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Biomedical subjects

M Duvnjak

Publications and source records attributed to M Duvnjak.

29 records · Page 2Linked to original sources
PubMed1991

Dopamine agonists prevent duodenal ulcer relapse. A comparative study with famotidine and cimetidine.

The present study investigated both the healing rate (after four weeks) and the relapse rate (during six months) following treatment with the dopamine-like drugs bromocriptine (2.5 mg twice daily), amantadine (100 mg nocte), or with the H2 blockers cimetidine (800 mg nocte), and famotidine (40 mg nocte) in 124 patients with endoscopically proven duodenal ulcer (DU). The ulcer was completely healed in 27 (amantadine), 26 (bromocriptine), 23 (cimetidine), and in 24 (famotidine) patients. Relapse was noted in 34.7% (cimetidine) and 25% (famotidine) versus 11.7% (amantadine) and 7.7% (bromocriptine) DU patients. No significant difference was found in initial healing rates. However, the relapse rate in the cimetidine-treated group was significantly higher than in all the other test groups. Additional comparisons between all the treatment categories showed a significantly lower relapse rate with the dopamine-like agents. These important new results indicate that dopamine-like compounds are equally effective as H2 blockers in inducing DU healing and may offer a promising advantage over H2 blockers concerning their efficacy in preventing ulcer relapse in DU patients.

Adult↗
PubMed1991

The value of pancreatic pseudocyst amylase concentration in the detection of pseudocyst communication with the pancreatic duct.

The aims of the study were to compare the results of endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous cystopancreatography (PCP) in the detection of the communication between the pancreatic pseudocyst and the pancreatic duct, and to assess the reliability of the increased amylase concentration in the pseudocyst content as an indicator of the existence of communication between the pancreatic pseudocyst and the pancreatic duct system. Forty-three patients were included in the study. Pseudocystic fluid content was obtained by percutaneous aspiration. Twenty-four patients had pseudocyst amylase concentrations above 64 Wolgemuth units (WU), and 19 patients had less than 64 WU. The communication between pseudocyst and the pancreatic duct was determined in 22 patients by ERCP and in 13 patients by PCP, all in the group with increased pseudocyst amylase concentration. Due to high sensitivity and specificity of pseudocyst amylase concentration for the existence of pseudocyst communication with the pancreatic duct, we conclude that guided percutaneous aspiration of the pancreatic pseudocyst with the determination of amylase concentration in the fluid can replace ERCP as a method of choice for the detection of pseudocyst communication with the pancreatic duct.

Adult↗
PubMed1990

Influence of the degree of liver failure on portal blood flow in patients with liver cirrhosis.

Portal vein haemodynamics as demonstrated by the pulsed Doppler system were studied in 37 patients with cirrhosis who had been classified in three groups (A, B, and C) in accordance with the degree of liver failure. Maximal inner diameter of the portal vein was significantly lower in patients who were considered to be in good condition (group A) than in patients with moderate and severe liver failure (group B and group C) (p less than 0.001). A significant difference was also found between group A and group B and between group A and group C with regard to the portal blood velocity and portal blood flow (p less than 0.001). In accordance with the presence and size of the oesophageal varices, in patients with large varices the portal blood velocity and portal blood flow were significantly lower than in patients without varices (p less than 0.001), whereas maximal inner portal vein diameter was significantly higher (p less than 0.001). This study demonstrated that in patients with cirrhosis circulatory alterations in the portal vascular bed may be, at least in part, an indicator of the stage of liver disease.

Adult↗
PubMed1990

[Spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis and "tense" ascites].

In the study 52 patients with decompensated liver cirrhosis and "tense" ascites were included. According to the clinical picture, ascites cultures and the number of polymorphonuclears in cmm of the ascitic fluid, all patients were selected in one of the following groups: 1. group of patients with sterile ascites (28), 2. group of patients with spontaneous peritonitis (16), and 3. group of patients with bacterascites (8). The results have shown that the incidence of spontaneous peritonitis is much higher in the group of "tense" ascites patients than in the group of all patients with ascites, the ratio being 30.7% compared to 6% in all cirrhotic patients with ascites. Spontaneous bacterial peritonitis correlates with increased polymorphonuclears in the ascitic fluid (p less than 0.05), decreased pH values (p less than 0.0), and increased amounts of total proteins in the ascitic fluid (p less than 0.05). The lethality rate in the group of spontaneous peritonitis and sterile ascites was 43.7% and 7.1% respectively. Early diagnosis and, of course, adequate therapy are the main points in spontaneous bacterial peritonitis.

Adult↗
PubMed1989

[Evaluation of disorders of portal and total hepatic blood flow in patients with chronic diffuse liver diseases].

