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P Misiuna

Publications and source records attributed to P Misiuna.

At least 19 recordsLinked to original sources
PubMed2000

Esophageal motility impairment--the cause or consequence of gastroesophageal reflux disease?

There are at least three, well-known, different groups of motor activity disturbances of the upper part of alimentary tract which can induce the development of gastroesophageal reflux disease (GERD) and enlarge the risk of excessive exposure of the esophageal mucous membrane on gastric juice and/or biliary contents. Most important is insufficiency of the lower esophageal sphincter (LES), which causes gastroesophageal reflux at 50-60% of patients suffering from GERD. Other reasons include impairment of stomach function (increase of intra-gastric pressure, late emptying and/or hypersecretion), and impairment of esophageal clearance. The question: does motility impairment of the esophagus occur primary or secondary to the gastroesophageal reflux, is still not enough clarified. Motor activity of the esophagus before and after the antireflux operation was prospectively assessed in 57 patients. Motility of the esophagus was determined by estimation: the efficacy of LES, general motor activity of the body of the esophagus and motor activity of the body during the reflux episodes, basing on 24-h manometry. Comparison of general pre- and postoperative data revealed significantly positive influence of Nissen-Rossetti fundoplication on improvement of motor activity of the esophagus, but the results differed in relation to the height of the measurements. Moreover comparison of the data during gastroesophageal reflux episodes revealed negative changes of the manometric parameters in the upper and middle esophagus. We conclude that post-operative improvement of esophageal motility confirms the secondary dysfunction in the peristalsis, connected with pathological reflux. However, lack of the complete normalization in motor activity after operation suggests that disorder may partially occur as primary impairment of motor activity or as the secondary dysfunction, which is fixed in the course of GERD.

Esophageal Motility Disorders↗
PubMed1999

The GU-MACH study: the effect of 1-week omeprazole triple therapy on Helicobacter pylori infection in patients with gastric ulcer.

AIMS: To study the efficacy of omeprazole triple therapy in the eradication of Helicobacter pylori in patients with active gastric ulcer, and to assess healing and relapse of gastric ulcer. METHODS: A double-blind, randomized study was carried out in 18 centres in Germany, Hungary and Poland. Patients (n = 160) with gastric ulcer and a positive H. pylori screening test were randomized to a 7-day twice daily treatment with omeprazole 20 mg, clarithromycin 500 mg and amoxycillin 1000 mg (OAC) or omeprazole 20 mg, clarithromycin 250 mg and metronidazole 400 mg (OMC), or with omeprazole 20 mg once daily (O). After completion of this 1-week treatment, patients were treated with omeprazole until healing (maximum 12 weeks), and followed for 6 months. H. pylori was assessed by urea breath test (UBT) and histology. RESULTS: Eradication rates ITT were OAC 79% (95% CI: 65-90%), OMC 86% (95% CI: 73-94%) and O 4% (95% CI: 0-14%). Eradication rates PP were OAC 83% (95% CI: 68-93%), OMC 93% (95% CI: 80-98%) and O 3% (95% CI: 0-13%). Gastric ulcer relapses occurred in 5, 0 and 11 patients in the groups, respectively. CONCLUSIONS: The results from the study demonstrate that OMC and OAC 1-week regimens are safe and effective for eradication of H. pylori in gastric ulcer patients, and that ulcer relapse is infrequent after successful eradication.

Adult↗
PubMed1997

Does p53 overexpression cause metastases in early invasive colorectal adenocarcinoma?

OBJECTIVE: To find out whether p53 overexpression correlates with metastatic potential and other adverse prognostic factors in early invasive colorectal carcinoma and whether measurement of the expression of p53 protein could be helpful in the choice of treatment (endoscopic/local or radical resection). DESIGN: Retrospective study. SETTING: University hospital, Japan. SUBJECTS: Overexpression of p53 protein in the primary tumour was examined immunohistochemically in 50 patients with early invasive colorectal cancer. MAIN OUTCOME MEASURES: Differences in p53 overexpression between subgroups. RESULTS: Abnormal accumulation of nuclear p53 was detected in the primary tumour of 20 patients (40%) with early invasive colorectal cancer. We found p53-positive cells in 7 (78%) of 9 that had metastasised to regional lymph nodes or distant organs, or both, and in 13 (32%) of 41 that had not metastasised (p = 0.02). p53 Immunoreactivity was also present in 10 (71%) of 14 superficial (type II) lesions compared with 10 (28%) of 36 protruding (type I) ones (p = 0.009) and in 12 (57%) of 21 moderately differentiated adenocarcinomas compared with 8 (28%) of 29 well-differentiated adenocarcinomas (p = 0.045). There was no significant correlation between p53 overexpression and the depth of tumour invasion or angiolymphatic involvement. The p53-positive metastasising tumours had features that corresponded to those of early carcinoma arising de novo. CONCLUSION: Our results seem to support the postulate that p53 overexpression in early invasive colorectal carcinomas is associated with an increase in their metastatic potential.

