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Biomedical subjects

J Faller

Publications and source records attributed to J Faller.

At least 19 recordsLinked to original sources
PubMed2002

[Medicamentous kidney protection in type 2 diabetic patients--is cheaper also more economical? A model calculation for Swiss health care].

Impaired renal function occurs in about 50% of patients suffering from type 2 diabetes, and diabetic nephropathy has become the leading cause of endstage renal disease. Reduction of blood pressure to levels around 120/80 mmHg is one of the most effective way to slow progression of diabetic nephropathy. Recent meta-analyses, however, have emphasized on the fact that ACE inhibitors (ACEI) and non-dihydropyridine calcium channel blockers (NDHP-CCB) exert nephro-protective effects which go beyond the effect of blood pressure reduction. This has lately been confirmed by a prospective trial in comparison to the betablocker atenolol. Based on these data, demographics of the Swiss population, literature data on mortality rates of type 2 diabetics with impaired renal function and studies on true costs of antihypertensives, we calculated the costs of a longterm intervention (20 years) with antihypertensives in 3536 middle-aged Swiss patients with type 2 diabetes and macro-albuminuria whose antihypertensive regimen was based either on the ACEI lisinopril, or the ND-HP-CCB verapamil, or the betablocker atenolol. Under atenolol, acquisition costs were lowest, whereas faster loss of renal function over time increased mortality rate and thus reduced the number of patients to be treated. Nevertheless, due to the fact that patients reached uremia and had to be dialyzed, 20 years of atenolol-based regimen with costs of 316 millions of Swiss francs turned out to be much more expensive than the lisinopril- or the verapamil-based regimen with 121 and 38 millions of Swiss francs, respectively. Thus, low acquisition cost is not necessarily the only important determinant of overall costs of drug therapy.

Adult↗
PubMed2001

[Flesh-eating bacteria infection of an immunocompromised patient].

After years of steadily declining morbidity and mortality due to group A streptococcal infections, a resurgence of severe, invasive disease has been ongoing since 1980, leading to the recognition of streptococcal shock syndrome (STSS), necrotizing fasciitis, the most severe form of invasive infection. The patients suffer from rapid local deep soft tissue destruction, severe septic shock and multi organ failure. The increased incidence of these infections has been accompanied by remarkable vigor in virulence and severity of the disease. The reason for this impressive change in the epidemiology and clinical manifestation of group A streptococcal infections remains unknown. The possible etiological factor is changing in virulence factor or the lack of protective immunity of the population (immunocompromise) against the invasive strains. We describe a severe necrotizing fasciitis of a 41-year-old previously immunocompromised woman. The patient developed severe septic shock, multi organ failure and perineal and lower abdominal skin, fat and fascia necrosis due to mixed GAS (aerob, anaerob) infection of the perineum and the Bartholini glands. After an aggressive surgical debridement, antibiotic and supportive therapy the generalised and local infection was treated.

Adult↗
PubMed2001

[Gastrointestinal stromal tumors in our practice].

The classification of tumours originating from the wall of gastrointestinal organs changed dramatically since of electronmicroscopy and immunohystochemistry were introduced. Previously these tumours were classified as leiomyomas, leiomyosarcomas or schwannomas. With the new methods these disorders can be described in more details and unified, and so the change to provide correct prognosis improved. Still, there are some unanswered questions remaining for the pathologists. In our material in the past 5 year we treated 9 patients because of GIST. Most of them were found in the stomach (6), one developed in the oesophagus, one in the small bowel and another one in the rectum. With describe our patients and look at the related articles literature about this important diseases. Though the incidence is under 1% of patients operated on because of gastrointestinal diseases, we would like to share our experiences in treatment.

Adult↗
PubMed2000

Effect of extrusion on isoflavone content and antiproliferative bioactivity of soy/corn mixtures.

The present studies were conducted to determine changes in the quantities of select isoflavones and in the bioactivity (ability to inhibit proliferation of human breast cancer cell lines) of extracts from blends of soy protein and cornmeal during extrusion processing. The extrusion of samples resulted in an average 24% decrease in the concentration of total isoflavones for all samples. Although the amounts of specific genistein-derived and daidzein-derived forms changed following extrusion, the content of the aglycones genistein and daidzein per g sample generally did not change. The extrusion of samples generally resulted in decreased antiproliferative action toward breast cancer cells, although antiproliferative activity was not eliminated. Therefore, extrusion of soy protein/cornmeal-containing foods are likely to retain a considerable portion of their isoflavone content and some of the health benefits associated with soy.

Cell Division↗
PubMed2000

Isolated massive pleural effusion caused by pancreatico-pleural fistula.

