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M Ihász

Publications and source records attributed to M Ihász.

At least 19 recordsLinked to original sources
PubMed2000

Intraabdominal abscess managed successfully via the laparoscopic approach.

A rare complication of laparoscopic fundoplication-an intraabdominal abscess located between the fundus and the caudate lobe of the liver-is described. A 41-year-old man had undergone a laparoscopic Nissen-Rossetti fundoplication for longstanding gastroesophageal reflux disease. On the 5th postoperative day, the patient's general condition became worse, and he developed intermittent-remittent fever (40 degrees C), an elevated white blood cell count (WBC), and an accelerated sedimentation rate. Evidence of leakage was excluded by Gastrografin swallow. The diagnosis was finally revealed by means of ultrasound and computed tomography (CT) scan, which showed an intraabdominal fluid collection with an air cap of ~10 cm in diameter situated between the diaphragmatic crura, the caudate lobe of the liver, and the gastric fundus. The location did not allow semi-invasive management of the abscess, such as ultrasound or CT-guided puncture and drainage. On the 8th postoperative day, a laparoscopic exploration was performed utilizing the previous port sites. The adhesions were easily dissected, and evacuation of ~300 ml of white, dense fluid, and lavage and drainage were performed without intraabdominal dissemination of pus. The patient was discharged on the 12th postoperative day free of symptoms. Microbiological examination of the pus showed the presence of Peptostreptococcus. The patient remained symptom free. At 8 weeks postoperatively, barium swallow, endoscopy, 24-h pH monitoring, and stationary manometry of the esophagus yielded normal results. Because there was no direct evidence of leakage at the fundus, the development of the abscess was concluded to be due to the use of deep transmucosal stitches rather than seromuscular ones to create the wrap. The nonabsorbable multifilament suture material passing through the entire gastric wall could have facilitated bacterial contamination of the operative field.

Abdominal Abscess↗
PubMed1999

[Result of Panzytrat 25000 therapy following total gastrectomy].

Thirteen patients who had undergone total gastrectomy because of gastric cancer in 11 cases and gastric lymphoma in 2 cases (6 female, 7 male) at the 3rd Department of Surgery, Semmelweis University, Medical School have been followed up. The length of follow up period varied between 7.5 months and six years. Vitamin B12 substitution was applied in each case (300 micrograms/month). In 6 cases early temporary iron substitution was necessary. Regular pancreatic enzyme substitution (pancreatin) was used during meals in these patients. At the beginning Kreon (Chinoin) or Neo-Panpur (Egis) treatment was applied. Since April 1996 the patients have been treated by Panzytrat 25,000 (Knoll) which has higher enzyme content comparing with the previous ones. Following gastrectomy the digestion and absorption improved due to pancreatic enzyme substitution and the body weight increased. The serum albumin and cholesterol levels elevated significantly, while the serum uric acid levels did not changed. The iron absorption improved, patients did not require iron substitution later, except two cases. One of them needed transitoric and the other continuous iron substitution. Side effects were recorded in six cases. One of the 13 patients stopped application of Panzytrat 25,000 because of epigastric pain among other side effects (2 epigastric pain, 2 hyperuric state, 2 frequent discharge of stool) and returned to well tolerated Neo-Panpur.

Female↗
PubMed1998

Biliary tract complications in laparoscopic cholecystectomy. A multicenter study of 148 biliary tract injuries in 26,440 operations.

BACKGROUND: The higher risk of biliary tract injury is considered the most significant disadvantage of laparoscopic cholecystectomy. METHODS: A national multicenter retrospective study was performed to determine the frequency, etiology, and treatment of biliary tract injuries between January 1, 1991, and December 31, 1994. Follow-up was by questionnaire. RESULTS: Some 148 biliary tract complications were observed during 26,440 laparoscopic cholecystectomies. There was no significant correlation found between the number of LCs performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage, but in the 2nd year of practice, the incidence of both complications decreased. In institutes with more conversions, more cases of bile leakage were also observed. A significant positive relationship was found between biliary tract injuries and postoperative bile leaks. There was no significant relationship between usage of intravenous and intraoperative cholangiography and ERCP. In univariant analysis of the type of injury, the primary treatment modality did not affect the outcome of injury or entail the necessity of reoperation. Obscure anatomy leads to significantly more main bile duct injuries. According to multivariant analysis, the outcome is significantly influenced unfavorably by the necessity of repeated interventions and advanced age. CONCLUSIONS: The definitely higher risk of bile duct injury mentioned in early studies was not confirmed.

