Judit Hallay

Impaired cerebrovascular reactivity in sepsis-associated encephalopathy studied by acetazolamide test

IntroductionThe pathophysiology of sepsis-associated encephalopathy (SAE) is not entirely clear. One of the possible underlying mechanisms is the alteration of the cerebral microvascular function induced by the systemic inflammation. The aim of the present work was to test whether cerebral vasomotor-reactivity is impaired in patients with SAE.MethodsPatients fulfilling the criteria of clinical sepsis and showing disturbance of consciousness of any severity were included (n = 14). Non-septic persons whithout previous diseases affecting cerebral vasoreactivity served as controls (n = 20). Transcranial Doppler blood flow velocities were measured at rest and at 5, 10, 15 and 20 minutes after intravenous administration of 15 mg/kgBW acetazolamide. The time course of the acetazolamide effect on cerebral blood flow velocity (cerebrovascular reactivity, CVR) and the maximal vasodilatory effect of acetazolemide (cerebrovascular reserve capacity, CRC) were compared among the groups.ResultsAbsolute blood flow velocities after adminsitration of the vasodilator drug were higher among control subjects than in SAE. Assessment of the time-course of the vasomotor reaction showed that patients with SAE reacted slower to the vasodilatory stimulus than control persons. When assessing the maximal vasodilatory ability of the cerebral arterioles to acetazolamide during vasomotor testing, we found that patients with SAE reacted to a lesser extent to the drug than did control subjects (CRC controls:46.2 ± 15.9%, CRC SAE: 31,5 ± 15.8%, P < 0.01).ConclusionsWe conclude that cerebrovascular reactivity is impaired in patients with SAE. The clinical significance of this pathophysiological finding has to be assessed in further studies.

Alfacalcidol treatment restores derailed immune-regulation in patients with undifferentiated connective tissue disease

Vitamin D deficiency may contribute to pathological changes in the number and function of CD4+ T helper cell subsets (CD4+Th1, CD4+Th17, CD4+CD25(bright)Foxp3-natural regulatory T cells-nTreg) in patients with undifferentiated connective tissue disease (UCTD). The aim of the present study was to evaluate, whether alfacalcidol could restore immune-regulatory changes in patients with UCTD. We assessed the optimal dose of alfacalcidol that could normalize the elevated levels of IFN-γ expressed by the CD4+Th1 cells and the IL-17 expressed by Th17 cells. Furthermore alfacalcidol decreased the Th1 and Th17 related cytokine levels, repaired the nTreg/Th7 balance, and restored the functional activity of nTreg cells. Twenty one UCTD patients with Vitamin D deficiency (<30 ng/ml) were administered with three different daily doses of alfacalcidol. Seven patients were supplemented with 0.5 μg/day, 7 patients with 1.0 μg/day, and 7 patients with 1.5 μg/day alfacalcidol treatment during 5 weeks. Our results indicated that 1.0 μg/day alfacalcidol during 5 weeks was the optimal therapeutic regime to increase the vitamin D levels, repair the nTreg/Th17 balance and raise the capacity of nTreg cells to suppress the proliferation of autologous CD4+CD25- cells. 1.5 μg daily dose alfacalcidol was not more effective than the 1.0 μg/day treatment. In this study we described that vitamin D deficiency can contribute to the complex immune-regulatory abnormalities in patients with UCTD and vitamin D substitution therapy can improve the fine balance of pro- and anti-inflammatory processes in the disease.

The relationship between selenium and gastrointestinal inflammatory diseases

The cell-membrane toxicity of reactive oxygen and nitrogen species (RONS) plays an increasing role in the pathomechanism of gastrointestinal tract diseases. Trace elements are important parts of antioxidant protecting system, especially the selenium (Se), which, in the form of glutathione peroxidase contributes to the immunity of the gut (GALT). Due to the absorptional disorders and consequent malnutrition observed in the course of inflammatory bowel diseases (IBD) an important role is associated with nutritional therapy, including energy-, protein- and trace element-support. Human studies show, that IBD is mostly accompanied by lower serum Se concentrations, reduced antoxidant and increased proinflammatory activity. Adequate Se-replacement may reduce the severity of organ failure and infections, but not mortality. However, it is encouraging that in animal studies obvious preventive effect of Se has been found on IBD and chronic inflammation induced colon cancer .A gastrointestinalis traktust erintő megbetegedesek patomechanizmusaban egyre nagyobb szerepet tulajdonitanak a reaktiv oxigen- es nitrogengyokok sejtmembran-karosito hatasanak. Az antioxidans vedelemben alapvető fontossagu a nyomelemek, koztuk a szelen szerepe, amely glutation-peroxidaz formajaban reszet kepezi a belfal immunrendszerenek. A gyulladasos belbetegsegekben megfigyelhető felszivodasi zavar es kovetkezmenyes malnutritio miatt nagy a jelentősege a taplalasterapianak, a megfelelő energia-, feherje- es nyomelempotlasnak. A human tanulmanyok ramutatnak, hogy a gyulladasos belbetegseg tobbnyire alacsonyabb szerumszelenszinttel jar egyutt, ezzel egyutt merhetően csokken az antioxidans es nő a proinflammatorikus aktivitas. A megfelelő szelenpotlas lehet kedvező hatassal a szervkarosodas mertekere, a fertőzesek sulyossagara, de a mortalitas csokkeneset nem igazoltak az eredmenyek. Nemi bizakodasra adhat okot, hogy allatkiserletekben a szelen egyertelmű preventiv hatasat mutattak ki mind a gyulladasos,...

