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L Harsányi

Publications and source records attributed to L Harsányi.

At least 19 recordsLinked to original sources
PubMed2001

Technical modifications for improving the success rate of PEG tube placement in patients with head and neck cancer.

BACKGROUND: Patients with head and neck cancer (HNC) benefit from nutritional support by means of PEG tubes, but endoscopy may be impossible when there is partial or complete trismus and/or stenosis or occlusion of the upper aerodigestive tract. METHODS: PEG tubes were placed in 277 patients with HNC. Oral insertion of an endoscope into the esophagus was impossible in 27 patients. Transnasal endoscopy was performed (n = 4). In the cases of high-grade tumor obstruction, the endoscope was introduced into the esophagus through a straight laryngoscope (n = 9). When upper aerodigestive tract occlusion was present, endoscopy with PEG placement was successfully performed during surgery by means of the opened pharynx after tumor resection (n = 12). RESULTS: In 25 of the 27 cases PEG tubes could be placed by using the above alternative techniques. There were no immediate complications, and no complications occurred within 30 days of PEG placement. CONCLUSIONS: Transnasal, straight laryngoscopic, or intraoperative open endoscopy can improve the success rate for PEG tube placement in patients with HNC.

Adult↗
PubMed2001

[Successfully operated infraperitoneal hemangiopericytoma infiltrating the left ureter].

Hemangiopericytoma is a very rare tumour originating from the lining cells of small vessels. Despite benign histology it is clinical presentation similar to malignancy. There are only less than hundred cases reported sporadically in the literature. Authors report a case and successful radical removal of an infraperitoneal hemangiopericytoma infiltrating the left ureter. The literature of this strange, rare pathology is also analysed in the article.

Adult↗
PubMed2001

[Rare indication for surgery: liver metastasis of planocellular laryngeal cancer].

This is a report of a successfully operated case of a solid liver metastasis developed following radical total laryngeal extirpation. The biological characteristic of the laryngeal cancer is also discussed from the surgical point of view. We underline the importance of a detailed, regular control of patients with malignancies and encourage of active surgical treatment of solid metachronous liver metastases.

Carcinoma, Squamous Cell↗
PubMed1999

[Percutaneous endoscopic gastrostomy: experience of three years].

UNLABELLED: Patients who are not able to eat do need tube feeding. The most preferred way of artificial enteral nutritional support is feeding via percutaneous endoscopic gastrostomy (PEG) tubes. Head and neck cancer patients do represent a special group of patients needing a PEG. On the one hand at the time of admission to the hospital they are mainly undernourished. On the other hand the failure rate of placing a PEG is the highest among them. Furthermore in the perioperative period nasogastric tubes do cause a lot of complications in these settings. 188 PEG placements were carried out from July 1995 till November 1998. INDICATIONS: head and neck cancer (n = 171), neurologic disorders (n = 17). PEG tubes were placed 76 times during intratracheal narcosis and 112 times following local anaesthesia. 39 times there was a prior abdominal surgery in our patients medical history. The pull-through, the push-wire and the introducer techniques were used. Beside the usual oro-gastric way of endoscopying (n = 163), 25 times the following alternative ways of entering the upper gastrointestinal tract were used: transnasal route (n = 4), through a Kleinsasser type direct laryngoscope (n = 7) and via the opened pharynx (n = 14). No immediate or late onset procedure related complications occurred. During a follow-up of 22,480 tubedays 26 minor (dermatitis n = 24, ulcer n = 2) and 8 major (abscess n = 4, perforation/peritonitis n = 3, stomach and bowel wall necrosis n = 1) complications occurred. The success rate of placing a PEG was 98.9%. In head and neck cancer patients placing a PEG is suggested when there is a need for at least a 7 days time tube-feeding. Using the described alternative ways, a PEG tube can be placed almost always. Because of the uncertain outcome, nutritional support via PEG tubes is suggested also in cachectic patients and in vegetative state as well.

Enteral Nutrition↗
PubMed1999

[Difficulties of artificial nutrition in short bowel syndrome].

