[Surgical treatment of intraabdominal hemorrhage in peliosis hepatis]. / Chirurgische Behandlung der intraabdominellen Blutung bei Peliose der Leber.

INTRODUCTION: Peliosis is an infrequent entity characterized by multiple blood-filled cavities mostly involving the liver. Peliosis hepatis usually appears as a rare autopsy finding in asymptomatic patients or in patients with chronic wasting diseases. However, peliosis hepatis may present as hepatic dysfunction or shock from hepatic rupture. MATERIAL AND METHODS: In our report we present the case of a 33-year-old woman with hepatic peliosis causing a hemoperitoneum resulting from liver rupture, which needed immediate surgical treatment. On the basis of symptoms and the laboratory parameters the acute abdomen was evaluated by abdominal ultrasound and CT scan, both revealing a hemoperitoneum and a lesion in the left liver lobe. RESULTS: Embolization was performed by superselective catheterization of the left hepatic artery to stop the bleeding. After stabilization of the patient, left lobectomy of the liver was performed because of the ruptured 15-cm liver tumor. The patient recovered well and was discharged without residual complaints. Histopathologic analysis showed focal parenchymal peliosis. DISCUSSION: The authors evaluate the effectiveness of the surgical strategy in a case of life-threatening focal hepatic disorder. Besides surgery, the authors emphasize the importance of invasive radiological interventions in these cases.

[Treatment of acute necrotizing pancreatitis: a comparative study]. / Az akut nekrotizáló pancreatitis kezelésének összehasonlító vizsgálata.

The authors compared the therapeutic results of acute necrotizing pancreatitis during two separate time periods involving 97 and 24 patients, respectively. In the group "A", the time period lasted between May 31, 1991 and December 31, 1997. This group consisted of 97 patients, who, in addition to undergoing intensive treatment and antibiotic prophylaxis, later underwent late necrectomy and closed peripancreatic drainage. Jejunal nutrition only occurred in a limited number of 52 patients (53.6%), and was mostly used after a second operation. The group "B" consisted of patients from the time period between January 1, 1999 and December 31, 1999, and consisted of 24 patients treated in each case with intensive treatment in addition to antibiotic prophylaxis, early nasojejunal nutrition, and if necessary CT-guided percutaneous peripancreatic drainage was used. In the case of surgical intervention necrectomy and closed peripancreatic rinsing drainage was used. In group "A", significantly more early operations were performed than in group "B" (31 patients, 32.0% vs. 2 patients, 8.3%). In group "A" the number of reoperations was also higher as a total of 91 (83.5%) were reoperated as compared to group "B" in which a total of 18 (75.0%) reoperations took place. In the group "B", mortality was also lower (12.5%), than in the "A" group (17.5%). The authors attribute the successful therapy to the early jejunal nutrition, CT-guided percutaneous peripancreatic drainage and to the introduction of prophylactic antibiotics.

[CT-guided percutaneous drainage in the treatment of acute necrotizing pancreatitis]. / CT-vezérelt perkután drenázs alkalmazása az akut nekrotizáló pancreatitis kezelésében.

The authors analysed the results of the treatment of 24 patients with acute necrotizing pancreatitis. Besides intensive and operative treatment prophylactic antibiotics, early naso-jejunal feeding, CT guided percutaneous peripancreatic drainage are favourable to avoid septic complications and to postpone the first operation. In 11 patients percutaneous drainage was performed. Using percutaneous drainage three patients (33.3%) recovered without operation, the mean drainage time was 23.4 days. The first operation could be postponed in the other 8 patients after percutaneous drainage. No complications occurred as result of the interventions, although in one patient the drain slipped out spontaneously. Due to the complex treatment the total mortality rate was 12.5%.

Evaluation of hemostatic changes and blood antioxidant capacity in acute and chronic pancreatitis.