Adenocarcinoma↗
PubMed1997

[Stomach and esophageal neoplasm. Changes over 16 years in clinical materials].

Increasing prevalence of adenocarcinoma of the esophagus and esophago-gastric junction has been reported. The aim of the study was to determine whether this phenomenon is reflected in the cohort of patients referred for surgery to our institution. Clinical and pathological records of patients with adenocarcinoma of the stomach (n = 433) or gastro-esophageal junction (n = 302), and squamous cell carcinoma of the esophagus (n = 266) were reviewed from 1981 to 1996. Yearly prevalence of carcinoma of the gastric cardia in comparison to carcinoma of (a more distal) stomach has not changed, ranging 19-46%. From 1981 to 1984 out of 58 gastric resections, 14 (24%) total gastrectomies were done, whereas from 1993 to 1996 total gastrectomies were performed in 104 out of 138 (75%) patients with gastric cancer (p < 0.001). In the first 4 years of the study period adenocarcinoma of the cardia and/or esophagus was found in 19% of all patients with esophageal and junctional tumors, while in the last 4 years,-in 30%. Resection rates for gastric and cardiac cancers have not changed significantly, 75-100% and 21-65% respectively. Resection rate for carcinoma of the esophagus increased from 50% (17/34) to 79% (53/67) (p = 0.006, test chi2). Increasing rate of total gastrectomies can be explained by a trend towards more proximal localisation of the primary gastric tumors and/or clinical application of Laurén classification for the choice of operative procedure. Higher resection rate for carcinoma of the esophagus is a result of increasing experience of the surgical team, improvement in preoperative staging, new palliative modalities, and application of preoperative chemo-/radiotherapy.

Carcinoma, Squamous Cell↗
PubMed1997

[Complications of endoscopic sphincterotomy].

The aim of the study is an analysis of the complications among the patients who underwent endoscopic sphincterotomy. In years 1991-1996 in our Department 412 patients underwent endoscopic sphincterotomy. Bile ducts stones, acute bile pancreatitis, papilla Vateri stricture and the postoperative bile fistula were the indications for the procedure. Complications occurred in 37 patients (12 of them were operated on). One patient died due to duodenal perforation. GI bleeding, acute pancreatitis, common bile duct perforation, recurrence of the stricture and missing the concrement in the duct were the main complications. Endoscopic sphincterotomy remains the recommended method in describe cases.

Acute Disease↗
PubMed1997

[Comparison of the usefulness of ultrasonography and computed tomography in diagnosis of acute necrotizing pancreatitis].

The aim of this paper is to evaluate the sensitivity and specificity of ultrasound and computed tomography imaging in necrotizing acute pancreatitis. Since 01'95 till 12'96 we treated 36 patients with acute pancreatitis. They were diagnosed by US and contrast enhanced CT. 15 patients were intraoperatively classified as necrotizing pancreatitis. US done several times before operations positively predicted only 8 cases as having necrosis (sensitivity 53.3%) and in 7 patients the extension of its spread (specificity 87.5%). Preoperative CT positively predicted 13 cases of necrosis (sensitivity 86.6%) and the extension of its spread was properly stated in 7 patients (sensitivity 46.6%). 4 times preoperative CT was done twice. Contrast enhanced CT is better than US in predicting of the existence of pancreatic necrosis but it is not in evaluation of the extension of necrosis spread.

Contrast Media↗
PubMed1997

Topography of Helicobacter pylori infection in gastric cancer patients.

