[Immunohistochemical demonstration of pepsinogens I and II in the gallbladder]. The immunohistochemical expression of pepsinogen I (PI) and pepsinogen II (PII) was studied in 103 gallbladder carcinomas, 25 non tumoral gallbladder lesions and 23 gallbladder cancer metastases. PI was positive in 6% of carcinomas and only in 2% of non tumoral contiguous mucosa. PII was positive in 46% of carcinomas and 43% of controls. Metastases were negative for both enzymes. Pyloric gland metaplasia of non tumoral mucosa adjacent to the tumor expressed PII in 68.9% and PI in 3.4% of cases. The same lesion in non tumoral gallbladders was positive for PII in 66.6% of cases, and no case expressed PI. There was no relationship between PI expression and the histological degree of differentiation. Only tumors with serosal or subserosal involvement were positive for PI. PII had a higher expression in early or well differentiated tumors. Tumors with pyloric gland metaplasia in the contiguous non tumoral mucosa expressed PII more frequently. Our results, based on the expression of PI and PII, suggest a relationship between the presence of pyloric gland metaplasia and some types of gallbladder cancer.


[Dynamics of Chagas infection transmission in Chile: model and simulation]. Triatoma infestans is the principal vector for Chagas disease in Chile. Although there is enough epidemiological information about human infection, the effect of vector and host (animals and man) populations interrelations over Chagas disease prevalence has not been studied. This work studies a determinist mathematical model for the dynamics of Chagas disease transmission by Triatoma infestans, relating entomological population parameters with infection propagation. The effect of invasion of susceptible animal and human populations by infected triatomine insects and the stability of Chagas disease endemic was simulated. The Ro parameter was estimated. This is a gross appraiser of the infection reproductive rate that relates triatomine insect density, bite rate and mortality. The infected population at equilibrium was estimated. The resulting endemic was highly stable with a great amount of chronic and few acute cases. There is always an acute Chagas epidemic stage after a recent invasion. The need for a threshold triatomine insect population for the genesis of an endemic is proposed.


Degree of preparedness of the individual preventive health system during the Gulf War. We learned the following lessons concerning the role of public health nurses in the Gulf War: Coherence and clarity in the organization of the network is essential. A solution is needed for childcare for nurses while at work. Home aides should be mobilized to aid in evacuation.


[Endoscopic treatment of gastroduodenal digestive hemorrhage]. Endoscopy is extremely useful for the diagnosis of upper gastrointestinal bleeding. At the present time, therapeutic measures are been used during the endoscopy to stop bleeding. This paper reports the experience of hospital de Talca in the endoscopic treatment of upper gastrointestinal bleeding. Thirty four patients (22 male) with bleeding not originating from esophageal or gastric varices were treated with direct absolute alcohol injection into the bleeding lesions. The procedure was successful in 31 patients. Three of the 34 patients required surgery, but only one of those successfully sclerosed (97% success). There were no complications attributable to the procedure. It is concluded that this therapeutic modality must be implemented in places were gastrointestinal endoscopy is performed.


[Controlled study of the effect of silymarin on alcoholic liver disease]. A controlled trial on the use of Silymarin in patients with alcoholic liver disease was performed. Seventy two patients were admitted to the trial and randomly assigned to an experimental or controls group. Experimentals received 280 mg/day of Silymarin and controls an equal number of placebo tablets. Three patients on placebo and nine on Silymarin were lost from control (p = 0.035), remaining in control 34 patients receiving placebo and 25 patients receiving the drug. Both groups did not differ in their initial laboratory assessment and were followed up for an average of 15 months. Ten patients died during the follow up (5 in placebo and 5 in Silymarin); life table analysis did not show significant differences in mortality. Patients who died had lower serum albumin and prothrombin time and higher total bilirubin, alkaline phosphatases and CCLI on the initial clinical and laboratory assessment. Final laboratory values and their changes in those who survived did not differ between Silymarin and placebo. Twenty two patients on placebo (65%) and 14 on Silymarin (58%) recognized alcohol ingestion or had a positive urine sample analysis for alcohol during follow up. Those who abstained from alcohol had a significant fall in gamma glutamyl transferase during follow up. No other significant differences were observed between these two groups. It is concluded that in this trial, Silymarin did not change the evolution or mortality of alcoholic liver disease.


