Andrea Furka

Concerning the importance of changes in hemorheological parameters caused by acid-base and blood gas alterations in experimental surgical models

Acid-base equilibrium and pH of blood have important clinical consequences in numerous diseases and pathophysiological conditions. The micro-rheological parameters of blood, such as red blood cell deformability and red blood cell aggregation are influenced by several metabolic factors, and provide information regarding inflammatory, septic and tissue or organ ischemia-reperfusion processes. Despite the anticipated logical relation of the blood acid-base condition, blood gas parameters and pH to red blood cell deformability and aggregation, controversial data can be found in the literature. Furthermore, related to ischemia-reperfusion hemorheological studies little is known about this issue. In this paper we aimed to thought-provokingly overview some aspect of acid-base changes, blood pH and hemorheological parameters, discussing certain results from ischemia-reperfusion experimental surgical models (local versus systemic changes), laboratory technical and experimental design protocols related to in vitro and in vivo studies.

Hemorheological changes caused by intermittent Pringle (Baron) maneuver in beagle canine model

In liver resection operations the Pringle (Baron) maneuver can be used for temporary ischemia by clamping the hepatoduodenal ligament intermittently. In this beagle canine model we investigated whether hemorheological parameters may alter in systemic, portal and hepatic venous blood and in arterial samples during-after Pringle maneuvers. In Pringle Group unilateral femoral artery and external jugular vein were cannulated. From median laparotomy the hepatoduodenal ligament was exposed. The portal venous system was catheterized via a mesenteric vein and through the inferior caval vein a catheter was led to the hepatic veins. After stabilization, a 15-minute Pringle maneuver was carried out three times with 5-minute interpolated reperfusion periods. In Control Group Pringle maneuvers were not made. Before and after Pringle maneuvers parallel blood samples were taken from the cannulated vessels for determining hematological parameters and erythrocyte aggregation. Following Pringle maneuvers erythrocyte deformability, blood and plasma viscosity were also tested. The results showed that besides systemic hemorheological effects of the intermittent Pringle maneuver local leukocyte count, hematocrit and erythrocyte aggregation index altered mainly in portal venous blood, depending on the repeating number of the maneuvers. Thus, investigations of hemorheological parameters might be useful to determine the optimal duration of the Pringle maneuver.

Inoperábilis periauricularis daganat sikeres sugárkezelése

Surgery has been considered the first choice of treatment in planocellular skin cancers. However, adjuvant radiotherapy is often required in R1 resection or in lymph node positivity. Inoperable cases are also treated with ionizing radiation with palliative purpose. The authors present a case report of a successful treatment of an 87-year-old diabetic patient with a T4N1M0 stage periauricular destructive tumour treated with 3D conformal adaptive radiotherapy. Complete remission occurred although the initial treatment aim was only palliation.

Anterior Approach for Liver Resection in the Treatment of Large Liver Tumors

Background: We compared retrospectively the results of the patients who underwent hemihepatectomy through anterior approach (AHH) with those undergoing conventional hemihepatectomy (HH). Patients and Methods: In 119 patients hemihepatectomy was done, 52 of them were anterior approaches. We used this technique if the tumor size was large or if the tumor seemed to be fragile, and thus a liver mobilization would be very dangerous. We started the operation with dissecting parenchyma from the anterior surface toward hilus without preparation of the hilus. Resection of the liver was performed with the help of CUSA dissector. Results: No patient died following AHH. Two re-operations were performed in the HH group, and 2 patients died. The operation time was not significantly different in both groups. The need for blood transfusion was much less during AHH. The average nursing days were also similar in both groups. However, in those cases in which the operations were performed because of liver malignancies, there were no differences in the survival rate after 32-month follow-up between both groups. Conclusions: AHH can be performed safely. The blood consumption during AHH is significantly lower than during HH. The median survival rate was similar in both groups. Our team suggest the anterior approach for liver resection in those cases when the hilar structures and the hepatic veins cannot be isolated easily.

Causes of death of patients with multiple injuries in Debrecen, Hungary

OBJECTIVE To find out the main causes of death of people who had multiple severe injuries. DESIGN Retrospective study. SETTING Teaching hospital, Hungary. SUBJECTS 86 people with severe multiple injuries, of whom 59 died and had necropsies. MAIN OUTCOME MEASURE Establishment of a database. RESULTS Consumption of alcohol was a common precursor. Head and chest injuries predominated. More pedestrians than people in vehicles were killed, and there were 8 suicides and 3 murders. There were no gunshot injuries. CONCLUSIONS Reduction of deaths from multiple injuries is as much a socioeconomic as a medical matter.