Transcatheter embolization for the control of posttraumatic hemobilia.

Angiography is the definitive diagnostic procedure for the patient with haemobilia. As well as giving precise localisation of the source of the haemorrhage, it provides an effective alternative to surgery for its control. In a case discussed, the bleeding sites were identified by angiography, and the bleeding was controlled by transcatheter embolisation.

On the specificity and mode of action of a xylanase from Trametes hirsuta (Wulf.) Pilát.

The mode of action of the extracellular endo-(1 leads to 4)-beta-D-xylanase produced by Trametes hirsuta on a (4-0-methyl-D-glucurono)-D-xylan and a modified, essentially neutral D-xylan from white willow (Salix alba L.) has been studied. Xylotetraose and xylohexaose, together with aldotetraouronic and aldohexaouronic acids, were the main products. The acidic oligosaccharides had a 4-O-methyl-D-glucopyranosyluronic acid group attached to the non-reducing D-xylosyl end-group. The action pattern of the xylanase corresponds to that of a typical endo-enzyme that acts more readily in the middle of chain, and the specific region of its action appears to involve five D-xylosyl residues. The products of the enzymic treatment of the D-xylan have revealed a regular distribution of the 4-O-methyl-D-glucopyranosyluronic acid groups attached to the D-xylan backbone.

Purification of xylanase from the wood-rotting fungus Trametes hirsuta.

Xylanase (EC 3.2.1.8) was purified from a crude extracellular enzyme of the wood-rotting fungus Trametes hirsuta by a four-step procedure involving precipitation with ammonium sulphate, gel filtration on Bio-Gel P-10, column chromatography on DEAE-Sephadex A-50 and preparative electrophoresis on polyacrylamide gel. The isolated enzyme, electrophoretically homogeneous, was separated from beta-xylo-sylosidase and other hydrolytic enzymes studied. The analysis of the degradation products of water-soluble (4-0-methylglucurono)-D-xylan from willow by the purified xylanase showed it to be endoxylanase (beta-1,4-xylan xylanohydrolase).

Studies on xylanase from Basidiomycetes. Selection of strains for the production of xylanase.

Formation of extracellular xylanase was studied in 10 strains of wood-destroying fungi belonging to Basidiomycetes during their submerged cultivation with willow sawdust. The highest enzyme activity was found in the fungus Trametes hirsuta (Wulf.) Pilát. The effect of sources of carbon and nitrogen, cultivation time and initial pH of the cultivation solution on the formation of xylanase by the fungus Trametes hirsuta was investigated. The highest production of the enzyme was reached during cultivation in the presence of willow sawdust, asparagine and at the initial pH of 5.0. The presence of xylanase, cellulase, mannanase and amylase as well as of beta-xylosidase, beta-glucosidase, beta-mannosidase and beta-galactosidase was demonstrated in the enzyme preparation obtained after a 10-day submerged cultivation of Trametes hirsuta under optimal conditions.

Some properties of an endo-1,4-beta-D-xylanase from the ligniperdous fungus Trametes hirsuta.

Some properties of purified endo-1,4-beta-D-xylanase (1,4-beta-D-xylan xylanohydrolase, EC 3.2.1.8) from the ligniperdous fungus Trametes hirsuta were investigated. The enzyme was stable between pH 4.0 and 8.0 were optimum activity at pH 5.0--5.5. The temperature optimum was 50 degrees C and the enzyme was stable for up to 30 min at 45 degrees C; however, it was denatured at higher temperatures. The Km for 4-O-methylglucurono-D-xylan was 6.36.10(-3) equivalents of D-xylose per litre, the activation energy was 28 kJ mol-1. The molecular weight determined by means of gel chromatography was 22000--24000. The enzyme was activated by Ca2+ and inhibited by Ag+ and Hg2+. On the basis of the effect of 2-hydroxy-5-nitrobenzyl bromide. N-bromosuccinimide and N-acetylimidazole it may be assumed that trytophan and possibly tyrosine residues influence the enzyme catalysis.

[Value and results of esophageal transsection in treatment of bleeding esophageal varices]. / Bedeutung und Ergebnisse der Oesophagustranssektion bei der Behandlung von Oesophagusvaricenblutungen.

A report on 40 patients is given, who had to undergo esophageal transection due to bleeding varices. 17 patients were operated as an emergency, 23 patients had a prophylactic treatment. Mortality was high with 58.82% and 21.7% respectively. The need of blood replacement was higher in the emergencies. The main cause of death was liver failure, the average time of survival 40 months. We conclude that esophageal transection is of some value in cases of acute bleeding, after failure of non-interventional treatment.

Alterations of glycosaminoglycans in human liver and kidney tumors.

Glycosaminoglycans were investigated in surgically removed human liver and kidney tumours by applying biochemical methods. Four liver adenoma, 6 focal nodular hyperplasia and 9 primary hepatocellular carcinoma samples were compared with normal liver from autopsy cases and also with liver tissue adjacent to PHC. The studies on kidney included 14 renal cell carcinoma and 4 wilms' tumour samples. Three findings emerged from the quantitative and qualitative characterization of the tumours with epithelial origin. 1) The rise in the amount of total GAG was not limited to the malignant lesion. Similar increase was observed in benign liver tumours and also in the tissue adjacent to liver or kidney malignant tumours. 2) The dominant type of the GAG subclasses varies with the histology of the tumours. In benign liver tumours dermatan sulfate, in PHC and renal cell carcinoma chondroitin sulfate, but in Wilms' tumour hyaluronate was the prominent GAG subclass. 3) In all tumour-affected tissues dermatan and chondroitin sulfates had lower degree of sulfation. However, in the histologically different tumours various disaccharides showed reduced level of sulfation. The GAG alteration in renal cell carcinoma was compared with the prognostic factors of each individual case. This analysis showed a good correlation between HS/CS ratio and the prognostic factors of the kidney tumour cases.