BACKGROUND/AIMS: We examined changes in hemostasis, in levels of total antioxidant capacity, and pancreatic enzymes (amylase, lipase) in patients with pancreatitis 1, 3 and 7 days after admission to the clinic, in order to evaluate the inflammatory processes in acute and chronic pancreatitis and to identify new prognostic markers. METHODOLOGY: The rate of CD62 expression--a marker of platelet hyperactivity--and the rate of platelet-leukocyte aggregates were measured by flow cytometry. The connection between the parameters measured and the severity of pancreatitis and also the differences of the parameters in acute and chronic pancreatitis were investigated. RESULTS: On the basis of previous studies it was assumed, that there is a connection between the level of parameters measured and the inflammatory process in the pancreas, and also between the defending processes of the body against free radicals. CONCLUSIONS: Based on our results, we suggest to extend the laboratory measurements to the investigation of hemostatic parameters. The measurement of plasma level of fibrinogen, von Willebrand factor and the rate of platelet activation is especially important.

[Necrosis of the galea as rare complication of infection of a traumatic temporal hematoma]. / Galea nekrózis, mint a traumát követó temporalis haematoma abscedalodás ritka szövódménye.

Authors report a case of infective traumatic temporal haematoma causing septic focus. The suppurative inflammation developed two weeks after the trauma causing necrosis of an extensive part of the galea on a big area of the crown of head. A septic process increased producing necrotic alteration of the affected periosteum of the cranial bone and plegmon in the tissue of the neck. Authors report the surgical plastic procedures that were used to establish a granulating layer and to cover the surface in the area of the removed necrotic part of the galea. Authors emphasize the significance of the danger of the inflammatory infiltration and report the effect of the Curiosin solution on the wound-healing.

[Association of carcinoid tumor of the appendix and Crohn disease (case report and review of the literature)]. / Appendix carcinoid tumor és Crohn-betegség társulása (esetismertetés és irodalmi áttekintés).

The authors describe the coexistence of the carcinoid of the appendix and Crohn's disease. In the case of their woman patient the carcinoid was identified with the examination of the resected ileoascendent part of the bowel resulting of the complication of the Crohn's disease. 10 similar association is known in the literature but none of the patients had the signs of the carcinoid syndrome. Subsequent adrenerg syndrome after an alimentary hypoglycemia (increased evacuation of the cathecolamines and their metabolites in the urine), food allergy (increased IgE type antibody to milk protein) or gastroenteropancreatic (GEP) neuroendocrine tumor (based on the result of the 111In-octreoscan and the increased 5-hydroxyindolaceticaciduria) equally suspected of the symptoms (palpitation, flush) manifested after the operation. They look for the connection between the genesis of the intestinal carcinoid and the Crohn's disease with working up the bibliography. Summing up the references with a view of the latest it can be stated that the carcinoid of the appendix occurs more than orders of magnitude in the samples from inflamed surrounding than the samples from autopsy (0.24%--820/338,000 inflamed appendix and 0.03%--19/53,430 appendix from autopsy). Consequently the inflammation create favourable condition for the development of the carcinoid of the appendix.

Influence of NaCl supplementation on vasopressin secretion and water excretion in premature infants.

The study was carried out to assess the possible involvement of excess AVP and free water retention in the development of late hyponatremia by comparing the postnatal course of plasma AVP and urinary excretion of AVP and sodium as well as creatinine, osmolar and free water clearances in premature infants with (group S) and without (group NS) NaCl supplementation. Plasma total protein and albumin concentrations were also determined. Group NS consisted of 8 infants with a birth weight of 1,150-1,730 g (mean: 1,440 g) and gestational age of 28-32 weeks (mean: 30.4 weeks). Group S included 8 infants with a mean birth weight of 1,390 g (range: 980-1,700 g) and a mean gestational age of 30.1 weeks (range: 27-32 weeks). Measurements were made on the 7th day and weekly thereafter until the 5th week of life. NaCl supplementation was given in a dose of 3-5 and 1.5-2.5 mmol/kg/day for 8-21 and 22-35 days, respectively. Infants receiving sodium supplements had significantly greater urinary sodium excretion (p < 0.01), retained more sodium (p < 0.01), maintained plasma sodium at normal levels and gained weight at slightly higher rates when compared with those on low sodium. Plasma AVP tended to be higher in group S but did not differ significantly from that in NS group. Urinary AVP excretion, however, either expressed in ng/day or ng/100 ml GFR, was significantly higher in group S, although the age-related increase could not be seen when correction was made for GFR.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intra-partum ethamsylate (dicynone) administration in the prevention of cerebral hemorrhage in premature infants]. / Intrapartum elkezdett ethamsylate (dicynone) kezelés a koraszülöttek agyvérzésének megelözésére.