The role of Helicobacter pylori in gastric carcinogenesis is a subject of an increasing interest. In this report we describe a prospective study on the resected stomachs to establish the prevalence of H. pylori in different types of gastric carcinoma. The material consisted of 62 consecutive patients operated on stomach adenocarcinomas Fifty six percent of the patients were intestinal type, 34%--diffuse type and 10%--mixed type. The presence of H. pylori was studied in specimens from surgically removed stomachs. The conformation of the bacterial infection was done by means of rapid urease test, microbiological culture, Warthin-Starry and immunohistochemical staining. The overall prevalence of H. pylori infection was 69% (43/62). There was a statistically significant difference in the infection rates between the types of carcinoma--75% in the intestinal type and 62% in the diffuse type. The most sensitive was immunohistochemical staining. The bacterial colonies were cumulated far from the tumor tissue. In cardiac cancer the most intense of infection was an antrum and lower part of gastric body. In opposite; in antrum and pylorus cancer the scope of colonisation increased in fundus and subcardiac region with statistical signification. We could not detect H. pylori in the tumor tissue itself as in the normal mucosa of the stomach. In gastric antrum the most intense colonisation was detected on mucosal atrophy, but in the upper part of the stomach--on the mucosal metaplasia.

Adult↗
PubMed1997

[Correlations between risk factors for metastasis in early tumors of the large intestine].

UNLABELLED: Intramucosal colorectal cancers (Tis) are treated by local excision. Controversies remain as to the management of patients with the submucosally invasive colorectal cancers (EIC). The decision for radical surgery or local excision depends on an estimate of the risk of metastases. AIM: To estimate correlations between the risk factors for metastases in EIC and to evaluate the tests that identify the metastasising EICs. In the study, we investigated the relationships between selected prognostic factors (the gross appearance, depth of submucosal invasion, vessel invasion, grade, presence of adenoma component, and p53 overexpression) and the frequency of metastases in 64 EICs. STATISTICAL ANALYSIS: Fisher's exact test and log-linear analysis. Tests' evaluation: sensitivity, specificity, predictive values. The metastases were detected in 11 tumours (17%). The metastases were found with the significantly (p < 0.05) higher frequency in moderately differentiated adenocarcinomas, in tumours with massive invasion, with vessel invasion, and with the p53 overexpression. The only interaction was between the grade and the depth of invasion. No other interaction between the risk factors was found with the multivariate analysis. The evaluation of the depth of invasion was characterised by the highest sensitivity in detecting metastases, and by the highest negative predictive value. The highest specificity and the positive predictive value were found for the evaluation of vessel invasion. The massive submucosal invasion, vessel invasion, moderately differentiated characteristics, and the p53 overexpression seem to be the independent risk factors for metastases in EIC. The evaluation of these factors should be helpful as prognostic tests and for the proper choice of the treatment modality for the patients with EIC.

Adenocarcinoma↗
PubMed1997

[Comparison of combined (endoscopic sphincterotomy + laparoscopic cholecystectomy) and classical treatment of obstructive jaundice in the course of cholelithiasis].

UNLABELLED: Since August 1993 till December 1996, 672 patients with the gallstone disease were submitted to the laparoscopic cholecystectomy (LC). In 78 (11.7%) of them, the endoscopic sphincterotomy (ES) was performed before LC for the treatment of the coexistent obstructive jaundice caused by bile duct stones (Group I). ES was successful in 70 patients (90%). The laparoscopic cholecystectomy was done after the bilirubinemia reached the level within the normal ranges. This period (4 days to 35 days) was dependent on the level of hyperbilirubinemia at presentation. In 12 cases both procedures were performed at the same time. LC was successful in 67 patients (96%). The mean period between ES and LC was 2.7 days. The mean time of hospital stay was 6.3 days. In other 52 patients open cholecystectomy with T drainage was done for the treatment of the gall stone disease complicated by the obstructive jaundice (Group II). Comparing the two group of patients, the significantly shorter time of treatment and hospital stay as well as the lower incidence of complications was observed in Group I. CONCLUSION: ES and LC in patients with the obstructive jaundice caused by stones results in lower morbidity and shorter time of treatment when comparing with patients treated by classical open cholecystectomy with T drainage.

Cholecystectomy, Laparoscopic↗
PubMed1997

[Postoperative evaluation of esophageal mucosal change dynamics in patients with reflux diseases].

