Biomedical subjects
Publications and source records attributed to H Kiss.
This case report is about a 23-year-old female patient who underwent heart transplantation because of dilatative cardiomyopathy. Four months after transplantation she conceived. Thirteen months postoperatively, the patient had spontaneous vaginal delivery and gave birth to a child in good physical condition.
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Ho:YAG, Nd:YAG, and Erb:YAG laser ablation of Polymethylmethacrylate (PMMA) was investigated under in vitro and simulated clinical conditions. Ablation rates were measured for all lasers and after ablation, macroscopic and microscopic appearance of the ablation site was investigated. The mean ablation rates of the Erb:YAG, Ho:YAG, and Nd:YAG laser increased from 8 microns per pulse at 100 mJ to 44 microns per pulse at 300 mJ from 100 microns per pulse at 200 mJ to 222 microns per pulse at 800 mJ and from 28 microns per pulse at 100 mJ to 189 microns per pulse at 800 mJ, respectively. Macroscopic investigation exhibited melting of bone cement for the Ho:YAG and Nd:YAG lasers and pulse-to-pulse vaporization for the Erb:YAG laser. The width of thermal alteration, however, was comparable for all lasers used. Removal of cement from bone specimens under simulated clinical conditions showed good detachment of cement when the fiber was used parallel; in case of perpendicular use, remainders of cement and carbonization of bone could be observed upon histological investigation.
This case report is on a 23-year old female patient, who underwent cardiac transplantation because of dilatative cardiomyopathy. Four months after transplantation she became pregnant. 13 months postoperatively, the patient had spontaneous vaginal delivery and gave birth to a healthy newborn in good physical condition.
Subcutaneous recombinant human erythropoietin (rHuEpo) treatment of renal anemia was performed in four boys and eight girls on CAPD, aged 0.8-12.5 (mean 7.4) years. In contrast to previous studies, our therapeutic goal was not set with a hematocrit of 30% but with full correction of anemia. Following a maximum weekly rHuEpo dosage of median 120 (range 100-240) IU/kg body weight, hematocrit increased in 10 children from 24 (14-29)% within 12 (4-17) weeks to 40.1 (33.5-48.4)%. The weekly increase in hematocrit was 1.27 (0.5-3.1)%. The corrected reticulocyte count increased from 1.3 (0.7-1.8)% to 2.3 (1.4-3.9)% within 4 (2-6) weeks. Eight children fulfilled the protocol; six with an uncomplicated course were able to maintain a hematocrit of 37.1 (35.1-42.7)% with only one sc medication per week of approximately two-thirds of their highest weekly rHuEpo dosage. No serious adverse effect of rHuEpo therapy was observed.
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To date, investigators have relied on hysterosalpingography, hysterosalpingoscintigraphy, and laparoscopic chromopertubation for the diagnosis of tubal disease causing infertility. With the development of the "linear everting catheter" system it may now be possible to evaluate the tubal lumen and to diagnose changes in the tubal wall or the tubal mucosa by direct visualization. This paper describes our initial clinical experience with 14 women who underwent evaluation for infertility. The new catheter system allowed both inspection of the tubal ostium without cervical dilation or concomitant hysteroscopy and virtually atraumatic access to the tube by means of an endoscope measuring half a millimeter in diameter and a magnification of 40. Given adequate experience with this technique it may also be performed in an outpatient setting. Ultimately, tuboscopy may come to play a major part in the diagnosis of sterility. Other potential applications of this new technology are the tubal transfer of embryos, intratubal insemination and the conservative treatment of tubal pregnancy.
One hundred twenty-two patients with tuberculous or pyogenic spondylitis were investigated retrospectively. Patient histories, laboratory tests, and radiographic findings were compared statistically between the two groups. Significant differences were calculated for the interval between onset of symptoms and diagnosis, erythrocyte sedimentation rate, mean vertebral loss at discharge, and sclerosis of the vertebral bodies involved. Open or closed biopsy was performed in 91 patients. The result provided a clear distinction between tuberculous and pyogenic spondylitis in 62.2%, either by means of histology or by culture growth. In pyogenic spondylitis, staphylococci were the most predominant bacteria isolated. Neurologic deficits were demonstrated in 17.8% of patients with tuberculous spondylitis and 22.7% with pyogenic spondylitis. At follow-up examinations, only two patients still had a motor deficit. Additionally, pain, gibbus formation, and bony fusion were evaluated, but no significant differences were found. The combination of several unspecific findings such as patient history, erythrocyte sedimentation rate, and radiographic assessment can lead to the correct diagnosis. A definitive diagnosis is established by means of biopsy, histologic evidence, and bacterial culture.