VATS therapy of chylothorax caused by leiomyomatosis complicated with tuberous sclerosis complex.

Lymphangioleiomyomatosis with tuberous sclerosis complex is a rare disease. One of the most frequent complications of lymphangioleiomyomatosis is pleural effusion (chylothorax) wich can be treated with the use of VATS. Authors report a case of pulmonary lymphangioleiomyomatosis in a 56-year-old female patient with tuberous sclerosis complex with an 8-week history of recurrent chylothorax, dyspnea and debilitating weakness. By CT scan a flat tissue proliferation was seen in the site of the thoracic duct and it was supposed to be the reason for the pleural effusion. A VATS resection of this laesion and ligation of the thoracic duct was performed successfully. Chylothorax is often associated with pulmonary lymphangioleiomyomatosis. Lymphangioleiomyomatosis combined with tuberous sclerosis complex is extremely rare. In case of chylothorax VATS treatment is successful and may be the first choice.

Role of selenium in gastrointestinal inflammatory diseases

The cell-membrane toxicity of reactive oxygen and nitrogen species (RONS) plays an increasing role in the pathomechanism of gastrointestinal tract diseases. Trace elements are important parts of antioxidant protecting system, especially the selenium (Se), which, in the form of glutathione peroxidase contributes to the immunity of the gut (GALT). Due to the absorptional disorders and consequent malnutrition observed in the course of inflammatory bowel diseases (IBD) an important role is associated with nutritional therapy, including energy-, protein- and trace element-support. Human studies show, that IBD is mostly accompanied by lower serum Se concentrations, reduced antoxidant and increased proinflammatory activity. Adequate Se-replacement may reduce the severity of organ failure and infections, but not mortality. However, it is encouraging that in animal studies obvious preventive effect of Se has been found on IBD and chronic inflammation induced colon cancer .A gastrointestinalis traktust erintő megbetegedesek patomechanizmusaban egyre nagyobb szerepet tulajdonitanak a reaktiv oxigen- es nitrogengyokok sejtmembran-karosito hatasanak. Az antioxidans vedelemben alapvető fontossagu a nyomelemek, koztuk a szelen szerepe, amely glutation-peroxidaz formajaban reszet kepezi a belfal immunrendszerenek. A gyulladasos belbetegsegekben megfigyelhető felszivodasi zavar es kovetkezmenyes malnutritio miatt nagy a jelentősege a taplalasterapianak, a megfelelő energia-, feherje- es nyomelempotlasnak. A human tanulmanyok ramutatnak, hogy a gyulladasos belbetegseg tobbnyire alacsonyabb szerumszelenszinttel jar egyutt, ezzel egyutt merhetően csokken az antioxidans es nő a proinflammatorikus aktivitas. A megfelelő szelenpotlas lehet kedvező hatassal a szervkarosodas mertekere, a fertőzesek sulyossagara, de a mortalitas csokkeneset nem igazoltak az eredmenyek. Nemi bizakodasra adhat okot, hogy allatkiserletekben a szelen egyertelmű preventiv hatasat mutattak ki mind a gyulladasos,...

