Erzsébet Rőth

Effects of Silymarin Supplementation in Patients with Chronic Hepatitis C Receiving PEG-IFN + Ribavirin Antiviral Therapy. A Placebo-Controlled Double Blind Study

Abstract Objectives Since oxidative stress may play a pathogenetic role in chronic hepatitis C and the sustained virological response to antiviral therapy is limited in HCV1 genotype infection, a double blind study was performed in HCV1 patients receiving peginterferon + ribavirin treatment, in order to assess the efficacy of supplementation with an antioxidant flavonoid, silymarin. Patients and Methods 32 naive HCV1-positive patients with biopsy-proven chronic hepatitis C, to be treated with peginterferon + ribavirin, have been randomised as follows: Group A: 16 patients received antiviral therapy for 6 to 12 months plus placebo for the first 3 months; Group B: 16 patients were treated with peginterferon + ribavirin for 6 to 12 months plus they received 166 mg oral silymarin twice a day for 3 months. Serum alanine aminotransferase and HCV RNA levels, as well as parameters of oxidative stress such as plasma or RBC haemolysate malondialdehyde, superoxide dismutase, glutathione peroxidase, catalase and myel...

The role of the inhibition of glutathione-s-transferase in the protective mechanisms of ischemic postconditioning

The antioxidant glutathione-S-transferase (GST) is a crucial determinant of the development of ischaemic-reperfusion (I/R) injury, and plays a pivotal role in the regulation of the mitogen activated protein kinase (MAPK) pathways involved in stress response and apoptosis. The aim of this study was to investigate whether inhibition of GST can abolish the benefit of ischaemic postconditioning (IPoC). A neonatal rat cardiomyocyte cell culture was prepared and divided into 6 groups: (I) control group without treatment; (II) cells exposed to simulated I/R; (III) simulated I/R (sI/R) with IPoC; (IV) ethacrynic acid (EA) alone; (V) sI/R with EA; and (VI) sI/R and IPoC together with EA. Viability of the cells was measured by MTT assay, the quantity of apoptotic cells was assessed by flow cytometry following annexin V-FITC - propidium-iodide double staining. The activation of JNK, p38, ERK/p42-p44 MAPKs, and GSK-3β protein kinase was determined by flow-cytometric assay. GST inhibition markedly increased the apoptosis and decreased the cell viability despite IPoC. The protective effect of IPoC was lost in GST-inhibited groups for all MAPKs and GSK-3β. GST activity is required for the survival of cultured cardiomyocytes under stress conditions. GST inhibition was associated with differential activation of MAP and the protein kinases regulating these pathways in the process of ischaemic postconditioning.

Histological examination of vascular lesions caused by stent implantation in humans and in comparative experimental animal model.

A comparative analysis of human and experimental animal (canine) tissues was performed to characterize and describe cellular and histological responses during the processes of newly forming intravascular tissues after stent implantation. Routine histological and immunohistochemical evaluation of 20 human samples and 9 samples from animal models were used one day, one week and one month after the stent implantation. After one day of implantation, there was no difference between the human and canine peripheral arteries, suggesting a similar cellular and histological response in the early phase. In contrast, after one week of implantation, during the proliferative phase the repairing human tissue showed less intensive production of inflammatory cells and more intensive increase in number of vascular cells than did the canine model. In addition, cellular changes normally restituted by the end of one month in canine peripheral arteries, but vascular cells persisted in human atherosclerotic arteries. In conclusion, results of this study suggest differences in both phases of vascular repair in the post-stented period, because both proliferative and regressive phases showed histological differences in canine and human samples. In canine, the restitution of vascular wall was completed by the end of first month but persistent vascular cell proliferation was visible in the human peripheral arteries. It can be suggested that delayed cellular response might indicate restenosis but also can be considered considered as a progression of the original arterial disease.

