Biomedical subjects
Publications and source records attributed to P Baláz.
The authors present a case-review of a polymorbid patient, who underwent repetitive endoscopic transgastric drainage of the pancreatic pseudocyst in chronic pancreatitis. 3 months after the stents were released, the terminal ileus perforated. Ileocaecal resection was then completed. Further postoperative course was uncomplicated and the patient's current clinical condition is good.
INTRODUCTION: The parietal peritoneum appears to be a suitable material for the vascular system reconstructions. AIM: The aim was to assess and compare thrombogenicity and ability for endothelization of the mesothelial and submesothelial side of the parietal peritoneum in the canine venous system. MATERIAL AND METHODOLOGY EXPERIMENTAL ANIMALS: canis familiaris (n = 13), half-breeds of both sexes, aged between 1 and 2 years, weighting 15-25kgs, underwent authological transplantations of the peritoneal grafts with the mesothelial side in the lumen- the group M (n = 5) and with the submesothelial side in the lumen the group S (n = 5). In the control group K (n = 3) a part of the venous wall was used as a graft and was affixed back to its original place. The bioptic samples collected on the 10th, 20th, 30th and 40th postoperative day (POD) were stained using the HE staining, NADPH-d and imunohistochemically on the intermedial filaments. The endothelization rate of the peritoneal graft was measured using morphometry and the trombogenicity was assessed peroperatively. RESULTS: In none of the trial groups a presence of thrombi was detected peroperatively. In the first trial group (group M), the onset of the peritoneal graft epithelization (reaching 20%) was recorded on the 10th POD. The endothelization process was completed on the 30th POD in this trial group. In the second trial group (group S), the peritoneal graft epithelization reaching 10% was recorded on the 10th POD. The process was completed on the 40th POD. In the third trial group K, no endothelial changes were recorded during the experiment. CONCLUSION: Both sides of the peritoneum do not show signs of thrombogenicity and possess ability for endothelization.
Intestinal transplantation is the logical alternative to definitive total parenteral nutrition in patients with chronic intestinal failure. It has become a lifesaving procedure for patients with intestinal failure who cannot be treated using conventional therapies. In children (over 50% of the recipients) indications include short gut syndrome, primary disorders of intestinal motility and mucosal diseases. In adults, the major indication for intestinal transplantation is inadaptable short bowel syndrome after total or subtotal resection. Patients with irreversible intestinal failure and total parenteral nutrition dependency without consistent liver disease must be considered as candidates for isolated small bowel transplantation. Patients with irreversible intestinal failure and end-stage liver diseases are candidates for lifesaving procedure such as combined liver-small bowel transplantation. The appropriate timing for transplantation remains vague. Advanced disease has further consequences because a considerable number of patients may die of progressive liver failure or infection before suitable organs are available. Candidates for intestinal transplantation should be assessed early and should undergo transplantation.
INTRODUCTION: Damages to the small intestinal wall resulting from ischemic-reperfusion changes, represent common complications of the clinical transplantation of the small intestine. AIM: Evaluation and quantification of the histological changes in the jejunal wall following its autotransplantation in a dog using the scale according to Park. MATERIAL AND METHODS: In dogs (n = 8), mongrel of both sexes, aged from 6 months to 2 years, weighting from 10 to 25 kgs, a resection of the jejunum followed by its autotransplantation was performed. At the time of the jejunal harvest, then after one-hour-long cold ischemia, 20 minutes after its reperfusion and then the 10th and the 20th day after the transplantation, bioptic samples of the whole jejunal wall were taken to be examined histologically. After being stained with hematoxyllin-eosine, the samples were evaluated according to the Park grading system. STATISTICS: The severity of the jejunal wall damage at the respective biopsy samples collection times was evaluated using the t-test for two dependent samples. RESULTS: After an hour-long cold ischemia, signs of increasing damage to the intestinal wall were observed, when compared to the peroperative sample (0 +/- 0) up to the degree 0.68 +/- 0.5 of the Park grading schema (p < 0.05). This damage degree increased 20 minutes after the reperfusion up to the value of 4 +/- 0 (p < 0.05). On the 10th and the 20th day a practically normal histological picture of the jejunal wall was observed. The histological changes in both cases were graded 0.38 +/- 0.5 (p < 0.05). CONCLUSION: Maximum histological changes following the autotransplantation of the small intestine with an hour-long cold ischemia were observed 20 minutes after the reperfusion. After 10 postoperative days, a practically normal histological picture of the small intestinal wall structure was observed. It remained unchanged even on the 20th postoperative day.
