Adhesion stabilization in the early postoperative period in a rat model / Az adhézió stabilizálódásának meghatározása a korai posztoperatív idoszakban patkány modellen

Introduction: Adhesion formation is a complex series of events that results from cellular and molecular processes where, in contrast to the normal case, events that support adhesion genesis dominate over adhesion lysis. Tissue injury, haemorrhage, tissue desiccation and inflammatory processes, among others, play a role in its induction. Since the presence of adhesions can be associated with a number of negative complications, the primary aim is to prevent their development. There are several preventive targets for the process, but in many cases therapy is only provided immediately after the procedure. In this study, we present an experimental rat model of adhesion, where the aim is to understand the stabilization period of adhesion. All animals underwent the same surgical procedure, inducing tissue injury, minor haemorrhage and tissue desiccation, differing only in the timing of reoperations and sampling. On postoperative days 1­7, we assessed macroscopically and histopathologically the type of adhesions formed, the adhesive tissue, the stability of the adhesion. We found that stabilization was a process lasting several days, with unstable and moderately stable adhesions predominating by postoperative day 4. Knowing this allows to broaden the therapeutic window, targeting the most appropriate period in the early postoperative period, possibly combining treatments, to make adhesion prevention even more effective.

Is sputum cytology reliable for detection of atypical lung epithelial proliferative changes triggered by cigarette smoking?

BACKGROUND: In recent years, Saudi Arabia has witnessed major tobacco smoking-related disease, such as cardiovascular disease and cancer, particularly among the younger population. METHODOLOGY: The present study aimed at evaluating the effect of cigarette smoke on lung epithelial cells. RESULTS: This was a cross-sectional case-control study involving 300 apparently healthy volunteers living in Ha'il, Northern Saudi Arabia. Cigarette smokers (N = 100) were used as cases, and non-smokers (N = 200) were used as controls. A sputum specimen was obtained from each participant, employing all necessary safety precautions and sample adequacy measures. RESULTS: Among 300 study subjects, cytologic atypia was identified in 14/300 (4.7%). Among the 14 cases with atypical cytologic changes, 13/14 (92.9%) were in smokers and 1/14 (7.1%) was in a non-smoker. The risk of lung cytologic atypia associated with cigarette smoking, was OR (95% CI) = 29.73 (3.82-230.87), P = 0.0001. Out of 300 study subjects, metaplasia was identified in 45/300 (15%). Among 45 cases with metaplastic changes, 26/45 (57.8%) were in the smokers and 19/45 (42.2%) were in non-smokers. The risk of lung epithelial metaplasia associated with cigarette smoking was OR (95% CI) = 3.34 (1.74-6.41), P = 0.0003. CONCLUSION: Cigarette smoking is a significant risk for developing lung epithelial atypia, lung metaplasia, and inflammatory cell infiltrate (especially chronic inflammation). Sputum cytology is a simple, non-invasive method that can be used in screening at-risk populations for early detection of lung proliferative changes associated with tobacco smoking.

The Utility of Nucleolar Organizer Regions Quantitation in Early Prediction of Lung Neoplastic Transformation.

BACKGROUND:  Cancer burden can be reduced by early detection of early neoplastic changes applying suitable screening methods. This study aimed to assess the utility of nucleolar organizer regions (NORs) quantitation in early prediction of lung neoplastic transformation. METHODOLOGY: This study investigated 200 apparently healthy individuals categorized into two groups; smoking exposed individuals (N=100), and were categorized as cases, and smoking nonexposed (N=100), and were ascertained as controls. Sputum specimen was attained from each participant (paying all indispensable safety precautions and sample adequacy processes).  Results: Out of the 200 volunteers assessed in the present study, mean NORs counts of >2.00 were identified in 16/200(8%) of the study subjects. All 16/16(100%) cases were found with lung epithelial metaplasia (squamous metaplasia). Out of the 100 cases, mean NORs counts of >2.00 were identified in 16/100(16%), hence, all the controls were identified with mean NORs counts of <2.00. The risk of lung cellular proliferative changes associated with smoking exposure are odds ratio (OR) (95% confidence interval, CI) = 39.2485 (2.3199-664.0052), p = 0.0110, z statistic = 2.543. CONCLUSION: NORs count is a simple, specific, cost-effective, and reliable method that can give a quantitative measurement for the risk of lung neoplastic transformation. For at risk-population (tobacco users), it is recommended to perform the argyrophilic NORs (AgNORs) method beside sputum cytology.

[Analysis of the utilization of one-day surgery in Hungary]. / Az egynapos sebészeti ellátás igénybevételi mutatóinak elemzése Magyarországon.

