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Biomedical subjects

P Kupcsulik

Publications and source records attributed to P Kupcsulik.

At least 19 recordsLinked to original sources
PubMed2001

[Sapheno-peritoneal shunt for the treatment of ascites].

For the surgical treatment of drug resistant ascites caused by hepatic cirrhosis usually different types of valvular plastic tubes are used, implanted as peritoneo-venous shunts. These shunts drain the ascites into the jugular vein. In the 1st Surgical Department of the Semmelweis University Budapest we have performed 267 peritoneo-venous shunt operations. We introduced a new method using an autolog venous graft with a peritoneo-venous anastomosis, that drains the ascites into the saphenous, then femoral vein. So far we performed 5 such interventions. The early results suggest that sapheno-peritoneal shunt can be successfully used for treatment of ascites. With this operation complications of plastic grafts are avoidable.

Ascites↗
PubMed2000

Trabecular angiomyolipoma mimicking hepatic cell carcinoma.

Hepatic angiomyolipomas are rare tumors, especially in comparison with those occurring in the kidney. Nevertheless, it is important to be aware of their existence, especially when occurring in the liver, where they might have different subtypes. Not infrequently they are composed of rather irregular cells with epithelioid appearance. In these cases hepatocellular carcinoma or the possibility of other malignant tumors has to be ruled out, with the aid of numerous immunohistochemical reactions. The authors present a case of a female patient, whose liver lesion was first diagnosed on cytological examination as a hepatocellular carcinoma. Based on the preoperative cytological diagnosis, a large liver lobe resection was performed. Histological examination found an angiomyolipoma of the above-mentioned type, and the final diagnosis was ascertained with the aid of vimentin, smooth muscle actin (SMA), and HMB-45.

Actins↗
PubMed1999

Ascorbate-mediated electron transfer in protein thiol oxidation in the endoplasmic reticulum.

Addition of, or gulonolactone oxidase-dependent in situ generation of, ascorbate provoked the oxidation of protein thiols, which was accompanied by ascorbate consumption in liver microsomal vesicles. The maximal rate of protein thiol oxidation was similar upon gulonolactone, ascorbate or dehydroascorbate addition. Cytochrome P450 inhibitors (econazole, proadifen, quercetin) decreased ascorbate consumption and the gulonolactone or ascorbate-stimulated thiol oxidation. The results demonstrate that the ascorbate/dehydroascorbate redox couple plays an important role in electron transfer from protein thiols to oxygen in the hepatic endoplasmic reticulum, even in gulonolactone oxidase deficient species.

Animals↗
PubMed1999

Sedation for ambulatory endoscopy.

Diagnostic and therapeutic fiberoscopy of gastrointestinal tract is often performed ambulatory and sedation is sometimes also required. Indication for sedation can be the intervention itself or the patient's psychological state. Aim of the study was to compare the effects of midazolam and combination of midazolam and fentanyl during endoscopy. Twenty eight cases were investigated: oesophagogastroduodenoscopy (n = 14) and colonoscopy (n = 14). Anaesthetics were midazolam (M) in 16 cases, midazolam-fentanyl (MF) in 12 cases. Non-invasive mean arterial pressure, pulse rate, acid-base balance and blood gases (by Astrup method) were recorded before endoscopy, at the 5th and 10th minutes of endoscopy, 15 minutes after intervention and also before emission. Pulse rate changed between 78-92/min. Mean arterial pressure appeared between 84-90 mm Hg. In MF group both were lower but there was not significant difference between the groups. The values were in normal range, there were not metabolic acidosis which needed correction. Onset of sedative effect was 2.8 min. in M group, 2.3 min. in MF group. The ability for adequate reaction returned within 11 min. in M group, within 14 min. in MF group. Fentanyl prolongs sedative effect of midazolam and offers sufficient pain relief. After 3 hours, patients could be emitted from the hospital.

Acid-Base Equilibrium↗
PubMed1997

[A case of unusual complication of diaphragmatic herniation of transverse colon following transhiatal esophagectomy].

The authors report a rare complication observed after transhiatal esophagus extirpation performed for esophageal cancer. In this case the transverse colon herniated into the pleural cavity through the esophageal hiatus. Herniation completed on the 6.th. postoperative day and caused mechanical ileus. In the first few postoperative days, radiology pointed to a basal pulmonal infiltrate, later it resembled relaxation of the diaphragm, which was rather misleading. Recognition of the real situation was possible only on the 6.th.postoperative day. The patient was reoperated and the pathological state could be reversed. The esophageal hiatus was reconstructed. In the opinion of the authors the complication may have developed partly due to the opening of the left pleural cavity in the course of extrathoracal esophagectomy, and partly to the fact that the spleen was removed during operation. The outcome after reoperation was uneventful. The authors consider this as a rather rare and instructive case.

Colon↗
PubMed1997

[Gastroenterologic endoscopic ultrasonic examinations using a convex transducer].

