[NEUROINTERVENTIONAL TREATMENT OF ACUTE ISCHEMIC STROKE: OUR EXPERIENCE IN KAPOSVAR, HUNGARY]. / AZ AKUT ISCHAEMIÁS STROKE NEUROINTERVENCIÓS KEZELÉSÉVEL SZERZETT KAPOSVÁRI TAPASZTALATAINK.

AIM OF THE STUDY: In the present study, we report procedural and mid-term functional outcome data on the first 50 neurointerventional treatments of acute ischemic stroke in the Kaposi Mór County Hospital, Kaposvár, Hungary. MATERIALS AND METHODS: Endovascular recanalization of occluded large cervical and intracranial arteries was performed following an unsuccessful intravenous lysis or when intravenous lysis was contraindicated. A control cohort was retrospectively formed by analyzing data of 16 patients who has been unsuccesfully treated with iv. lysis before neurointervention was available in our hospital. RESULTS AND CONCLUSION: Recanalization rate was 84% and major complication rate was 2% in the neurointerventional group. Mid-term good functional outcome, defined as mRS 0-2, was achieved in 44% in the neurointerventional and in 13% in the intravenous lysis group, after 11.5 and 39.7 months follow-up period, respectively. Subgroup analysis revealed patient age as the strongest predictive factor of good functional outcome. Our data shows that neurointerventional treatment of acute ischemic stroke gives substantially improved functional outcome, in accordance with the results of the recently published international randomized trials.

[Comparison of the results of laparotomy and laparoscopic surgery in patients with Crohn's disease]. / A nyitott és minimálisan invazív beavatkozások eredményeinek összehasonlítása Crohn-betegségben.

INTRODUCTION: Crohn's disease is an inflammatory bowel disease which may affect different parts of the gastrointestinal tract. AIM: To compare retrospectively the results of laparotomy and laparoscopic surgery performed in patients with Crohn's disease between January 1, 2005 and October 31, 2012 in the Department of Surgery, University of Szeged, Hungary. METHOD: Patients were divided into two groups based on the types of surgery; 103 patients underwent laparotomy and 30 patients had laparoscopic surgery programmed. 22 patients had 24 primary acute interventions. RESULTS: The mean age was significantly lower in the laparoscopic surgery group (p = 0.042). The laparoscopic ileocecal resections have been found significantly shorter than laparotomies (p = 0.033). When ileocecal resection was performed the operation time was significantly longer (p = 0.033) while hospitalization time (p = 0.025) and intensive care unit treatment time (p<0.001) were shorter and the bowel passage also started earlier in the laparoscopic group as compared to the laparotomy group. CONCLUSIONS: Laparoscopic surgery results in smaller surgical trauma, better cosmetic outcome, shorter hospitalization time and not higher complication- and morbidity-rate as well as shorter operation time in certain cases. However, it requires more qualified surgical team and the operation expenses are higher.

[Tolosa-Hunt syndrome]. / A Tolosa-Hunt-szindróma.

Both men and women are affected by the rare disease called Tolosa-Hunt syndrome. We don't know exactly what causes it to evolve. It is usually put into the categories of either idiopathic inflammation or pseudotumor. Its pathological feature is a non-specific inflammatory process with fibroblastic, lymphocytic, plasmocytic infiltration, which can be found, for the most part, in the wall of the sinus cavernosus. Granulocytic and giant-cell infiltrations have been described too. The possibility of autoimmune disease has also come up. In our current study we describe the case of a female patient who recovered with the help of a steroid therapy. Through examining her, we also found immunological alterations, which should urge us to thoroughly examine the further observations of this kind.

[Spontaneous thoracic hernias--report of two cases, surgically treated]. / A spontán mellkasfali sérvekrôl két operált eset kapcsán.

