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Biomedical subjects

Attila Oláh

Publications and source records attributed to Attila Oláh.

At least 19 recordsLinked to original sources
PubMed2006

Multiorgan resection (including the pancreas) for metastasis of cutaneous malignant melanoma.

CONTEXT: Several studies have demonstrated improved survival after complete resection of hollow viscus gastrointestinal metastases of malignant melanoma. Patients with metastatic disease of intra-abdominal solid organs might also benefit from complete surgical resection. CASE REPORT: The authors report the case of a 22-year-old female patient with multiorgan abdominal metastases of cutaneous malignant melanoma, including the ovarium, jejunum, stomach and pancreas. All metastases were resected successfully. CONCLUSION: In highly selected patients with melanoma metastatic to intra-abdominal solid organs and hollow viscus gastrointestinal organs, aggressive attempts and complete surgical resection may improve survival.

Adult↗
PubMed2006

Smoking and education: Do psychosocial variables explain the relationship between education and smoking behavior?

The effect of education, depressive symptoms, trait anxiety, and coping traits (approach-belief, monitoring-creating-executing, and self-regulating) were tested on smoking behavior among 574 young adult males. We hypothesized that depression, anxiety, and coping traits were mediators in the relationship between education and smoking. Univariate analyses showed a significant association between smoking behavior and depressive symptoms, higher trait anxiety score, and lower scores on approach-belief and self-regulating traits. Education was significantly associated with depressive symptoms and coping traits. Although we found significant associations between smoking and education, smoking and depression, and education and depression, the hypothesis was not supported. A similar pattern was found in the case of coping traits. A multivariate logistic regression showed that low education (OR = 4.29), severe depression (OR = 1.84), and low self-regulating coping traits (OR = 2.19) were independent risk factors for smoking. The relationship between education and smoking cannot be explained by these individual variables.

Adaptation, Psychological↗
PubMed2006

[A novel technique for the closure of the pancreatic remnant using jejunal serosa following distal pancreatectomy].

Postoperative complication rate after distal pancreatectomy is as high as 10-30% in the published literature. Intraabdominal abscess formation and pancreatic fistula are the most common and clinically relevant complications, and they are thought to depend on surgical technique and skills. Using a novel method, we covered the pancreatic stump with the serosal surface of the first jejunal loop. Our aim was to compare the efficacy of this new technique to the traditional "stapling and handsewn suturing" method in terms of postoperative complication rate. Between 2002 and 2005, 50 patients, who underwent distal pancreatectomy, were randomized prospectively into two groups. In the first group of patients (n=23) the remnant of the pancreas was closed by the novel technique using the serosal surface of the first jejunal loop. In the second group (n=27) the pancreatic stump was closed in the traditional way using a combination of stapler and handsewn suture method. The incidence of postoperative pancreatic fistula and/or intra-abdominal abscess formation were compared using Fischer's test. Pancreatic fistula was defined as a loss of greater than 100 ml fluid drainage beyond postoperative day 5. We found a significantly lower postoperative complication rate using the novel technique compared to the traditional way to cover the pancreatic stump after distal pancreatectomy (8.7% vs. 33% (P = 0.0458). However, there was no significant difference in postoperative hospital stay. We concluded that using the serosal surface of the first jejunal loop is a simple, quick and secure method of closure of the proximal pancreas in terms of surgical practicability. This new technique significantly decreases the rate of postoperative fistula or abscess formation after distal pancreatectomy.

Abdominal Abscess↗
PubMed2005

[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].

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.

Abdominal Neoplasms↗
PubMed2005

[Current possibilities in the treatment of infected pancreatic necrosis].

This is a retrospective study about 80 patients treated for infected necrosis of the pancreas between 1998-2003. Operation was performed in 74 patients, diagnosis was achieved by CT or U.S. guided drainage in 12 patients. In further 6 patients drainage and antibiotic therapy provided cure. In patients who were drained pre-operatively (n=12) the first surgical intervention was performed on average on the 30.2 days after admission, while in the group of patients without drainage surgery became necessary after 15.6 days. The difference is statistically significant (p = 0.001). Our data proved that in certain cases percutaneous drainage can delay surgical intervention. Our results also prove that percutaneous drainage itself can lead to complete cure. In our own practice this stands for about 20% of our patients. In 3 patients we proved that if the patients general condition is stable infected necrosis detected by fine needle aspiration can be successfully treated by antibiotic therapy, without surgical or further radiological intervention.

Adult↗
PubMed2005

[Combination of early nasojejunal feeding with modern synbiotic therapy in the treatment of severe acute pancreatitis (prospective, randomized, double-blind study)].

