Search

Background: Previously a report has suggested that administration of lung protective strategy for one-lung ventilation(OLV) results in oxygen desaturation of the brain parenchyma. The aim of our work was to confirm that the maintenance of normocapnia during protective OLV strategy results in alteration of cerebral blood fl ow and cerebral oxygen saturation as compared to double-lung ventilation., Methods: Data were obtained from 24 patients undergoing thoracic surgery. Cerebral oxygen saturation (rSO2) was continuously monitored by INVOS 5100C Cerebral Oxymeter System along with measurement of cerebral blood fl ow velocity (MCAV) by transcranial Doppler sonography. Arterial blood samples were taken for blood gas analysis in the awake state, in the supine and lateral decubitus position during double-lung ventilation (DLV), and during OLV., Results: When ventilation was changed from DLV to OLV, no significant change was observed in rSO2. A significant decrease of rSO2 was found compared to the value observed during DLV in lateral decubitus at the time point 60 minutes after the start of OLV. No clinically significant changes in the MCAV was observed throughout the course of the thoracic surgical procedure., Conclusions: OLV does not result in clinically relevant decreases in cerebral blood fl ow and cerebral oxygen saturation during application of lung protective ventilation if normocapnia is maintained.

Background: The ideal tidal volume (TV) during one-lung ventilation (OLV) remains controversial. High TVs may increase the incidence of postoperative lung injury after thoracic surgery. There is nonetheless little evidence that the use of low TV during OLV will fail to provide adequate arterial oxygenation. We evaluated the influence of low (5 mL/kg-1) and high (10 mL/kg-1) TV on arterial oxygenation during one-lung ventilation in clinical conditions., Methods: A hundred patients scheduled for lung surgery were studied. Patients were randomly assigned to either 30 minutes of one-lung ventilation with a TV of 10 mL/kg-1 at a rate of 10 breaths/minute (Group 10, N.=50) or a TV of 5 mL/kg-1 with 5 cmH2O PEEP at a rate of 20 breaths/minute (Group 5, N.=50). According to the rules of crossover design during the subsequent 30 minutes, each patient received the alternative management. Arterial blood partial pressures, hemodynamic responses, and ventilatory parameters were recorded. Results are presented as means ± SDs; P<0.05 was considered statistically significant., Results: PaO2 was unaffected by TV (10 mL/kg-1: 218±106 versus 5 mL/kg-1: 211±119 mmHg, P=0.29). Calculated intrapulmonary shunt fraction was also similar with each TV during OLV (5 mL/kg-1: 25±9% versus 10 mL/kg-1: 24±8%, p=0.14). In contrast, low TV significantly increased PaCO2 (10 mL/kg-1: 39±6 versus 5 mL/kg-1: 44±8 mmHg, P<0.001). There were significant differences both in peak (10 mL/kg-1: 27±6 versus 5 mL/kg-1: 21±5 cmH2O, P<0.001) and plateau airway pressure values (10 mL/kg-1: 22±6 versus 5 mL/kg-1: 18±5 cmH2O, P<0.001) during OLV., Conclusion: Low TV (5 mL/kg-1) accompanied by 5 cmH2O PEEP provides comparable arterial oxygenation and intrapulmonary shunt fraction during one-lung ventilation as higher TV (10 mL/kg-1) without PEEP.

About 30% of the Hungarian population has some type of allergy, 65% of them have pollen sensitivity, and at least 60% of this pollen sensitivity is caused by ragweed. The short (or common) ragweed (Ambrosia artemisiifolia = Ambrosia elatior) has the most aggressive pollen of all. Clinical investigations prove that its allergenic pollen is the main reason for the most massive, most serious and most long-lasting pollinosis. The air in the Carpathian Basin is the most polluted with ragweed pollen in Europe. The aim of the study is to analyse how ragweed pollen concentration is influenced by meteorological elements in a medium-sized city, Szeged, Southern Hungary. The data basis consists of daily ragweed pollen counts and averages of 11 meteorological parameters for the 5-year daily data set, between 1997 and 2001. The study considers some of the ragweed pollen characteristics for Szeged. Application of the Makra test indicates the same period for the highest pollen concentration as that established by the main pollination period. After performing factor analysis for the daily ragweed pollen counts and the 11 meteorological variables examined, four factors were retained that explain 84.4% of the total variance of the original 12 variables. Assessment of the daily pollen number was performed by multiple regression analysis and results based on deseasonalised and original data were compared.

