One-lung ventilation does not result in cerebral desaturation during application of lung protective strategy if normocapnia is maintained.

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.

Effects of different tidal volumes for one-lung ventilation on oxygenation with open chest condition and surgical manipulation: a randomised cross-over trial.

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.

Meteorological variables connected with airborne ragweed pollen in Southern Hungary.

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.

Expression of carbonic anhydrase IX in human pancreatic cancer.

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.

Dual role of serum soluble E-cadherin as a biological marker of metastatic development in gastric cancer.

BACKGROUND: Soluble E-cadherin serum levels as a potential biological marker for gastric cancer were analysed with special consideration to clinical and pathological features. METHODS: Seventy-one healthy control subjects and 166 patients with gastric cancer were enrolled. Gastric cancer patients were classified into intestinal-type (51%) and diffuse-type (49%), according to Laurén. Soluble E-cadherin serum levels were measured with enzyme-linked immunosorbent assay. RESULTS: The mean logarithmic concentrations of soluble E-cadherin in gastric cancer patients were significantly higher than those of control subjects, with an average of 4.03 (+/- 0.32) versus 3.86 (+/- 0.24), respectively (P < 0.0001). The concentration of soluble E-cadherin was significantly higher in the intestinal-type group than in the diffuse-type group, with an average of 4.07 +/- 0.3 versus 3.98 +/- 0.34, respectively (P = 0.0494). In the intestinal-type group, concentrations of soluble E-cadherin were significantly higher in more advanced stages (stages III-IV) than in earlier stages (stages I-II), with an average of 4.13 +/- 0.29 versus 3.96 +/- 0.31, respectively (P = 0.0234). In the diffuse-type group, concentrations of soluble E-cadherin were significantly higher in localized than in metastatic gastric cancer, with an average soluble E-cadherin concentation of 4.15 +/- 0.3 versus 3.95 +/- 0.32, respectively (P = 0.0139). CONCLUSION: Serum soluble E-cadherin concentrations exhibit a completely different pattern in intestinal-type and diffuse-typegastric cancer. Serum levels are increased in intestinal-type gastric cancer, especially in advanced stages, whereas in diffuse-type gastric cancer E-cadherin levels are decreased in advanced, metastasized cancer.We conclude that soluble E-cadherin concentrations should be interpreted along with Laurén classification and thus might serve as a biological marker in intestinal-type gastric cancer.

[Change in the allergen spectrum of hay fever patients in the Southern Great Plains of Hungary (1990-1998)]. / A szénanáthás betegek allergénspektrumának változása a Dél-Alföldön (1990-1998).

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.

[Comparison of various methods in the detection of Helicobacter pylori infection]. / A Helicobacter pylori-fertózést kimutató eljárások összehasonlítása.

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.

[Celiac disease today: review of the growing knowledge]. / A coeliakia napjainkban: a bóvüló ismeretek áttekintése.

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.

Pituitary adenylate cyclase activating polypeptide (PACAP) is present in human and cat gastric glands.

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.

How effective is the routine mediastinal blockdissection in the surgery of non-small cell lung cancer?

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.

[Lawn grass (Poaceae) causing hayfever in the South Plain of Hungary. Results of aeropalinologic and allergologic studies 1989-95]. / Pázsitfüvek (Poaceae) okozta szénanátha a Dél-Alföldön. Aeropalinológiai és allergológiai felmérés eredménye 1989-1995.

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.

Anterograde transport of brain-derived neurotrophic factor and its role in the brain.

The role of neurotrophins as target-derived proteins that promote neuron survival following their retrograde transport from the terminals to the cell bodies of neurons has been firmly established in the developing peripheral nervous system. However, neurotrophins appear to have more diverse functions, particularly in the adult central nervous system. Brain-derived neurotrophic factor (BDNF), for example, produces a variety of neuromodulatory effects in the brain that are more consistent with local actions than with long-distance retrograde signalling. Here we show that BDNF is widely distributed in nerve terminals, even in brain areas such as the striatum that lack BDNF messenger RNA, and that inhibition of axonal transport or deafferentation depletes BDNF. The number of striatal neurons that contain the calcium-binding protein parvalbumin was decreased in BDNF+/- and BDNF-/- mice in direct proportion to the loss of BDNF protein, which is consistent with anterogradely supplied BDNF having a functional role in development or maintenance. Thus the anterograde transport of BDNF from neuron cell bodies to their terminals may be important for the trafficking of BDNF in the brain.

A continuous striatal infusion of 6-hydroxydopamine produces a terminal axotomy and delayed behavioral effects.

