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Biomedical subjects

M Fried

Publications and source records attributed to M Fried.

At least 55 records · Page 3Linked to original sources
PubMed2001

[The development of bariatric surgery and the role of the First Surgical Clinic of the General Medical School Hospital and the First Medical School of Charles University in Prague in this specialty].

The authors discuss the development of bariatric surgery in Europe and the USA from its beginnings at the onset of the fifties. More detailed attention is paid in particular to the development of the method of gastric bandings and the role at the First Surgical Department in this field in "classical" as well as miniinvasive surgery. Results of gastric banding are summarized in 683 patients operated since 1983, in particular the numbers of early and late complications after laparotomies and laparoscopic operations, similarly as complications which are directly associated with gastric banding itself. In the conclusion it is stated that the First Surgical Department of the General Faculty Hospital and First Medical Faculty Charles University in Prague belong as regards their results in surgical treatment of obese subjects and the position in the field of bariatric surgery on an international scale to the foremost departments in this field worldwide.

Czech Republic↗
PubMed2001

[Percutaneous electrogastrography in the perioperative period in laparoscopic gastric banding at the First Surgical Clinic of the General Faculty Hospital in Prague].

Percutaneous electrogastrography (EGG) is a method which makes non-invasive follow-up of the myoelectric gastric activity possible. The authors present the results of assessment of the myoelectric gastric activity during the perioperative period in patients undergoing, at the First Surgical Clinic General Faculty Hospital, laparoscopic non-adjustable gastric banding. The data were recorded using a Microdigittrapper and evaluated using spectral analysis and Fourier's transformation. The authors mention also briefly conditions which must be met to ensure the study, and the physiological and pathophysiological background of the method. In 14 patients the ECG record was made 24 hours prior to surgery and then 5 hours, 24 and 48 hours after surgery on fasting and after a fluid bolus. The assembled results of the dynamics of perioperative changes on the EGG were compared with results obtained in a group of healthy volunteers. The most frequent finding during the early postoperative period was bradygastria, the return to preoperative values occurred on average 48 hours after surgery. Percutaneous electrogastrography is a non-invasive method which can provide the surgeon during the early postoperative period with information on myoelectric gastric activity.

Adult↗
PubMed2001

[History and present status of surgical treatment of morbid obesity].

Problems of extreme and morbid obesity take on constantly considerable relevance in 21st century. The prevalence of the obesity (BMI--Body Mass Index > 30 kg/m2) is still on the increase worldwide. In the Czech Republic approximately 16% of male and 20% of female in the age of 20-65 years are obese (BMI > 30 kg/m2). To begin with the effective cure is always indicate in case of the obesity over BMI > 30. The bariatric surgery is indicating in the occurrence of failure of conservative care of morbidly obese patients with recurrences of overweight. The morbid obesity with serious associate health complications often represents the vital danger of the patient's life. The development of the bariatric surgery passed from resections of the bowel, gastric bypasses, biliopancreatic diversions, horizontal gastroplasties to in the present the most frequently used methods as the vertical bandage gastroplasty (VBG) and the gastric bandage (GB). The standard applications of the miniinvasive laparoscopic methods with significant decrease of postoperative complications radical changes of the bariatric surgery in the present years.

Biliopancreatic Diversion↗
PubMed2001

[Surgical treatment of morbid obesity--gastric banding].

Approximately 16% of male and 20% of female of the age from 20 to 65 years are obese in the Czech Republic. The restrictive bariatric procedure of stomach--gastric banding (GB) is one of possibilities to cure the morbid obese patients after failure of conservative therapy. The ratio of complications (5-18%) after GB presenting in various papers is comparable with the ratio of complications (4-23%) in others bariatric procedures. From 1993 to 1999, 517 morbid obese patients (mean BMI 51.1) underwent laparoscopic nonadjustable gastric banding (LNGB) at 1st Surgical Department, Charles University Teaching Faculty Hospital in Prague. As the early complications (during hospitalization) offered swelling of the gastric mucous in the place of GB in 5.6% (n = 29), the oesophagitis, the gastritis or the gastric ulcer in 1.5% (n = 9) and perforation of the stomach wall in 0.6% (n = 3). As the late complications offered the bleeding from peptic ulcer in 0.4% (n = 2), sequential migration of gastric band through the stomach wall inside in 0.6% (n = 3) and the slippage of anterior stomach wall or the dilatation of the pouch above gastric bandage in 5.1% (n = 26). The serious complications in 6.3% (n = 32) claimed surgical procedures. Other complications in 7.5% (n = 39) have been treated conservatively. The 86% (n = 446) of obese patients after LNGB were without complications.