BACKGROUND: We showed previously that probiotics containing lactobacilli significantly improve the outcome of acute pancreatitis. "Synbiotic 2000", a new synbiotic composition with high colony forming unit (CFU) comprises four different types of pre- and probiotics. In this prospective, randomized, double-blind study we evaluated the role of "Synbiotic 2000" in the treatment of severe acute pancreatitis. METHODS: Patients with severe acute pancreatitis were randomized into two groups. Nasojejunal feeding was commenced within 24 hours after admission in both groups and continued for at least seven days. The first group of patients received four different lactobacilli preparations with 10(10) CFU, respectively, and prebiotics containing four bioactive fibres (inulin, beta-glucan, resistant starch and pectin) in addition. Patients in the second (control) group received only prebiotics. RESULTS: 62 patients with severe acute pancreatitis completed the study. Altogether 8 patients died. We detected lower incidence of multiorgan failure (MOF), septic complications and mortality in the first group compared to the control, but the differences were statistically not significant. The total incidence of systemic inflammatory response syndrome (SIRS) and MOF were significantly different between the two groups (8 vs. 14; p < 0.05). Furthermore, the number patients recovering with complications were significantly less in the first group receiving modern synbiotic therapy compared to the control (p < 0.05). Finally, we found lower rate of late (over 48 hours) organ failure in the first versus the control group (3.0% vs. 17.2%). CONCLUSION: Our results suggest that early nasojejunal feeding with synbiotic may prevent organ dysfunctions in the late phase of severe acute pancreatitis. In addition, our data also indicate that the infection of pancreatic necrosis may be associated with early phase organ failure.

Adult↗
PubMed2004

[Double resection for synchronous pancreatic and renal cell cancer--case report].

Reports of synchronous or metachronous double kidney-pancreas cancers are very rare. Authors present the history of a 72-year-old woman who had a 10 kg loss of weight and epigastric pain. A complete gastroenterological check-up was carried out: kidney and synchronous pancreatic body cancer were found. The patient underwent distal pancreatectomy, splenectomy and nephrectomy with a worthwhile outcome. After an uneventful postoperative period the patient was discharged in good condition. Histology verified primary pancreatic ductal adenocarcinoma with synchronous primary renal clear cell carcinoma. The patient received oncotherapy and was well at 6 months' follow up. The appearance of different primaries in an individual may indicate a genetic predisposition to different neoplasms. In the literature there are some studies of double primary cancers, they are important because it might provide understanding of a shared genetic basis of different solid tumors. The association between these two cancers demands more detailed epidemiological and molecular investigation.

Aged↗
PubMed2004

[Invagination caused by a malignant jejunal polyp--lessons from a diagnostic error].

Authors reviewed the records of a patient with a 6 year long history of severing abdominal complaints, correct diagnosis came only in the state of acute abdomen for ileus. He underwent numerous radiological exams and gastroscopies in the course of repeated check-ups in other institute. Due to these results his complaints were managed as gastro esophageal reflux. After years of ineffective therapy his parents and physician suggested him to apply for psychiatric treatment. Finally, for the symptoms and radiological results of mechanical upper small bowel obstruction he underwent urgent laparotomy. Approximately a 40 cm long jejunal invagination was found caused by a large jejunal polyp. Segmental small bowel resection was carried out. Histologic examination of the resected specimen proved Grade I. adenocarcinoma. One year after an uneventful postoperative period the patient is free of complaints and symptoms. The differential diagnosis between upper small bowel obstruction and severe vomiting of esophago-gastro-duodenal origin is relatively difficult. For this we recommend utilizing all the recent diagnostic methods in case of hesitancy or ineffective therapy.

Abdomen, Acute↗
PubMed2003

Pancreatic transection from blunt abdominal trauma: early versus delayed diagnosis and surgical management.