Adolescent↗
PubMed1997

Investigation of effect of lesser curvature seromyotomy of the stomach in animal experiments.

The effectiveness of seromyotomy of the lesser curvature of the stomach--the simplified version of proximal selective vagotomy--was investigated in eleven dogs. Decreased acid secretion was proved with congo red test and pH measuring by glass electrode. No significant damage to the motor function of the stomach was found with scintigraphy. Histological examinations revealed neurofibre degeneration peripherally to the seromyotomy line after peripheral vagotomy and vacuolar degeneration in the ganglion cells and amputation neuromas in the seromyotomy line.

Animals↗
PubMed1997

Complications of laparoscopic cholecystectomy in Hungary: a multicentre study of 13,833 patients.

OBJECTIVE: To report our countrywide experience of laparoscopic cholecystectomy with particular reference to complications. DESIGN: National multicentre retrospective study. SETTING: 71 university departments and public hospitals in Hungary. SUBJECTS AND INTERVENTIONS: 13,833 patients operated on between 1 January 1990 and 31 December 1993. Follow up by questionnaire. RESULTS: 732 patients (5.3%) required conversion to open cholecystectomy, urgently because of intraoperative complications in 204 (1.5%), electively for acute or chronic inflammation or obscure anatomy in 441 (3.2%), for unexpected findings in 72 (0.5%) and for technical problems in 15 (0.1%). There were postoperative complications in 598 (4.3%) but reoperation was indicated in only 154 patients (1.1%). There were bile duct injury in 81 (0.6%) and 199 bleeds (1.4%) which required conversion in 102 patients (0.7%) and reoperation in 38 (0.3%). 36 of the 181 postoperative recognized bile leaks required reoperation (20%). 19 patients died (0.1%). CONCLUSIONS: The morbidity and the mortality of laparoscopic cholecystectomy are better than after the open operation. The 2-6 times higher risk of bile duct injury mentioned in early studies was not confirmed.

Cholecystectomy, Laparoscopic↗
PubMed1996

[Laparoscopic cholecystectomy causing injury to biliary tracts. Analysis of the results of 26,440 operations in Hungary].

The authors analyse the etiology, diagnosis, treatment and outcome of 148 biliary tract injuries in connection with 26,440 laparoscopic cholecystectomies performed in 89 domestic institutes between January 1st, 1991, and December 31st, 1994. There was no significant correlation between the amount of laparoscopic cholecystectomies performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage (wide range of figures were found in different institutes), but in the second year of practice, the incidence of both complication decreased (there was statistically significant difference between the regression co-efficients). There was no significant correlation between the laparoscopic cholecystectomies performed and the rate of conversion, but the co-efficient of the regression curve showing the correlation of the absolute number of laparoscopic cholecystectomies and conversions significantly decreased in the second year of practice. In institutes having significantly more conversions, more cases of bile leakage was found also. There is a significantly positive relationship between biliary tract injuries and postoperative bile leakage; the more lesions are found in an institute, the more cases of bile leakage they have. There was no significant relationship between the incidence biliary tract injuries and postoperative bile leakage and the usage of intraoperative cholangiography, preoperative intravenous cholangiography and/or ERCP. The partial and complete injuries of main bile ducts were detected intraoperatively significantly more often while most of the lesions of the area of cystic duct were detected postoperatively. There was no significant difference between the types of the only postoperative recognized injuries and the time of establishing the diagnosis. Simple suture was performed in 69.2% of the partial injuries (with or without T-tube or other drainage), while 63.3% of the complete transsections were treated with biliodigestive anastomosis. In univariant analysis the type of injury, the primary treatment modality did not affect on the outcome (the ratio of cured and expired), but significantly more patients continue to have complaints following biliodigestive anastomosis than following the treatment of lesions around the cystic duct. The older the patient is, the worse the prognosis is. The primary treatment modality (biliodigestive anastomosis or biliary tract reconstruction with or without drain) did not significantly altered the necessity of reoperation. Thermic injury caused significantly more partial than complete lesion. Disturbance in identification of the anatomic structures leads significantly more partial or complete main bile duct injuries than lesion in region of the cystic duct and causes more complete transsections than partial lesions. According to multivariant analysis the outcome is significantly influenced in an adverse way by the necessity of repeated interventions and higher age.

Analysis of Variance↗
PubMed1996

Long-term clinical results of highly selective vagotomy performed between 1980 and 1990.