[Utility of high-resonance ultrasonography in the diagnosis of acute appendicitis]. The clinical records and the ultrasound findings of 48 patients studied because of a presumptive diagnosis of acute appendicitis in a one-year period were reviewed. Ultrasound examination was performed using graded compression and high resolution probes when acute appendicitis was suspected and the clinical history or physical examination was unclear. The ultrasound findings were correlated with the clinical course or surgical and pathological findings. This procedure was useful in the diagnosis of acute appendicitis, with 84.6% sensibility and 95.5% specificity. Predictive value for positive results was 95.7% and 84% for negative results. These figures agree with results previously communicated in the literature. It is concluded that high resolution ultrasonography is useful in the differential diagnosis of atypical acute appendicitis.


[Continuous hemodialysis in the treatment of chronic renal insufficiency in emergencies]. Continuous hemodialysis is advantageous for the treatment of renal failure in critically ill patients. This study reports our experience in the treatment of emergencies during chronic renal failure with continuous hemodialysis using a Cuprofane membrane. Eighteen patients with acute decompensations of chronic renal failure were treated with continuous hemodialysis (14 arteriovenous and 4 veno-venous). Procedures lasted a mean of 44.2 h, blood urea nitrogen decreased from 150.3 +/- 49.8 to 60.6 +/- 30.7 mg/dl, metabolic acidosis was corrected raising serum bicarbonate from 10.1 +/- 44 to 17.8 +/- 3.3 mEq/L and hyperkalemia was corrected. Mean ultrafiltration was 239.6 +/- 124.6 ml/h which allowed to withdraw a mean 10.590 ml of ultrafiltrate. Two patients were complicated with femoral artery pseudoaneurysms and one patient with a catheter related sepsis. Global mortality was 16.7%, which compared favorably with the 32.1% predicted mortality according to the Simplified Acute Physiology Score. It is concluded that continuous hemodialysis, a readily available procedure, is suitable for the treatment of emergencies during chronic renal failure.


[Acute non-cardiogenic pulmonary edema secondary to upper airway obstruction. Clinical case]. Noncardiogenic pulmonary edema is a well recognized complication of upper airway obstruction. We report the case of a previously healthy 18-year-old male who presented this complication following laryngospasm after anesthesia. He developed severe pulmonary edema with hypoxemia, high cardiac output and low pulmonary capillary pressures. He was managed with mechanical ventilation and PEEP. Pulmonary edema resolved within 24 hours. The clinical picture, etiology, differential diagnosis and prevention are also discussed.


[Esophageal achalasia of chagasic origin: report of a case diagnosed in the pre-symptomatic stage]. A 42 year old male that presented with functional gastrointestinal symptoms is presented. X ray examination showed an esophageal diameter of 3 cm, measured 6 cm above the gastroesophageal junction. This finding, according to previous experiences of the authors, is highly suggestive of Chagasic esophageal involvement. The patient resided in a highly endemic area for Chagas disease; hemagglutination, latex agglutination and ELISA serological tests for Chagas disease were positive. The manometric study of the esophagus confirmed the diagnosis showing an elevated lower esophageal sphincter pressure and hypomotility and poor amplitude contractions of the esophageal body. Barium enema and EKG were normal. Upper gastrointestinal endoscopy disclosed an erosive gastritis that could explain the patients' symptomatology. The antiquity of Chagas infection was estimated in 18 years. This case represents an example of early diagnosis of esophageal involvement in the course of Chagas disease.


[Role of cytokines and growth factors in joint destruction processes]. Cytokines and growth factors are important mediators of inflammatory reactions and play a central role in the physiologic regulation of bone and cartilage cell activities and in joint destruction. The net effects of cytokines on target tissues depend on the relative pericellular concentrations of several cytokines and their inhibitors in the inflammatory tissue. It is possible to suppress the effects of cytokines with natural or synthetic inhibitory molecules. The measurement of cytokines and their inhibitors may be useful to understand the pathogenesis and to develop new therapies for inflammatory joint diseases. In this review the following cytokines will be reviewed: interleukin 1 and its inhibitor, tumor necrosis factor alpha and its inhibitor, interleukin 6, interferon gamma, transforming growth factor beta, colony-stimulating factors, fibroblast growth factors, platelet derived growth factor and prostaglandins.