The authors present two cases of atraumatic (spontaneous) thoracic lung hernias, which are extreme rarities in the international literature, too. Risk factors and clinical pictures discussed and operative treatments are demonstrated. The spontaneous thoracic (intercostal) hernias were provoked by intractable cough caused by chronic obstructive pulmonary disease (COPD) in both cases. Multi-slice spiral CT (MSCT) scan as well as the secondary 3D 'volume rendering' (VRT) reconstructions unequivocally suggested this rare condition. Provided with the exact diagnosis, the surgical correction of the thoracic wall resulted in full recovery of the two patients. Finally, the authors briefly discuss data of thoracic hernias published in the Hungarian and the international literature. They conclude that the awareness of this extremely rare condition is important due to the high prevalence of COPD as a risk factor. Diagnostic imaging demonstrated can provide significant help in the correct diagnosis of similar cases.

[Rare complication of COPD: spontaneous thoracic wall lung hernia]. / A COPD ritka szövôdménye: spontán mellkasfali (tüdô)sérv.

A case of spontaneous thoracic (intercostal) lung herniation originating from a chronic obstructive pulmonary syndrome (COPD) is presented. The authors present the classification, the clinical aspects and the patho-anatomic features of hernia along with the steps of diagnostic procedures. They discuss the potential pathomechanism of intercostal muscle disruption and the attached literature of this disease. The thoracic wall herniation was detected via a chest radiograph and confirmed by CT-imaging with the help of a special "3D" reconstruction-method. The knowledge of rare lung herniation is important because of the huge increase in the number of COPD-cases in our country recently.

[Magnetic resonance urography in the diagnosis of the ectopic ureters]. / Mágneses rezonancia urográfia az ectopiás ureterek kórismézésében.

INTRODUCTION: Ectopic ureters are often very difficult to diagnose with conventional diagnostic modalities (physical examination, ultrasound, intravenous urography, cystography, urethro-cystoscopy, isotop examinations) in children. AIM OF THE STUDY: The authors report their experience with a relatively new method, the magnetic resonance urography (MRU) diagnosing ectopic ureters in childhood. METHOD: MRU was used in 7 girls to detect an ectopic ureter in the last 3 years. On the basis of typical clinical signs, an ectopic ureter was suspected in all patients, but it could not be demonstrated by conventional diagnostic methods. Thus, MRU was done to confirm the suspected diagnosis. RESULTS: In all of the 7 patients, the examinations demonstrated ectopic ureters with the intraoperative findings further confirming the pre-operative diagnosis. In 2 patients, the intraoperative findings of the upper urinary tract anomalies were slightly different from the MRU report. CONCLUSION: The MRU is a reliable diagnostic method to diagnose ectopic ureters which are not easily detectable with conventional diagnostic modalities.

New features in synthesis of talampanel related 2,3-benzodiazepines.

Analogues of talampanel (1), a highly active AMPA antagonist 2,3-benzodiazepine, were synthesized, where the characteristic amino-function was either transposed or sterically shielded. For the key intermediates (hemiketals 6a, b) a new synthetic method of different mechanism was developed. The inactivity of several new compounds indicates the significance of the 4-amino(phenyl) function in BDZs of type 1.

Unprecedented cyclizations of calix[4]arenes with glycols under the Mitsunobu protocol, part 2.(1) O,O-and O,S-bridged calixarenes.

[reaction: see text] Cycloalkylations of p-tert-butylcalix[4]arene (CA) and p-tert-butylthiacalix[4]arene (TCA) with various aliphatic glycols were performed under the Mitsunobu protocol using the DEAD/TPP system. CA gave 1,3-dialkylated diols, while C(2)-C(10) glycols gave 1,2- and 1,3-bridged calixarenes. The reaction of TCA with C(2) diols afforded sulfonium phenoxide betaines via O,S-cyclization, which is the first example for the alkylation of the sulfide bridge.

Mechanism of the Gibbs Reaction. Part 4.(1) Indophenol Formation via N-Chlorobenzoquinone Imine Radical Anions. The Aza-S(RN)2 Chain Reaction Mechanism. Chain Initiation with 1,4-Benzoquinones and Cyanide Ion.