Preconditioning is a method that may reduce the negative side-effect of pneumoperitoneum

Abstract Increased intra-abdominal pressure during laparoscopy leads to hypoxia due to reduced blood flow. Aim of our study was to investigate whether preconditioning can reduce this negative effect of the pneumoperitoneum. Fifty female Wistar rats were used, divided into 5 groups. I: Sham operation (Sham), II: conventional pneumoperitoneum (PP), III: transvaginal pneumoperitoneum (TV), IV: preconditioning for 2.5 minutes in two cycles (Pre 2.5), V: preconditioning for 5 minutes (Pre 5). Malondialdehyde (MDA), reduced glutathione (GSH), sulfhydrylgroup (SH-) concentrations, superoxide-dismutase (SOD) and mieloperoxidase (MPO) activity, and anti-apoptotic pathway marker p-AKT level and inflammatory cytokine TNF-α were measured. SOD activity and GSH concentration were decreased in PP and TV groups comparing to Sham and preconditioning groups. MPO activity was decreased also in PP and TV groups comparing to the Sham group but in the preconditioning groups it has remained high. MDA concentration in plasma was...

A különböző szilikonbevonatú polipropilén hálók szöveti integrációja@@@Tissular incorporation of different silicone covered polypropylene meshes is distinct

INTRODUCTION/AIM Laparoscopic ventral hernia repair requires a surgical mesh implanted in intraperitoneal position. The combined, double layer meshes are promising in animal models as well as in human practice. The aim of this study was to compare the biological behaviour of two different textured silicone covered polypropylene mesh. MATERIALS AND METHODS 3 × 4 cm big full thickness defect of the abdominal wall was created in New Zealand White rabbits. The defect was covered in 20 animals with a polypropylene mesh with laminar silicone layer on the visceral surface (LSPP), while the remaining 20 cases the defects were covered with a macroporous textured silicone impregnated polypropylene mesh (MSPP). Intraperitoneal adhesion formation and tissue ingrowth in the meshes were investigated. Immunohistochemistry was used to detect proliferation activity (Ki-67), neovascularization (VEGF), and to visualize mesothelial layer (CK) over the mesh. Scanning electron microscopy was used to investigate the visceral surface of the meshes. RESULTS While intraperitoneal adhesion formation showed no difference after 1 week, LSPP mesh induced significantly less adhesions after 21 days. The Ki-67 positivity was significantly lower and the number of the VEGF positive cells increased with time in the MSPP group, this was missing in the LSPP group. The thin neoperitoneum layer was detected over MSPP mesh only with CK antibody. CONCLUSION The material and texture of the mesh are responsible for tissular incorporation which is in accordance with the generated foreign body reaction.

A szabad gyökös reakciók jelentősége a szívizom ischaemiás-reperfúziós károsodásában és az endogén adaptáció indukálásában

Absztrakt Az aerob előlenyek szoveteiben az oxigenellatas legkisebb zavara is sulyos karosodasokhoz vezethet. A keringes helyreallitasa, az ugynevezett reperfuzio, az egyetlen alternativa a sejtek eletkepessegenek megőrzesere, amelynek azonban kimenetelet alapvetően meghatarozza a keringes helyreallitasa előtt eltelt ischaemias idő hossza. Ha ez az időtartam meghaladja a reverzibilis elvaltozasok zonajat, letrejonnek a reperfuzios karosodasok, amelyek szivizom eseteben aritmiat, a kontraktilis erő csokkeneset, vegul a sejtek elhalasat okozzak. Kiserleteink soran bizonyitottuk, hogy a reperfuzio soran robbanasszerűen keletkező reaktivoxigen-szarmazekok gyorsitjak a szivizom-karosodas kialakulasat, de amennyiben kisebb mertekű es rovidebb idejű a reperfuziot megelőző időtartam, akkor a szabad gyokok genindukciohoz es az antioxidans enzimek feherjeinek szintezisehez vezetnek. A reperfuzional keletkező szabad gyokok ugynevezett Janus-arcu viselkedese vezetett ahhoz, hogy szerepuket kiserletes munkank soran a ...

