PubMed Health⌕ Search

Biomedical subjects

F Jakab

Publications and source records attributed to F Jakab.

At least 19 recordsLinked to original sources

[Haemodialysed, hemiparetic patient operated on for aortic aneurysm followed by successful renal transplantation].

The authors present the case of a 58 years old male patient. According to his preceding record in 1991 he suffered speech disturbance and left-side hemiparesis due to multiplex vascular lesions. A fresh cerebral ictus caused a right side hemiparesis mainly in the upper limb in 1993 and sensomotororic aphasia has also been developed. In 1995 the patient was begun acute haemodialysis treatment due to his gravis uremic state, then his dialysis was continued 3 times 4 hours weekly. In 1997 the then 56 years old inveterate right-sided hemiparetic patient, treated with chronic haemodialysis requested to be put on the transplantation waiting list. The first thing that had to be done in case of this high-risk patient was the resection of the abdominal aortic aneurysm (38 mm x 67 mm x 115 mm in size) noticed at the ultrasound examination which was carried out in January 1997. The continuity of the vessel was secured by graft-interposition where the arteria mesenterica was also implanted. Following the successful operation, the patient was qualified for the transplantation list and in the February of 1998 a successful kidney-transplantation was carried out. Following the temporary, post-transplantation difficulties (post-operative 5th day acute rejection well-reacting to 3 steroid-shots; the two re-operations due to partial necrosis in the uretero-ureteralis anastomosis and successfully overcoming the Pseudomonas aeruginosa uroinfection) the patient is currently doing well and has no complaint.

Aortic Aneurysm, Abdominal↗

[Acute pancreatitis: recent advances in understanding its pathophysiology].

This article reviews the recent changes in the understanding of acute pancreatitis pathophysiology emphasizing results deriving from the more detailed comprehension of the local and systemic aspects of the inflammatory process. The authors briefly discuss those theories that have been influencing the basic philosophies of treatment efforts. The role of premature digestive enzyme activation as the principal determinant of the pathoetiology and mortality of this disease has been questioned lately, and the inflammatory explosion has been placed into the center of attention. Simultaneously with the enzyme activation, the pancreatitogenic noxious event rapidly induces the formation of oxygen derived free radicals, activation of the transcription factor NF kappa-B, with consequent citokine production, cellular adhesion molecule upregulation and leukocyte hyperstimulation. Numerous other mediator cascades are activated in parallel, the uncontrolled surge of proinflammatory stimuli, and activity of the effector cells lead to multiple organ failure in severe cases. A genetically determined catastrophe management program is set forth in the acinar cell with pancreatitis associated protein expression and activation of the apoptosis machinery. Therapeutic approaches based on these recent findings are briefly touched upon.

Acute Disease↗

[Metastasized carcinoid tumor treated with interferon and octreotide].

The carcinoid tumours are rare forms of the gastrointestinal tumours (they make up 2%), though lately they have shown an upward tendency. Among different types of treatments of the carcinoid tumours in non metastatised cases, the surgical intervention stands first on the list. But when symptoms emerge, most of the tumours have metastases, for which there are various types of treatments. The authors introduce the combined therapeutical possibilities in connection with metastatised carcinoid tumours. A combination of octreotid and interferon is used in the course of the treatment. Authors introduce the therapy's indications and experiences gained during the follow up of events.

Antineoplastic Agents, Hormonal↗

Pancreatic pseudocyst propagating into retroperitoneum and mediastinum.

The extrahepatic pseudocysts of pancreatic origin sometimes propagate into mediastinum and retroperitoneum. A large pseudocyst of pancreatic origin propagating into the mediastinum up to the aortic arch is published. The surgical intervention has been urged by the dislocation of the heart, by the danger of autodigestion of the mediastinal aorta and by the danger of rupture. Attention is directed to the external drainage operation which is suitable for emptying of the pseudocyst not independently from the ripeness of pseudocyst wall and the characteristics of the pseudocyst content. Should the time short after the exacerbation and should the amylase content high in the cyst, the immediate result of external drainage better and reliable safe.

Adult↗

The current surgical treatment of primary malignant melanoma of the skin.