Interest in endoscopic ultrasonography (EUS) has increased during the past fifteen years. Since few years new instrument have been produced, which was equipped with a small curved array transducer mounted in a front of the optic lens. The instrument, which is connected to a Hitachi ultrasonic scanner allows for duplex examination, colour flow imaging, and spectral analysis for measurement of flow velocity. Comparing to the recent unit with mechanical sector transducer, this instrument was equipped with a working channel, which allows to perform biopsies and define the TNM stages. The paper is discussed the evaluation of 55 patient data. This method developing worldwide quickly. By this new EUS technology there is a growing opportunity to substitute other either costly or more invasive methods, and using the TNM classification there is also possible to define whether the patient is suitable for curative surgical intervention or not.

Adult↗
PubMed1997

Helicobacter pylori and congestive gastropathy.

This study evaluates the prevalence and significance of Helicobacter pylori (H. Pylori) infection in patients with portal hypertension. 118 patients were selected, i. e. 90 patients with portal hypertension (66 males, 24 females, mean age 49.1 +/- 2.1 years) and 28 noncirrhotic patients with nonulcerative dyspepsia as a control group (twelve males, 16 females, mean age 47.6 +/- 2.8 years). In all patients diagnostic upper endoscopy was performed and gastric biopsies were taken for histological examination and diagnosis of H. pylori infection. Of the portal hypertensive patients, 42 patients (47%) had congestive gastropathy, eleven (26%) of whom were positive for H. pylori infection and 48 (53%) did not have gastropathy, twelve (25%) of whom were positive for H. pylori infection. In the control group, 15 of 28 (54%) were positive for H. pylori infection. H. pylori was found less frequently in congestive gastropathy patients than in the control group. We found also that the presence and severity of congestive gastropathy is independent of the H. pylori status. We conclude that the role of H. pylori infection in the pathogenesis of congestive gastropathy seems to be unlikely and we suggest that there is no need for its routine eradication in cirrhotic patients.

Adult↗
PubMed1996

[Alternatives to liver transplantation].

Methods of artificial liver support gained evolving interest by giving a bridge to liver transplantation. The most reliable concept transient liver support is represented by an apparatus employing hepatocytes as extracorporeal devices or implantable systems. Xenotransplantation from animal donors is not yet widely accepted, but latest experiences with transgenic donors may alleviate this technology useful for clinical application. Living related liver transplantation has been accepted to overwhelm donor availability with special regard to those countries, where cadaveric donation has not been established. Auxiliary liver grafting gained popularity for the treatment of fulminant hepatic failure, with special interest to the late regeneration of the host liver leading to avoid the need for continuous immunosuppression. As a consequence of enormous morbidity and mortality of chronic liver diseases in Hungary, the calculated number of patients requiring liver transplantation is about three times higher than that in other countries of Europe. Life threatening complications of liver cirrhosis such as variceal bleeding, or intractable ascites could be effectively treated by endoscopic or surgical means. To give chance patients with end stage liver disease being transplanted in Hungary, transplant centers should be built up according to demographic and geographic requirements.

Animals↗
PubMed1996

Helicobacter pylori infection in congestive gastropathy.

BACKGROUND: This study determines the prevalence and significance of Helicobacter pylori infection in portal hypertensive patients. MATERIALS AND METHODS: Patients numbered 118 and consisted of 90 patients with portal hypertension (66 men; 24 women; mean age, 49.1 +/- 2.1 years) and 28 noncirrhotic patients with nonulcer dyspepsia, (12 men; 16 women; mean age, 47.6 +/- 2.8 years), who made up the control group. In all patients, diagnostic upper endoscopy was performed, and gastric biopsies were taken for histological examination and diagnosis of H. pylori. RESULTS: Of the portal hypertensive patients, 42 (47%) had congestive gastropathy, 11 (26%) of whom were positive for H. pylori, and 48 (53%) did not have gastropathy, 12 (25%) of whom were positive for H. pylori. In the control group, 15 of 28 (54%) were positive for H. pylori. H. Pylori was found less frequently in congestive gastropathy patients than in the control group. We found also that the presence and severity of congestive gastropathy is independent of H. pylori status. CONCLUSIONS: We conclude that the role of H. pylori in the pathogenesis of congestive gastropathy is unlikely, and we suggest that there is no need for its routine eradication in cirrhotic patients.

Adult↗
PubMed1994

[Ultrasonographic examination of the circulation in the hepatic vein in diffuse liver diseases].

UNLABELLED: 59 patients suffering from diffuse liver lesion and 28 healthy individuals had undergone duplex ultrasound examination of the hepatic vein circulation. Three time-velocity spectra had been noticed and later divided into three groups: 1. Normal (triphasic) spectrum. 2. Decreased and deformed amplitudes. 3. Flat flow spectrum. RESULTS: The control group matched the normal (triphasic) spectrum of type 1 without exception. Type 2 could be observed in steatosis, chronic active hepatitis and cirrhosis alike. The type 3 spectrum was shown significantly, to occur with 71% sensitivity and with 100% specificity in cirrhosis of the liver. The comparison of the results with the circulation velocities measured in the main portal vein showed a sensitivity of 88% and a specificity of 94%. Based on this initial experience, authors hold the view that a technically simple hepatic vein Doppler-sonography can complete the clinical analysis with significant additional information in cases of diffuse liver lesion.

