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Zahradnikova P, Pechanova R, Fedorova L, Jager R, Nedomova B, Babala J. Laparoscopic management of the congenital chylous ascites in a newborn: Case report. J Minim Access Surg 2023; 19:548-551. [PMID: 37282439 PMCID: PMC10695317 DOI: 10.4103/jmas.jmas_304_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/27/2023] [Indexed: 06/08/2023] Open
Abstract
Congenital chylous ascites (CCA) is a rare condition seen in the neonatal period. The pathogenesis is primarily related to congenital intestinal lymphangiectasis. Conservative treatment of chylous ascites involves paracentesis, total parenteral nutrition (TPN), medium-chain triglyceride (MCT)-based milk formula, use of somatostatin analogue and octreotide. Surgical treatment is considered when conservative treatment fails. We describe a laparoscopic treatment of CCA using the fibrin glue technique. A male infant, in whom foetal ascites was detected at 19 weeks of gestation, was born by caesarean section at 35 weeks of gestation weighing 3760 g. There was evidence of hydrops in the foetal scan. A diagnosis of chylous ascites was made by abdominal paracentesis. A magnetic resonance scan was suggestive of gross ascites, and no lymphatic malformation was identified. TPN and octreotide infusion was started and continued for 4 weeks, but the ascites persisted. The failure of conservative treatment led us to perform laparoscopic exploration. Intraoperatively, chylous ascites and multiple prominent lymphatic vessels around the root of the mesentery were noted. The fibrin glue was applied over the leaking mesenteric lymphatic vessels in the duodenopancreatic region. Oral feeding was started from post-operative day 7. After 2 weeks of the MCT formula, ascites progressed. Thus, laparoscopic exploration was necessary. We introduced an endoscopic applicator for fibrin glue and applied it into the place of leakage. The patient was doing well with no appearance of ascites reaccumulating and was discharged on the 45th post-operative day. Follow-up ultrasonography (1st, 3rd and 9th months after discharge) showed a small amount of ascitic fluid but with no clinical significance. Laparoscopic localisation and ligation of leakage sites could be difficult, especially in newborns and young infants due to the small size of lymphatic vessels. The use of fibrin glue to seal the lymphatic vessels is quite promising.
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Affiliation(s)
- Petra Zahradnikova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Rebeka Pechanova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Lenka Fedorova
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Rene Jager
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Barbora Nedomova
- Department of Paediatric Anaesthesiology and Intensive Medicine, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
| | - Jozef Babala
- Department of Paediatric Surgery, Faculty of Medicine, Comenius University in Bratislava, National Institute of Children’s Diseases in Bratislava, Slovakia
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Mulholland P, Krell D, Khan I, McBain C, Patel C, Wanek K, Hopkins K, Jeffries S, Jager R, Smith P, Liu Q, Stupp R, Tomlinson I. AT-43 * MULTI-CENTRE, RANDOMIZED, DOUBLE-BLIND PHASE II STUDY COMPARING CEDIRANIB (AZD2171) PLUS GEFITINIB (IRESSA, ZD1839) WITH CEDIRANIB PLUS PLACEBO IN SUBJECTS WITH RECURRENT/PROGRESSIVE GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bibza J, Sykora L, Cingel V, Duchaj B, Babala J, Kralik R, Horn F, Jager R, Sandorova D. Laparoscopic cholecystectomy in children. ACTA ACUST UNITED AC 2013; 114:230-1. [PMID: 23514557 DOI: 10.4149/bll_2013_047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED In 95 children (age 6-18 y) treated for gallstones between 2002-2010, 95 laparoscopic cholecystectomies were carried out. Symptomatic cholecystolithiasis was the indication for laparoscopic cholecystectomy in most of the cases. In three patients, there was a conversion to open cholecystectomy. Postoperative complications due to failure of bile drainage arose in three patients. Restored bile drainage was secured for two biliodigestive anastomosis. Bile leak in a third patient solved a temporary biliary stent. Laparoscopic cholecystectomy is the gold standard for gallstones (Ref. 8). KEYWORDS gallstones, laparoscopic cholecystectomy, cholecystolithiasis, bile drainage.
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Affiliation(s)
- J Bibza
- Department of Pediatric Surgery, Comenius University Children's Hospital, Bratislava, Slovakia.