[Therapeutic possibilities in the management of Budd-CHiari syndrome (case reports and review of the literature)]. / A Budd--Chiari-syndroma kezelésének lehetöségei (betegbemutatás és irodalmi áttekintés).

The authors treated six female patients with Budd--Chiari syndrome. Having compared their own experience with the data of literature they concluded that the medical treatment of Budd--Chiari syndrome is usually without any success. Survival of the patients can only be expected by portosysthemic shunts or liver transplantation.

[Causes and management of local tumor recurrence after low resection of the rectum]. / A mély rektumrezekciókat követö lokális tumor recidívák okairól és kezelésük lehetöségeiröl.

The postoperative course of 64 patients resected with EEA stapler because of their midrectal cancer have been followed. 13 (20.3%) local tumor recurrence have been observed in the first 24 postoperative months. 5 patients could be rectum exstirpated at the reexploration, only colostomy was performed in 8 cases. All the inoperabel patients have died in a year, but 3 of the exstirpated ones overlived this time. A direct connection have been observed between the Dukes stadium and the differentiation of the tumor, the distance of the distal resection line from the lower end of the tumor and the probability of the local recurrence. No connection has been found between the distance of the tumor from the linea dentata and the local tumor recurrence. On the basis of the oncological observations the deep rectal resection can be performed only by tumors in stadium Dukes A and B, if the tumor is well differentiated, there are no signs for local propagation or lymph node metastases, and more then 2 cm distal distance can be kept by the resection from the lower and of the tumor. In all other cases the rectum exstirpation must be the method of choice.

[Tumor necrosis factor production in septic conditions following pancreatitis (preliminary report)]. / Tumor necrosis factor termelés vizsgálata pancreatitist követö szeptikus állapotokban (Elözetes közlemény).

Detectable TNF levels in sera 33% of patients with sepsis following pancreatitis have been found. No correlation was observed between serum TNF concentration and the severity of illness. However, monocytes and granulocytes of septic patients exerted higher TNF-mediated cytotoxicity than leukocytes of normal blood donors. The in vitro TNF-producing capacity was also higher in the patients in the study group, and it decreased only before fatal outcoming of sepsis. Our results suggest that determination of the TNF-producing capacity of leukocytes might be more informative than measurement of the serum TNF level in the evaluation of the severity or prognosis of sepsis.

[Incidence of fungal infection in surgical diseases of the pancreas]. / Gombás fertözés elöfordulása a pancreas sebészi betegségeiben.

Recently the number of mycotic infections has increased significantly. Authors have observed 13 mycotic infections on operated patients suffering pancreatic diseases between 1984 and 1990. 9 of 13 patients had pancreatic abscesses as well. The risk factors of fungal infections are analysed. It is important to take differentiation between fungal colonisation and septicaemia caused by yeasts. Repeated microbiological examinations can promote recognising of the fungal invasion. The base of the therapy is to avoid risk factors of infections and to use antifungal medication in time.

[Surgical treatment of stomach cancer with extended removal of lymph nodes]. / A gyomorrák sebészi kezelése kiterjesztett nyirokcsomó eltávolítással.

The authors evaluate the results of extensive lymph node dissection for gastric cancer at 50 patients. It has been found that the lymph node dissection did not increase the risk of operation. The mortality rate was 2%. The average number of removed and histologically examined lymph nodes was 26. The extensive lymph node dissection and the accurate histology provided opportunity for precise staging. Their first evaluation of survival showed an encouraging improvement of prognosis regard to that of patients survival treated by traditional surgical method. Besides it they reviewed the classification of Japanese Research Society for Gastric Cancer for the lymph drainage of the stomach and the surgical technique of the lymph node dissection.

[Surgical management of liver echinococcosis]. / A máj echinococcosis sebészi kezelése.

In the last ten years 62 patients were operated on by the authors because of liver echinococcosis. Each of the infections caused by echinococcus granulosus. In the course of the examination ultrasonography, abdominal X-ray, Casoni test and ELISA were used. Angiography and ERCP were applied only to answer special questions. The echinococcus cysts were removed in 15 cases by atypical liver resection, in 42 cases by pericystectomy and in 5 cases by partial cystectomy using the Pringle's manoeuvre in all of them. Operative mortality was 3.22%. Jaundice was observed in three cases, fever in five cases, wound infection in two cases. Reoperations had to be performed in two cases. All of the patients were treated postoperatively with mebendasol (Vermox). Recurrence of the infection could not be observed.

[Pheochromocytoma in Recklinghausen neurofibromatosis]. / Pheochromocytoma Recklinghausen neurofibromatosisban.

The authors describe the case of a 38-year-old hypertensive woman who suffered from neurofibromatosis, pheochromocytoma, scoliosis and diabetes mellitus. Because of the residual pheochromocytoma surgical intervention was repeated. According to the available literature this is the first case in Hungary where pheochromocytoma was associated with neurofibromatosis.