Comparative value of esophagoscopy and biopsy in correlation with 24 hour esophageal pH metry parameters were assessed in 53 consecutive patients operated on due to GERD. The special attention was paid to the type and intensity of esophageal mucosa injury and the quantity of the pathological gastroesophageal reflux. The therapeutic effect of the Nissen Rossetti fundoplication on postoperative changes in esophageal mucosa was also estimated on the average 18 months after the antireflux procedure. Pre and postoperative efficiency of the antireflux mechanism and patients conditions were evaluated on the grounds of anamnesis, physical examination, x-ray examination, endoscopy with biopsy, 24 hours pH metry, LES and body of the esophagus manometry. The results were shown as mean and standard deviation. Statistical significance was determined using SPSS/PC-packet, Smirnow-Kolmogorow and Wilcoxon test, with p values < 0.05 considered as significant. After the operation complete and durable relief of reflux symptoms was obtained in 83% patients, with high significant decrease of DeMeester score from 21.15 +/- 12.19 to 3.43 +/- 5.22, p < 0.0002. Endoscopy following the operation confirmed significant regression of the GERD pathology, mainly in II and III degree according to Savary Miller classification, from 98.1% to 18.9%, p < 0.005. In comparison with other types of the pathology, Barrett's esophagus was always connected with significant higher quantity of the pathological gastroesophageal reflux before as well as after the operation. Biopsy following the operation revealed not significant regression of mucosal GERD lesions in 54.7%. The healing changes were observed first of all in the most severe esophageal injuries-chronic squamous esophagitis (64%), CLE except intestinal type of metaplasia (86.&%) and low grade dysplasia of squamous epithelium (100%). The absence of regression after the operation was always combined with unsatisfactory decrease of 24 hour pH metry parameters: DeMeester score, percentage of total time pH < 4.0 and time pH < 4.0 in supine position. Postoperative progression of GERD pathology was noticed in 12.6% patients. One third patients had the same biopsy outcome before and after the operation, even in those without any GERD complaints. Biopsy in correlation with 24 hour pH metry analysis similarly like endoscopy revealed in CLE twice higher DeMeester score than squamous esophagitis, hyperplasia or normal esophageal mucosa. The study proved that more advanced stages of GERD pathology were connected with higher quantity of the gastroesophageal reflux. The results presented in this study confirmed high efficacy of the Nissen Rossetti fundoplication in surgical treatment of GERD. We would to emphasize that with unsatisfactory biopsy results following the operation should be the reason for permanent follow up endoscopic and histopathologic verification.

Adult↗
PubMed1997

[The effect of Nissen-Rossetti fundoplication on the motor function of swallowing in patients with reflux diseases].

This prospective study was undertaken to assess the motility of the middle and lower esophagus and LES resting pressure changes following the N-R fundoplication for GER. The study was carried out in 53 consecutive patients (37 women, 16 men, median age 49.1 +/- 6.2 years), operated due to antireflux mechanism insufficiency. Threefold solid state for manometry and double channel for pH metry catheters in the body of the esophagus were used before and after the operation (median follow up time was 18 months). The LES length and resting pressure were evaluated with Synectics On-line interface. The objective results obtained during 24-h pH metry and manometry were shown as median and standard deviation, with statistical significances determined using the SPSS/PC+ packet (p < 0.05 considered as significant). The individual patients' data were analyzed by Synectics software. 24-h pH metry confirmed that Nissen-Rossetti fundoplication efficaciously reduced pathological GER (significant decrease of DeMeester score from 105.6 +/- 12.2 to 5.2 +/- 3.4, p < 0.0002). Manometry proved the increase of the LES resting pressure from 7.6 +/- 3.2 to 18.2 +/- 4.2, p < 0.0005, and its total length from 3.1 +/- 0.8 to 4.2 +/- 1.0, p < 0.01. The improvement of the esophageal body peristalsis was found first of all in total period. Motility changes following N-R fundoplication during the reflux period were unsatisfactory. The frequency of peristalic contractions with higher amplitude and longer duration significantly increased after the operation in total period in all levels. The increase of the complete peristaltic contractions following N-R fundoplication was high significant from 22.15% to 60.21%, p < 0.0001. Although significant improvement of the efficacy of esophageal peristalis was observed, however it was still under 50% of normal level all the time (15.4% v. 41.7%, p < 0.002). The most impressive improvement of esophageal peristalis was noticed in the lower part of the esophagus. The increase of the complete peristaltic contractions during the reflux period was observed only in upright position. Least profitable changes in esophageal body motility were noticed during the reflux period in supine position. In comparison with the total period manometry results the efficacy of the esophageal perystalsis during the reflux period was defected before as well as after the operation, (11.2% v. 22.5%, p = NS).

