Esophageal dilatation using the Savary-Gilliard sound set]

Authors present a method of esophageal dilatation and report their experiences. The place of esophageal dilatation among other therapeutic approaches of esophageal stricture is discussed. The advantage of Savary-Gilliard bougies and guide wire and its applications are presented. During one and a half year 218 esophageal dilatations were performed at 82 patients. 11 patients were intubated endoscopically. Esophageal perforation occurred in 2 cases (0.93%). Dilatation of the esophagus with Savary-Gilliard bougies and using of the guide wire are considered a safe and many-sided method in the diagnosis and treatment of esophageal strictures.     

Late complications of pancreatic injuries following blunt abdominal trauma]

In connection with three successfully operated cases authors are treating the types of late pancreatic complications after blunt abdominal trauma. It is emphasized that the preoperative diagnosis is difficult. Many times weeks or months pass away after the trauma without any symptoms and only developed complication can be noticed first. The importance of the first provision and the need for a careful examination of the pancreas at operation is underlined. In the case of the less suspicion of pancreatic injury they suggest wide, adequate drainage. At last they call attention to the responsibility of the surgeon making the first operation.     

A nationwide evaluation of multiple congenital abnormalities in Hungary

A population-based study of 7,049 index patients with multiple congenital abnormalities (MCA) born in Hungary during 1973-1982 was organized by the Hungarian Center for Congenital Anomaly Control. All clinically recognized syndromes and associations which were submitted (2,049) were accepted without any further follow-up. New or supplementary information was requested in the case of unspecified MCA (320). A copy of detailed necropsy records was requested from pathologists in lethal cases (2,022). Following these steps, apparent but not true instances of MCA were excluded (399), and an attempt was made to assign as many of the remainder as possible in 17 well-delineated MCA entities (900). The living index patients with severe MCA were referred where possible to the regional centers for evaluation (864). One hundred and seventy entities were identified, and seven cases were excluded as not representing MCA. In the so-called 3,393 unidentified cases for which no diagnosis was possible, the component abnormalities were tabulated according to their number. The final count was 6,643 cases with MCA, which is equivalent to a birth prevalence of 4.0 per 1,000 total births, and to 10% of recorded cases with congenital anomalies. As a result of this program the proportion of recognized syndromes and associations among children with MCA increased from 29% to 47%. The accuracy of diagnoses has improved, e.g., the occurrence of unspecified cases decreased from 4.5% to 2%. As a result of this study, the number of chromosomal (1,700), Mendelian (557), and teratogenic (104) syndromes and associations (758) was considerably greater than the initial notifications indicated.     

Cerebral ischemia induces transient intracellular redistribution and intranuclear translocation of the raf proto-oncogene product in hippocampal pyramidal cells

Summary In this report we describe changes in the intracellular redistribution of raf serine/threonine protein kinase (product of the raf proto-oncogene family) in hippocampal neurons following cerebral ischemia in Mongolian gerbils. For immunohistochemical localization studies polyclonal antisera specific for each of the A, B, and Raf-1 isotypes of raf, as well as a pan-raf antisera, were employed. Of these, only sera recognizing B-raf, as well as the general v-raf (raised against the conserved C-terminal region) were positive, indicating that B-raf is the major isotype in this neuronal region. Three different ischemie models were used (repeated 3 times for two min and single 5 or 15 min occlusions, of the common carotid arteries) to demonstrate that ischemie insult causes redistribution of raf protein kinase into the cell nucleus of hippocampal neurons. Increased amounts of raf protein in the nuclei of pyramidal cells following ischemia was confirmed by Western blot analysis of isolated nuclear fractionations. Moreover, an elevation in the level of nuclear raf protein also was detected in the contralateral (i.e. non-occluded hemisphere) neurons of CA1 and CA3 subfields 4 days after the ischemie insult indicating a possible transsynaptic increase in the amount of raf protein along with redistribution. The intranuclear translocation of the immunoreactive material started from the perinucleolar rim and with time extended throughout the nucleus. Enhanced levels and altered redistribution of the raf polypeptide in the nuclei of pyramidal cells of the CA3 subfleld appears to be reversible and returns to the normal level 12 days following the ischemic insult. In addition to triggering the above changes in the intracellular redistribution of raf, ischemie insult also caused an increase in the level of B-raf protein in reactive astrocytes.     

