Redox potential measurement as a rapid method for microbiological testing and its validation for coliform determination.

The redox potential is one of the most complex indicators of the physiological state of microbial cultures and its measurement could be a useful tool for the qualitative and quantitative determination of the microbial contamination. During the bacterial growth, the redox potential of the medium decreases. The shape of the redox potential curve is characteristic on the type of microorganism, and the rate of the change (dE/dt) is proportional to the living cell concentration. Defining the time required to reach a significant change in redox potential as Time to Detection (TTD), similarly to the impedimetric measurements, a strict linear correlation could be established between the TTD and the logarithm of the initial concentration of microorganisms. On the base of this calibration curve, the determination of living cell concentration could be simplified. For the experiments, a computer-controlled multi-channel measuring system and software was developed by the authors. The redox potential measurement method was tested and validated for the determination of coliform bacteria. The results have proved the high efficiency and reliability of the new method.

Lymphadenectomy in gastrointestinal surgery for malignancy.

In a randomised study 25 patients with gastrointestinal surgery combined with extended lymphadenectomy (three field lymphadenectomy in case of esophageal cancer, D2 lymphadenectomy in case of gastric cancer) has been compared to the same number of patients with limited lymphadenectomy (D1). The operation time and the need for blood transfusion has increased in the extended lymphadenectomy group. The complication rate was more than doubled in the extended lymphadenectomy group, due to fluid or lymph collection, lymphatic edema, and infection. The mapping and staging was superior in extended lymphadenectomy group, but increased morbidity and mortality has been found in this group. However the favourable effect of extended lymphadenectomy on survival needs further long-term studies and proofs.

Experiences with duodenum preserving pancreatectomy.

According to the principle of surgery for chronic pancreatitis the preservation of pylorus, duodenum or distal part of common bile duct gives the benefit of more physiological intervention. 2 patients with duodenum preserving pancreatectomy are presented. The operation was carried out for chronic pancreatitis. Both patients had jaundice and needed T drainage. Both patients suffered from very severe malnutrition with cachectic condition adding severe pain. None of them proved to be malignant by the frozen section. Previous diabetes, severe chronic inflammation of the whole pancreas, destruction of the pancreatic ductal system and cysts helped the decision-making for ablation of pancreas with preservation of duodenum which seems organ saving procedure. In comparison with the Whipple operation the duodenum-preserving pancreatectomy spares the patient a gastrectomy, a duodenectomy and a resection of distal common bile duct.

[Late post-tracheostomy airway complications in patients with central nervous system injuries]. / Központi idegrendszeri sérültek késöi posttracheostomiás légúti szövödményei.

At decannulation or often weeks later some of the patients undergone long-term mechanical ventilation through tracheostoma reveal symptoms of airway stenosis. Posttracheostomy airway complications detected during the rehabilitation of 34 patients with central nervous system injury are presented. Endoscopic examinations (total 130) were performed with Olympus BF B3 and OES 20-type fiberscopes and Friedel-type rigid bronchoscopes under local or general anaesthesia. Stridor (20 cases) and possible decannulation (10 cases) were the main indications of the first endoscopic examinations. Stridor was caused by tracheal (12 cases) and laryngeal (8 cases) stenosis. With six patients decannulation was possible after the first endoscopy. Removal of granulomas and sutures was successful in 8 cases. Rigid bronchoscopic dilatations were temporarily successful in 7 cases, but in five of them it had to be repeated on emergency. Further therapeutic interventions were: recannulation (3 cases), retracheostomy (4 cases), implantation of silicon T-endoprothesis (5 cases), tracheal resection (4 cases). Three patients are discussed in details. Eliminating airway complications largely contributed to rehabilitation of the nervous and musculoskeletal system, improved the quality of life, and in acute cases it was a life-saving measure. In order to prevent the development of late airway complications or detect them in time, it is recommended to have an endoscopic protocol following every tracheostomy: 1. at the time of decannulation 2. at closing the trachea and 3. 2-3 months after decannulation.