The mechanism of the Gibbs reaction, a colorimetric phenol assay that applies N-chlorobenzoquinone imines 1 in an aqueous basic medium, was investigated. It is concluded that N-chloroimine radical anion 7 generated in a single electron transfer (SET) from the anion of phenol 4 to N-chloroimine 1 can produce indophenol dye 3 in three distinct routes. For more reactive reagent-substrate pairs, a route is proposed that involves a fast combination of the radical pair in the solvent cage and, consequently, the total rate of which exhibits a pH-independent second-order kinetics, as does the preceding SET itself. For less reactive reagents, a route is proposed in which the N-chloroimine radical anion 7 escapes from the solvent cage to initiate a chain reaction, evidenced by its characteristic kinetics. It has been found in the kinetic experiments that during propagation the chlorine of the chain carrier N-chloroimine radical anion 7 is substituted by the anion of 4 in a bimolecular rate-determining step. Therefore, the mechanism of the chain reaction is termed S(RN)2. In the case when the anion of 4 is less active, a competitive reaction along a third route can proceed in which the N-haloimine radical anion 7 yields benzoquinone imine 6 by the elimination of halogenide and the abstraction of an H-atom from the medium. Compound 6 is also known to give indophenol 3 with a second-order but pH-dependent rate that is considerably faster than the rate in the first route. On the basis of the different kinetic characteristics outlined above a clear distinction can be made among these three pathways. In this paper, evidence is also presented for the initiating SET. Furthermore, it is of high importance that the N-haloimine radical anion 7 can also be generated from reagent 1 using external electron donors and, independently of its origin, it can be spin trapped with 2,2,6,6-tetramethylpiperidine-N-oxyl.

[New methods for the diagnosis of acute pulmonary embolism]. / Az akut pulmonalis embolia diagnosztikájának újabb lehetöségei.

INTRODUCTION: Pulmonary embolism is a high mortality cardiovascular disease, which is difficult to diagnose even today. AIM AND METHOD: In this study the symptoms and the results of diagnostic methods were analysed in 81 patients with acute pulmonary embolism, admitted during a one-year period to Kaposi Mór County Hospital. The patient records were examined with special emphasis on the diagnostic value of novel methods such as D-dimer assay and chest computed tomography scanning along with the routine techniques used in the management of pulmonary embolism. RESULTS: In all patients ECG, in 88% of the cases chest X-ray, in 57% blood gas analysis and in 53% D-dimer assay results were evaluated. 14.8% of the patients died during hospitalisation. The following diagnostic imaging procedures were undertaken: in 80.2% of the cases lung scan, in 59.3% echocardiography and in 8.7% of the cases spiral computed tomography scan were prepared. In 12.3% of all cases thrombolysis proved necessary. The results were compared with data from International Cooperative Pulmonary Embolism Registry Study, which analyses 2454 patient cases. CONCLUSION: It is foreseen that the increasing use of echocardiography, lower limb ultrasound and highly informative spiral computed tomography scanning as an additional means in pulmonary embolism diagnostics may in some cases spare the use of pulmonary scintigraphy.

[Sapheno-peritoneal shunt (Routte-operation) in the treatment of refractory ascites]. / Sapheno-peritonealis shunt (Ruotte-mútét) a terápiarezisztens ascites kezelésére.

We describe the results of an operative method applied in patients suffering from refractory ascites. Instead of the well-known shunt-implants we started to re-use Ruotte's method, which was published 100 years ago. According to our observations the anastomosis formed by the long saphenous vein and the peritoneal surface eliminates not only the known complications of the traditional shunt-operations but also provides an effective early and a late ascites inflow. The flow of the ascites was convincingly proven by regularly performed colour Doppler UH tests. This old/new method is applicable in patients with therapy-resistant ascites to eliminate the traditional shunt-models.

Potential metabolites of a condensed 2,3-benzodiazepine derivative.

Putative metabolites of an AMPA antagonist imidazo-2,3-benzodiazepine (2) were synthesized and compared to constituents formed from the parent compound by a rat liver perfusion method. As metabolic transformations, hydroxylation of the 2-methyl group and N-acetylation of the amino functionality in parent compound (2) were registered. The hydroxylated analogue 12 of 2 exhibits a weak AMPA antagonist activity.