Adult↗
PubMed2000

Phase I chemotherapy study of biochemical modulation of folinic acid and fluorouracil by gemcitabine in patients with solid tumor malignancies.

PURPOSE: This phase I biochemical modulation study evaluated the maximum-tolerated dose (MTD), toxicity, and effectiveness of the combination of folinic acid (FA)/fluorouracil (5-FU) followed by escalated dose levels of gemcitabine (FFG) in patients with advanced solid tumors. PATIENTS AND METHODS: Patients were refractory to primary treatment and/or without effective treatment options. Twenty-eight patients received an intravenous (IV) infusion of FA 100 mg/m(2) over 1 hour and a 5-FU 450 mg/m(2) IV bolus in the middle of the FA infusion. After the FA infusion, gemcitabine was administered at a steady rate of infusion of 10 mg/m(2)/min over initially 30 minutes and with increases of an additional 15 minutes at each given level. One cycle consisted of six weekly treatments followed by a 2-week rest. RESULTS: The MTD of gemcitabine was established at 900 mg/m(2) given over 90 minutes. Eight patients of 21 with metastatic colorectal cancer achieved responses (one complete response; seven partial responses), for a response rate of 38%. Responses were seen across the gemcitabine doses of 300 to 900 mg/m(2). One patient had prior treatment with FA/5-FU for advanced disease. Patients with colorectal carcinoma had a median survival of 18 months, and the patient with lung carcinoma has been alive for 24+ months. CONCLUSION: The combination chemotherapy of FFG was well tolerated and may benefit patients with advanced colorectal carcinoma. A phase II evaluation in this patient population is in progress.

Adult↗
PubMed2000

[Cyanosis and cirrhosis of liver: hepatopulmonary syndrome].

A 66-year-old man with Child-B alcoholic cirrhosis presented with melaena due to hemorrhagic gastritis. Clinical examination revealed cyanosis and clubbing accompanied by severe hypoxaemia without signs of obstructive or restrictive lung disease. Contrast-enhanced echocardiography showed right to left shunt due to intrapulmonary shunting leading to the diagnosis of hepatopulmonary syndrome. Hypoxaemia in patients suffering from chronic liver disease can have different causes but in the presence of cyanosis and clubbing without signs of lung disease the hepatopulmonary syndrome should be suspected. When presence of intrapulmonary shunts has been proven by contrast-enhanced echocardiography, a 100% oxygen test can determine the need for pulmonary angiography and thus determine the indication for interventional therapy or liver transplantation. The patient described was treated supportively with long-term oxygen therapy 6 l/min. Three months later his clinical condition was stable. An attempt to reduce the need for nasal oxygen failed.

Aged↗
PubMed2000

Isolation and genomic analysis of the human surf-6 gene: a member of the Surfeit locus.

The human Surfeit locus contains at least six tightly clustered genes (Surf-1 to Surf-6) of which five (Surf-1 to Surf-5) have been characterised and found not to share any sequence homology. The organisation and juxtaposition of the Surfeit genes are conserved between human and mouse. The Surf-6 gene that encodes a novel nucleolar-matrix protein with nucleic-acid binding properties has been characterised in mouse. In this work, we have isolated and analysed the human Surf-6 homologue and determined its genomic organisation in the Surfeit locus. The human Surf-6 gene has five exons spread over a distance of 4.3kb and has features of a housekeeping gene being ubiquitously expressed, having its 5' end located within a CpG rich island and lacking a canonical TATA box. The intragenic region between the 3' end of the Surf-5 gene and the 5' end of the Surf-6 gene is 3.2kb and contains a pseudogene of the ribosomal protein gene rpL21. The putative human Surf-6 protein is 361 amino acids long and includes motifs found in both the mouse and fish Surf-6 homologues, which may underlie the functions of Surf-6. Three amino acid polymorphisms have been detected at codons 163, 175 and 311 by SSCP analysis.