Erb:YAG and Hol:YAG laser ablation rates of fibrocartilage and nucleus pulposus were measured in vitro simulating clinical conditions. After ablation macroscopic and microscopic appearance of the ablation site was investigated. Hol:YAG and Erb:YAG laser mean ablation rates increased almost linearly with rising energies, showing higher total ablation rates for the Hol:YAG laser due to its higher achievable energy density. At comparable energy densities the Erb:YAG laser appears to be more effective with respect to the corresponding ablation rates. Consequently, the ablational threshold proved to be lower for the Erb:YAG laser. Whereas during Hol:YAG laser ablation, some smoke formation and considerable tissue shrinking occurred, these effects could not be observed during Erb:YAG laser ablation. Consequently macroscopic and microscopic inspection showed some thermal damage after Hol:YAG and only minimal alterations after Erb:YAG laser ablation. Adjacent thermal damage was determined and proved to be lower for the Erb:YAG laser. In our opinion the characteristics of each laser system provide certain advantages for special clinical indications.
The injection of different substances into early, unruptured tubal pregnancies is increasingly advocated. In this study, fertility was evaluated after treatment of tubal pregnancy by means of prostaglandins. The overall tubal patency rate was 86.4% and 14 of 20 patients (70%) could subsequently achieve pregnancy.
The incidence of tubal pregnancy has been increasing in recent years. The improvement in diagnostic procedures leads to an early detection of tubal pregnancies. As a result, conservative treatment modalities are more feasible today. In this study, we compared the treatment of tubal pregnancy by means of locally applied prostaglandin with pelviscopic surgery. 75 patients with an early tubal pregnancy were included in each group. The comparison between the two groups showed, that prostaglandin treatment has a higher failure rate, than treatment by pelviscopic surgery. However, postoperative fertility indicated better results in the prostaglandin treated patients.
Since ectopic pregnancy may terminate in spontaneous recovery we compared treatment by means of prostaglandin (PG) application with expectant management in laparoscopically verified tubal gestations. Twelve patients received local and systemic PG, 4 patients were treated with sodium chloride and in 7 patients laparoscopy was discontinued without medical therapy. The comparison between the PG group and the placebo groups revealed a highly significant difference with regard to a subsequent necessary surgical intervention and hospitalisation. Expectant management may only be recommended in very selected cases, whereas PG treatment seems to produce favourable results in cases of early tubal pregnancy.
The incidence of tubal pregnancy has increased markedly over the past years. Reasons for this are increased infections of and operations on the tubes and also improved diagnosis of the condition. The development of sensitive pregnancy tests, a constant improvement in ultrasound, introduction of laparoscopy and last, but not least, an increase in the degree of awareness amongst the general public have led to a much earlier diagnosis of tubal pregnancies. Therefore, it is possible to treat tubal pregnancies in a more conservative fashion operatively but also medically.
Authors describe pseudosarcoma, a rare esophageal tumour in a 52-year-old male patient. The tumour of complex histological appearance has characteristic macroscopic, microscopic and clinical features. Although its histogenesis is unclear, it can be well distinguished from the real carcinosarcoma and represents an independent class of tumours.
In the present study we tried to evaluate the cancer marker CA 19-9, CA 12-5, CA 15-3 as well as the enzyme creatine-kinase (CK) whether they are of any diagnostic value in cases of tubal pregnancies. 15 patients with laporoscopically verified tubal pregnancy were compared with 15 patients with normal intrauterine pregnancies of the same age. Except one case of elevated CK in a patient with tubal pregnancy all other values were within the normal range. We concluded, that tumor markers and CK are inefficient for preoperative differential diagnosis in cases of tubal pregnancies.
In this prospective multi-centre-study, the new treatment of tubal pregnancies by means of local prostaglandin (PG) F2 alpha and systemic PG E2 application was compared to the usual surgical technique of eliminating the conceptus. In 71 patients treated with PG, the method proved to be successful in 81%; 21 patients (19%) required surgical intervention later. With an initial beta-hCG level of 2500 mIE/ml, the success rate increased to 88%. The duration of hospitalisation was significantly reduced in the PG group compared to the patients treated by primary operation (3 +/- 1 versus 6 +/- 2 days). In the PG-group, only 2 of 24 hysterosalpingograms showed tubal occlusions after treatment, whereas occlusion was present in 3 of 8 patients of the surgically treated group. Four subsequent intrauterine pregnancies in the PG-group occurred compared to none in the surgical group. PG treatment of tubal pregnancy in patients with a low initial beta-hCG value (less than 2500 mIE/ml) revealed promising results with regard to reduced postoperative morbidity and future fertility.
The aim of this retrospective study involving 471 patients was to investigate the percentage of patients who returned to work after acute myocardial infarction. In the group of 350 patients who did not undergo subsequent aortocoronary bypass operation 70% returned to work, whereby half of these patients started work again within 6 months after infarction. A significantly higher number of patients who were enrolled in a cardiac rehabilitation programme returned to work as compared with patients not participating in such a programme (72% vs. 59%, respectively; p less than 0.04). There was, however, no difference between these 2 groups with respect to either the time point of resumption of work after myocardial infarction or the duration of employment between infarction and eventual retirement. Of the 121 patients who underwent an aortocoronary bypass operation, only 38% returned to work (p less than 0.001 vs. patients without bypass surgery).