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Biomedical subjects

L Kiss

Publications and source records attributed to L Kiss.

196 records · Page 11Linked to original sources
PubMedDate not supplied

Respiratory analogue computer model.

An analogue computer model has been constructed to simulate the dynamic behaviour of the human cardiorespiratory system for studying the effect of changes in different system-variables--as alveolar ventilation, functional residual capacity (FRC) of the human lung and the cardiac output--on the partial pressure of carbon dioxide in the arterial and mixed venous blood (pCO2a, pCO2v). The respiratory analogue computer model (RACM) simulates reliably well-known clinical physiological as well as pathological phenomena. Reducing FRC or breath rate an oscillation of pCO2a has been developed, but the mean value has not been changed. In alveolar hypoventilation the pCO2 of blood increases in good conformity with the clinical experience. Reducing cardiac output a characteristic dissociation appeared: pCO2v and pCO2a diverged from each other by increasing pCO2v and decreasing pCO2a. Since in general clinical practice of intensive care only arterial blood gas values are checked regularly, the conclusion that the patient's condition is improving by decreasing pCO2a is a serious misinterpretation in this case, because peripheral tissues are in balance with the increasing venous carbon dioxide tension, and consequently cannot get rid of this toxic agent. The computer-model-based conclusion has led to the practice of sampling both arterial and venous carbon dioxide tensions for better state assessment of seriously ill patients.

Carbon Dioxide↗
PubMedDate not supplied

[Injuries to the duodenum and pancreas in 42 operated cases].

42 consecutive patients who sustained injuries to the duodenum or/and pancreas were admitted to our hospital. Over a twenty year period 32 blunt injuries and 10 penetrating injuries were encountered. Penetrating injuries were always suspected and treated by time: following blunt injury diagnostic delay was encountered in 14 patients and insufficient surgical procedure because of intra-operative misinterpretation in 2 patients. Most of the patients had associated intra-abdominal organ injuries. Adjusts to diagnosis such as abdominal roentgenograms, serum amylase levels and gastroduodenography was not helpful. CT scan and ultrasound allowed to confirm the suspected diagnosis in 3 cases only. Intraoperative diagnosis was also challenging. Complete mobilization of the strictures surrounding the duodenum and the pancreas to provide entire exposure was necessary in 12 patients treated first in a peripheral hospital, diagnosis of the injury have been missed at first laparotomy and reoperation was necessary in all of them. Suture closure of the duodenum and drainage of the pancreatic region wee the most common reparative techniques used. More complicated procedures with pancreatic and/or duodenal resection were performed in 12 patients. Overall mortality in patients surviving more than 24 hours was 14%. Suture live dehiscence after delayed operation (4) and 2 deaths due to brain injury.

Adolescent↗
PubMedDate not supplied

[The intraoperative colonic irrigation in emergency surgery].

Bowel preparations is frequently impossible in various ante colonic diseases, such as left-sided colonic obstruction. The goal of intraoperative colonic irrigation is to obtain, during surgery, a bowel preparation offering the possibility of primary resection with immediate anastomosis, when preoperative bowel preparation has not been feasible. Technical aspects of intra-operative colonic irrigation are described. Indications for this methods are presented: left-sided obstructing carcinomas, diverticulitis, more rarely inflammatory stenosis or functional obstruction. The surgical management of left colonic emergencies has evolved in the past few decades. Recently, there has been increasing interest in resection with primary anastomosis in selected cases. The post operative mortality rate was 13 per cent. The incidence of clinical anastomotic leakage was 6.65 per cent.

Carcinoma↗
PubMedDate not supplied

[The diagnostic strategy in abdominal trauma].

Diagnosis of a deep visceral lesion in an adult following abdominal contusion is almost always difficult as the abdominal signs are later or masked by associated lesions. All of the controlled studies agree on the superiority of peritoneal puncture-lavage over metrosonography or CT scan in the diagnosis of homeoperitoneu. The diagnostic performance of CT, TDM in the identification of lesions solid organs is very much better that that of ultrasonography. The diagnosis of an isolated lesion of a hallow viscus benefited from progress in imaging to a much lesser degree an peritoneal puncture lavage with leucocyte count remains the key examination. The diagnostic strategy must be based on the patient's clinical condition and on this hierarchy of complementary investigations.

Abdominal Injuries↗
PubMedDate not supplied

[Observations regarding lymphatic gastric drainage in malignant gastric pathology through intra-operatory lymphography].

The authors became interested in the lymphatic drainage of the stomach in order to attempt to determine for each region the type of drainage and the risk of cancer spread. They studied 50 dissection, including the stomach, 115 cases records of gastric carcinoma, 8 lymphographies by ultrafluid lipiodal, and 48 preoperative injections of vital colorant. The system of drainage proposed by Rouvière was on the whole confirmed; however, one should emphasize the doubling of the hepatic chain, the existence of long collectors which bypass a relay in the left gastric artery, the importance of the posterior gastric artery which transmits the lymphatic of the splenic chain. Finally, the authors emphasize the existence of 3 longitudinal areas on the stomach where the presence or absence of valvules in the subserous collectors orients the lymph towards the lesser or greater curvature of the stomach, which easily explains the onset of isolated carcinomatous adenopathy, situated on the curvature opposite the neoplasm.

Coloring Agents↗
PubMedDate not supplied

[Observations regarding surgical treatment in liver trauma].