In our Department, between 1991 and 1996, 132 patients, there of 87 male-45 female, average age of 48.2 years underwent surgery because of stage 1 (T2) to stage 3 melanoma that was located on the skin. None of patients suffered from early or in situ melanoma. Our retrospective study was based on those 94 patients who had been followed up by Department or dermatology-oncology in our medical centre. Surgery is still the primary treatment for cutaneous malignant melanoma. Thin melanomas (up to 2 mm in thickness) can be excised with 2 cm margins. Whether this is also true for thicker melanomas is not known and the only way to obtain more knowledge is to participate in prospective randomised studies. Elective lymph node dissection is associated with significant morbidity which includes lymphedema, wound complications and paresthesias of the extremity. For this reason we use an alternative operative approach uses selective lymphadenectomy with identification of the sentinel node.

Dermatologic Surgical Procedures↗

Experience acquired by applying gentamicin-sponge.

Chronic suppuration is a reverting problem in surgical practice. The concerned region either has insufficient circulation due to basic disease, or systemic antibiotics takes no effect due to inflammatory barrier developed meanwhile. For this reason Authors initiated systematic use of gentamicin sponge (Garamycin, Schering-Plough, USA) two years ago. During this period we implanted gentamicin sponge in 40 cases. After primary intervention in 85% of treated patients we observed complete recovery, or in case of ulcus cruris we reached proper condition for skin-transplantation. Three patients needed further incision and in two cases amputation of diabetic foot could not be avoided. Our results support the effectivity of gentamicin sponge in treating local inflammatory processes supplementing and increasing efficiency of surgical procedures.

Amputation, Surgical↗

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.

Blood Transfusion↗

Transverse hepatectomy in surgical treatment of gallbladder carcinoma.

In the surgical treatment of gallbladder cancer not only the traditional resections (right trisegmentectomy, lobectomy), but newer, parenchyma sparing multisegmentectomies, resection of 4B, 5, 6, that is transverse resection is also justified, as it is shown by demonstrating the 2 first cases in Hungary with transverse hepatectomy. World-wide there is a tendency for more aggressive surgical treatment in case of gallbladder cancer. For this reason we introduced transverse hepatectomy in our surgical practice, and in this paper we demonstrate the technical details of the new procedure. The goal of the transverse resection is to remove the tumour with an adequate margin of resection. The remaining hepatic parenchyma allows good quality of life for the patients till recurrence develops.

Carcinoma↗

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.

Cachexia↗

Preoperative work up and therapeutic schedule for patients with duplex tumors.

Authors analyze the cases of duplex and multiplex tumors among the more than two thousand operated upon patients a year at the Surgical Department of Uzsoki Hospital, Budapest, Hungary. The study enrolls a two years period evaluating the medical history of our patients in hope of a more sophisticated and effective diagnostic and therapeutic regimen. Our experience gained by analyzing data of our patients with synchron tumors shows that the patient's life expectancy is much better if performing a radical multivisceral tumor extirpation at the same sitting even if keeping in mind the higher perioperative risk. In accordance to the above mentioned concept we would like to stress the utmost importance of the interdisciplinary cooperation.

Cooperative Behavior↗

Resection of giant schwannoma by combined surgical exposure.

Contrary to the past experience the giant Schwannoma with symptoms of canalis vertebralis compression has been removed by combined surgical exposure in one sitting. Laminectomy, decompression of the canalis vertebralis and immediately subsequent extracanalicular resection of the tumour by retroperitoneal approach was performed in one sitting by two surgical teams. The advantages of the combined surgical exposure: 1. The affliction of the patients caused by the operation significantly decreased. 2. The expenses of the treatment, nursing and hotel decreased as well. 3. The surgical team of different specialists remove the tumour together in both approaches.

Aged↗

Diagnostic-staging laparoscopy.

Recently instead of the old fashioned, traditional explorative laparotomy the newer up-to-date procedure, the diagnostic-staging laparoscopy has been generally used in the everyday surgical practice of the Authors. Evaluating 32 diagnostic and staging laparoscopy Authors draw the attention to the importance of this procedure which has high diagnostic value, and reduces the complication rate. Biopsy, cytology, frozen section can be done. Authors carries out diagnostic and staging laparoscopy in cases of esophageal, liver, stomach and pancreas tumours just immediately before surgery.

Abdomen↗

Jejunal nutrition.

Contrary to the past experience of forced parenteral nutrition nowaday's the enteral [jejunal] nutrition enjoys priority. It is not questionable, that well adjusted and controlled application of fluid, ion, fat, carbon hydrate, amino acid promoted convalescence. The experiences of the Authors supports that enteral nutrition through technically proper outperformed jejunostomy does not increase complication rate and beside well controlled food administration provides the physiologic stimules of food, the method is relatively easy and cost effective. For this reason the Authors initiated jejunostomy at the end of larger interventions such as Akyama procedure, total gastrectomy, multivisceral interventions, pancreatectomy, operations for massive gastrointestinal bleeding and finally reoperations with extreme negative N-balance and with the chance of inability of oral feeding for several days.