Background: Carbonic anhydrase IX has been linked to cancer development and progression., Aim: To analyse carbonic anhydrase IX expression and anhydrase inhibition in pancreatic cancer and to correlate these findings with p53 expression and microvessel density., Materials and Methods: Seventy-seven pancreatic cancers were examined (43 males, 34 females; mean age, 64 years). The anti-carbonic anhydrase IX M75 antibody was used for immunohistochemistry and Western blot analysis. Microvessels were visualized using the anti-CD34 antibody, and p53 expression in cancer cells was assessed with a specific anti-p53 antibody. Quantitative polymerase chain reaction was performed in order to assess carbonic anhydrase IX mRNA levels in the pancreas. Furthermore, pancreatic cancer cell lines were treated with acetazolamide, a carbonic anhydrase inhibitor., Results: In the normal pancreas, carbonic anhydrase IX immunoreactivity was observed at the basolateral membrane of ductal cells in 24 cases (31%). Carbonic anhydrase IX expression was found at the membrane and in the cytoplasm of pancreatic cancer cells in 16 pancreatic cancers (21%). Carbonic anhydrase IX expression was independent of the localization, stage, size, metastases and differentiation of the tumour. p53 expression was significantly more frequent in poorly differentiated cancers (P=0.0323); however, p53 expression and microvessel density were independent of carbonic anhydrase IX expression. Overall, carbonic anhydrase IX expression was not altered in pancreatic cancers vs. adjacent normal pancreatic tissue as assessed by Western blot and quantitative polymerase chain reaction analysis. However, incubation of pancreatic cancer cell lines with acetazolamide led to a significant inhibition of cell proliferation in AsPC-1 and PANC-1 pancreatic cancer cells., Conclusion: Carbonic anhydrase IX expression is observed in both ductal epithelial and cancer cells of the pancreas. Although the expression of carbonic anhydrase IX in pancreatic cancer is not associated with angiogenesis or advanced disease, it may well be a target for carbo-anhydrase inhibitors in a subset of pancreatic cancers.

Coeliac disease is the most common disorder with malabsorption of the small intestine, caused by the gluten fraction of cereals in genetically predisposed individuals. T-cell mediated autoimmune processes are initiated by gluten exposure, leading to both intestinal and extraintestinal manifestations, therefore coeliac disease is nowadays considered to be a systemic disorder. More and more diseases are proved to be associated with coeliac disease, in these conditions screening is strongly recommended. The studying of the recently explored autoantibodies against tissue transglutaminase brought us further in the understanding of the pathophysiology of coeliac disease. The spreading of reliable serologic methods modified our knowledge on the clinical picture and prevalence of the disease. In case of long-term dietary abuse the most common complications are decreased bone mineral density and development of lymphomas. Sustained glutenfree diet results in clinical and histological restitution, affects the course of associating diseases beneficially and decreases the risk for malignancies.

On the basis of their 9-year-long allergological and aeropalinological studies the authors examined if the allergen spectrum of their hay fever patients in connection with the seasonality of the symptoms and the pollen count of these 9 years has changed or not. The results of the skin prick tests and of the case histories of patients examined in 1990/91 and 1997/98 were compared. Pollen counting was performed with a Lanzoni VPPS 2000 sampler. By the end of the examined period the ratio of severely polysensitized patients (with 4 or more positive skin prick tests) increased significantly according to the significantly increased amount of positive skin prick tests to trees, rye and plantago. As the seasonality of the patients, symptoms did not change during this period, this increase in skin prick test positivity means a latent allergy. In a few years, however it may become a manifest allergy causing symptoms in early springtime. According to the pollen count results the atmospheric pollen pollution of the region was markedly high during the possible period of these patients' sensitisation.