Alleles↗
PubMed2000

Cost analysis of antibiotic prophylaxis for PEG.

BACKGROUND: There are conflicting recommendations regarding the prophylactic use of antibiotics in patients undergoing placement of percutaneous endoscopic gastrostomy tubes. The purpose of this decision analysis was to assess the cost-effectiveness of antibiotic prophylaxis in percutaneous endoscopic gastrostomy. METHODS: A decision tree was modeled using the data of 7 published prospective placebo-controlled trials. Infectious complications were classified as grade I (requiring local care), grade II (requiring intravenous antibiotics), or grade III (requiring surgery). Medication costs were estimated from the United States average wholesale prices of the 1998 Red Book. Physician and facility costs were estimated based on the 1998 Medicare costs. A one-way sensitivity analysis was performed by varying the probability rates of the complications associated with percutaneous endoscopic gastrostomy and the costs of their treatment. RESULTS: The average cost of prophylactic antibiotics was $13.10. Antibiotic prophylaxis led to expected cost savings of $76.72 per percutaneous endoscopic gastrostomy. A sensitivity analysis suggested that antibiotic prophylaxis for percutaneous endoscopic gastrostomy was the preferred strategy unless the average probability of grade III complications dropped below an improbably low threshold value of 0.09%. CONCLUSION: Antibiotic prophylaxis in percutaneous endoscopic gastrostomy is a cost-effective strategy.

Antibiotic Prophylaxis↗
PubMed2000

In-vivo real-time magnetic resonance monitoring of endoscopic laser applications in the porcine gastrointestinal tract.

BACKGROUND AND STUDY AIMS: Endoscopic laser therapy involves a risk of perforation, mainly because the depth of tissue destruction is not visible. Magnetic resonance (MR) imaging is capable of showing temperature changes, and is therefore suitable for monitoring thermal therapies such as laser. This animal study assessed the feasibility of real-time MR monitoring of endoscopic laser applications in the gastrointestinal tract. MATERIALS AND METHODS: The procedures were carried out using an MR-compatible endoscope in three live pigs in a 0.5-Tesla interventional MR system. Nd:YAG laser applications were performed in the lower gastrointestinal tract (n = 7) and upper gastrointestinal tract (n = 5), and were monitored using real-time color-coded T1-weighted gradient echo sequences. The postmortem macroscopic tissue coagulation sizes were compared with the lesion diameters seen on real-time MR. RESULTS: The endoscope did not cause any artifacts during continuous MR imaging. Ten of the twelve laser lesions were visible with temperature-sensitive MR imaging, and their sizes correlated well with the diameters of the postmortem macroscopic coagulation zones (r = 0.76, P = 0.009). Two laser lesions were not visible on MR due to technical limitations inherent with the healthy animal model. CONCLUSIONS: The formation of endoscopic laser lesions in the porcine gastrointestinal tract can be accurately visualized using real-time temperature-sensitive MR imaging. This new technique has the potential to spare healthy tissue while ensuring full treatment coverage of the targeted lesion with fewer therapy sessions.

Animals↗
PubMed2000

Transnasal versus transoral endoscopy for the placement of nasoenteral feeding tubes in critically ill patients.