BACKGROUND AND AIMS: Pancreatic trauma is relatively uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. PATIENT MATERIAL: The clinical course and surgical management of 14 patients with distal pancreatic transection or severe laceration with or without main pancreatic duct (MPD) injury caused by blunt abdominal trauma were analyzed in a university teaching hospital. The average age of the 14 patients (12 male, 2 female) was 28.9 years (range 5-56). Six patients had isolated pancreatic trauma, and intra-abdominal and extra-abdominal (mean 0.8) injuries associated with pancreatic transection were seen in the other 8 patients. RESULTS: Nine patients were diagnosed and operated on within the first 24 h. Eight of them underwent transection of the gland with MPD injury; distal pancreatectomy with splenectomy was performed in 3 and without splenectomy in 2, distal pancreatogastrostomy in 1, and - due to associated duodenal laceration and/or contusion of the pancreatic head - pylorus-preserving pancreatoduodenectomy in 2. In 1 case (grade II laceration) only external drainage was necessary. All the patients with early, correctly diagnosed parenchymal and ductal injury survived. Only 1 patient required reoperation due to haemorrhage after pancreatoduodenectomy. The other 5 cases were referred elsewhere after initial treatment, and all of them underwent some kind of external drainage. Three had undetected MPD injury, and in the other 2 cases the parenchymal lesions were either underestimated or missed. All of these cases required subsequent resection (1), internal drainage due to fistula (2), or drainage of developed abscess (2). Three of them had severe septic and pulmonary complications; 1 patient with MPD injury was lost to follow-up. CONCLUSION: Patients requiring delayed surgical intervention after an unsuccessful period of observation or a subsequent operation due to undetected MPD injury demonstrated a higher rate of pancreas-specific mortality and morbidity.

Abdominal Injuries↗
PubMed2003

[Early jejunal nutrition with combined pre- and probiotics in acute pancreatitis--prospective, randomized, double-blind investigations].

BACKGROUND: Development of infection of pancreatic tissue in patients with severe acute pancreatitis dramatically increases morbidity and mortality. Colonisation of the lower gastrointestinal tract and oropharynx, mostly with gram-negative but sometimes also gram-positive bacteria is known to precede the contamination of the pancreatic tissue by a few days. A few specific lactic acid bacteria such as Lactobacillus plantarum 299 were effective in preventing colonisation of the gut by potential pathogens, to reduce endotoxemia and to stimulate the gut-associated lymphatic system (GALT) and the immune system. METHODS: Patients with acute pancreatitis, arriving within 48 hours after onset of disease showing typical clinical picture and laboratory signs of pancreatitis (plasma amylase > 200 U/l, CRP > 150 mg/l and an Imrie-score = or > 3) were randomised into two groups During the first week the treatment group received a freeze-dried preparation containing 10(9) live Lactobacillus plantarum 299 together with an oat fibre substrate. The control group received a similar preparation, but the Lactobacillus plantarum 299 had been inactivated by heat. For seven days the treatment was repeated twice every day. The preparations were delivered to the hospital in sachets so the content was unknown to the investigators, staff and patients. RESULTS: Forty five patients completed the study before there was indication that one group differed from the other in a statistically significant way, at which time the study was discontinued and the code broken. At this time 22 patients had received treatment with live and 23 patients with heat-killed Lactobacillus plantarum 299. Infected necrosis and abscesses occurred in 1/22 (4.5%) in the treatment group vs. 7/23 (30%) (p = 0.023) in the control group. The length of stay was 13.7 days in the treatment group vs. 21.4 days in the control group (not statistically significant). CONCLUSIONS: Supplementing Lactobacillus plantarum 299 is an effective tool to prevent pancreatic sepsis, to reduce the number of operations and length of stay. The only patient who developed sepsis in the treatment group did so eight days after the treatment had been discontinued. One week treatment, as in the present study, is too short. It should be provided for at least 2 weeks, or more appropriately, as long as the patients are treated with antibiotics or have signs of GI colonisation.

Acute Disease↗
PubMed2003

[Role of procalcitonin rapid test in the differential diagnosis of uninfected and infected forms of acute pancreatitis].

We analysed the clinical value of the procalcitonin quick test (PCT-Q; BRAHMS Diagnostica, GmbH, Berlin) in infected pancreatic necrosis verified by guided fine-needle aspiration (FNA). In a prospective, controlled study the results of 24 patients were evaluated during 2001. PCT-Q test was performed in patients with necrosis verified on CT scan and/or septic symptoms. If PCT-Q test was positive or septic complication (infected necrosis or abscess) developed CT or US guided fine-needle aspiration was performed with Gram staining and bacterial culture of the sample. Positive FNA result was indication for surgery with repeated staining and bacterial culture of the surgical specimen. Septic complications of pancreatic origin developed in 12 patients. Comparing the results fine-needle aspiration was more authentic with a sensitivity of 92% and a specificity of 100%, while the sensitivity of the PCT-Q test remained 75% and its specificity 83%. Comparing abscess and infected necrosis, significantly higher procalcitonin values were detected in patients with necrosis. These results show that PCT-Q test can be a possible non-invasive method besides fine-needle aspiration. Elevated levels of procalcitonin (higher than 2 ng/ml) clearly suggest infection of the necrosis, while lower values do not exclude the possibility of local septic progression.

