Katalin Pető

Adhesion formation with open versus laparoscopic cholecystectomy: an immunologic and histologic study.

BackgroundThis randomized study aimed to compare the reaction of the immune system to the process of postoperative adhesion formation after open and laparoscopic cholecystectomy.MethodsIn this study, 20 mongrel dogs were used: 10 each in the laparoscopic and open cholecystectomy groups. Blood and peritoneal lavage samples were taken up to postoperative day 14, followed by second-look laparoscopy and reoperation to detect the rate of adhesion formation. Also, specimens were obtained from the liver bed for histology.ResultsIn the open cholecystectomy group, the white blood cell count was higher in blood samples and lower in lavage specimens. Adhesion formation was extensive, and the histologic immune reaction was more intensive in the open cholecystectomy group.ConclusionThis randomized study proved that laparoscopic cholecystectomy was associated with less immune suppression, less inflammatory reaction, and therefore less adhesion formation than open cholecystectomy.

Red blood cell and platelet parameters are sepsis predictors in an Escherichia coli induced lethal porcine model

OBJECTIVE In a fulminant porcine sepsis model, we determined the kinetics of hypoxia induced changes in relation to sepsis parameters and markers of organ damage. METHODS Female pigs were challenged by live Escherichia coli and samples were analysed up to 4 hours. Bone marrow reactions were determined by analysing immature forms of peripheral blood cells by a hematology analyser and light microscopy. Platelet mitochondrial membrane depolarisation was determined by flow cytometry. RESULTS Core temperature, modified shock index and lactate levels all became significantly elevated compared to baseline values at 4 hours in septic animals. At 2 hours already the reticulocyte count, nucleated red blood cell count and the absolute number of dysplastic platelets became significantly elevated. The platelet mitochondrial membrane depolarisation was significantly decreased by 2 hours in septic animals compared to the baseline values and to control animals. No massive organ damage was evident during the 4-hour observation period, but uric acid levels in septic animals became significantly elevated already by 2 hours. CONCLUSIONS In this Escherichia coli induced porcine model, severe sepsis was evident by conventional criteria at 4 hours while several - mostly hypoxemia induced - biomarkers were already altered by 2 hours.

Characteristics of thrombin generation in a fulminant porcine sepsis model

INTRODUCTION The activation of blood coagulation has been demonstrated in most cases of sepsis, however previous studies in humans could not detect hypercoagulability with global hemostasis assays. In a fulminant porcine sepsis model we analysed coagulation screening tests and thrombin generation to evaluate hemostatic alterations. MATERIALS AND METHODS Live Escherichia coli bacteria were inoculated to female pigs and prothrombin time, activated partial thromboplastin time, thrombin time and fibrinogen were measured by coagulometry. Platelet counts, platelet aggregates and platelet phosphatidyl serine (PS) expression were studied, furthermore in in vitro experiments the PS-inducing ability of septic and control plasmas was investigated by flow cytometry. Thrombin generation was carried out by the Ascent Fluoroscan reader and results were evaluated by the Thrombinoscope software. RESULTS Clotting assays showed a large variability, but no systematic changes during the 4-hour observation period. Platelet count significantly decreased and the number of platelet aggregates increased already by 2h compared to baseline values and to control animals. Although the increase in platelet PS expression was non-significant in the septic group, the septic plasma elicited PS expression on normal human red blood cells. Thrombin generation became significantly faster, but the quantity of formed thrombin demonstrated both hypo- and hypercoagulability depending on the setting of the assay. CONCLUSIONS Enhanced thrombin generation without activators and the PS-inducing capacity of septic plasma are signs of hemostatic activation during fulminant sepsis while the decreased amount of generated thrombin upon tissue factor and phospholipid induced activation demonstrates attenuated thrombin forming ability.

Pressure Distribution during Negative Pressure Wound Therapy of Experimental Abdominal Compartment Syndrome in a Porcine Model

(1) Introduction: Negative pressure wound therapy (NPWT) is a frequently applied open abdomen (OA) treatment. There are only a few experimental data supporting this method and describing the optimal settings and pressure distribution in the abdominal cavity during this procedure. The aim of our study was to evaluate pressure values at different points in the abdominal cavity during NPWT in experimental abdominal compartment syndrome (ACS) animal model; (2) Methods: In this study (permission Nr. 13/2014/UDCAW), 27 Hungahib pigs (15.4–20.2 kg) were operated on. ACS was generated by implanting a plastic bag in the abdomen through mini-laparotomy and filled with 2100–3300 mL saline solution (37 °C) to an intraabdominal pressure (IAP) of 30 mmHg. After 3 h, NPWT (Vivano Med® Abdominal Kit, Paul Hartmann AG, Germany) or a Bogota bag was applied. The NPWT group was divided into −50, −100 and −150 mmHg suction groups. Pressure distribution to the abdominal cavity was monitored at 6 different points of the abdomen via a multichannel pressure monitoring system; (3) Results: The absolute pressure levels were significantly higher above than below the protective layer. The values of the pressure were similar in the midline and laterally. Amongst the bowels, the pressure values changed periodically between 0 and −12 mmHg which might be caused by peristaltic movements; (4) Conclusions: The porcine model of the present study seems to be well applicable for investigating ACS and NPWT. It was possible to provide valuable information for clinicians. The pressure was well distributed by the protective layer to the lateral parts of the abdomen and this phenomenon did not change considerably during the therapy.

[Main indicators of educational activity at the Department of Operative Techniques and Surgical Research at the University of Debrecen between 2000-2013].

The authors provide a review about the main parameters of the gradual and postgradual educational activity of the Department of Operative Techniques and Surgical Research between 2000-2013. In this period of time several new subjects and courses have been introduced. The thematics have been widened, and the educational topics underwent a significant change and development: new teaching videos, revised note-books and a new textbook have been prepared through these years. Further, new training models (surgical training models, phantom and biomodels) have also been evolved. The educational activity of the Department was supported significantly several times (financial, contribution, grants) from the University of Debrecen, partner companies, HEFOP and TÁMOP grants. Infrastructural development in conjunction with the above increased the quality of educational standards in gradual and postgradual education, too. All these changes and developments were presented on various professional meetings and published in relevant journals, as part ofinternal quality control.

A DE OEC Sebészeti Műtéttani Tanszék oktatási tevékenységének főbb mutatói 2000–2013 között

The authors provide a review about the main parameters of the gradual and postgradual educational activity of the Department of Operative Techniques and Surgical Research between 2000-2013. In this period of time several new subjects and courses have been introduced. The thematics have been widened, and the educational topics underwent a significant change and development: new teaching videos, revised note-books and a new textbook have been prepared through these years. Further, new training models (surgical training models, phantom and biomodels) have also been evolved. The educational activity of the Department was supported significantly several times (financial, contribution, grants) from the University of Debrecen, partner companies, HEFOP and TÁMOP grants. Infrastructural development in conjunction with the above increased the quality of educational standards in gradual and postgradual education, too. All these changes and developments were presented on various professional meetings and published in relevant journals, as part ofinternal quality control.