Blood Circulation↗
PubMed1992

[Surgical implications of chronic liver diseases].

Complications of chronic liver diseases requiring surgical interventions are the following: esophageal varices and bleeding, ascites hypersplenism, some forms of liver insufficiency. The most widely accepted method for treatment of esophageal varices is endoscopic sclerotherapy. Portal systemic shunts are indicated in some cases. Intractable ascites is to be treated by peritoneovenous shunt insertion. "Ressissance" of paracentesis is not confirmed by late results. Splenectomy is proposed if clinical signs are prominent. If portal hypertension exists, shunt should be performed simultaneously. Liver transplantation is indicated in cases of irreversible liver damage. Optimal selection of patients and timing of transplantation remains of critical importance. As a consequence of numerous technical modifications liver transplantation becomes more popular. Statistical data on liver diseases in Hungary call for urgent development of hepatology. Cooperation of physicians is of outmost importance to realize it.

Chronic Disease↗
PubMed1991

[The role of gastroesophageal reflux in the hemorrhaging of esophageal varices. Effect of endoscopic sclerotherapy].

From January 1st to December 31st 1987, 51 prospectively selected patients underwent 24-hour intraesophageal pH monitoring before, and 5 weeks after endoscopic paravariceal sclerotherapy (ESCL). Patients were divided into two groups: in group I. first pH monitoring was done 24 hours after acute variceal bleeding; in group II. one month after a previous bleeding episode. Gastroesophageal reflux (GER) was expressed by percentage of time below pH 4, and by average number of reflux episodes, lasting longer than 5 seconds, per hour. In group I. the time below pH 4 (10.3 +/- 2.05%) and the number of reflux episodes (24.4 +/- 4.2/h) were significantly higher, than those in group II. (2.57 +/- 0.14%; 2.39 +/- 0.31/h). Pathologic GER parameters were significantly more frequent in group I. (50% and 73%), than in group II. (16.7% and 29.1%). ESCL significantly reduced GER in both groups of patients. In group I. GER remained pathologic at 12.5% and 20.8% of patients. In group II. time below pH 4 became normal at all of the patients, and only one of them has pathologic number of reflux episodes. Our data give evidence of GER having a possible causative role in initiating variceal bleeding. ESCL significantly reduces GER. This effect might contribute to long term results of ESCL.

Endoscopy↗
PubMed1991

[Endoscopic intubation and intracavitary irradiation in the palliative treatment of inoperable esophageal tumors].

The authors have applied at first in Hungary the intracavital after loading radiotherapy in patients suffering from esophageal tumor. A new method was elaborated for the combined use of endoscopic tube insertion and intracavital irradiation. Out of the 155 patients admitted on the 1st Surgical Department of Semmelweis University, Budapest, 63 had been treated only by tube insertion, 44 were intubated and irradiated, whereas 48 patients had intracavital radiotherapy without intubation. Radiotherapy was performed at the Radiological Unit of Semmelweis University. The irradiation dose ranged from 26,9 to 32,2 Gray in average. The mean survival of group I. was 4,0 months, that of group II. 6,3 months, and in group III. 7,0 months respectively. The expected survival is proportional to the radiation dose. No correlation exists between tumor localisation and survival. Respiratory fistula, the most common complication, occurred in different groups as follows: 3,4%, 6,2%, and 9,0%; but could have been treated by tube insertion, or adequate positioning of the tube. The combined use of intubation and intracavital after loading radiotherapy has been proven to be suitable for palliative treatment of inoperable esophageal tumors.

Aged↗
PubMed1989

[Duplex ultrasonography of the portal circulation before and after sclerotherapy of esophageal varices].

Authors examined 40 patients suffered from portal hypertension before and after sclerotherapy of esophageal varices with duplex ultrasonography. The patients were divided into four groups: the first and recurrently bleeding patients and those who were treated with propranolol. The average velocity of the main portal vein before the treatment was significantly lower in the patient group, than in the normal control group. There were no significant changes observed after treatment. The portal blood flow increased in the first bleeding patients who did not take propranolol. The diameter of the main portal vein increased in the recurrently bleeding patients. The conclusion is, that the duplex ultrasonography of the portal circulation is a valuable noninvasive method. One has to take into consideration the limits of this technique and further data are needed for the diagnostic and prognostic accuracy.

Esophageal and Gastric Varices↗
PubMed1989

[Laryngo-pharygo-esophagectomy in the surgical excision of multicentric esophageal-laryngeal cancer].

The occurrence of esophageal cancer and lethality show rising tendency in Hungary. Despite of the improving operative technique and decreasing rate of mortality in the hospitals the late survival is low. The main cause of this fact is the late recognition of the esophageal tumors in the majority of the cases. In the patient material of the authors 80% of the cases were in stage III-IV and were from oncological viewpoint practically inoperable tumors. The sad late results may be due also to the lack of a uniform consideration concerning the complex therapy of the esophageal cancer (surgical + cytostatic and/or radiotherapy). A case is presented where the surgical and radiological treatment brought success. The location of the tumor was unusual and the applied surgical technique is new in the Hungarian literature.

Carcinoma, Squamous Cell↗