[Multidisciplinary study of cerebrovascular accidents: I. Definition, design, and general results]. Cerebrovascular accidents (CVA) constitute a major cause of adult cardiac cardiovascular mortality in Chile. From July 87 to August 89 we prospectively studied 300 patients with CVA utilizing a multidisciplinary approach. Besides clinical evaluation this included brain CT scan (48 hrs), glucidic and lipid profile. Occlusive CVA were additionally studied with 2D-Echocardiogram, 24 hr Holter, Cerebral Angiography and/or carotid Duplex Echotomograph, and a second brain CT scan was performed within the first week. We found a 62.3% incidence of cerebral infarcts, 28.3% of cerebral hemorrhages and 9.3% of transient ischemic attacks. Cerebral infarcts were found to be cardiac related in 33.5% of cases, whereas 13.2% were lacunar, 4.4% were atherothrombotic and 14% had no precise etiology. Hypertension was associated to cerebral hemorrhages in 76% of cases, 26% of which were intracranial. At 2 months of follow-up 16.3% of patients were severely handicapped and mortality was 19.3%. We have confirmed that cerebral infarcts constitute the most common cause of CVA and most of them are cardiac related. Hypertension appears to be the most important cause of cerebral hemorrhage. A multidisciplinary approach to cerebrovascular accidents allowed a more precise diagnosis and contributed to implement appropriate therapeutic and preventive strategies. Proper identification of high risk patients could contribute to decrease the high incidence and mortality of CVA in our community.


Behavioral effects of repeated aluminum administration in the rat. Behavioral effects of repeated aluminum administration during prenatal periods were studied in THA rats. Four groups of pregnant rats were administered a daily dose of 0, 90, 180 or 360 mg/kg of aluminum chloride from the 8th day to 20th day of gestation by gavage. No differences were observed between the aluminum treated offspring and controls in terms of body weight. Delays in pivoting, longer latency and more rearings in an open field test were observed in the 360 mg/kg treated group, but no other developmental alterations were found. Urination in the open field test in the 180 mg/kg and 360 mg/kg treated groups was significantly more frequent than in the other two groups of rats. These results suggest that repeated doses of aluminum chloride during the prenatal period affects neuromotor maturation and emotionality in rats.


Object losses and resolutions of women in middle adulthood. Women in middle adulthood frequently experience loss of objects during this life stage, and thus their psychiatric disorders are often related to object losses. This paper presents three cases of women in middle adulthood whose onset of illness was precipitated by object loss and discusses the psychodynamics, nature of their object loss and mourning process. All three cases presented symptoms of depressive anxiety, paranoid reaction and hypochondriacal anxiety, however, the onset of their illness was related to losses of objects. In addition, it was found that they had not resolved grief towards other losses in the past which preceded the object loss that precipitated the illness. Furthermore, the patients found new objects after completing their mourning process. However, these were not new objects, but rather a rediscovery of objects which they had lost in the past. Such findings are thought to be useful, not only in the treatment of women in middle adulthood, but also in elucidating psychiatric disorders which are precipitated by loss of objects.


Treatment of bilateral urolithiasis.

Treatment of bilateral urolithiasis. Patients with bilateral urolithiasis diagnosed at their first visit were followed for at least one year after the start of treatment. In this retrospective study of 123 patients, the basic metabolic workup revealed no specific underlying cause of simultaneously occurring bilateral nephrolithiasis, and none of the currently used therapeutic regimes proved to be efficient in attaining clinically acceptable stone-free rates at the 3, 6 and 12-month follow-ups. Of 38 patients treated with extracorporeal shockwave lithotripsy (SWL), 21 underwent treatment of both kidneys and 10 (48%) were free of stones bilaterally after 12 months. All of the 17 patients treated with unilateral SWL failed to achieve a stone-free state on the contralateral side. In another group, treated with medication alone to minimize risks of stone recurrence, only 3 of 26 (11.5%) patients were stone-free on both sides 12 months after the start of medication. Since we achieved a stone-free state of both kidneys in no more than 12% of the non-medicated cases, it seems warranted to treat bilateral urolithiasis with SWL more frequently, particularly when patients cannot return regularly to the stone clinic for a longterm follow-up.


Resolution of developmental tasks pertaining to prolongation of adolescence. The establishment of ego identity is a developmental task of primary importance in adolescence. Adolescence is considered to be a period of psychosocial moratorium for the establishment of ego identity and incorporation into adult society. Some youths are known to consciously or unconsciously extend this period of psychosocial moratorium in order to escape incorporation, prolonging the resolution of developmental tasks associated with adolescence. This paper discusses the psychodynamics of the prolongation of adolescence through presentation of the therapeutic consultation of a male patient in his early 30's prolonging establishment of ego identity, or in particular, that of work identity. Analysis in this case revealed that the prolongation of adolescent mentality was deeply related to the wound of narcissism peculiar to adolescence. Additional comments are given on the therapeutic mechanism of therapeutic consultation.