Acute Disease↗
PubMed2003

[Extraskeletal osteosarcoma in the gallbladder].

Extraskeletal osteosarcoma is a rare malignant soft tissue tumor. Authors present the history of a 61-year-old woman who had bone like tissue in her gallbladder at cholecystectomy. Histology proved, it was extraskeletal osteosarcoma of the gallbladder. Such disease has not been previously reported in the literature. She developed metastatic disease five months after the operation: multiplex cystic-calcified metastases appeared in the abdominal wall and in the peritoneal cavity. We present pathology findings, including ultrastructural features.

Abdominal Wall↗
PubMed2003

[Membranous constriction of the colon caused by non-steroidal anti-inflammatory drugs--case report].

A 79-year-old female patient with rheumatoid arthritis treated with NSAIDs on long-term developed iron-deficiency anaemia and subsequently subacute intestinal obstruction. Barium enema showed multiple diaphragm-like strictures. At colonoscopy the lumen of the ascending colon was divided into compartments by multiple thin circumferential mucosal membranes. Right hemicolectomy was carried out. The histology of the resected specimen confirmed diaphragm disease of the large bowel. Diagnosis is usually difficult, even at laparotomy, due to the poor external presence of the disease. Such lesions are rare (about 10 cases have been reported in the world literature) and are similar to those previously described in the small bowel. With the increasing world-wide use of NSAIDs, clinicians must be aware of this rare gastrointestinal complication, which may require emergency surgical intervention.

Age of Onset↗
PubMed2003

[Surgical treatment of small intestinal diseases, causing hemorrhage, and diagnosed with capsule endoscopy].

The wireless video capsule endoscopy is a new, painless, non-invasive technique for imaging the small bowel. It can be used to visualise the entire small bowel in selected patients where bleeding source cannot be verified by conventional diagnostic methods. Authors operated on three patients between November 2002 and March 2003, after intestinal bleeding source was detected by capsule endoscopy. The conventional diagnostic techniques could not provide correct diagnosis. The first patient, a 63-year-old man underwent right hemicolectomy one year earlier because of to colonic cancer. The source of bleeding was local recurrence penetrating into small bowel. The second patient, a 56-year-old woman underwent small bowel resection because of Meckel diverticulitis more than 30 years ago. By capsule endoscopy an ulcer was detected in the anastomosis. In the third case--a 60-year-old woman--an ulcerated leiomyoma was found in the first jejunal loop, next to the duodeno-jejunal flexure. In all the three patients resection was performed. The postoperative periods were uneventful. All patients are free of symptoms since the procedure. Capsule endoscopy was able to localise the source of intestinal bleeding, when conventional diagnostic methods were ineffective.

Endoscopy, Gastrointestinal↗
PubMed2003

[Changes in the operability of colorectal cancers in the past twenty years].

We lose more than 3000 patients a year in Hungary as a result of colorectal cancer. Our aim was to determine how the last 20 years' development of surgical techniques and related specialties has affected the outcome in this patient group at our Department. This retrospective study shows a significant increase in the resectability of colorectal cancer, while there has been a substantial decrease in perioperative mortality.

Colorectal Neoplasms↗
PubMed2002

Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate.

OBJECTIVE: We investigated the effect of early jejunal feeding on septic complications and mortality rate in patients with acute pancreatitis in a two-phase, prospective, controlled study. METHODS: In the first, randomized phase of the study, conventional parenteral nutrition was compared with early (within 24-72 h after the onset of symptoms) enteral nutrition. Of 89 patients admitted with acute pancreatitis, 48 patients were randomized into a parenteral group (Rindex 10, Infusamin S, Intralipid 10%; 30 kcal/kg) and 41 patients into an enteral group (jejunal tube feeding; Survimed OPD; 30 kcal/kg). RESULTS: The rate of septic complications (infected pancreatic necrosis, abscess) was lower in the enteral group (P = 0.08, chi(2) test). In the second phase of the study, early jejunal feeding was combined with prophylactic imipenem (Tienam, 500 mg intravenously twice each day) when necrosis of the pancreas was detected by abdominal computed tomography. When the outcomes of 92 patients in the third group were compared with those of patients in the parenteral group, the rate of septic complications decreased significantly (P = 0.03). Multiple organ failure (P = 0.14) and mortality (P = 0.13) tended to decrease. CONCLUSIONS: We believe that the combination of early enteral nutrition and selective, adequate antibiotic prophylaxis may prevent multiple organ failure in patients with acute pancreatitis.

Acute Disease↗