The total hepatic blood flow measured with radioactive colloidal gold and the portal blood flow with the echo-Doppler method were investigated in 19 healthy examinees and 63 patients with chronic diffuse liver diseases. In the group of healthy examinees, the average values of the total hepatic blood flow was 1254 +/- 231 ml/min and of the portal one 1104 +/- 227 ml/min. The lowest blood flow values were obtained in patients with decompensated cirrhosis, especially in the hepatic (704 +/- 186 ml/min) and the portal blood flow (562 +/- 198 ml/min). In all the groups of examinees, registered values of the total hepatic blood flow were significantly higher than the values of the portal blood flow. The relations of the values obtained by both methods, among groups, were similar. By both methods decreased values are not obtained in liver steatosis and chronic persistent hepatitis in relation to the normal values. In patients with more serious forms of chronic diffuse liver diseases (cirrhosis and chronic active hepatitis) significantly lower blood flow values than the normal ones were obtained. Both methods contribute to the investigation of liver circulation disturbances, liver function damages, and to the follow-up of the liver disease course. The possibility of an indirect evaluation of the arterial hepatic blood flow from the difference of hepatic and portal blood flows may mean a new approach to the investigation of pathophysiological liver occurrences.

Adult↗
PubMedDate not supplied

Assessment of value of pancreatic pseudocyst amylase concentration in the treatment of pancreatic pseudocysts by percutaneous evacuation.

The aim of our study was to determine the value of the percutaneous pancreatic pseudocyst evacuation. We assessed the relation between the amylase concentration of the pseudocyst contents and the final outcome of the disease treated by the percutaneous evacuation. Forty-three patients with a history of acute pancreatitis and pancreatic pseudocysts larger than 5 cm in diameter that persisted beyond 6 weeks were divided into four groups relative to the amylase concentration in the pseudocystic contents and the number of evacuations. The results show a good correlation between low amylase concentration in the liquid pseudocystic contents (less than or equal to 64 WU) and the healing rate after the percutaneous evacuation (p less than 0.001). The percutaneous evacuation of the pseudocysts failed in patients with increased amylase concentrations in the pseudocyst fluid regardless of the number of evacuations. We conclude that surgical treatment is indicated in patients who have amylase-rich pseudocyst contents.

Adult↗
PubMedDate not supplied

[New findings in the etiopathogenesis of ulcers and reevaluation of therapy].

The etiopathogenesis of ulcer disease is comprehensive and many experimental and clinical data failed to prove the primary cause of the disease. Although much has been learned concerning the pathophysiological mechanism which appear important in the development of ulcer disease, our present knowledge of the etiology of this disease is incomplete. Depression of the gastric acid secretion still remains the main treatment approach, although the cytoprotective drugs are interesting therapeutic challenge. Etiology of the peptic ulcer disease is not solved yet, but the defense mechanisms of the gastric mucosa are much more clear what will lead to better understanding of the defense mechanisms in the gastric cancer. Omeprazole is an interesting new drug healing peptic ulcer in almost 100% of the patients. A philosophic question may be asked: "Do we need to know the etiology of the disease in order to be able to treat it properly?" Omeprazole heals the ulcer and, in fact, we do not know its etiology. In the cost-benefit ratio, the most widely used drugs are still H2-receptor antagonists and sucralfate, and omeprazole is reserved for the patients with resistant ulcer disease, Zollinger-Ellison syndrome and severe reflux esophagitis.

Humans↗
PubMedDate not supplied

Factors predictive of the healing of pancreatic pseudocysts treated by percutaneous evacuation.

BACKGROUND/AIMS: Pseudocyst formation is a well-known complication of pancreatitis which develops over 1 to 4 weeks in approximately 15% of patients. Nearly one-third of pancreatic pseudocysts resolve spontaneously; however, if there is no resolution within six weeks, evacuation must be performed. The aim of this study was to prospectively assess the reliability of the following: etiology; location; amount of pseudocyst liquid; and concentrations of certain biochemical parameters (LDH, glucose, proteins, sodium, potassium, bilirubin, lipase and amylase) in the pseudocyst content and patients' serum, in terms of the efficacy of ultrasound-guided percutaneous evacuation as a therapeutic approach. METHODOLOGY: Pseudocyst fluid was obtained by ultrasound-guided percutaneous evacuation in 67 patients, with a history of pancreatitis and pancreatic pseudocysts larger than five centimeters in diameter, with a matured membraneous wall that persisted for more than six weeks. RESULTS: There is a prognostic value associated with the location of the pseudocyst, the amount of pseudocyst liquid and the concentration of proteins, potassium, lipase and amylase in the evacuated material. CONCLUSION: Analysis of the aforementioned parameters provides an early forecast of the outcome of percutaneous evacuation.

Adult↗