Two cases of oral-stings by sperm bag of squid. Two patients after eating raw squid complained of severe pain and foreign body sensation in their oral cavity. On consultation of a doctor, several small spindle-shaped stings stuck on the surface of the tongue and mucous membrane of the oral cavity were found. After all stings were pulled out, the pain was allayed and the wounds eventually healed. The foreign bodies were tentatively determined to be the sperm bag of Tadorodes pacificus. These cases suggest that fresh squids should be carefully prepared before eating them raw or "sashimi".


Genetic predisposing factors in non-insulin dependent diabetes with persistent albuminuria. We designed this study to elucidate a possible involvement of genetic factors which influence the progression of renal dysfunction in patients with non-insulin dependent diabetes mellitus (NIDDM). A total of 328 patients was randomly selected in the Tokai University Hospital. They had been cared for in our hospital as NIDDM for the past five years, until April, 1989. Fifty-six patients with persistent albuminuria, and an equal number of patients without persistent albuminuria were included in this study. No significant differences were observed between the two groups in terms of age, estimated period of illness, blood pressure, body-mass index, HbAlc, blood glucose, total cholesterol, triglyceride level and mean blood pressure. The family histories obtained by questionnaires revealed that there might be some genetic predisposing factors leading to the onset of nephropathy in patients with NIDDM, especially in cases with paternal high blood pressure. It is suggested that paternal hypertension might be related to the development of nephropathy in patients with NIDDM.


Determination of salicylic acid by HPLC in plasma and saliva from children with juvenile chronic arthritis. A high performance liquid chromatography (HPLC) method has been developed for measuring salicylic acid in the plasma and saliva of children with juvenile chronic arthritis (JCA). Samples were extracted with diethyl ether and, after drying, redissolved in methanol to be chromatographed. Quantitation of salicylic acid was performed by reverse phase HPLC on a spherisorb ODS-2 column, using methanol: water: acetic acid as mobile phase. Phenolic was monitored by absorbance at 237 nm. Linearity between the amount of mass injected and the response in the detector was determined. This method was applied to compare concentrations of salivary and plasma salicylic acid. The method also permitted the quantitation of salivary salicylate as a non-invasive, indirect method for monitoring the concentration of plasma salicylate in patients with JCA.


Acute rheumatic fever.

Acute rheumatic fever. A funny thing has happened on our way to the elimination of rheumatic fever from the United States. It is quite clear that, at least in some areas, rheumatic fever has made a dramatic resurgence. Although all the factors accounting for this are not clearly understood, there are several obvious conclusions that must be drawn: 1. Rheumatic fever is no longer the province of the poor and overcrowded. 2. Clinical manifestations, as embodied in the Jones criteria, may have changed somewhat over the years. 3. New insights into the genetics and immunology of rheumatic fever may lead to a vaccine and/or effective therapy in the future. 4. Rheumatic fever will continue to occur unless and until we resume an aggressive approach to the treatment and prophylaxis of pharyngitis, probably utilizing benzathine penicillin as our primary drug.


Academic careers: choice and activity of graduates of a pediatric residency program 1974-1986. In summary, our data suggest that the playing field for academic medicine is changing. It is more patient care oriented, more multifaceted and supported more by clinical dollars than in the past. Greater flexibility in what constitutes "academic success" is necessary to assure a supportive environment in which tomorrow's academic faculty can develop and flourish. To accomplish these goals promotion systems that reward not only research but also teaching and clinical care accomplishments will be necessary. Clinicians will need to be compared with clinicians, teachers with teachers, clinical investigators with clinical investigators and basic investigators with basic investigators. Sources of support will need to be more clearly targeted along activity lines with clinical dollars supporting the clinician, medical education dollars supporting the teacher-educators and federal and foundation dollars supporting research. In our department, time and effort for research (45%) approximates dollar support for this activity (44%), while clinical dollars (43%) fund to a greater degree time and effort committed to clinical care (34%), and administration and teaching dollars (13%) under fund time and effort committed to these activities (21%). This suggests the need to identify increased funding to support teaching and education. Promotion expectations for women will need to be more flexible and adjusted to family responsibilities and demands. Most of all, however, we academic faculty must support enthusiastically the importance and joy of our work. We must be encouraging to our colleagues and our students and continue to recognize that for all of the difficulties and challenges, academic life is a rewarding and fulfilling enterprise.