BACKGROUND: Nasoenteral feeding tube placement with the Seldinger technique using transoral endoscopy is a tedious procedure. This study compared the transoral approach with a new technique that uses a transnasal endoscope without the need for a mouth-to-nose wire transfer. METHODS: Critically ill patients requiring nasoenteral feeding tube placement were randomly assigned to the transoral technique using a standard upper endoscope (n = 80) or the transnasal method using a 5.3 mm fiberscope (n = 80). Procedure time, medication requirement, technical difficulty, patient tolerance, and radiologic tube position were assessed. RESULTS: The two groups were similar with regard to baseline medication, endoscopic findings, as well as overall technical difficulty and patient tolerance. The transnasal technique required less procedure time (median 8.0 versus 12.0 minutes, p < 0.001) and less relaxant medication (p = 0.029). Furthermore, it caused fewer circulatory (p = 0.040) and respiratory (p = 0.016) alterations regardless of the application of sedative or relaxant medication. The transnasal endoscope was inferior with respect to passage through the pylorus (p = 0.003) and duodenum (p = 0.020). These differences were significant in univariate hypothesis testing. Bonferroni correction for multiple testing of data removed the significance at p > 0.0031. Both techniques achieved similar rates of successful tube placement in the small bowel (86% versus 84%, p = 0.82). CONCLUSION: Transnasal endoscopy allows accurate placement of nasoenteral feeding tubes in critically ill patients and is superior to transoral endoscopy in terms of procedure time, medication requirement, and safety.

Adult↗
PubMed2000

Is the diagnostic yield of upper GI endoscopy improved by the use of explicit panel-based appropriateness criteria?

BACKGROUND: Increasing the appropriateness of use of upper gastrointestinal (GI) endoscopy is important to improve quality of care while at the same time containing costs. This study explored whether detailed explicit appropriateness criteria significantly improve the diagnostic yield of upper GI endoscopy. METHODS: Consecutive patients referred for upper GI endoscopy at 6 centers (1 university hospital, 2 district hospitals, 3 gastroenterology practices) were prospectively included over a 6-month period. After controlling for disease presentation and patient characteristics, the relationship between the appropriateness of upper GI endoscopy, as assessed by explicit Swiss criteria developed by the RAND/UCLA panel method, and the presence of relevant endoscopic lesions was analyzed. RESULTS: A total of 2088 patients (60% outpatients, 57% men) were included. Analysis was restricted to the 1681 patients referred for diagnostic upper GI endoscopy. Forty-six percent of upper GI endoscopies were judged to be appropriate, 15% uncertain, and 39% inappropriate by the explicit criteria. No cancer was found in upper GI endoscopies judged to be inappropriate. Upper GI endoscopies judged appropriate or uncertain yielded significantly more relevant lesions (60%) than did those judged to be inappropriate (37%; odds ratio 2.6: 95% CI [2.2, 3.2]). In multivariate analyses, the diagnostic yield of upper GI endoscopy was significantly influenced by appropriateness, patient gender and age, treatment setting, and symptoms. CONCLUSIONS: Upper GI endoscopies performed for appropriate indications resulted in detecting significantly more clinically relevant lesions than did those performed for inappropriate indications. In addition, no upper GI endoscopy that resulted in a diagnosis of cancer was judged to be inappropriate. The use of such criteria improves patient selection for upper GI endoscopy and can thus contribute to efforts aimed at enhancing the quality and efficiency of care. (Gastrointest Endosc 2000;52:333-41).

Adult↗
PubMed2000

The effect of intra-gastric acidity and flora on the concentration of N-nitroso compounds in the stomach.