Introduction: The impact of one-day surgery has been increasing since the past few decades. This type of health service could fulfil many requirements of health policy, health care services, governments as well as patients. Aim: The aim of the research was to assess the publicly financed case numbers and interventions of one-day surgery in Hungary between 2010 and 2015 from different aspects. Method: A retrospective and quantitative research was made, based on data of the National Health Insurance Fund of Hungary. The database contained all publicly financed one-day surgery cases (both theoretical and performed cases), intervention codes (WHO) as well as the related medical field. Then the database also contained all relevant information related to the patients (age, sex, residency according to the county) and the type of the provider health care institutions. Results: Our results showed an increasing tendency according to the case numbers of one-day surgery from 130 995 (2010) to 251 328 (2015). The mean age of patients also increased in the analyzed period; in 2010: 47.4 years, in 2015: 54.5 years. In 2010, 42% of the theoretically defined one-day surgery cases were practically performed as one-day surgery cases which increased significantly to 65% in 2015. Gynecology, ophthalmology, general surgery and urology have had a significant impact in one-day surgery in Hungary. Conclusion: The analyzed data showed a significant increase of accounted cases, and we could identify the remarkable impact of gynecology and ophthalmology in one-day surgery in Hungary. Orv Hetil. 2019; 160(17): 670-678.

[Plasmapheresis in the treatment of hypertriglyceridemia]. / Hypertriglyceridaemia kezelése plazmaferézissel.

The authors present the case of a 38-year-old woman with severe hypertriglyceridemia-induced acute recurrent pancreatitis (triglyceride 16 761 mg/dl, 189.4 mmol/l). According to the knowledge of the authors, such a high triglyceride has not been previously reported in Hungarian and international scientific literature. The patient received conventional treatment (fluid replacement, analgesic, antibiotics, discontinuation of oral intake) and plasmapheresis too. After two sessions of plasmapheresis with one month interval the clinical and laboratory parameters greatly improved. Severe hypertriglyceridemia (triglyceride level more than 1000 mg/dl, ≈11.3 mmol/l) is an independent risk factor for acute pancreatitis. Plasmapheresis seems to be safe and effective to rapidly decrease triglyceride levels and to remove the causative agent for pancreatitis in a patient with severe hypertriglyceridemia.

[The frequency of bacteria in human gallstones]. / Epekövekben levo baktériumok elofordulásának gyakorisága.

INTRODUCTION: Complications caused by lost gallstones within the abdominal cavity are well known. Abscesses, perforation of the gastro-intestinal tract were all described in the literature, but gallstones were found in hernial sac, or even in sputum after it penetrated through the diaphragm into the respiratory tract. These complications can develop between several weeks to several years postoperatively. Most complications can be treated surgically only. MATERIALS AND METHODS: Fifty gallstones and bile samples were collected from 50 patients who underwent cholecystectomy (36 female / 14 male, avarge age: 60.8 ± 6.8 years). All samples were sent for microbiological examination. RESULTS: bacterial colonization of the gallstone and the bile were found in 16 cases. Four of them showed acute inflammation in the gallbladder while pathological signs of chronic inflammation in the gallbladder wall were detected in eight cases. Empyema was found in four cases. Bacteria from enteral origin (Esherichia coli, Enterococcus faecalis, Enterobacter cloacae) was detected in 13 cases, while non-enteral (Klebsiella penumoniae, Streptococcus alfa-haemoliticus) colony were detected in three cases. Positive bacterial cultures were identified in twelve female and fourmale patients. CONCLUSIONS: Different types of bacteria can be found in the gallstones, which may cause various complications.

[The mechanism of adhesion formation and the possibilities of modeling -- a preliminary study]. / Az adhaesioképzodés mechanizmusa és modellezésének lehetoségei -- Elokísérleti modellek.

A huge number of factors play a significant role in the process of adhesion formation, like bleeding, the presence of foreign bodies, tissue injury, tissue destruction, ischemia and hypoxia. Adhesions are present in 95% of the cases following abdominal surgery. As a result of adhesions a large number of postoperative complications can occur, such as abdominal pain, bowel motility disturbances and infertility. Hence, it is important to know the precise mechanism of adhesion formation process and establish a suitable animal model to investigate the underlying mechanisms. Molecules which play a part in the process of adhesion formation were collected from the international literature. Male Wistar rats were used to create the adhesion model. Bleeding, implantation of foreign bodies, creation of ischemic areas and tissue destructions were carried out. Within this experiment the tiny bleeding and ischemic areas did not result in adhesion formation. The adhesion formation due to foreign body implantation depends on the type of the materials. Due to the inhibitory mechanism of adhesion formation there was no adhesion detectable due to tiny peritoneal destruction. The most reliable model was the one when gross tissue destruction of the abdominal wall was applied and the resulting bleeding initiated the adhesion formation process. It is also extremely important to know the key participants in the complex process of adhesion formation. This reliable model can help to work out the proper method of prevention.