Anaesthesia of the myasthenic patients during thymectomy

Myasthenia is a rare autoimmune disease characterized by fluctuating muscle weakness and fatigability due to a reduction in available acetylcholine receptors at the neuromuscular junction. Data of 186 patients suffering from myasthenia were collected retrospectively. All patients underwent thymectomy over a 23 years period from 1981 to 2006 without surgical mortality. Postoperative ventilation was required for more than 24 hours in seven patients and one patient needed postoperative ventilatory support more than seven days. Thymectomy for myasthenia was performed using promethazine and atropine in general anaesthesia. Introduction could be facilitated with propofol, etomidate or thiopental and sevoflurane, avoiding use of any muscle relaxants. Non-depolarizing muscle relaxants were not used during the procedures. Adequate surgical conditions were provided by short-acting inhaled anaesthetics (sevoflurane) and small doses of opiates. 95% of the narcotized patients were immediately extubated after the procedure in the operating room. Length of stay in intensive care unit could have been reduced without any postoperative ventilatory support. Nonsteroid analgesics and nalbuphine were used for pain relief. Anaesthesia of thymectomy is based on volatile gases. Airway complications can be prevented with use of small amounts of anticholinergic drugs, perhaps steroids.

Az enteralis táplálás indikációi és gyakorlata@@@Indications and practice of enteral nutrition

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patients condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy.

Indications and practice of enteral nutrition

Malnutrition in hospitalised patients has a significant and disadvantageous impact on treatment outcome. If possible, enteral nutrition with an energy/protein-balanced nutrient should be preferred depending on the patients condition, type of illness and risk factors. The aim of the nutrition therapy is to increase the efficacy of treatment and shorten the length of hospital stay in order to ensure rapid rehabilitation. In the present review the authors summarize the most important clinical and practical aspects of enteral nutrition therapy.

A szelén és az emésztorendszer gyulladásos betegségeinek kapcsolata

The cell-membrane toxicity of reactive oxygen and nitrogen species (RONS) plays an increasing role in the pathomechanism of gastrointestinal tract diseases. Trace elements are important parts of antioxidant protecting system, especially the selenium (Se), which, in the form of glutathione peroxidase contributes to the immunity of the gut (GALT). Due to the absorptional disorders and consequent malnutrition observed in the course of inflammatory bowel diseases (IBD) an important role is associated with nutritional therapy, including energy-, protein- and trace element-support. Human studies show, that IBD is mostly accompanied by lower serum Se concentrations, reduced antoxidant and increased proinflammatory activity. Adequate Se-replacement may reduce the severity of organ failure and infections, but not mortality. However, it is encouraging that in animal studies obvious preventive effect of Se has been found on IBD and chronic inflammation induced colon cancer .A gastrointestinalis traktust erintő megbetegedesek patomechanizmusaban egyre nagyobb szerepet tulajdonitanak a reaktiv oxigen- es nitrogengyokok sejtmembran-karosito hatasanak. Az antioxidans vedelemben alapvető fontossagu a nyomelemek, koztuk a szelen szerepe, amely glutation-peroxidaz formajaban reszet kepezi a belfal immunrendszerenek. A gyulladasos belbetegsegekben megfigyelhető felszivodasi zavar es kovetkezmenyes malnutritio miatt nagy a jelentősege a taplalasterapianak, a megfelelő energia-, feherje- es nyomelempotlasnak. A human tanulmanyok ramutatnak, hogy a gyulladasos belbetegseg tobbnyire alacsonyabb szerumszelenszinttel jar egyutt, ezzel egyutt merhetően csokken az antioxidans es nő a proinflammatorikus aktivitas. A megfelelő szelenpotlas lehet kedvező hatassal a szervkarosodas mertekere, a fertőzesek sulyossagara, de a mortalitas csokkeneset nem igazoltak az eredmenyek. Nemi bizakodasra adhat okot, hogy allatkiserletekben a szelen egyertelmű preventiv hatasat mutattak ki mind a gyulladasos,...

Myastheniás betegek altatása thymectomia soránr

Myasthenia is a rare autoimmune disease characterized by fluctuating muscle weakness and fatigability due to a reduction in available acetylcholine receptors at the neuromuscular junction. Data of 186 patients suffering from myasthenia were collected retrospectively. All patients underwent thymectomy over a 23 years period from 1981 to 2006 without surgical mortality. Postoperative ventilation was required for more than 24 hours in seven patients and one patient needed postoperative ventilatory support more than seven days. Thymectomy for myasthenia was performed using promethazine and atropine in general anaesthesia. Introduction could be facilitated with propofol, etomidate or thiopental and sevoflurane, avoiding use of any muscle relaxants. Non-depolarizing muscle relaxants were not used during the procedures. Adequate surgical conditions were provided by short-acting inhaled anaesthetics (sevoflurane) and small doses of opiates. 95% of the narcotized patients were immediately extubated after the procedure in the operating room. Length of stay in intensive care unit could have been reduced without any postoperative ventilatory support. Nonsteroid analgesics and nalbuphine were used for pain relief. Anaesthesia of thymectomy is based on volatile gases. Airway complications can be prevented with use of small amounts of anticholinergic drugs, perhaps steroids.