GnRH pulses--the regulators of human reproduction. The data reviewed in this chapter provide evidence that the pattern of GnRH secretion appears to be an important factor in regulating gonadotropin subunit gene expression, gonadotropin synthesis and hormone secretion. The data on gonadotropin synthesis were obtained in rodents and hence, must be interpreted with caution when applied to primates. Despite this reservation, the data suggest a similarity of regulatory mechanisms in mammalian species. The data also provide an explanation for the mechanisms whereby a single gonadotropin-releasing hormone can differentially regulate the three gonadotropin genes and allow differential hormone secretion. In overall agreement with this view, the observations during pubertal maturation reveal increasing GnRH pulsatile secretion during puberty with an evolution from predominant FSH to a predominant LH secretion by the gonadotropes. In males, the patterns of GnRH secretion appear to be fairly consistent throughout adult life, but in women cyclic changes occur which perhaps are important in maintaining cyclic ovulation. It is proposed that once pubertal maturation has been established, GnRH is secreted at a relatively fast frequency (one pulse per hour), and an essential feature of repeated ovulatory cycles is the slowing of this GnRH stimulus during the luteal phase: to allow subsequent preferential FSH release. This slowing of GnRH secretion appears to be effected by estradiol and progesterone acting to enhance hypothalamic opioid activity. Similar mechanisms involving increased opioid tone appear to be causally related to the reduced frequency and irregular GnRH stimulus seen in hypothalamic amenorrhea and hyperprolactinemia. In contrast, some forms of polycystic ovarian disease may reflect abnormalities of the estradiol-progesterone/opioid/GnRH neuron feedback mechanisms, with failure to establish slowing in the peripubertal anovulatory cycles. The resulting persistent GnRH stimulus increases LH with consequent effects of abnormal follicular maturation and enhanced ovarian androgen production. Present data are supportive of these hypotheses, but future studies will determine whether these views prove to be correct. However, current data provide strong support for the view that the pattern of GnRH secretion is a critical factor in the regulation of differential gonadotropin synthesis and secretion in mammalian species.


An experimental approach to understanding the genetic and neurobiological basis of alcoholism. The development and characterization of an animal model to study mechanisms underlying abnormal alcohol-seeking behavior have been described. Raised by genetic means, it demonstrates the importance of genetic factors in this behavior. It has allowed the elucidation of neural pathways and neurotransmitter systems that subserve alcohol-seeking behavior. It offers the potential for screening new medications for the treatment of alcoholism, based upon these kinds of newly discovered knowledge.


Response to Coss-86 neoadjuvant therapy assessed by computed tomography and histology. Authors state that in osteosarcoma the measure of mineralization of the tumorous osteoid can be precisely assessed with CT. Hounsfield Units (H.U.) values < 300 demonstrate tumorous osteoids not yet mineralized. Over this limit, however, there is a linear correlation between H.U. values and the extent of mineralization. Since CT detects only tumorous osteoids and demonstrates its measure of mineralization, it does not provide information about the tumour cell components. Consequently, it is not a suitable tool for the assessment of tumour response to neoadjuvant chemotherapy. CT has, however, some advantages over conventional radiographic estimation of tumour extent and detection of tumorous osteoid before mineralization. Because of this diagnostic power, CT is indispensable in limb salving surgeries when the level of amputation is to be determined.


Late vascular complication after blunt trauma. The left clavicle of a 52-year-old patient was fractured at a road traffic accident in 1991. Three months after uneventful recovery axillary vein thrombosis developed on the side of the trauma, which was treated conservatively. One year after the trauma embolization of the left hand developed. The cause was an intimal tear with application thrombus, which were successfully excised. The case proves the importance of awareness of late vascular complications after blunt traumas.


Double-blind study on the effectiveness of a bioflavonoid in the control of tinnitus in otosclerosis. Ipriflavone (7-isopropoxy-isoflavone) was attempted to relieve tinnitus of otosclerotic patients prior to stapedectomy and continuing the treatment postoperatively in a 6 months regimen. As a whole the double-blind study revealed effectiveness of Ipriflavone in the control of tinnitus when preoperatively administered as well as in combination with stapedectomy. The small number of cases (9 patients treated with Ipriflavone and 7 patients with placebo) needs further confirmation of the present data. Predominantly low-tone tinnitus rises the possibility of its cochlear origin in otosclerosis, as a consequence of mechanical or hydrodynamic causes or hydrostatic pressure elevation due to spread of the otosclerotic focus onto the cochlear duct.