[Trocar site herniation (TSH) following laparoscopic cholecystectomy: incidence, pathogenesis, and prevention -- animal study]. / A trokárok helyén kialakult hasfali sérvekrol (Trocar Site Hernia) laparoscopos cholecystectomia után: incidencia és megelozés -- állatkísérletes tanulmány.

INTRODUCTION: In 1968 R. E. Fear first reported a trocar site hernia (TSH) in his large series on laparoscopy. Currently, the incidence of TSH is estimated to be 0.65-2.80%. Ports ≥10-mm are usually closed, but ports of the 5-mm trocars are always left open, which may lead to herniation. MATERIAL AND METHODS: Authors guided teaching courses for hands-on animal laparoscopic cholecystectomy (LC) operations, where trainees performed LC-s on 60 animals. Two and four weeks following the operations the animals underwent second look laparoscopy to detect adhesion formation. RESULTS: Trocar site herniation was observed, and in 20% of the animals herniation was found. 70% of the hernias were situated in the 5-mm ports and 30% in the 10-mm ports. CONCLUSION: Port sites should be closed to prevent the formation of TSH. Attention should be payed on the closure of 5-mm trocar sites as well.

[The treatment of Aspergillus empyema using open thoraco-myoplasty with the preservation of lung function -- case report]. / Aspergillus empyema kezelése nyitott thoracostomiával és izomplasztikával, a tüdo funkciójának megorzésével -- esetismertetés.

CASE REPORT: Invasive aspergillosis is a life threatening complication in immune-compromised patients causing lung tissue destruction. Aspergillus empyema requires aggressive multimodality treatment. MATERIAL AND METHOD: We present a case of Aspergillus empyema treated by thoracic and plastic surgery preserving the lung function in an 18 year-old male patient suffering dermatomyositis and treated with steroids for a long time. After open window thoracostomy (OWT) we used pedicled musculus latissimus dorsi (MLD) flap and mobilised the anterior serratus muscle to close the pleural cavity. CONCLUSION: The intrathoracic use of muscle flaps after OWT in case of chronic Aspergillus empyema can preserve the underlying lung tissue. Cooperation of thoracic and plastic surgeons - as in the cases presented - provides an excellent opportunity to treat successfully of otherwise hopeless patients.

Fine needle aspiration cytopathology of pediatric lymphadenopathy among Sudanese children.

BACKGROUND: Pediatric lymphadenopathy is a challenging medical situation for the child patient, the parents, and the physician. Although the bulk of masses will be benign the fear of malignancy is omnipresent. Therefore, the objective of this study was to identify the common cytopathological patterns of lymphadenopathy among Sudanese children. METHODS: One hundred pediatric patients presenting with peripheral lymphadenopathy were included in the study, their ages ranging from 2 to 14 years, with a mean age of 7 years. Demographic characteristics, clinical manifestations and FNA materials were prospectively obtained. RESULTS: FNA was performed in 100 cases (100%). There were no technical complications. All cases confirmed adequacy of specimen. Overall, FNA demonstrated 90 (90%) benign lesions and 10 (10%) malignant diagnosis. The benign lesions were reactive lymphoid hyperplasia (n=64), followed by benign granulomatous disease (n=26). Of the 10 cases diagnosed with malignancy, 7 (7%) were cases of non-Hodgkin`s lymphoma and the remaining 3 (3%) were Hodgkin's lymphomas. CONCLUSION: Pediatric lymphadenopathy is common in Sudan. CLA is the common frequent site. Lymphoma represents a major challenge in this setting.

[Effect of "Pintes" white wine on metabolic parameters in patients with metabolic syndrome]. / Pintes fehérbor hatása az anyagcsere-paraméterekre metabolikus szindrómás betegekben.

UNLABELLED: Moderate alcohol consumption has been associated with decreased cardiovascular mortality in the general population. Relatively few studies have been conducted to evaluate the effect of white wine on insulin sensitivity. AIMS: The authors studied the impact of moderate Pintes white wine consumption on insulin sensitivity and other metabolic parameters. METHODS: The prospective study involved 18 patients with metabolic syndrome. The patients consumed Pintes white wine for 4 weeks, and parameters were measured before and after consumption. RESULTS: The HOMA-IR decreased significantly after white wine consumption (2.28±2.04 vs 1.08±0.6; p = 0.002). There were no changes in serum cholesterol, LDL-cholesterol, triglyceride and fasting plasma glucose levels. CONCLUSION: White wine consumption improved insulin sensitivity in patients with metabolic syndrome.

