Biomedical subjects

P O Horváth

Publications and source records attributed to P O Horváth.

5 recordsLinked to original sources

PubMed2005

Does transthoracic compared to transhiatal resection alter the early postoperative course of oesophagectomy?

SUMMARY: Several techniques for esophageal resections have been reported. However, clear clinical evidence is still lacking whether any of the procedures is superior to the others regarding morbidity and mortality in the early postoperative period. Two operative approaches for esophageal carcinoma, transhiatal and transthoracic, were compared with respect to operative morbidity, mortality and systemic inflammatory response. In our prospective study between 2000 and 2002 83 patients were investigated. In a retrospective post hoc analysis patients were divided into two groups due to the performed operational procedure, transhiatal (TH) or transthoracic (TT). Multiple Organ Dysfunction Score (MODS) was monitored daily (t1,t2,t3). Serum procalcitonin (PCT) levels were determined on admission to the ICU (t0), then 24 hourly (t24,t48,t72). Microalbuminuria (M:Cr) was measured before (tp), and after surgery (t0,t6,t24,t48,t72). For statistical analysis Wilcoxon rank sum test, Mann-Whitney U-test and chi-square test were used as appropriate. We examined 52 patients in the TH group, and 31 patients in the TT group. There was no significant difference between the two groups regarding age, male/female ratio, and SAPS II scores. Operations lasted significantly longer in the TT group: 375 (300-480) min compared to the TH group 240 375 (180-319) min, P < 0.001. ICU mortality was similar in both groups (TH: 46 survivors/6 non-survivors; TT: 27 survivors/4 non-survivors; P = 0.607, respectively). Daily MODS did not differ significantly between the two groups. The observed inflammatory markers (PCT and M:Cr) followed the pattern we described earlier, without significant difference. In this study there was no difference in the clinical and biochemical variables of the patients between the transthoracic and transhiatal groups. The observed early postoperative morbidity and mortality may indicate, that both procedures can be considered as procedures with similar postoperative risk.

Aged↗

PubMed2005

Gastroesophageal reflux disease progressing to achalasia.

Two achalasia patients with former complaints of heartburn were examined. Antisecretory drugs were used by the patients when dysphagia occurred. Barium X-ray and esophageal manometry were performed and achalasia was diagnosed in both patients. Twenty-four-hour pH-metry showed significant and long-lasting acid reflux during supine position. Prolonged reflux episodes can be explained not only by the swallow-unrelated transient relaxation of lower esophageal sphincter (LES) and mechanical damage of the esophageal body, but also by its chemical insensitivity. Thus preoperative detection of reflux should determinate either the operational procedure and the postoperative follow up of the patient.

Adult↗

PubMed2001

Primary cricopharyngeal dysfunction: treatment with balloon catheter dilatation.

BACKGROUND: Primary cricopharyngeal dysfunction (PCD) is a rare, idiopathic, functional disorder of the upper esophageal sphincter, characterized by dysphagia, frequent aspiration, and functional narrowing at the level of the upper esophageal sphincter. METHODS: Five of 29 patients with oropharyngeal dysphagia were found to have PCD. Patients presented with severe dysphagia and predisposition to aspiration. Radiography demonstrated narrowing at the level of the upper esophageal sphincter and aspiration. An endoscope could be introduced into the esophagus in only 2 patients before dilation. OBSERVATIONS: In contrast to organic stenoses, these functional upper esophageal sphincter stenoses were dilated without difficulty with a balloon catheter. After low-pressure (1.5-2 atm) progressive balloon dilation (to 20 mm), superficial mucosal injury was observed only in one patient. After dilatation, symptoms resolved and barium swallow demonstrated normal passage through the upper esophageal sphincter. During a mean follow-up of 21 months (7-33), redilation was necessary in only 1 case. CONCLUSIONS: Balloon catheter dilatation of PCD is minimally invasive and provides both important diagnostic information and effective therapy. It should be the first choice of therapy for PCD.

Aged↗

PubMed1999

First Hungarian, internet-based prospective, multicenter study: the hernia-project.

In inguinal hernia repair, different laparoscopic and open techniques of tension-free repair using synthetic meshes have been reported to result in better patient comfort and lower recurrence rates compared with conventional procedures like Shouldice's or Bassini's operation. In comparison with the laparoscopic procedure, open tension-free repair can be performed under local anaesthesia and is less expensive. For these reasons, the recent trend in inguinal hernia surgery, has been towards using an open, mesh-based tensionless repair (Lichtenstein technique). To evaluate and support the widespread use of this technique in Hungary a large, prospective multicentre trial was initiated at 15 March 1999. Prospective registration of 1500 hernia operation using Lichtenstein technique is undertaken that is carried out in 15 hospitals. Postoperative outcome, complications and recurrence is recorded through a five years period. The case presentation and data collection is internet based. Each center participating in the study is connected by internet to the coordinating center and all information concerning this study is sent by this way. This system is able to generate actual statistical data in every moment of the study.

Hernia, Inguinal↗

PubMed1990

The significance of gastric lymph-vessels in the surgical treatment of cancer of the stomach.

Authors give an account of the classification of gastric lymph-circulation and lymph nodes suggested by the Japanese Research Society for Gastric Cancer. The importance of lymphatic structures in the accurate determination of oncological stages of gastric cancer and that of a radical lymphadenectomy during resection is emphasized. Total or subtotal removal of the stomach should be completed with the removal of primary, secondary and tertiary lymph node groups. In cases of stages II-IV, the 5-year survival rate is increased by 30-50% without an increase of postoperative lethality and complications. The operation time is prolonged by 40-60 min if resection is combined with a lymphadenectomy.

Gastrectomy↗