Diagnosis and therapy of retroperitoneal abscesses. The surgical importance of the retroperitoneal space is indisputable. Bordered by the transverse fascia, the abdominal and lumbar muscles and the spine, it is in connection with the mediastinum and the subperitoneal area, and may be the site of various processes causing diagnostic and therapeutic problems. Retroperitoneal processes may arise from organs which are completely or partly retroperitoneal (duodenum, kidneys, major vessels). Of these processes the retroperitoneal abscesses are dealt with in the present work.


Endoscopic diagnostics of colorectal cancers. According to the data of cancer registries, the morbidity and mortality of colorectal cancers have considerably increased in the past 15 years. The Hungarian data follow this international trend: yearly 2000-3000 new cases must be reckoned with. Early diagnosis could substantially improve the mortality rates which in Hungary are rather unfavourable as compared to the international data. The results of the surgical treatment of colorectal cancers have not improved essentially in the past decades, although early diagnosis, followed by timely treatment, may increase the chances for cure and improve the postoperational quality of life. Screenings performed in Hungary also report on the favourable results of early diagnosis.


Side effects and complications of cervical cryotherapy. The side effects and complications of 1248 cervical cryosurgeries performed in the course of 12 years are scrutinized. The side effects (hypogastric discomfort, vascular reactions) are negligible, a profuse vaginal discharge should be reckoned with following the treatment.


Surgical aspects of Crohn's diseases.

Surgical aspects of Crohn's diseases. There is no other abdominal disease with so frequent and diverse complications as Crohn's disease. One of the most frequent complications is ileus (45%) due to the deflection and stricture of a bowel segment caused by inflammation and granulation. Fistulas--often multiple--between the involved bowel segment(s) and the hollow organs are also frequent (29%). The probability of complications increases with the duration of the disease. If they are life-threatening, the therapy is unequivocally surgical. The conservative treatment of some non-life-threatening complications may be attempted. Surgery is justified only if the complication is life-threatening or a long-lasting active conservative treatment has been proved unsuccessful. The most frequently employed surgical solution is resection of the involved bowel segment(s), recently stricture plasty. Surgical mortality is 4.1%. A characteristic feature of the disease is the frequency of recurrences (28% and 33.3%, respectively). The mortality of the second operation is 18.6%. Prognosis is always uncertain, since recurrences may appear many years after the surgical intervention.


Distal transfer of the greater trochanter for the correction of trochanteric overgrowth. For the correction of trochanteric overgrowth resulting from ischaemic necrosis following conservative therapy in early childhood for congenital dislocation of the hip, 83 trochanteric transfers were carried out whose results were analysed over a mean follow-up period of 4.5 years (3-10 years). During operation the insertion of the gluteal minimus muscle to the trochanter was carefully detached in a way that only the fibres of the gluteus medius remained on the bone. Thus the gluteus medius could maximally be stretched in isolation, by a distal transfer of the greater trochanter and that was the way for obtaining the best results. To prevent subluxation of the head of the femur surgical correction of the acetabulum was carried out (usually Chiari's pelvic osteotomy) if the covering of the head was imperfect. The trochanter was fixed using A0 cancellous bone screw, no plaster fixation was applied and full loading was allowed 4 weeks after surgery. On the basis of changes in Trendelenburg's sign in patients operated before the age of 14 years, good results were found in 92%, whereas in older patients the result was 75%. Subjective opinions were quite similar in both groups. Positive evaluation of the results was given in 70% and 68% by patients in the younger and older group, respectively.


Serum levels of trace elements (selenium, copper, zinc) in gynaecological diseases. The serum levels of selenium, copper and zinc were examined in benign and malignant gynaecological tumours and in metropathia haemorrhagica. According to the authors, the examination of several trace elements is necessary for the determination of the nature of the process. The levels of significance of the changes are dealt with.


Promotion of epithelialization of the uterine cervix surface following cryotherapy. The vaginal application of sugar powder after cryotherapy considerably decreased the amount and duration of leukorrhea following cryotherapy of benign alterations of the uterine cervix. The time needed for epithelialization of the surface of the portio became shorter. The method is recommended for the decrease or elimination of the discomfort caused by post-cryotherapeutic leukorrhea.


When should endoscopic polypectomy be followed by surgery? The authors give an account of their observations concerning the examination of 148 polyps endoscopically removed from 116 patients. Malignant transformations were found in 16 adenomas out of 139 neoplastic polyps. The author's view regarding the therapeutic strategy after endoscopic polypectomy is presented. The systematic control and follow-up of polypectomized patients is considered to be important.


