Magyar sebészet
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Microcirculatory disturbances are known to affect the integrity of the gastrointestinal barrier. In our experiments, we aimed at characterizing the intramural microcirculatory reactions in response to various circulatory disorders using intravital microscopy with orthogonal spectral imaging technique. For the analysis and comparison of the microcirculatory reactions in the intestinal ileal mucosa, longitudinal muscle and Peyer's patches, a novel mathematical formula was established. ⋯ Systemic circulatory disorders are characterized by a non-uniform microcirculatory failure and a redistribution of blood flow between the different layers favouring the mucosa. Using the suggested mathematical formula, the microcirculatory alterations can be characterized and compared.
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We studied the effects of gastric tube formation and thoracic epidural anaesthesia (TEA) on gastric microcirculation, hemodynamic and bowel motility changes. The experiments were performed on pentobarbital-anesthetized, mongrel dogs. Mean arterial pressure (MAP), gastric and mesenteric blood flow (Transonic Systems Inc.) and small bowel motility changes (strain gauge technique) were monitored. ⋯ MAP was significantly reduced by 30%, while the arterial blood flow in gastric and mesenteric arteries was significantly increased. TEA significantly improves microcirculation of the distal portion of the gastric tube and increases intestinal motility. These results show that epidural anaesthesia is favourable and should be recommended during reconstructive oesophageal surgery.
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We analysed the clinical value of the procalcitonin quick test (PCT-Q; BRAHMS Diagnostica, GmbH, Berlin) in infected pancreatic necrosis verified by guided fine-needle aspiration (FNA). In a prospective, controlled study the results of 24 patients were evaluated during 2001. PCT-Q test was performed in patients with necrosis verified on CT scan and/or septic symptoms. ⋯ Comparing abscess and infected necrosis, significantly higher procalcitonin values were detected in patients with necrosis. These results show that PCT-Q test can be a possible non-invasive method besides fine-needle aspiration. Elevated levels of procalcitonin (higher than 2 ng/ml) clearly suggest infection of the necrosis, while lower values do not exclude the possibility of local septic progression.
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As a result of mammographic screening nonpalpable breast lesions are found with increasing frequency. The surgical management of these lesions presents two main problems: (1) How to localize the lesion pre- and intraoperatively; (2) What should be the extension of the axillary dissection for malignant lesions. This study is aimed to evaluate the technical feasibility of radioguided excision of nonpalpable breast lesions and the possibility of performing simultaneous sentinel lymph node biopsy for malignant lesions. ⋯ The biopsy was successful in 45 patients (90%). The sentinel lymph node was histologically positive in 2 patients (4.4%). Radioguided localization with the intraoperative use of a gamma-probe is an easy, rapid and highly accurate technique for removing nonpalpable breast lesions and allows simultaneous sentinel lymph node biopsy for malignant lesions.
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Randomized Controlled Trial Clinical Trial
[Effect of prophylactic N-acetylcysteine on postoperative organ dysfunction and inflammatory markers after major abdominal surgery for cancer. Prospective, randomized, double-blind, placebo-controlled clinical trial].
To investigate whether short-term N-acetylcysteine (NAC) infusion administered before and during extensive abdominal surgery could modify the progression of early postoperative organ dysfunction and systemic inflammatory response. ⋯ The results of this study do not support the routine use of NAC as a prophylactic drug during surgery, and reinforce previous evidence which challenge the indication of NAC in the critically ill patient.