Fresh arterial grafts obtained during multi-organ excisions widen a spectrum of treatment possibilities for obliterating arterial disorders of low extremities or for the abdominal aortic aneurysm in patients waiting for organ transplantation. Between the year 1998 and the end of the year 2002, our work-team performed parallel reconstructions of the abdominal aorta using fresh grafts and cadaverous kidney transplantations in a group of five patients. The simultaneous surgical treatment of the both disorders during a single hospitalization as well as a considerable decrease of the artificial blood vessel prosthesis infection risk during chronic imunosuppression, represent the biggest advantage of this method. On the other hand, the risk of possible surgical complications is increased in these patients. During the operation and postoperation period, our four patients suffered from no serious complications. In case of one patient, ischemic colitis occurred which required surgical revision and subtotal colectomy. In this article, the authors describe the postoperation course of the patient condition with the above complication, which required a close cooperation of surgeons, anesthesiologists and nephrologists, in full detail.
The authors describe new approaches to the treatment of diffuse peritonitis, using the Mannheim Peritonitis Index scoring system. Depending on the score, the authors determined the types of additional surgical procedures such as "sipping drainage", laparostomy and repeated laparotomies.
The authors analyzed in a retrospective study the stage of carcinomas of the stomach and colorectum in their material. In 1996-1998 they operated 35 patients with gastric tumours and 77 patients with colorectal cancer. In both groups they operated more than 50% of the patients in the IIIrd or more advanced stage of the disease. 22.8% gastric tumours and 19.5% colorectal tumours were operated in the acute stage. The situation in the group is alarming, it is essential to improve the early diagnosis and thus also treatment in all links of the chain: patient--attending physician--surgeon--society.
According to data in the literature complications develop in association with colostomy in 20-66% of patients, occlusion of the colostomy occurs in 10-17%. The authors analyze their own group of 122 patients where in 1994-1998 a colostomy was made. Sixty-two patients were operated with developed ileus, 19 colostomies were later abolished and the passage per vias naturales was reconstructed. The authors recorded 38.5% complications, they were most frequent in axial transversostomies and sigmostomies, wound infections were most frequent. For prevention of complications the authors emphasize that stricter indications for colostomy should be used. The same applies to the selection of the type and site of colostomy and exact surgical technique, ATB prophylaxis and lavage, use of modern stomic appliances, perspectives of using the laparoscopic technique.
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BACKGROUND: The two preservation solutions most commonly used in human transplantation surgery are University of Wisconsin (UW) and Custodiol (histidine-tryptophan-ketoglutarate; HTK). The aim of our study was to compare the protective effect of UW and HTK solutions on preservation-induced injury of jejunal grafts, as evaluated by the histological changes (semiquantitative method) and small bowel mucosal serotonin levels (as a possible new quantitative method). METHODS: Male Wistar rats (n = 50) weighing 316 +/- 52 g were divided into two main groups according to which preservation solution was used, i.e. UW (n = 25) or HTK (n = 25), and each of these groups was divided into five subgroups according to cold ischemic time (0, 1, 6, 9 and 12 h). Jejunal mucosa biopsy specimens were obtained to determine the serotonin concentration in mucosa and for standard light histology. To grade histological changes in mucosa, Park's small bowel injury grading system was used. RESULTS: Histological examination revealed that injury increased with cold ischemic time in the UW as well as in the HTK group, and there were no significant differences in injury between the two groups, except for the 6-hour cold ischemic period (p < 0.05), when HTK-preserved grafts showed a lower degree of injury (0.97 +/- 0.41) compared with UW-preserved grafts (1.25 +/- 0.39). The mucosal serotonin concentration decreased with cold ischemic time in both groups, and there were significant differences (p < 0.05) in concentrations between the groups after 9 and 12 h of cold ischemia. A significantly higher concentration was measured in grafts preserved in UW solution at these time points. CONCLUSION: The concentration of mucosal serotonin in rat small bowel grafts preserved for 9 and 12 h in UW preservation solution was significantly higher than that in HTK solution. These findings indicate a better protective effect of UW solution on small bowel injury after 9 h of cold ischemia.