BACKGROUND: Massive pleural effusions are uncommon but well-documented complications of chronic pancreatitis, usually caused by the development of a pancreaticopleural fistula. The mechanism of the fistula formation is thought to be rupture of the pancreatic duct or pseudocyst. MATERIAL AND METHODS: In the past 7 years we have treated 5 patients with massive pleural effusion of pancreatic origin in the Surgical Department of Semmelweis University Medical School. 4 patients were males; the average age was 52 years (range: 46-59 years). RESULTS: All 5 patients had a history of alcohol abuse and were admitted to the pulmonary department because of respiratory distress. Other symptoms such as abdominal pain, chest pain, or weight loss were not always present. The diagnosis was confirmed by a markedly elevated amylase level in the aspirated pleural fluid. Abdominal ultrasound, CT scan, and ERCP examinations were carried out in order to determine the cause of the pancreaticopleural fistula. Conservative (nonsurgical) treatment was effective within 3 weeks in only one case. The other 4 patients required surgical management. In 3 cases distal pancreatic resection with splenectomy and cholecystectomy was done. In one case cystojejunostomy was performed. All 5 patients have been cured with complete resolution of their pleural effusions. CONCLUSIONS: Patients with large pleural effusions may have underlying pancreatitis with a pancreaticopleural fistula. It is important to establish this diagnosis because treatment may require operative interventions.

Acute Disease↗
PubMed1999

Stability of isoflavones during extrusion processing of corn/soy mixture.

The influence of extrusion processing in the presence of corn on the quantity and quality of genistein, daidzein, and their respective beta-glucoside, acetyl glucoside, and malonyl glucoside derivatives was evaluated. Products of 100% soy (textured) and a blend of 20% soy protein concentrate (SPC) and 80% corn meal (direct-expanded) were extruded, with evaluations before and after extrusion. In addition, a 3 x (3 x 3) split-plot factorial experiment investigated the influence of barrel temperature (110, 130, 150 degrees C), moisture content (22, 24, 26%), and relative residence time (1, 0.8, 0.6) on extruder response and isoflavone profile. The extrusion barrel temperature had the most influence on isoflavone profile, especially decarboxylation of the malonyl beta-glucoside, followed by the moisture content. The amount of extractable isoflavones decreased after extrusion for both the SPC and SPC/corn meal blend when extracted with 80% aqueous methanol but remained approximately the same when first hydrated with water before extraction. However, initially hydrating with water produced enzymatic glycolysis in the unextruded samples, increasing the aglycons dramatically.

Food Handling↗
PubMed1998

[Abdominal trans-sphincter resection of the anus: new possibilities in the surgical management of deep rectal cancer, with preservation of the anal sphincter].

The last decade has brought marked changes in the surgical treatment of rectal cancer: as the indication of the sphincter-saving procedures was extended, the rate of the abdomino-perineal excision has decreased even in the case of tumours of the distal third of the rectum. However, even with the use of the modern stapling devices, the anterior resection and colo-anal anastomosis may not always be feasible by the traditional abdominal approach. In these cases the sphincter-saving resection can be performed by a particular approach, the abdomino-transsphincteric technique. The authors present this seldom used operation. From the 1-st of January 1994 to the 31-st of August 1996 14 abdomino-transsphincteric resections have been performed. The mean age of the patients was 62.2 (38-81) years. The lower edge of the tumours was situated at 6.3 (5-8) cm from the anal verge. The anastomosis was performed by the double stapling technique in 8 and by hand suture in 6 cases, its distance from the anal verge was 3.2 (3-4) cm. A colon J-pouch was used in 3 cases and a diverting colostomy was performed routinely. One patient died in the postoperative period and a reoperation (abdomino-perineal excission) was performed because of left colon necrosis: Anastomotic leakage was observed in one case. By the time of the present study, 11 patients have had their colostomies closed. The continence is acceptable in every case and all the patients experience a better subjective quality of life, than it was while wearing the colostomy. The use of this technique has helped to avoid a permanent colostomy in 21 out of 33 cases operated on for cancer of the distal rectal third in the reviewed period.

Abdomen↗
PubMed1998

[New approach to the management of gastrointestinal tumor].

The author summarizes the changes recently developed in the treatment of gastrointestinal tumors. He gives a detail analysis of stages of malignant diseases as well as he demonstrates the newest opinion about the lymphadenectomy, tumor resection, and new therapy modalities of liver metastases.

Gastrointestinal Neoplasms↗
PubMed1997

The use of modified Baylor score in the prediction of rebleeding in peptic ulcer hemorrhage.