Rat models of Parkinson's disease typically employ a rapid nigral injection of 6-hydroxydopamine (6-OHDA) to produce a near-complete loss of nigrostriatal dopamine neurons, and thus, model end stage disease. The present report describes the use of a continuous, low dose infusion of 6-OHDA into the striatum which produces a terminal axotomy of nigrostriatal dopamine neurons and protracted behavioral response. A solution of 6-OHDA in 0.4% ascorbate, delivered at 37 degrees C from osmotic minipumps, was stable for 8 days as determined by its retained toxicity to a dopaminergic neuroblastoma cell line. The continuous infusion of 0.2 mu g 6-OHDA per h did not affect the striatal uptake of [3H]%GABA, [3H]choline, or [3H]glutamate but reduced [3H]dopamine uptake by 55% within 1.5 days after the start of the infusion. The striatal infusion of 6-OHDA produced a dose-dependent reduction of striatal dopamine and DOPAC levels but did not alter HVA, 5-HT, or 5-HIAA. An increase in amphetamine-induced ipsiversive rotations occurred within 1.5 days after the acute striatal injection of 20 mu g or 30 mu g of 6-OHDA but required 4 days to develop with the continuous 6-OHDA infusion. The topography of the lesion mapped by [3H]mazindol binding showed that, beginning by 1.5 days, a diffuse depletion of terminals encompassed much of the striatum in the 30 mu g acute injection group, whereas in the continuously infused rats, the lesion was apparent only by 4 days and was restricted to a smaller and more completely lesioned area. Unlike acutely lesioned animals, continuously infused rats revealed no obvious loss of dopamine neurons in the pars compacta by 5 weeks after 6-OHDA. The continuous striatal infusion of 6-OHDA can produce a topographically limited terminal axotomy of dopamine neurons and a protracted behavioral impairment.

Structural order of membranes and composition of phospholipids in fish brain cells during thermal acclimatization.

A comparison of the structural orders of membranes of a mixed brain-cell population isolated from Cyprinus carpio L. acclimated to either summer (23-25 degrees C) or winter (5 degrees C) revealed a high degree of compensation (80%) for temperature, as assayed by electron spin resonance spectroscopy. The cells rapidly forget their thermal history and adjust the physical properties of the membranes when shifted to the other extreme of temperature either in vivo or in vitro. Phospholipids separated from both types of animals exhibit only around 10% compensation. Arachidonic and docosahexaenoic acids are the major polyunsaturated fatty acids in the brains, but the fatty acid composition of the brain total phospholipids does not vary with adaptation to temperature. Separation of phosphatidylcholines and phosphatidylethanolamines into molecular species revealed a 2- to 3-fold accumulation of 18:1/22:6, 18:1/20:4, and 18:1/18:1 species in the latter; 18:0/22:6 showed an opposite tendency. Molecular species composition of phosphatidylcholines did not vary with the temperature. The same trends of changes were seen with brains of freshwater fish from subtropical (Catla catla L.) or boreal (Acerina cernua) regions. It is concluded that the gross amount of docosahexaenoic acid (22:6) plays only a minor role in adjusting the membrane physical properties to temperature. Factors other than lipids might be involved in the adaptation processes. Due to their specific molecular architecture, molecules such as 18:1/22:6, 18:1/20:4, or 18:1/18:1 phosphatidylethanolamine might prevent the contraction of membranes in the cold and may provide an environment for some other components involved in the temperature regulation of physical properties of nerve cell membranes.

Overlapping and distinct actions of the neurotrophins BDNF, NT-3, and NT-4/5 on cultured dopaminergic and GABAergic neurons of the ventral mesencephalon.

The neurotrophins brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), and neurotrophin-4/5 (NT-4/5) were compared for their effects in promoting the survival and/or regulation of expression of phenotypic markers of dopaminergic and GABAergic neurons in cultures derived from embryonic rat ventral mesencephalon. Dopaminergic neuron number and phenotypic expression were monitored by tyrosine hydroxylase (TH) immunocytochemistry, and measurement of high-affinity dopamine uptake activity and dopamine content, respectively. High-affinity GABA uptake, glutamic acid decarboxylase (GAD) activity, and endogenous GABA content were used to detect GABAergic neurons. Seven days of treatment with either BDNF or NT-3 resulted in dose-dependent increases in the number of TH-positive neurons, with maximal responses of 3-fold and 2.3-fold, respectively. Dopamine uptake activity and dopamine content were similarly increased. The effects of BDNF and NT-3 on dopamine uptake activity showed no additivity. NT-4/5 treatment elicited the greatest increase (7-fold) in the number of TH-positive neurons, as well as a 2.6-fold increase in dopamine content. In marked contrast to BDNF or NT-3, NT-4/5 had no effect on dopamine uptake capacity. BDNF, NT-3, or NT-4/5 also produced dose-dependent elevations of 2-3-fold in GABA uptake activity. These effects were not additive. GAD activity was increased by BDNF (1.8-fold) and NT-3 (threefold) treatment, but not by NT-4/5, whereas GABA content was increased to a similar extent by all three neurotrophins. NGF had no effect on any of the parameters measured in this study. Northern analyses indicated that the mRNAs encoding TrkB and TrkC, the functional high-affinity receptors for BDNF and NT-4/5, and NT-3, respectively, are expressed in the substantia nigra of adult rat brain, as well as in cultures of developing ventral mesencephalon. Taken together, our results indicate that BDNF and NT-3 have broadly similar effects in promoting the survival and differentiated phenotype of both dopaminergic and GABAergic neurons of the developing substantia nigra. Although BDNF and NT-4/5 are thought to act through the same high-affinity receptor, TrkB, it is evident that these two neurotrophins have distinct as well as overlapping actions toward mesencephalic dopaminergic or GABAergic neurons.

[Aeropollinologic and allergologic studies for the clarification of "poplar tree hay fever"]. / Aeropolinológiai és allergológiai vizsgálatok a "nyárfa-allergia" tisztázására.

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.

[A case of numerous foreign bodies found in the esophagus and the right main bronchus]. / Nagy mennyiségü idegentestet nyelö és a jobb oldali föhörgöbe aspiráló operált betegünkröl.

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.