Transgastric small bowel resection by using hybrid technique — Experimental study

Abstract Introduction:The Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an abdominal operation carried out with flexible endoscopic instruments and their advanced versions via natural orifices. The NOTES causes theoretically less pain, operative stress, shorter hospitalization, quicker recovery and it is scarless. The aim of this investigation was to evaluate the feasibility and safety of transgastric small bowel resection. Materials and methods: Seven domestic pigs were investigated and entered the study; body weight 25 kg in average. General anesthesia was performed. One trocar was used for laparoscopic observations during gastrotomy and transgastric penetration with the gastroscope, later for assistance with a grasper for manipulation of the bowel loops and for the application of the linear stapling device. Then the needle knife was used to complete a 1.5 cm long incision in the gastric wall. The gastroscope was advanced into the peritoneal cavity and a small bowel loop was identified and ...

Az antioxidáns flavonoid silymarin szupplementációja hatásának placebokontrollos vizsgálata PEG-IFN + ribavirin antivirális kezelésben részesülő krónikus C-hepatitises betegekben@@@Effects of silymarin supplementation in chronic hepatitis C patients treated with peg-interferon + ribavirin. A placebo-controlled double blind study

UNLABELLED Since oxidative stress may play a pathogenetic role in chronic hepatitis C, and sustained virological response to antiviral therapy is limited in HCV1 genotype infection, a double blind study was performed in HCV1 patients treated with pegylated interferon + ribavirin, to assess the efficacy of supplementation with the antioxidant flavonoid silymarin. PATIENTS AND METHODS Thirty-two naive HCV1 positive patients with biopsy proven chronic hepatitis C, to be treated with pegylated interferon + ribavirin, have been randomized: group A): 16 patients have been given the antiviral therapy for 6-12 months plus placebo for the first 3 months; group B): 16 patients have been treated with pegylated interferon + ribavirin for 6-12 months plus silymarin, 2 x 166 mg/day, was given for 3 months. Serum alanine aminotransferase and HCV-RNA levels as well as parameters of oxidative stress such as plasma or red blood cell hemolysate, malondialdehyde, superoxide dismutase, glutathione peroxidase, catalase and myeloperoxidase were determined after 0, 1, 3, 6 and 12 months during the treatment. Sustained virological response as undetectable serum HCV RNA was evaluated 24 weeks after the end of therapy. RESULTS In the silymarin group, a more rapid decrease in the malondialdehyde level as well as a marked decrease in superoxide dismutase and an increase in myeloperoxidase activity after month 12 were found, alanine aminotransferase normalized in 6/16 (vs control 9/16) cases, and sustained virological response occurred in 3/16 (vs 7/16) patients. DISCUSSION/CONCLUSION Although silymarin supportation to antiviral therapy improved oxidative stress, it was able to affect favourably neither the alanine aminotransferase nor the sustained virological response. These contradictory findings may be related to randomization bias as patients in study group B had more negative predictors of response: they were older with higher fibrosis score and even with more severe pretreatment baseline oxidative stress. Regarding the recently published in vitro experiments with silybinin on HCV replication as well as the newest convincing clinical observations, we do suggest further studies with more than three times higher doses of silymarin in controlled trials to assess the value of this supplementation in antivirally treated HCV patients.

A hasi sebészet új generációja: a természetes testnyílásokon keresztül végzett sebészet@@@New generation of abdominal surgery: the Natural Orifice Transluminal Endoscopic Surgery