A retrospective analysis was conducted of 778 patients who underwent highly selective vagotomy between 1980 and 1990. Surgery was performed for duodenal ulcers without any complications in 485 (62.3%) patients; for duodenal ulcers with complications such as stenosis, bleeding, or perforation in 270 (34.7%); for combined duodenal and ventricular ulcers in 12 (1.5%), and for ventricular ulcers alone in 11 (1.4%). Pyloroplasty was additionally performed in the presence of complications only. The incidence of intraoperative complications proved to be as high as 1.4%, occurring in 11 patients, while postoperative complications developed in 247 patients (31.7%). Although the overall mortality was 0.6% (5 patients), the mortality rate of those patients who underwent surgery for uncomplicated ulcer disease was 0.2% only (2 patients). The patients comprised 554 men (71.2%) and 224 women (28.8%) with an average age of 41.4 +/- 0.7 years. The average duration of duodenal ulcer disease was 9.5 years, and 643 (83.2%) of the patients were able to be regularly followed up for between 3 and 13 years. Recurrence developed in 62 patients (9.6%): in the duodenum in 57 patients (91.9%), and in the stomach in 5 (8.1%). The rate of recurrence according to sex was 9.4% in men and 10.3% in women, being 42 and 20 patients, respectively. The average duration until recurrence appeared was 27.06 +/- 3.44 months. A reoperation proved necessary in 28 of these 62 patients (45.1%). The clinical results were evaluated by means of a modified Visick classification, according to which 81.8% of the patients belonged to groups 1 or 2, 7.9% to group 3, and 10.3% to group 4.

Adult↗
PubMed1996

[Bile duct injuries in laparoscopic cholecystectomy. A computerized analysis of 148 lesions in 24,440 operations in 89 Hungarian institutes (publication by the Hungarian Society of Surgery)].

The authors analyse the etiology, diagnosis, symptoms, treatment and outcome of 148 biliary tract injuries in connection with 26,440 laparoscopic cholecystectomies performed in Hungary. In univariant analysis, the type of injury, the primary treatment modality did not affect the outcome of injury or the necessity of reoperation; in multivariant analysis, the outcome is significantly influenced adversely by the necessity of repeated interventions and higher age. Disturbances in the identification of anatomic structures lead significantly to more main bile duct injuries than lesions in the region of the cystic duct and cause more complete trans-sections than partial lesions.

Bile Ducts↗
PubMed1995

[Laparoscopic cholecystectomy and cancer of the gallbladder].

Performing a series of 960 laparoscopic cholecystectomies we have removed 3 unsuspected gallbladder cancers. In one case we have observed the development of trocar site abdominal wall metastasis twice. After resection and reresection of the metastases the patient is symptom-free in the 14th month. During laparoscopic cholecystectomy if there is a suspicion of gallbladder cancer we have to manipulate with special care to avoid rupture of the gallbladder. In doubtful cases frozen section is mandatory. If the malignant process extends over the serosal layer--conversion and radical-extended operation is recommended.

Abdominal Muscles↗
PubMed1995

[The role of sonography in laparoscopic cholecystectomy].

Between January 1991. and December 1993. in the 3rd Surgical Department of Semmelweis Medical University 735 laparoscopic cholecystectomies were performed. Intraoperative and postoperative complications occurred in 2.7% and 3% respectively. Conversion to open procedure was necessary in 8.4%, reintervention was indicated in 2.3%. The total occurrence of common bile duct stones was noticed in 1.6%. The incidence of bile duct injury 0.54%. The role of sonography in laparoscopic cholecystectomy is multiple: patient-selection, diagnosis of complications, ultrasound guided interventions in cases of complications, follow up of patients. The authors compared in 419 cases the preoperative sonography with the intraoperative finding. The risk of intra- and postoperative complications was significantly higher if the stone was impacted into the cystic region, if the gallbladder was enlarged, especially with wall-thickening and signs of acute inflammation. The fibrosis and scarring of gallbladder represent an increased risk as well. The accuracy in estimation of common bile duct dilatation is very high, but in the judgement of bile duct stones there was a high false positive rate. In spite of this, the echography is very well applicable for patient-selection. In the patient group selected with positive sonographical finding for open cholecystectomy, the prevalence of common bile duct stones was 25%, compared with 1.6% in laparoscopic group. In cases of postoperative complications the diagnostic sonography may be followed with ultrasound-guided puncture and/or drainage.

Adolescent↗
PubMed1994

[The effect of lesser curve seromyotomy of the stomach in animal experiments].