Protective effect of radio-detoxified endotoxin (Tolerin) on the ultrastructure of pancreas in experimental endotoxin shock of rats. The ultrastructural changes of pancreas exocrine cells were studied after the intravenous administration of endotoxin (LPS) or radio-detoxified endotoxin (150 kGy 60Co-gamma irradiated: RD-LPS or Tolerin). The LPS (1 mg/rat) induces an autolytic destruction in the membranes of the mitochondria of the pancreas exocrine cells. The RD-LPS given in similar dose does not produce any autolytic change. However, a small dose (100/micrograms/rat) of RD-LPS (Tolerin) as a pretreatment can protect the autolytic destruction of the mitochondria induced by LPS. This may be attributed to the membrane stabilizing effect of RD-LPS.


Surgical treatment of stenosed duodenal ulcers. Based on the clinical pattern (case history, radiological, endoscopic and laboratory examinations) four stages of ulcerous stenoses are distinguished (stage I: subclinical; stage II: compensated; stage III: decompensated; stage IV; complete stenosis). Organ-preserving vagotomy is justified only in stages I and II, in which the motoric function and emptying of the stomach is not yet damaged. In stages III and IV resection is the operation of choice. This view is supported by the results of the authors.


Limb lengthening operations.

Limb lengthening operations. Limb lengthening operations were first used at the beginning of this century, they were, however, performed more frequently only in the fifties. The various, continuously elongating devices have made possible a substantially greater lengthening than earlier. Wide-range investigations were begun with the various distraction devices and the results were examined in regard to the site of lengthening, the injury of the periosteal and endosteal vascular supply during the operation and the extent and rate of the lengthening. Detailed results of 224 lengthening operations performed in 191 patients are presented in Tables 1 to 8. Attention is called to the fact that the operation should be performed strictly individually, and the patients should be well prepared to the operation and followed carefully. The number of complications increases in direct ratio with the measure of lengthening, the end result is, however, influenced only by a minor part of the complications.


Diagnosis of hearing impairment in childhood. The authors carried out BERA examinations in 46 children difficult to test. Seven cases are described in detail. In connection with these cases attention is drawn to the unforeseeable difficulties of this examination method used already widely.


Pregnancy and delivery after operation for a pituitary microadenoma. The authors report on the successful pregnancy and permanent symptom-free condition of a young woman who underwent operation for pituitary microadenoma. At the time of submitting the publication mother and child are healthy. According to the available literature this is the first such case reported in Hungary.


Laser lingual tonsillotomy.

Laser lingual tonsillotomy. The classic surgical procedures for treatment of complaints caused by hyperplasia and chronic inflammation of the lingual tonsil are difficult, and may involve serious complications. Eleven patients with hyperplasia of the lingual tonsil were treated with a Tungsram TLS 61 CO2 laser coupled to an operating microscope. The average duration of hospitalization was 3-4 days. The advantages of the use of a CO2 laser are haemostasis, sealing of the nerve endings, decrease of postoperative pain, and no postoperative oedema, which is important because of the closeness of the larynx. There were no serious complications either during surgery or in the postoperative period, and the complaints of all 11 patients were eliminated or reduced.


Laparoscopic surgery with carbon dioxide insufflation causes respiratory acidosis. This study analyzes the changes in cardiopulmonary parameters of patients undergoing laparoscopic cholecystectomy. Six healthy females with normal preoperative cardiopulmonary status were selected for laparoscopic surgery using the same criteria as for traditional cholecystectomy. Respiratory and cardiovascular parameters were collected and compared prior to peritoneal insufflation and just before desufflation. Patients experienced significant elevations of arterial and end-tidal CO2, accompanied by decreased pH. Bicarbonate concentration, blood pressure and pulse rate remained constant. Based on these results, and on our laboratory investigations, we have introduced helium as an alternate agent for insufflation, and present the data from the first two patients so managed. No change was observed in EtCO2, PaCO2 or pH in either of these two patients during the course of surgery. We conclude that hypercarbia occurs in those undergoing laparoscopic cholecystectomy with CO2 insufflation. This acidosis requires compensation by increased minute ventilation to prevent decline in pH. In our initial experience, helium did not produce these changes, and therefore merits further investigation as an alternate agent for abdominal insufflation.