Abdomen↗

Experiences with ethanol infiltration of the liver metastases of colorectal tumors (preliminary study).

With the aid of improvement in imaging technique and with the ability of detection of hepatic tumours, the successful treatment of primary and secondary hepatic tumours using surgical methods has gained importance. Metastasectomies were performed in 16 cases at our department in 1996. In 6 cases atypical resections and/or infiltration with 96% ethanol were performed. In 3 instances ethanol infiltration into the metastases were accomplished during the resection, in 4 cases--when metastases were discovered 1-4 year after the resection of the primary tumours--the same method was used during the relaparatomy. 96% ethanol was injected directly into the metastatic tumours during operations. The early ultrasonograph examinations proved the total destruction of the metastases in diameter of 1-3 cm, and partial necrosis of the large (d = 3-8 cm) tumours. Two patients were lost from the follow up. Five patients are still alive after 2-8 months of the ethanol infiltration. In one patient after the ethanol infiltration of metastases /d = 3-5 cm/ in 6 segments of the liver we observed the dissemination of the tumour.

Aged↗

[Organizational difficulties in liver transplantation].

Author overviews the evolution of liver transplantation from the point of view of organization in North America, in Europe and in Hungary partly on the basis of his own experience. It can be stated, that in North America the liver transplantation has become the universal method for the treatment of end-stage liver diseases, only after 20 year long period since the beginning. This first 20 years could be characterized by the monopoly of few giant transplant centers. This period was different and shorter in Europe due to integration run by Eurotransplant and Council of Europe. In Hungary the need and hope for a well organized, functioning liver transplant programme has become reality after difficult long period. Individual efforts, organizations, scientific-, clinical-, experimental work are being regarded valuable experience, because due to this effort some liver patients can live with good quality of life, the results are included to the present programme, on the other hand this accumulated knowledge can serve as a basis for further transplant activity.

Humans↗

A new method to measure portal venous and hepatic arterial blood flow in patients intraoperatively.

The intraoperative measurement of the afferent circulation of the liver, namely the hepatic artery flow and portal venous flow was carried out upon 14 anesthetized patients having carcinoma in the splanchnic area, mainly in the head of the pancreas by means of transit time ultrasonic volume flowmeter. The hepatic artery flow, portal venous flow and total hepatic flow were 0.377 +/- 0.10; 0.614 +/- 0.21; 0.992 +/- 0.276 l/min respectively. The ratio of hepatic arterial flow to portal venous flow was 0.66 +/- 0.259. There was a sharp, significant increase in hepatic arterial flow (29.8 +/- 6.1%, p < 0.01) after the temporary occlusion of the portal vein, while the temporary occlusion of hepatic artery did not have any significant effect on portal venous circulation. The interaction between hepatic arterial flow and portal venous flow is a much disputed question, but according to the presented data here, it is unquestionable, that the decrease of portal venous flow immediately results a significant increase in hepatic artery circulation.

Abdomen↗

Changes in hepatic hemodynamics due to primary liver tumours.

Data regarding the afferent circulation of the liver in patients with primary hepatocellular carcinoma are controversial, we have carried out measurement of hepatic arterial and portal venous flow intraoperatively by transit time ultrasonic volume flowmetry. In patients with primary hepatocellular carcinoma the hepatic artery flow increased to 0.55 +/- 0.211 compared with the control value of 0.37 +/- 0.102 1/min. (p < 0.01). The portal venous flow decreased from 0.61 +/- 0.212 l/min. to 0.47 +/- l/min. P < 0.01). Due to the opposite changes in the afferent circulation the total hepatic blood flow did not change significantly, compared with controls. The ratio of hepatic arterial flow to portal vein flow increased to 1.239 +/- 0.246 in patients with hepatocellular carcinoma, which is double of the control value (0.66 +/- 0.259 l/min). After resection this ratio did not change. The resection did not alter hepatic artery or portal venous flow significantly, although the total hepatic blood flow decreased significantly (p < 0.01). On the basis of our early results it is possible that the ratio of the two circulations may be to deel measured with doppler ultrasound and provide diagnostic information.

Adult↗