The authors investigated the efficiency of the seromyotomy of the lesser curvature of the stomach in 11 dogs. Reduction of the acid production was verified by glass electrode pH measuring of the gastric mucosa. Scintigraphic examination showed that the operation did not damage the motor function (motility) of the stomach. The fact of peripheral vagotomy was established by histological examination: degeneration of nerve fibres was detected on the peripheral side of the line of the seromyotomy, vacuolar degeneration was found in the cells of parasympathetic ganglions, and amputation neurinomas were shown in the line of the seromyotomy.

Animals↗
PubMed1993

[Laparoscopic cholecystectomy].

Traditional cholecystectomy has been the standard surgical treatment of the gallstone disease for more than 100 years. The technical development led to a new surgical procedure and its rapid acceptance. This is laparoscopic cholecystectomy. Its application is becoming widespread in therapy too. But most of the surgeons are lack of technical experiences in this field. Currently it restricts the indications those are anyway the same of standard cholecystectomy. Besides its many advantages, laparoscopic cholecystectomy has its own disadvantages and being an invasive procedure, there are possibilities of complications. The latest can be reduced by the adequate choice of patients, the careful learning of the operative technic and by turning to open surgery (conversion) when it is necessary. Its morbidity is nearly equal to complications of standard cholecystectomy, but mortality rate is lower (0.05-0.2%). Our morbidity of performed 300 laparoscopic cholecystectomies was 6.4%. We had no death. The hospitalization became as short as 4 days. Our early clinical results (90%) are the same of traditional cholecystectomy. Laparoscopic cholecystectomy as a new surgical procedure involves the efficiency of the standard cholecystectomy and the noninvasive endoscopic technic. Laparoscopic cholecystectomy performed by well trained surgeons is a safe surgical procedure, its early results are excellent and makes the choice of surgical treatment, used in bile surgery richer.

Acute Disease↗
PubMed1993

[Complications of Crohn disease, surgical indications, surgical solutions and recurrence].

There is not another disease, of which complications would be such frequent and various as of Crohn's disease. One of the most common complications is intestinal obstruction, caused by angulation and stricture, as a result of inflammatory granulomas. Fistulas between affected intestines and cavital organs or the abdominal wall can also often be observed. The likelihood of appearing complications is correlating with the time from the onset of the disease. If they are dangerous for the patient's life, surgical intervention is required. In some of the cases, when complications don't threaten the patient's life, medical treatment may be beneficial. Surgery is indicated only in those cases, when complications mean danger, or the continuous active medical treatment is insufficient. Most frequently the resection of the damaged intestine is performed, nowadays stricture plasty is also recommended. The operative mortality is 4.1%. The disease is featured by frequent recurrences: 28% to 33.3%. The current operative mortality is 18.6%. The prognosis is always uncertain, because recurrence may occur many years after operation.

Crohn Disease↗
PubMed1992

[Etiology, symptomatology, diagnosis, differential diagnosis and management of Crohn disease].

The non specific, chronic, inflammatory, granulomatous Crohn's disease is not common in our country. Despite wide clinical and experimental experiences, its etiology hasn't been cleared yet. Its symptoms are especially various. The diagnosis--particularly in early stages--despite the clinical feature and modern diagnostic methods, is difficult. Only histology can give exact diagnosis. However Crohn's disease often can be diagnosed only on the basis of clinical symptoms, later appearing complications featuring this disease--particularly fistula--and indirect histological changes that can be seen in biopsy. Differential diagnosis--particularly in early stages--is also difficult, as the symptoms of Crohn's disease may be similar to symptoms of any other abdominal diseases. The therapy of Crohn's disease is mainly medical, even in some of those cases, when the occurring complications don't threaten the patient's life. Remission doesn't mean total recovery. Even by supporting treatment the disease may relapse at any time. Surgical treatment in indicated only in those cases, when complication occur threatening the patient's life, when active medical treatment is insufficient, or despite medical treatment progression can be observed.

Crohn Disease↗
PubMed1992

[Childhood accidents].

A survey of accidents in a period of one year in County Vas, Hungary was performed. The injury of children in the age-group of 0-14 was found in case 5841 i.e. in 22.5% of the total number of the injured. The incidence was 101/1000 head of puerile population. The rate of accidents appeared to be low in early childhood while it showed a significant increase in the school age. The home accidents accounted for the most of the accidents especially in the early childhood. Over the age of 7 the school and sport/playground accidents exceeded. The roads were involved as a high risk factor for each of the age groups. The high (21.5%) rate of fractures indicates severity of the injuries although the number of the most severe injuries remained low. The accident conditions of County Vas are at an advantage compared with international data meanwhile the high rate of accidents in the school age group calls for prevention and educational work.

Accidents↗