CA-125 monitored therapy with GnRH analogue of pelvic endometriosis. Thirteen patients affected by endometriosis have been treated with GnRH analogue Buserelin. CA-125 serum levels have been monitored before, during and after treatment. Analysis of data suggests the hypothesis of an individualized follow up by means of repeated assays of CA-125 and their reference to pre and post treatment graphs.


Operative laparoscopy for ovarian pathology. In the last few years, the improvements of the operative laparoscopy have led to the use of these techniques as an alternative to traditional surgical approaches. Ovarian pathology has been more and more treated by a laparoscopic approach. In this paper, the risks and complications of the operative laparoscopy in the different forms of ovarian pathology.


Reconstruction of spinal accessory nerve after radical neck dissection. Resection of the spinal accessory nerve in cases of radical neck dissection often causes considerable damage to the function of the shoulder girdle; it leads to limitation of the motion of the upper limb and pain in the shoulder girdle. It seems a sensible compromise to reconstruct the spinal accessory nerve in one-stage operation with radical neck dissection, which can often prevent extensive atrophy of the trapezius muscle, with a resultant improvement in the chance of successful rehabilitation. The technique of the operation is described: after completion of radical neck dissection, in one-stage operation an autogenous nerve transplant from the n. auricularis magnus is sewn onto the central and peripheral stumps of the spinal accessory nerve, which are protected by a "vein-muff" and the fascia of the muscle. After such spinal accessory nerve reconstruction, subjective complaints and objective symptoms were much milder in 6 patients than in the control group, which consisted of 10 patients who underwent a similar operation but without spinal accessory nerve reconstruction.


Is it possible to use the hypoosmotic swelling test as criteria for "freezeability" of human semen in an AID program? The aim of this study was to determine the possibility of the introduction of another parameter--the hypoosmotic swelling test--in the evaluation of the freezing potentially of anonymous donor's semen sample to be utilized in an AID program. 154 donor semen samples were frozen using classic seminal parameters: HOS tests were performed but not utilized as criteria for freezeability. All specimens were thawed and another HOS test was performed. All specimens were divided into two groups on the basis of the pre freezing HOS test value--HOS tests positive (> or = 55%) and HOS test negative (< 55%)--to verify if it's possible to correlate this value to the recovery of a good motility after thawing. A further division was performed: HOS tests highly positive (> or = 70%), HOS positive (60-55%) and HOS tests negative (< 55%) but the authors did not find any statistical difference. As concerns the clinical evaluation, were considered the last 15 pregnancies achieved with 11 samples out of 22 utilized. There was not any statistical difference. The data could seem to confirm the hypothesis that it is not possible to utilize the HOS test as a predictive value of "freezeability" of human semen sample.


Operative laparoscopy in assisted reproduction. After the introduction of transvaginal ultrasound guided recovery of oocyte, the use of laparoscopy in Assisted Reproductive Technology is limited to GIFT and ZIFT or TET method and to the selection of patients. In this paper the Authors discuss about these methods, the advantages of tubal gametes or embryos transfer versus uterine transfer.


Comparison between transabdominal and transvaginal ultrasound in the evaluation of a multiple follicular growth. The aim of this work is to compare transabdominal and transvaginal ultrasound measurement of ovarian size and follicular number and diameter during cycles of ovulation induction for assisted reproduction technologies. We included in our study fourty patients undergoing a controlled ovarian stimulation: the ultrasound monitoring of multiple follicular growth was performed by the same operator, with both transabdominal and transvaginal route, during the follicular phase of the cycle, until the day of human chorionic gonadotrophin (hCG) administration; in ten women was compared transabdominal and transvaginal evaluation of total number of recruited follicles > 5 mm in size on day -4, on day -2 and on the hCG administration day (day 0); moreover in all the patients transabdominal and transvaginal measurement of the mean follicular diameter of leading follicle and the mean ovarian diameters on hCG injection day was compared.


Asymptomatic torsion of the pregnant uterus. This case report describes a woman who was admitted to the hospital one week before term to an elective cesarean section because of two previously cesarean sections. Her present pregnancy was uneventful, the CTG on admission was normal. During the operation preformed in epidural anesthesia the uterus was found to have rotated 180 degrees to the right. It was easily rotated back to its normal position before a transversal incision was made in the lower uterine segment. A healthy female infant was delivered. Further the authors describes the role of ultrasound in making the diagnosis. The list various symptoms and etiologies. The authors emphasize the importance of reconstructing the normal anatomy making the uterine incision in order not to damage the uterine vessels.