Adult↗
PubMed1997

[Prognostic significance of cellular immunity in surgical treatment of esophageal cancer].

The aim of the study was to investigate the influence of perioperative changes of the cellular immunity parameters on long-term survival following esophagectomy for carcinoma of the esophagus. In 39 patients several immunological parameters have been assessed before and 2 weeks after the operation: WBC, lymphocyte count, lymphocyte T% (E-rosette test), helper/suppressor lymphocyte T subpopulations (teophylline test), NBT test, and in vivo Multitest CMI (skin delayed hypersensitivity for recall antigens). Survival was analyzed using Kaplan-Meier method according to the stage (pTNM, UICC'92) and to the grade of perioperative cellular immunity (pCI) deterioration. Three groups of patients were identified with: 1) improvement or stabilization of pCI (n = 5); 2) deterioration of 1 or 2 pCI parameters (n = 21); and 3) deterioration of 3 or more pCI parameters (n = 13). Follow-up time ranged from 4 to 65 months. Eight patients died in hospital due to postoperative complications, 3 patients are alive (1 of them with Tis alive at 52 months of follow-up), and the remaining patients died during follow-up. Mean survival time of patients in stage II (n = 7), III (n = 17), and IV (n = 14) was 18, 17, and 6 months respectively (p = 0.017, log rank test). Mean survival time of patients in group 1, 2, and 3 was 21, 20, and 5 months respectively (p < 0.001, log rank test). On bivariate survival analysis encountering both factors, stage was found to be the only independent prognostic factor (p = 0.008, Cox regression model). Deterioration of the cellular immunity in the perioperative period is entirely related to the stage of the disease, which is the only independent prognostic factor in carcinoma of the esophagus.

Adenocarcinoma↗
PubMed1997

[Iatrogenic esophageal injuries and their treatment].

In our Department 22 patients were treated due to esophagus perforations in the years 1990-1996. Most of them (16) occurred after endoscopic examinations: diagnostic-3, after strictures dilatation-10, endoscopic intubation-2, sclerotherapy-1, transesophageal cardioversion-1. There were 5 intraoperative perforations: 3-after cardiomyotomy, 2-after intubation. The following treatment was performed: oesophageal suture and drainage-5 patients, subtotal oesophagectomy with oesophagogastrostomy-3 patients, oesophagectomy with salivary fistula and oesophago-gastro or -colostomy in second operation--9 patients, perforation covered with gastric fundus--3, intubation--1 patient, conservative treatment--1 patient. Four (18%) patient died.

Dilatation↗
PubMed1989

Retroperitoneal tumors.

Retroperitoneal tumors (RPTs) are most commonly found in anatomically confined spaces. Primary RPTs are to be distinguished from those arising from retroperitoneal organs or from the metastatic masses. They may originate either from anyone of the three embryonal leaves or may take on more complex composition, consequently accounting for their varied histological appearance (1, 10). Badowski et al. (1) gave the following occurrence ratio: mesenchymal tumors account for 61.5%, mixed tumors for 23% and nervous tissue tumors--15.5%. They possess either benign or malignant potentials, with invasion of the neighbouring tissues and organs by the growth. The mode of disease at early stage is rarely conspicuous. Patients usually present with vague abdominal pains and palpable resistance. The techniques that are employed consist in the CT, USG and the selective angiography accompanied by passage films and the urography.

Adult↗
PubMed1984

[Changes in histochemical reactions in the epithelium of the small intestine of the dog with acute circulatory disorders].

Using histochemical methods for testing the activity of hydrolytic and respiratory enzymes, there were examined changes of the intestinal epithelium caused by acute ischemia which was produced by putting clamps on the upper mesenteric vessels. The changes were stronger after a simultaneous occlusion of the artery and vein and did not repair after restitution of circulation so having irreversible character.

Animals↗
PubMed1984

[The effect of acute ischemia on the small intestine of the dog].

There were carried out macroscopic and microscopic observations of dog's small intestine after putting a clamp on the artery only or on the artery and the upper mesenteric vein. Examinations were performed after 1 and 2 h of ischemia and in different periods after restitution of circulation. By means of histologic and histochemical methods it was found out that no later than after 1 h of ischemia there occur pathologic, irreversible changes in the wall of the small intestine.

Animals↗