The upper gastrointestinal bleeding is still an everyday problem. 40-50% of these bleedings are originating from peptic ulcer. The rate of rebleeding after initial hemostasis is 30-50%. In this group of patients we can observe the highest morbidity and mortality. The aim of this work is to select those patients who belong to the high risk group from the point of rebleeding. For this purpose we introduced after a retrospective analysis the modified Baylor score. In this scoring system the age, the number and severity of parallel illnesses, the hemostatus by the admittance, the ulcer size and location and the stigmata of recent hemorrhage are taken into consideration. On the basis of this every patient gets a score between 0 and 31. Based on our retrospective analysis we could establish three grades of risk groups: low risk (0-7), middle risk (8-11) and high risk (12 and over). In the low risk group there was no rebleeding. In the middle risk group we observed 4 rebleedings in 19 patients, while in the high risk group there were 32 rebleedings out of 36 cases. As a conclusion we can state, that the modified Baylor score is capable for the selection of high risk patients for rebleeding. With the early elective operations in these cases the high morbidity and mortality can be reduced.

Adult↗
PubMed1996

[Simultaneous occurrence and treatment of right atrial myxoma and extensive colonic polyposis causing recurrent intestinal hemorrhages].

The authors describe the case history of 68 year old man. Right atrial myxoma had been diagnosed two years prior to this present observation, however surgical intervention has been contraindicated due to high operative risk. Later the patient was referred to a cardiological evaluation because of chronic atrial fibrillation before a cataract surgery in a symptom free condition. The right atrial myxoma caused inflow obstruction and tricuspid regurgitation was removed before the eye surgery. In addition, tricuspid valve replacement and revascularization of three coronary arteries has been performed. The patient receiving chronic anticoagulant therapy experienced severe gastrointestinal bleeding the source of which turned out to be a partially malignant colon polyposis. The polyps were successfully removed by coloscopy and intra operative coloscopy. No gastrointestinal bleeding has been observed afterwards in spite of the continued anticoagulation. After review of the literature the authors observed that according to their knowledge the common occurrence of the right atrial myxoma and the colon polyposis had not been described before.

Aged↗
PubMed1996

Surgery for esophageal and cardia cancer in Hungary: a nationwide retrospective five-year survey.

A nationwide retrospective 5-year survey was conducted, examining the surgical treatment of cancer of the esophagus and the esophagogastric junction in Hungary. The population of Hungary is at low risk of developing esophageal cancer, with an associated mortality rate of 5.84 per 100,000 in 1992. During the 5 years between 1988 and 1992, a total of 1197 resections were performed for cancer of the esophagus and cardia, with 817 for esophageal cancer (in the cervical area in 40, the upper and midthoracic areas in 436, and the lower third in 341), and 380 for cancer of the cardia. Most of the procedures were total or subtotal esophagectomy, performed in 629 patients, with the stomach being used for replacement of the esophagus in 555 (88.2%) patients, the right colon in 46 (7.3%) and the left colon in 28 (4.5%). Transhiatal blunt esophagectomy was performed in 264 patients, representing 22.0% of all resections. The overall leakage rate was 21%, occurring in 251 patients, and the overall mortality rate was 13.5%, or 162 patients. A very strong correlation existed between the experience of the departments where surgery was performed and the mortality rate.

Anastomosis, Surgical↗
PubMed1996

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↗
PubMed1996

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↗
PubMed1996

The relationship between portal venous and hepatic arterial blood flow. I. Experimental liver transplantation.

The relationship between the changes in portal venous and hepatic arterial blood flows, in the liver is a much disputed question, it has tremendous significance in the practice of transplantation, and an explanation has been available since 1981, when Lautt published the so-called "adenosine washout theory". According to our earlier observations the decrease of portal pressure or flow consistently led to an increase in hepatic artery flow. At the same time changes in hepatic artery flow or pressure seemed to produce only inconsistent effects on the portal circulation. In the present experiments liver transplantation (OLTX) was carried out on mongrel dogs by Starzl's method. Electromagnetic flow probes were placed on the hepatic artery and the portal vein before removal of recipient's liver, and after completion of all vascular anastomoses to the newly inserted liver, during the recirculatory phase of OLTX. The flow probes were connected to a Hellige electromagnetic flowmeter, portal venous and systemic arterial pressures were also recorded. The control HAF was 241 +/- 23 ml/min, the average PVF was 517 +/- 47 ml/min before removal of the recipient's liver. In the recirculatory phase of HAF increased, by 71 +/- 12% (p < 0.001). The PVF decreased in most animals after OLTX. The decrease was in average -40.2 +/- 3.5% (p < 0.001). The THBF calculated by adding the HAF and PVF showed a small, but not significant decrease recirculation. The systemic arterial pressure decreased slightly and portal vein pressure rose in most animals after OLTX. There was a substantial increase in portal inflow resistance and prehepatic arteriolar resistance and a decrease in hepatic artery resistance. The decrease of PVF after OLTX can be explained by progressive fluid accumulation in the liver parenchyma and increased sinusoidal and portal inflow resistance. The prolonged and continuous increase in hepatic artery flow during the recirculatory phase of OLTX may be due to the decrease of portal flow. The exact mechanism, by which a change in portal flow leads to arteriolar dilatation, can be most probably explained by the "adenosine washout theory" of Lautt.

Animals↗