Comparison of the effectiveness of a mobile prosthesis created by the implantation of Hydron and cartilage after enucleation of the bulb

The authors submit experience with the use of embedded mobile implants of the eyeball made from hydrogel of methylmetacrylate ("HYDRON" SPOFA) and from costal cartilage of different shapes. From the aspect of cosmetic effectiveness similar results were obtained with the implant "HYDRON" SPOFA and costal cartilge in the shape of a flat cylinder. Spherical implants "HYDRON" SPOFA were expelled in 16.8%, while flat cylindrical implants from costal cartilage were not expelled. Other shapes of implants from costal cartilage are less suitable. Both mentioned implants produce a satisfactory cosmetic effect and ensure a stable mobile base for cosmetic prostheses of the eye.     

P53 overexpression as an indicator of overall survival and response to treatment in osteosarcomas

The p53 gene located at chromosome 17pl3 is found to be altered (allelic loss or other mutation) in multiple human cancers, including osteosarcomas. The mutated gene produces a protein with a prolonged half-life thus rendering it detectable by conventional immunohistochemistry. We examined the correlation between p53 expression and clinical prognosis as well as response to therapy. Twentyone patients with previously untreated and histologically verified highly malignant osteosarcoma were used for this study. Biopsy material taken both prior to the start of COSS 91 protocol and at the time of surgery (ten weeks later) was examined for alterations in p53 protein expression and drug resistance. Two patients who had strong (+++) p53 protein expression and three others who became positive during the chemotherapy had significantly worse prognosis (all of them died within one year) than those who showed no p53 expression both at biopsy and after chemotherapy (all 11 patients are alive, average follow-up time: 3.5 years). All patients who showed any kind of positive p53 protein expression on initial biopsy were non-respon-ders to chemotherapy. In contrast, 69% (9 out of 13) of those who exhibited no p53 expression on initial biopsy were responders or intermediate responders to chemotherapy. We concluded that p53 expression may be a useful prognostic factor in osteosarcomas. The direct correlation between p53 positive expression and resistance to therapy can help in identifying patients who are in need of a more vigorous or different chemotherapeutical protocol.     

Esophago-pericardial fistula caused by recurrent esophageal tumor

The esophago-pericardial fistula is a rare disease that causes a rather high mortality. Up to now less than 70 cases were published in the literature. The authors report an esophago-pericardial fistula caused by recurrent esophageal tumor one year after resection in the lower third esophagus for esophageal cancer. With conservative treatment the patient was kept alive for a month. No case report can be found in the literature of an esophago-pericardial fistula of the same etiology.     

Single layer continuous absorbable sutures for gastrointestinal anastomosis

Authors evaluated the safety of single layer continuous sutured anastomosis technique with two different types of absorbable sutures in 252 anastomoses performed on 178 patients. In the prospective, randomized study 5 oesophagus, 26 stomach, 117 small intestine, 32 colonic, 29 pancreatic and 43 biliary anastomoses were performed. In 136 cases poliglecaprone 25 (Monocryl), in 116 cases glycomer 631 (Biosyn) were used. All procedures were carried out by the same surgeon. Anastomosis related complication was detected in 7 cases (2.8%), some kind of anastomosis insufficiency--including minor leakage--in 5 cases (2.0%), but reoperation only in one case (0.4%) was required. There was no anastomosis related death. Authors overview the advantages of the technique, which is safe, cheap, easy to carry out, physiological and least harmful to the blood supply, so they recommend its use in the gastrointestinal surgery as a standard procedure.     

The role of diagnostic laparoscopy in staging of pancreatic cancers

Authors report elective diagnostic laparoscopy, and the role of this method in evaluating operability of pancreatic cancer. At their department 11 diagnostic laparoscopic procedures of pancreatic cancer were performed during the last 5 years. In 3 cases tumor proved to be resectable despite preoperative imaging results of unresectable condition. On the basis of international literature authors give brief summary of indications, cost and benefit of diagnostic laparoscopy, and its place in the diagnostic algorythm of pancreatic cancer.