[Efficacy and safety of ezetimibe/simvastatin combination therapy in patients with type 2 diabetes and nonalcoholic fatty liver disease]. / Ezetimib/simvastatin kombinált terápia biztonságossága és hatékonysága 2-es típusú diabeteses, nem alkoholos zsírmájú betegekben.

UNLABELLED: Nonalcoholic fatty liver disease is commonly associated with type 2 diabetes, dyslipidemia and obesity all of which are components of the metabolic syndrome. AIM: To determine the efficacy and safety of ezetimibe/simvastatin 10/20mg combination therapy on patients with type 2 diabetes and nonalcoholic fatty liver disease. METHODS: We studied nineteen patients with type 2 diabetes and nonalcoholic fatty liver disease diagnosed and treated between 2005 and 2008 at Health Center of Budaörs. After six months of ezetimibe/simvastatin (10/20mg/day) combination treatment, all patients were assessed for changes serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglycerides. RESULTS: Six months of ezetimibe/simvastatin administration reduced significantly the serum levels of ALT (63.78+/-5.12 vs 32.57+/-3.92 U/L; p < 0.0001), AST (50.79+/-3.66 vs 23.68+/-3.42 U/L; p < 0.0001), cholesterol (6.26+/-0.46 vs 4.02+/-0.31 mmol/L; p < 0.0001) and LDL-cholesterol (4.24+/-0.37 vs 2.22+/-0,1 mmol/L; p < 0.0001). Combination therapy reduced significantly serum triglyceride level (2.62+0.48 vs 1.33+0.20 mmol/L; p < 0.0001) and increased the level of HDL-cholesterol (1.02+/-0.12 vs 1.18+/-0.07 mmol/L; p < 0.0001). CONCLUSIONS: These findings indicate that ezetimibe/simvastatin combination therapy is safe and effective in patients with type 2 diabetes and nonalcoholic fatty liver disease.

Laparoscopic treatment of simultaneously occurring Morgagni and paraesophageal hernias.

A paraesophageal hernia was diagnosed in a 67-year-old female patient suffering from epigastric pain and gastroesophageal reflux disease. The patient underwent laparoscopy. Beside the paraesophageal hernia, a Morgagni hernia was also observed, with a significant part of the omentum herniated in the sac. A 360-degree Nissen fundoplication was performed, the Morgagni hernia sac was not resected, and its closure was performed with interrupted sutures. No complications were observed in the postoperative period and on one-year follow-up the patient was free of symptoms.

[The role of pneumoperitoneum and the "chimney effect" on the development of port site metastasis. A new experimental animal model using Furka's spleen tissue suspension]. / A pneumoperitoneum és a "kémény effektus" szerepe a port site metastasis kialakulásában. Furka-féle lép suspensióval végzett új állatkísérletes modell.

Following the introduction of laparoscopic cholecystectomy, laparoscopic technology has been applied in many other fields of surgery, including surgery for malignancies, even before prospective, randomised trials were available. Many authors observed development of port site metastases following laparoscopic surgery in malignancies (1-2%). The studies report about the pathomechanism of the development of port site metastasis, some describe the role of pneumoperitoneum. We developed a new model to show the role of pneumoperitoneum and the "chimney effect" on the development of port site metastasis, using a large experimental animal with a suspension of its own spleen tissue. On follow up histology viable spleen tissue was found between the layers of the trocar incisions.

[Laparoscopic versus open cholecystectomy: reaction in the liver bed]. / Laparoszkópos versus nyitott cholecystectomia: válaszreakciók a májágyban.

The aim of this study was to compare the incidence, size and localisation of adhesion formation following open and laparoscopic cholecystectomy and to determine immune and foreign body reactions in the liver bed. The experimental animals were divided into two groups: open (OC) versus laparoscopic (LC) cholecystectomy. In the 14th postoperative day the animals were reoperated, types and size of adhesion were measured and tissue samples were extracted from the liver bed for histology. Dense, curtain-like adhesions were formed in OC group. The adhesions developed not only in the operation area but also on other organs. The thread used to ligate the cystic duct and cystic artery caused foreign body reaction, which resulted in granuloma formation. Numerous macrophages, histiocyte giant cell reactions were also present in OC group. Considerable fibrosis was also observed in the majority of the animals. Slender adhesion formation formed after LC. It was mostly detected in the liver bed. Foreign body granulomas around the laparoscopic clips did not develop in the cases. Moderate inflammatory reactions were noticeable. Laparoscopic operative technique is less traumatic. Its advantage over the open technique is lower adhesion rate and better immune function and reaction. This operation technique is less immunosuppressive and development of adhesions is less compared to OC.