There are several possible methods to detect H. pylori in the gastric mucosa. The aim of our prospective study was to evaluate the diagnostic value of these tests and to define their place in the clinical practice. 109 (45 male, 64 female) patients who underwent upper GI endoscopy were included. Before endoscopy, whole blood was collected for serological test and 13C-UBT (13C-urea breath test) was performed. During endoscopy, multiple biopsies were collected from the antrum and corpus for the examination of H. pylori status by histology and rapid urease test. Patients with positive histology and a positive result of any other examinations, or--in case of negative histology--with two positive results of the remaining examinations were considered to be H. pylori-positive. 50 patients (46%) proved to be H. pylori-positive. Sensitivity and specificity, respectively, were as follows [in brackets: negative predictive value (NPV) and positive predictive value (PPV), respectively]: histology, 98% and 92% (98% and 91%); 13C-UBT, 93% and 98% (94% and 98%); rapid urease test, 83% and 100% (86% and 100%); serological examination, 86% and 74% (88% and 70%). The sensitivity and the clinical role of the methods used for the detection of H, pylori infection is different. Histology is the most reliable method if endoscopy in performed. The positive result of the rapid urease test is also of good diagnostic value. The 13C-UBT is the method of choice if no endoscopy is performed and the clarification of H. pylori status is necessary. This method can be useful to control the success of bacterium eradication as well. The serological examination provides instant result, therefore this method is proposed for screening and epidemiological studies.

In the present work we have studied the occurrence of pituitary adenylate cyclase activating polypeptide (PACAP) in human and cat stomach mucosa using immunohistochemistry. As seen under a light microscope, there were many large rounded and ovoid cells that were PACAP immunopositive, mainly in the neck of the gastric glands of both species. The immunopositive material was predominant in the perinuclear area. The PACAP immunolabeling was specific because the preincubation of the antiserum with PACAP abolished the immunostaining. In human samples under electron microscope, the PACAP immunoreactive cells have shown the characteristics of parietal cells. In faintly stained cells, the localization of DAB reaction product was associated with the surface of the intracellular canaliculi. Cell labeling could not be observed besides parietal cells.

The performance of ipsilateral mediastinal blockdissection as a routine in every non-small cell lung cancer (NSCLC) operation gives us a chance to judge the accuracy of the preoperative CT examination. The accuracy rate of the CT in our 316 cases was 70.6%, the false positive rate was 69.6%, the false negative rate was 18.2%. Taking into account the 18.2% false negative rate and the slightly better survival of patients operated with routine blockdissection compared to the survival of a group of patients who had mediastinal blockdissection only if suspicion of tumour spread arose, we consider the procedure reasonable in every NSCLC operation.

The importance of Grass (Poaceae) pollen as a cause of hay fever in the South-Plain of Hungary was studied by aeropalinological and allergological methods. Since 1989 the pollen counting has been performed with the help of a Lanzoni VPPS 2000 sampler. On the basis of the pollen counting the second most important allergen pollen of this region are the grass pollen. From 1989 to 1995 skin prick tests (Soluprick, Epipharm) were performed in 642 patients with seasonal allergic rhinitis. 261 of these patients suffer from hay fever in May and June when the daily pollen count of grass pollen is the highest. The skin prick tests of these 261 patients were positive to Poaceae in 84%, and to Secale in 63%. But 57% of the patients was allergic to both Poaceae and Secale, so the exact allergen research is very important before hyposensitisation. Ragweed (63%) and Mugwort (33%) sensitivity was found also in high percent of the grasspollinosis patients with symptoms during the late summer season too.

The authors performed allergen research on patients reported hay fever symptoms during the poplar pollen season (March), and in patients with hay fever symptoms during the time of the year that the seed hairs of the poplar trees are blowing in the air (May). Skin prick tests (Epipharm) and serum specific IgE tests (Epignost IgE Quick and Phadezym Populus deltoides RAST, Pharmacia) were performed on the basis of the pollen calendar of Szeged region on 30 patients. The pollen containt of the air was measured by means of a Lanzoni sampler. According to the pollen calendar of our region a large amount of grass pollens could be found in the air at the same time as the seed hairs of poplar trees are present (in May). The season of poplar pollen is in March in this area. Poplar pollen sensitivity was found on 8 patients. This is 6.8% of the total number of hay fever patients. They were found to be sensitive to other tree pollens too. The 23 patients complaining about hay fever symptoms in May, during the flaying of the cottons of the poplar trees in the air were all found to be sensitive to grass pollens. On the basis of our results the poplar pollen sensitivity is a relatively rare cause of hay fever. Our patients having complained about the seed hairs were all found to be sensitive to grass pollens. It seems that the grass pollens are the real cause of their disease.

The authors report about the elimination of foreign bodies fixed in the oesophagus and aspirated into the right main bronchus. They discuss the diagnostic work and the ways of its elimination. They emphasize the importance of cooperation between the endoscopist and the surgeon.