The high mortality rate in hepatic trauma is a concern for the surgeons on duty, who most know the physiopathological problems and the decisions needed in view of both hepatic and extrahepatic injures. The mortality rate from liver trauma has fallen from 60% at the beginning of this century, blunt trauma to the abdomen from accidents, is responsible for 80-90% of all liver injures in Europe. The severity of liver injuries in 268 patients in a prospective study (1978-1998), were treated according to a defined protocol. Non operative management was used in first day, for those who were haemodynamically stable on admission. In unstable patients who proceeded to surgery, under optimal condition the mortality rate was 34.3%. Death in patients with multiple injures should only rarely result from liver trauma. 92 patients with minor injures (grade I-II) were treated by simple suture, with mortality rate of 6%. 116 patients (43%) sustained complex hepatic injures (grade III to V); 64 patients with grade III (23%), 36 with grade IV (13%). 16 Patients (5%) grade V, injury under went finger fracture of hepatic parenchyma alone 36. The mortality rate in this group was 18% (III), 36% (IV). 16 patients with grad V injury were managed with 68% mortality rate. Juxtahepatic veins and retrohepatic V.C.I. injury continue to carry a prohibitive mortality rate (90-100%).

Adolescent↗
PubMedDate not supplied

[Acute colonic pseudo-obstruction or Ogilvie syndrome].

Acute colonic pseudo-obstruction is a clinical condition with the symptoms, signs and radiological appearances of acute large bowel obstruction but without any apparent mechanical cause. The mortality rate for patients undergoing surgery was 57%. The incidence of caecal-perforation was 1 for 7 patients. The pathogenesis of the syndrome is unknown but in more then 80% of cases many conditions that have been associated with this syndrome. The efficacy of prepulsid agents for the treatment of syndrome remains to be assessed in a controlled study. In our patients clinical observation, radiologic studies and direct observation during several hours of surgery had shown a complete lack of propulsive motility within of the large bowel. This can be related to the ganglionitis and later to the aganglionosis of the mesenteric plexus.

Aged↗
PubMedDate not supplied

[Long-term prognostic value of positive peritoneal washing in colon cancer].

UNLABELLED: We examined the prognostic value of free malignant cells in the peritoneal cavity of patients with colon adenocarcinoma. In 1996-1999, 88 patients underwent peritoneal washing with cytologic analysis immediately before elective colon resection for adenocarcinoma with no evidence of peritoneal metastases. Peritoneal washing fluid was collected before abdominal exploration centrifuged immediately and stained with the May-Grünwald-Giemsa and Harris-Shorr methods. Malignancy was defined as recommended by Papanicolaou. Free malignant cells in peritoneal fluid were found in 25 of 88 (28%) patients (Dukes A 0, of 11, Dukes B 10 of 31, Dukes C 11 of 37, Dukes D 4 of 9). The positive rate was 24 of 75 (32%) among patients with tumors involving the serous layer and 1 of 13 (8%) among the others (p = 0.00989). Positive peritoneal washing was not significantly associated with survival in multivariate analysis. CONCLUSION: The presence of free malignant cells in the peritoneal cavity of patients with colon cancer provided no further prognostic information relative to the Dukes classification in this study. The 5 years survival rates were 48% among patients with positive and negative peritoneal washing respectively (p = 0.09).

Adenocarcinoma↗
PubMedDate not supplied

Developing nurse managers in Hungary.

Success in the work of nursing administrators can be realized only if they have their own sphere of competency and authority. In the Hungarian management system, however, nursing administrators are only functional leaders; they do not have authority for decisionmaking nor do they have a major leadership role. Most hand in proposals and carry out decisions made by the general director/chief physician or other leaders of the hospital. Below, an overview of the present status of Hungarian nursing administrators and a suggested new structure of management that would provide nursing administrators with a full and independent right of decision, which would greatly improve the efficiency of nursing care.

Decision Making, Organizational↗
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[French adaptation, concurrent validation and factorial analysis of the Bech and Rafaelsen melancholia scale].

33 depressive patients diagnosed major depressive episode (DSM III) have been assessed by the French translation of the melancholia scale of Bech and Rafaelsen and the following scales: scale of depressive retardation (ERD) (Widlocher), Hamilton depression rating scale with 26 items (HDS 26), Montgomery and Asberg depression rating scale (MADRS). A concurrent validation shows that Bech-Rafaelsen melancholia scale is valid. A principal components analysis with VARIMAX rotation found 4 principal components: retardation and blunted affect, asthenia, anxiety, suicidal impulses.

Adult↗
PubMedDate not supplied

[The incidence of emergency thoracotomy in thoracic trauma. 7000 cases of thoracic trauma (T.T.) treated in the period of 1978-1995].

With intensive care, pleural drainage and judicious physiotherapy most thoracic injuries can be treated adequately. We reviewed the experience with urgent thoracotomy, to compare the relative indications and injury pattern after blunt versus penetrating trauma. Among 7000 patients with thoracic trauma (T.T.), excluding 319 resuscitative thoracotomy, 83 required urgent thoracotomy. A thoracotomy was necessary in 14% of the patients with blunt thoracic trauma, and 33% with penetrating trauma. Thoracotomy for penetrating trauma was performed earlier and had better results than thoracotomy for blunt trauma. Seventy-five percent of penetrating trauma were operated in the first hour after admission against 29% of blunt trauma. Postoperative mortality for penetrating trauma was three times lower than for blunt trauma (18% versus 56%). Surgical procedure depends on the type and extend of the thoracic and general injuries and on the patients general condition.

Emergencies↗