BACKGROUND: Correa's hypothesis proposes that gastric carcinogenesis is due to atrophic gastritis and hypochlorhydria which permit gastric bacterial colonization, the reduction of dietary nitrates to nitrites and the formation of potentially carcinogenic N-nitroso compounds (NOCs). OBJECTIVE: To test the hypothesis that omeprazole-induced hypochlorhydria is associated with increased intra-gastric concentrations of nitrate-reducing bacteria (NRB), nitrites and NOCs. DESIGN: Single-blind study in healthy volunteers. PARTICIPANTS: Fourteen healthy subjects (seven female, mean age 24 years), free of Helicobacter pylori infection, received a one-week course of placebo followed by a two-week course of omeprazole, 20 mg daily. METHODS: Fasted gastric samples, aspirated using a sterile double-lumen nasogastric tube at the end of the 1 st week (placebo) and the 2nd and 3rd weeks (omeprazole), were cultured aerobically and anaerobically; gastric pH and intra-gastric concentrations of nitrates, nitrites and NOCs were also determined. RESULTS: After weeks 1, 2 and 3, the intra-gastric concentrations of nitrate-reducing bacteria exceeded 10(5) colony-forming units (c.f.u.)/ml in 3, 7 and 9 subjects, respectively (P > 0.05). A gastric pH greater than 4.0 was associated with increased NRB (P < 0.05); however, neither increased gastric pH nor increased NRB, alone or in combination, was associated with increased intra-gastric concentrations of nitrites or NOCs (P > 0.05). CONCLUSIONS: A two-week increase in gastric pH in healthy, H. pylori-negative subjects was associated with increased intra-gastric concentrations of nitrate-reducing bacteria but not of nitrites or N-nitroso compounds. These data suggest that reduced gastric acid secretion is not a necessary precursor to the formation of carcinogenic N-nitroso compounds and that other mechanisms should be invoked to explain gastric carcinogenesis.

Achlorhydria↗
PubMed2000

A new genotype of hepatitis B virus: complete genome and phylogenetic relatedness.

The hepatitis B virus (HBV) genotype was determined in a total of 121 plasma samples collected in France and the US from patients chronically infected with HBV. HBV genotype A was predominant in this collection, appearing in 66 samples (54%), while genotypes B, C, D, E and F occurred in 4 (3%), 14 (12%), 23 (19%), 1 (1%) and 0 (0%) of samples, respectively. However, the genotype of a total of 13 (11%) samples (2 from France, 11 from the US) could not be determined with the methodology used. Sequence analysis, and subsequent phylogenetic analysis of the complete genome and the individual open reading frames, showed that the virus isolate from these samples was 3248 bp long and, phylogenetically, did not cluster with any of the known genotypes. This strain was provisionally called HBV genotype G. Virus isolates that were obtained from geographically separated regions like France and the US were closely related to each other. All virus strains analysed contained some characteristic differences when compared to genotype A: a translational stop codon at aa 2 and 28 of the preCore region; a 36 nt (12 aa) insert in the amino-terminal part of the Core antigen (HBcAg); a 2 aa deletion in the carboxy-terminal part of HBcAg; and a 1 aa deletion in the preS1 open reading frame. The deduced amino acid sequence of HBsAg suggests that this newly discovered genotype G strain belongs to serological group adw2.

Amino Acid Sequence↗
PubMed2000

The p21(WAF1/CIP1) promoter is methylated in Rat-1 cells: stable restoration of p53-dependent p21(WAF1/CIP1) expression after transfection of a genomic clone containing the p21(WAF1/CIP1) gene.

Rat-1 cells are used in many studies on transformation, cell cycle, and apoptosis. Whereas UV treatment of Rat-1 cells results in apoptosis, X-ray treatment does not induce either apoptosis or a cell cycle block. X-ray treatment of Rat-1 cells results in both an increase of p53 protein and expression of the p53-inducible gene MDM2 but not the protein or mRNA of the p53-inducible p21(WAF1/CIP1) gene, which in other cells plays an important role in p53-mediated cell cycle block. The lack of p21(WAF1/CIP1) expression appears to be the result of hypermethylation of the p21(WAF1/CIP1) promoter region, as p21(WAF1/CIP1) protein expression could be induced by growth of Rat-1 cells in the presence of 5-aza-2-deoxycytidine. Furthermore, sequence analysis of bisulfite-treated DNA demonstrated extensive methylation of cytosine residues in CpG dinucleotides in a CpG-rich island in the promoter region of the p21(WAF1/CIP1) gene. Stable X-ray-induced p53-dependent p21(WAF1/CIP1) expression and cell cycle block were restored to a Rat-1 clone after transfection with a P1 artificial chromosome (PAC) DNA clone containing a rat genomic copy of the p21(WAF1/CIP1) gene. The absence of expression of the p21(WAF1/CIP1) gene may contribute to the suitability of Rat-1 cells for transformation, cell cycle, and apoptosis studies.

5' Untranslated Regions↗