[Role of the monocye-lymphocye system and of endogenous mediators in the severity of acute pancreatitis and in development of its septic complications]. / A monocita/limfocita rendszer és az endogén mediátorok szerepe az akut pancreatitis súlyosságának és szeptikus szövódményeinek kialakulásában.

The activity of monocyte/lymphocyte system and the splanchnic circulation was investigated in acute pancreatitis. The splanchnic blood flow was characterised indirectly by gastric intramucosal pH changes, which strongly correlated with APACHE-II score, and predicted the bad prognosis. The high CD14/HLA-DR and CD14/CD16 coexpression, the low TNF-alpha production proved to be unfavourable prognostic factor in the early phase of the disease. The expression of IL-2, IL-10 and moderately of IL-4 was elevated, but the expression of INF gamma did not show significant alteration. The thrombocyte aggregation decreased in the early phase. There are bad prognostic signs if its level remains constantly low and ATP-release increases. The activity and index of phagocytosis were higher in comparison with controls, but these parameters were not increasable with higher cell concentration. The ROI production increased, and the increase in the fMLP and o'zymosan indicated LDCL seems to be unfavourable prognostic sign, which well correlated with the APACHE-II score.

[Surgery without boundaries]. / Határtalan sebészet.

Surgery at the turn of the century and at the millennium is characterised by an extremely rapid development. There are no boundaries anymore among the different branches of medicine, in different anatomical regions of the human body, between the living human and the artificial tissues, between the reality and the virtual reality. Nanotechnology and robotics offer new possibilities for minimally invasive procedures. By the introduction of telepresence surgery there are no more surgical limits among countries and continents, between Earth and Space as well. A new chapter in history of medicine is the Cyber Surgery. The future has already arrived. Even in this new world we have to follow the ethical requirements summarised in the Hyppocrates Oath.

Anaesthesiological indications and contraindications of minimally invasive surgery.

Spreading of laparoscopic techniques caused changes in anaesthesiological contraindications. In the first period laparoscopy was contraindicated in ischemic heart disease (IHD). Early mobilisation and short postoperative period are positive goals, IHD was taken out of contraindications. Present study compares changes in circulatory, blood gas and acid-base balance values during laparoscopic cholecystectomy (LC) in groups of patients ASA I-II. and ASA III. with IHD. There were 30 patients in group ASA I-II, 30 patients with IHD in category of ASA III. investigated during LC. Fifteen patients of both groups went under Propofol-Fentanyl (TIVA) anaesthesia, others were on Propofol-Fentanyl-N2O (IVA) protocol. All of them got also Atracurium. Pulse rate, mean arterial pressure, O2 saturation and end tidal CO2, blood gases and acid-base state were recorded before induction, after CO2 insufflation, after desufflation, 1 and 3 hours postoperatively. After CO2 insufflation there was a moderate tachycardia in both ASA III. groups (74/min-->88/min). In all groups pCO2 increased (40-->48 mmHg) but normalised till the 3rd postoperative hours (42 mmHg). Ventricular extrasystoles appeared in 3 ASA III. patients in IVA group. Three high risk patients had serious metabolic acidosis postoperatively. Present time the ischaemic heart disease does not contraindicates laparoscopic interventions. TIVA with Propofol is better choice because of its favourable effects on circulation and acid-base balance. Using N2O caused higher grade of intestinal distension. The cardio-respiratory, blood gas parameters and acid-base balance have to be monitorised in perioperative period of laparoscopic surgery.

[One year's experience of a mammography unit (author's transl)]. / Einjährige Erfahrungen der Mammographischen Station.

3035 examinations were performed at the newly-opened Mammography Unit of the Department of Radiology, Semmelweis University, Budapest in 1976 and 1977. Most of the examined persons presented themselves voluntarily and had some kind of complaints. 153 cases of breast cancer were detected and operated. 86% of the breast cancer patients had objective signs.