience with benazepril, a long-acting ACE inhibitor, in the management of diabetic hypertension].
The therapeutic advantage of the long acting ACE-inhibitor benazepril in a 12 weeks intervention period on 23 diabetic (3 IDDM, 20 NIDDM) patients with essential hypertension was studied. Participants-giving informed consent before beginning the study-on the base of repeated casual blood pressure measurements were divided into "slightly" (n = 8) and "moderately" (n = 15) hypertonic groups. Type of diabetes, time elapsed since its manifestation, actual antidiabetic therapy, period of existence of the hypertension (newly discovered vs known and treated for a time) were independent from the point of view of entering the study. Initial dose of benazepril was 5-10 mg/day depending on the blood pressure level, followed by a stepwise dose elevation according to the control investigations (at weeks 2, 4, 8 and 12 casual blood pressure control, at weeks 4 and 12 ambulantory blood pressure monitoring, ABPM as well) to a maximal daily dose of 20 mg. In the majority of patients benazepril was given in a morning single dose, in some cases because of a better tolerability divided into two parts. 20 patients received benazepril in monotherapy, 3 patients combined with other antihypertensive preparations. Parameters indicating severity of hypertension-hypertonic time index, hyperbaric impact-showed significant improvement already at week 4 when analysed in the total of patients and the moderately hypertonic group respectively. As a tendence the same was observed also in the slightly hypertonic group. No remarkable side effects, or alterations of the metabolic state and in the investigated laboratory parameters appeared. Based on these results benazepril is an effective choice in the treatment of diabetic hypertensive patients.
Angiotensin-Converting Enzyme Inhibitors↗
[Change of trend in the treatment of type 2 non-insulin-dependent diabetics].
Medical opinion about the significance of non-insulin-dependent diabetes has been recently changed for three reasons: epidemiological evidence about the continuously increasing disease-prevalence, accumulation of new intriguing details on the pathophysiology of the disease, and the growing clinical evidence about the importance of accelerated atheromatosis related to any stage of the disease. The new theoretical approach resulted in some new aspects of therapeutical management as well. There is an emphasis on the early recognition, the very strict metabolic control and the individualized form of the therapy. Well organized regular medical care for the diabetics, recognition and effective treatment of comorbidities (dyslipidemia, high blood pressure), self-involvement of the patients in the management (ie. patient education) are the corner stones of this approach. The authors give a short review about the armamentura of the therapy available nowadays, including rules of indication for different sulfonylurea drugs, combined sulfonylurea-insulin treatment and single insulin regimes as well.
Arteriosclerosis↗
[Hematologic abnormalities in pulmonary tuberculosiss].
This study surveys the extent and severity of haematological abnormalities which occurred in 380 patients with pulmonary tuberculosis. Full blood count, bone marrow aspiration smears, and bone marrow trephine biopsy was analyzed by authors. Anaemia was present in 32 percent of patients. Leucocytosis with neutrophilia occurred in 18 percent. Leucopenia with neutropenia, and lymphopenia was observed in 16 percent in patients with very severe clinical tuberculosis. Elevated platelet count occurred in 8 percent with deep vein thrombosis in legs in 50 percent. Dysmyelopoietic syndrome was diagnosed in one case by bone marrow trephine biopsy. There was a close correlation between the haematological abnormalities and the severity of clinical findings of pulmonary tuberculosis. This survey has revealed that haematological abnormalities are relatively common in severe pulmonary tuberculosis. It seems that body weight loss, white blood cell count, haemoglobin level and erythrocyte sedimentation rate are useful indices of severity of the tuberculosis. The return of these indices to a normal level is a good indication of disease control in that they correlate with sputum conversion to acid-fast bacilli negative.
Anemia↗
Investigation of effect of lesser curvature seromyotomy of the stomach in animal experiments.
The effectiveness of seromyotomy of the lesser curvature of the stomach--the simplified version of proximal selective vagotomy--was investigated in eleven dogs. Decreased acid secretion was proved with congo red test and pH measuring by glass electrode. No significant damage to the motor function of the stomach was found with scintigraphy. Histological examinations revealed neurofibre degeneration peripherally to the seromyotomy line after peripheral vagotomy and vacuolar degeneration in the ganglion cells and amputation neuromas in the seromyotomy line.
Animals↗
New aspects in the pathology of the preneoplastic lesions of the larynx.
In our 5-year biopsy study (1991 95) 51% of keratoses and 16% of adult-onset papillomas contained certain degrees of dysplasia. Koilocytosis associated with HPV infection was prominent in papillomas and the majority of keratosis but negligible in cancer. Using mouse monoclonal antibody against human p53 we detected by immunohistochemistry mutated p53 overexpression not only in cancer but in some cases of keratoses and papillomas. CD44 is a multifunctional integral cell membrane glycoprotein and is found in many mesenchymal, epithelial and tumor cells. CD44 has a great number of splice variants, isoforms supposedly implicated in development, progression and metastasis formation of tumors. Using monoclonal antibody to CD44 our study suggests that the expression of pan CD44 at successive stages of human laryngeal carcinogenesis gives preliminary information about the selection advantage to the tumor cells.
Adult↗