The authors expound the case of a 47 years old woman who was operated on 25 months ago for bowels necrosis caused from occlusion of arteria mesenterica superior. The operation was composed of a partial jejunale resection, total ileum resection and a right side hemicolectomy, the residual part of the intestine (jejunum) is 70-80 cm. Eleven months after the operation her status has got worse with 10-12 watery faeceses, abdominal pain and body weight losing (15 kg in 2 months). In the beginning a complete central parenteral and enteral nutrition was necessary. The authors expound the complications connected with the nutrition and the successful rehabilitation of the patient as well. They built her nutrition gradually completed with oral given nutriment. The nutritional status of the patient now is adequate and she is able to do the housekeeping.

Colectomy↗
PubMed1999

Clinical nutrition in liver and pancreatic diseases.

According to international and national surveys, 5-15% of patients admitted to hospitals require partial or total artificial nutrition. The development or progression of malnutrition influences patients' lives significantly and also increases the costs of their treatment substantially and unnecessarily. Nutrition therapy, meaning a balanced intake of food or provision of nutrients, is an essential part of the critically ill patient's care. The proper concern of physicians today is not whether nutritional support is indicated in hepatic and pancreatic diseases, but when and how it should be given. Author, therefore, gives guidelines to the nutritional therapy of patients suffering from liver and pancreatic diseases since their metabolic support still remains the most challenging problems in clinical nutrition.

Humans↗
PubMed1997

In vitro amylase release of preserved pancreas: a simple test to assess the viability of pancreatic allograft during preservation in the pigs.

To determine an in vitro marker of viability during pancreatic preservation, 12 pigs underwent total pancreas harvesting, and graft were stored in Euro-Collins or Belzer perfusion solution for up to 24 hours. Amylase concentration of the storage solution was analyzed in regular periods and tissue samples were taken for acridine-orange histochemical evaluation of viability in the same time. In vitro pancreatic amylase release (IU/g pancreas tissue) was calculated from the volume of solution and the weight of graft. A significant increase of amylase release was found in the course of preservation in both media. Comparing amylase release in different solutions we found significant difference between Euro-Collins and Belzer media (4 hours: 6.45 IU/g vs. 2.2 IU/g, 8 hours: 11.5 vs. 3.58, 24 hours: 8.7 vs. 42.8, respectively). Comparison of amylase release with histochemical evaluation of viability showed strict correlation. We concluded that amylase release is a good marker for exocrine tissue destruction as well as viability of preserved pancreas. Our data confirms that Belzer solution is superior in pancreatic preservation. It is suggested that after adaptation into human model in vitro pancreatic amylase release could be a time- and cost-saving, useful method in predicting pancreatic transplant function prior graft implantation.

Acridine Orange↗
PubMed1997

Pancreatic pseudocysts associated with chronic pancreatitis--early and late results of 1367 operations.

The authors hereby review the data of 1367 operations for pancreatic pseudocysts. The surgical procedures of choice in particular pancreatic pathologies are analysed in the light of early morbidity and mortality, as well as long term follow-up results. The best operations for pancreatic pseudocysts have been the internal drainage procedures, which resolve the pathological alterations without the necessity of pancreatic resection. The treatment of chronic pancreatitis may require combined surgical procedure, such as cysto-Wirsungo-gastrostomy. The pancreatic resections performed for the treatment of small pseudocysts in the pancreatic head have been superseded by the less invasive blunt, forced cysto-duodenostomies, representing better results secondary to the smaller perioperative risk for the patient. The cyst-to-stomach and cyst-to-duodenum internal drainage techniques are just as effective, but with shorter operation time, than the Roux-en-Y cysto-jejunostomies.

Adult↗
PubMed1997

Multimodality treatment of pancreatic pseudoaneurisms.