A hasi sebeszetbe tobb mint 20 eve vezettek be a minimalisan invaziv muteti technikat megvalosito laparoszkopos beavatkozasokat. A klinikai eredmenyek oda vezettek, hogy ezek jelentos resze ma mar rutinbeavatkozasnak tekintheto. A hasi sebeszet uj generaciojat a Natural Orifice Transluminal Endoscopic Surgery technika jelentheti. A modszer termeszetes testnyilasokon transluminalisan bevezetett (transgastricus, transcolonicus, transvaginalis), flexibilis endoszkoppal vegzett diagnosztikus es terapias hasi muteteket jelenti. Teoretikusan a modszer lehetoseget nyujt az invazivitas es a posztoperativ fajdalom tovabbi csokkentesere, a posztoperativ hasi servek elkerulesere es a kozmetikai eredmenyek javitasara. Jelenleg is szamos kutatocsoport dolgozik azon vilagszerte, hogy a mint minden uj technikanal joggal felmerulo kerdesekre (mutettechnika, indikacio, kontraindikacio, szovodmenyek, monitorozas) es aggalyokra tudomanyosan megalapozott valaszt kapjunk. A jelen kozlemeny attekintest kivan adni az uj sebeszeti technika eddig elert hazai es nemzetkozi kiserletes eredmenyeirol es klinikai vonatkozasairol. Kulcsszavak: termeszetes testnyilasokon keresztuli sebeszet (NOTES)Minimal invasive surgical techniques, namely laparoscopic procedures to the abdominal surgery have been introduced more than 20 years ago. In view of clinical results, the majority of these are considered as routinely performed procedure today. Natural Orifice Transluminal Endoscopic Surgery can be considered as a new generation of abdominal surgery. It means a method directed through natural orifices, and abdominal surgery operated by transluminal endoscopic techniques (transgastric, transcolonic, transvaginal) to reach diagnostic and therapeutic goals. Theoretically, this method allows the possibility to decrease invasiveness and postoperative pain, to prevent postoperative hernias and to improve cosmetic results. At present numerous researchers work worldwide to receive scientifically based answers to arising questions (surgical technique, indication, contraindication, complications, monitoring) and concerns in this area. The present paper gives an overview of the national and international literature on experimental results and clinical approaches in the field of this new surgical technique.

[New generation of abdominal surgery: the Natural Orifice Transluminal Endoscopic Surgery].

A hasi sebeszetbe tobb mint 20 eve vezettek be a minimalisan invaziv muteti technikat megvalosito laparoszkopos beavatkozasokat. A klinikai eredmenyek oda vezettek, hogy ezek jelentos resze ma mar rutinbeavatkozasnak tekintheto. A hasi sebeszet uj generaciojat a Natural Orifice Transluminal Endoscopic Surgery technika jelentheti. A modszer termeszetes testnyilasokon transluminalisan bevezetett (transgastricus, transcolonicus, transvaginalis), flexibilis endoszkoppal vegzett diagnosztikus es terapias hasi muteteket jelenti. Teoretikusan a modszer lehetoseget nyujt az invazivitas es a posztoperativ fajdalom tovabbi csokkentesere, a posztoperativ hasi servek elkerulesere es a kozmetikai eredmenyek javitasara. Jelenleg is szamos kutatocsoport dolgozik azon vilagszerte, hogy a mint minden uj technikanal joggal felmerulo kerdesekre (mutettechnika, indikacio, kontraindikacio, szovodmenyek, monitorozas) es aggalyokra tudomanyosan megalapozott valaszt kapjunk. A jelen kozlemeny attekintest kivan adni az uj sebeszeti technika eddig elert hazai es nemzetkozi kiserletes eredmenyeirol es klinikai vonatkozasairol. Kulcsszavak: termeszetes testnyilasokon keresztuli sebeszet (NOTES)Minimal invasive surgical techniques, namely laparoscopic procedures to the abdominal surgery have been introduced more than 20 years ago. In view of clinical results, the majority of these are considered as routinely performed procedure today. Natural Orifice Transluminal Endoscopic Surgery can be considered as a new generation of abdominal surgery. It means a method directed through natural orifices, and abdominal surgery operated by transluminal endoscopic techniques (transgastric, transcolonic, transvaginal) to reach diagnostic and therapeutic goals. Theoretically, this method allows the possibility to decrease invasiveness and postoperative pain, to prevent postoperative hernias and to improve cosmetic results. At present numerous researchers work worldwide to receive scientifically based answers to arising questions (surgical technique, indication, contraindication, complications, monitoring) and concerns in this area. The present paper gives an overview of the national and international literature on experimental results and clinical approaches in the field of this new surgical technique.