Dicynone has been in use in all premature births prophylactically since 1987 by the authors. The administration of the drug begins before or during delivery. The diagnoses of cerebral haemorrhage was established on autopsy and the cases were compared with the previous years when Dicynone was not administered. During prophylactic use of Dicynone the cerebral haemorrhages significantly reduced among premature babies. It is well known, that the etiology of the cerebral haemorrhages are multifactorial. Their favourable experiences confirm the literary communications, whereas use of Dicynone can be one of the efficacious preventive drug against palsy of the premature babies.

Postnatal changes in blood spot 17-hydroxyprogesterone level in healthy preterm and full-term neonates.

Blood spot 17OH-P concentrations were determined in 14 healthy premature (mean birthweight 1439 g, mean gestational age 30 weeks) and full-term newborn infants (mean birthweight 3532 g, mean gestational age 39.2 weeks) during the first five weeks of life to provide reference data for infants with various gestational and postnatal ages. It was demonstrated that with advancing age there was an abrupt fall in 17OH-P from 296.2 +/- 84.1 nmol/l on the first day to 101.2 +/- 19.5 nmol/l on the 7th day (p less than 0.001) and 75.7 +/- 8.7 nmol/l (p less than 0.05) on the 14th day in premature infants. In full-term neonates its initial value is much lower (90.1 +/- 12.5 nmol/l) and its fall during the first week is much less pronounced (51.5 +/- 6.5 nmol/l, p less than 0.01). Comparing the postnatal changes in 17OH-P in the two groups it proved to be significantly higher in premature than in full-term infants at all ages except for the 4th week. When blood spot 17OH-P values were studied as a function of gestational age at the age of 5 days a significant inverse relationship was found between the two parameters. It is assumed that in addition to placental 17OH-P production and perinatal stress, renal salt wasting may also account for the long lasting elevation of 17OH-P plasma level seen in premature infants.

Change in phage-sensitivity of Shigella flexneri strains. I. Changes in virulence and phage-sensitivity.

In the course of repeated passaging of virulent Shigella flexneri cultures in liquid media, avirulent variants and variants of reduced virulence appeared. They were easily recognizable by their colonial morphology. The avirulent variants became sensitive to certain phages not lysing the original virulent strains. The change of phage-sensitivity among the variants with no or decreased virulence was significant: chi 2 = 64.25; P less than 0.001. The amplification of phage-sensitivity developed in 15% of the originally avirulent cultures. No association was found between the loss of virulence and a specific phage-sensitivity pattern. In the majority of the cases sensitivity to phage Ms2 developed during the passages, but it was observed in some of the original strains, too. With few exceptions, sensitivity to phage Ms2 was associated with the total or partial degradation of the specific antigen and the antigenic structure detectable by S. flexneri factor sera. These exceptions were cultures with maintained or decreased virulence.

Changes in phage-sensitivity of Shigella flexneri strains. II. The F-like character of Ms2-sensitive variants.

Variants sensitive to male specific phage Ms2 appeared among Ms2 non-sensitive Shigella flexneri cultures in the course of liquid medium passages. Sensitivity to Ms2 was lost on acridine orange treatment and was transferable into Ms2 non-sensitive variants. The Ms2 sensitive variants had fimbrial antigen. Electron microscopy showed that Ms2 phages were adsorbed on the F-like fimbriae of these variants. It was assumed that F-like plasmids determining F-like fimbrial antigen were carried by these variants.

The effect of prostaglandin F2 alpha on third stage labor.

The effects of intramyometrially injected PGF2 alpha intravenous Ergometrin and no treatment were compared during 3rd stage labor in 140 patients. In comparison with Ergometrin or no treatment, PGF2 alpha significantly reduced the duration of 3rd stage labor, blood loss, incidence of subinvolution and subfebrility.