Vascular lesions of pancreatitis manifest in the form of haemorrhage into the pseudocyst (PC), the development of pseudoaneurisms (PA) or splenic lesions. Between 1987 and 1996 31 patients were found to develop vascular lesions either in the form of haemorrhage into a PC (12) or PA (19). Diagnosis of pancreatic PA was established preoperatively in 8 cases only. Gastrointestinal (GI) bleeding manifested in 12 patients, but only in 6 of them was the pancreatic origin of the bleeding considered. All patients were operated. For the management of the lesions resection of the pancreas (11 cases) or ligation of the bleeding vessel with external or internal drainage of the PC was performed (12 cases). Simple external drainage of a haemorrhaged PC in 3, and cystoduodenostomy or cystogastrostomy was performed in 5 cases respectively. Intraoperatively moderate bleeding gave some concern (7 cases), while post operatively pancreatic fistula developed in 9 patients drained externally. All stopped spontaneously. In two cases severe GI bleeding occurred post operatively. In both cases embolization of the bleeding vessels was performed successfully. No operative mortality occurred. The mean follow-up time was 40.6 months (5-106). Five patients died of unrelated causes, 3 patients underwent subsequent pancreatic operation, and 74.2% of the patients are doing well. Development of pancreatic PA was associated with a longer observation or conservative treatment period. Angiography should be considered whenever severe upper GI bleeding occurs in patients with known pancreatic disease and the source of bleeding is obscure. In selected cases selective embolization of the bleeding site may provide definitive treatment.

Aneurysm, False↗
PubMed1995

A detailed study on suicides in Baranya County (Hungary).

Suicidal deaths which occurred in Baranya County, Hungary between 1983 and 1987 were investigated with regard to biodemographical aspects. The number of suicidal deaths for this period was 1056 and the rate for this region was higher in villages than in towns. The male: female ratio was 3:1. The analysis of age groups showed that the rate increased with age and that the most frequent method was by hanging (50-55%). Moreover in 375 cases in-depth interviews were made with the relatives. The analysis of the interviews showed that 20% of elderly males could not cope with their losses and found no way out except through suicide. Suicide was less frequent among persons with intellectual occupations. Severe alcohol abuse was found in 165 cases. In 83% of the 1056 cases studied, pathological disorders of varying severity were observed. Toxicological analysis was performed in 810 cases but 17.9% of these cases should be isolated since they involved acute drug intoxication. Our data showed that most of the suicide victims contacted a doctor and received some treatment immediately before death or not long before. The present health and geriatric care systems in Hungary do not provide a level of psychotherapeutic care which could protect the population at risk from suicide. In our opinion, it would be reasonable to develop the knowledge of practitioners and health care personnel working in this field.

Adult↗
PubMed1995

Gastrocystoplasty, a wrong choice in an adult case.

A 28-year-old woman presented a huge vesico-vagino-rectal fistula after radiotherapy because of a gynecological tumour. Reconstruction consisted of a colostomy, closure of the rectal hole with a pedicled perineal skin graft, a bivalve opening of the bladder and, with the two valves coverage of the vaginal suture line, and augmentation gastrocystoplasty. The fistulas healed but the patient suffered from an intolerable burning sensation, that is why the stomach wall was removed and uretero-ileo-cutaneostomy was created. The colostomy was closed, and the patient now has a well functioning urine stoma.

Adult↗
PubMed1991

[The effect of two different methods of jejunal feeding on pancreatic function].

Pancreatic juice was continuously diverted from the Wirsungial duct by nasopancreatic drainage of the remnant of the gland after pylorus preserving partial pancreato-duodenectomy in 14 patients. On the 7th postoperative day with stabilized pancreatic secretion the juice was collected in 10 min fractions, while interdigestive secretory phases of the parenchyma were established by volume changes. At the beginning of a phase 100 ml slightly hyperosmolar (400 mosmol/L) oligopeptide diet with 90 kcal was given as a bolus injection for 7 patients or 60 min infusion into the second jejunal loop by fine needle catheter jejunostomy for 7 patients also. Pancreatic water, bicarbonate, protein, chymotrypsin, amylase levels peak, and integrated secretory responses were measured. It was observed, that infusion of the diet did not disturb cycling interdigestive phases and did not increase peak and integrated outputs. Bolus administration interrupted interdigestive phases and stimulated pancreatic water, bicarbonate, protein, chymotrypsin and amylase outputs nonparallelly. On the basis of their data authors concluded, that pancreatic secretion seems to be well preserved without duodenalregulatory mechanisms; and continuous jejunal infusion feeding seems to be useful in pancreatic disease and in other postoperative states when pancreas has to be put into rest.

Enteral Nutrition↗