Atmospheric pollen and spore contents in Szeged were determined with Lanzoni Sampler from July to October in 1989. Late-summer pollen calendar for Szeged was produced on the basis of this pollen counting. Skin prick tests in 69 patients with late-summer seasonal allergic rhinitis were carried out on the basis of this pollen calendar. All patients were found to be sensitive to Ambrosia. 83% of the patients were sensitized to Artemisia too. 93% of the patients were found to be polysensitive. 33% of the patients were found to be sensitive to Alternaria. The continuous atmospheric pollen and spore counting are of importance for the diagnosis and therapy of late-summer seasonal allergic rhinitis.

Water content in the liver in vivo was determined in 89 patients (33 with normal liver and 56 with chronic liver disease), simultaneously with ultrasonography and histopathological examination. A part of each biopsy specimen was used for this purpose. The difference between wet and dry weights was calculated from the pre- and post-lyophilization weights. According to the attenuation type of ultrasonic images, the patients were divided into two groups, viz., patients of low attenuation type (i.e. patients with type I bright liver) and those of high attenuation type (i.e. with type II bright liver). As to water content, no significant difference was observed between the two groups. No correlation was found between liver water content and histopathology either. It is concluded that knowledge of correlation between numerous parameters is needed to clarify the reason of attenuation differences.

It is pointed out that some cases of chronic pancreatitis causing severe obstruction may clinically simulate tumour. This can occasionally be confirmed by other examinations (e.g. ERCP) or by macroscopic inspection at surgery, and palpation. With the passive symptomatological treatment applied in these cases, the patients' condition keeps on deteriorating, reinforcing the suspicion of tumour. Sonography performed by a high-resolution equipment may raise, as an alternative to the tumour, the prevalence of chronic pancreatitis. Of 169 documented cases 7 were found to be of this condition. The strict criteria of establishing diagnosis are reviewed, supported by figures and case reports.

The authors have retrospectively reviewed 390 autopsy reports from their surgical clinic, to establish the frequency of chronic and acute lung complications in surgical patients. The retrospective analysis revealed that pneumonia was the most frequent acute pulmonary complication among patients who died in the surgical department. In postoperative cases, pneumonia contributed to or was responsible for 65% of all deaths.

The aim of the experiments was to study the effect of ligation of the superior mesenteric artery on the activity of the kinin-kallikrein system in the plasma and on arterial blood pressure. Ligation of 60 minutes did not change the free kallikrein activity of the plasma, while prekallikrein activity significantly decreased. Blood pressure showed a tendency to increase but not to a significant degree. Five minutes after the release of the ligation (during the period when the functional parameters of the intestinal mucosa returned to normal) free kallikrein activity increased and the arterial blood pressure decreased significantly. A rinse of the intestine with 5 p.c. glucose solution prior to the release of ligation prevents the increase in free kallikrein activity and the fall of blood pressure. The substances absorbed from the bowel lumen and activating the kinin system are probably responsible for the circulation failure following the ligation of the superior mesenteric artery.

A simple and inexpensive method has been developed for the determination of sulphate and other very weak bases and acids. It utilizes the partial protonation of the weak base or the partial dissociation of the weak acid, which has not been exploited for analytical purposes thus far. The procedure consists of three pH titrations: one with a test solution of known sulphate content, the second with the sulphate sample, and the third with a blank. This method can be used in the presence of several inorganic ions and organic matrices, including non-aqueous solvents. In aqueous medium sulphate contents above 10(-3)M can be determined. The use of solvent mixtures may increase the sensitivity of the method by two orders of magnitude.

The resection of the first rib with a transaxillary approach has been used in the operative treatment of this condition. This approach is though to have more advantages over the anterior (supraclavicular) or posterior (parascapular) ones. The segment resection of the middle third of clavicle would not seem to be justified in these cases. A case is reported in details, where the results support their concept.

Distribution of binding sites of [3H]SKF 38393, a selective dopamine D1 receptor agonist, was studied on forebrain coronal sections of CXBI/ByJ mice by radioligand binding and digital subtraction autoradiography. Highest levels of [3H]SKF 38393 binding were detected in olfactory tubercle and caudate nucleus/putamen. Intermediate to low concentrations of receptors were indicated in cortex, amygdala, hypothalamus, claustrum, and septal area, whereas the lowest binding was found in white matter tracts (commissura anterior, corpus callosum). Analysis of data on caudate nucleus/putamen indicates a striosomal pattern of binding with a gradient of binding sites from medial to lateral caudate/putamen. The distribution of [3H]SKF 38393 binding sites corresponds to that of dopaminergic projection fields in the studied areas.