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Bidlingmaier C, Kurnik K, Escuriola-Ettingshausen C, Jager R, Klamroth R, Male C, Marosi A, Nemes L, von Stackelberg A, Kreuz W. Immune tolerance induction with a factor VIII concentrate containing von Willebrand factor (Haemoctin SDH®) in 14 patients with severe haemophilia A. Haemophilia 2011; 17:e837-40. [PMID: 21649797 DOI: 10.1111/j.1365-2516.2011.02577.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mohl A, Boda Z, Jager R, Losonczy H, Marosi A, Masszi T, Nagy E, Nemes L, Obser T, Oyen F, Radványi G, Schlammadinger Á, Szélessy ZS, Várkonyi A, Vezendy K, Vilimi B, Schneppenheim R, Bodó I. Common large partial VWF gene deletion does not cause alloantibody formation in the Hungarian type 3 von Willebrand disease population. J Thromb Haemost 2011; 9:945-52. [PMID: 21362127 DOI: 10.1111/j.1538-7836.2011.04250.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Type 3 von Willebrand disease (VWD) is an autosomal recessive bleeding disorder, characterized by virtually undetectable plasma von Willebrand factor (VWF) and consequently reduced plasma factor VIII levels. Genetic mutations responsible for type 3 VWD are very heterogeneous, scattered throughout the VWF gene and show high variability among different populations. METHODS Twenty-five severe VWD patients were studied by direct sequencing of the 51 coding exons of the VWF gene. The total number of VWD type 3 families in Hungary is 24, of which 23 were investigated. RESULTS Fifteen novel mutations were identified in 31 alleles, five being nonsense mutations (p.Q1238X, p.Q1898X, p.Q1931X, p.S2505X and p.S2568X), four small deletions and insertions resulting in frame shifts (c.1992insC, c.3622delT, c.5315insGA and c.7333delG), one a large partial deletion (delExon1-3) of the 5'-region, four candidate missense mutations (p.C35R, p.R81G, p.C295S, p.C623T) and one a candidate splice site mutation (c.1730-10C>A). Six previously described mutations were detected in 17 alleles, including the repeatedly found c.2435delC, p.R1659X and p.R1853X. Only one patient developed alloantibodies to VWF, carrying a homozygous c.3622delT. CONCLUSION We report the genetic background of the entire Hungarian type 3 VWD population. A large novel deletion, most probably due to a founder effect, seems to be unique to Hungarian type 3 VWD patients with high allele frequency. In contrast to previous reports, none of the five patients homozygous for the large partial deletion developed inhibitors to VWF. This discrepancy raises the possibility of selection bias in some of the reports.
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Affiliation(s)
- A Mohl
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
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Jager R, Kralovics R. Molecular Pathogenesis of Philadelphia Chromosome Negative Chronic Myeloproliferative Neoplasms. Curr Cancer Drug Targets 2011; 11:20-30. [DOI: 10.2174/156800911793743628] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/13/2010] [Indexed: 11/22/2022]
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Mohl A, Boda Z, Jager R, Losonczy H, Marosi A, Masszi T, Nagy E, Nemes L, Obser T, Oyen F, Radványi G, Sallai K, Schlammadinger Á, Szélessy Z, Vezendy K, Schneppenheim R, Bodó I. P061 Type 3 von Willebrand disease in Hungary: A partial large deletion is the most common genetic defect. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jager R, Mels WA, Brinkman AC, Galama MY, Goulooze H, Heise J, Lowes P, Muller JM, Naber A, Rook A, Schuurhof R, Schuurmans JJ, Wiersma G. The Wide Field Cameras onboard the BeppoSAX X-ray Astronomy Satellite. ACTA ACUST UNITED AC 1997. [DOI: 10.1051/aas:1997243] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Costa E, Frontera F, Heise J, Feroci M, in 't Zand J, Fiore F, Cinti MN, Dal Fiume D, Nicastro L, Orlandini M, Palazzi E, Rapisarda# M, Zavattini G, Jager R, Parmar A, Owens A, Molendi S, Cusumano G, Maccarone MC, Giarrusso S, Coletta A, Antonelli LA, Giommi P, Muller JM, Piro L, Butler RC. Discovery of an X-ray afterglow associated with the γ-ray burst of 28 February 1997. Nature 1997. [DOI: 10.1038/42885] [Citation(s) in RCA: 740] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
We report studies on the expression of the archaebacterial membrane protein bacteriorhodopsin in Sf9 insect cells and in COS-1 mammalian cells. In both cell systems, the apoprotein bacterio-opsin was expressed at levels of approximately 1 microgram/10(6) cells. Immunofluorescence studies showed that the expressed protein was accumulated in the endoplasmic reticulum. However, upon addition of all-trans retinal to membranes isolated from either Sf9 or COS-1 cells expressing bacterio-opsin, the characteristic bacteriorhodopsin chromophore (lambda max at approximately 560 nm) was rapidly generated. This is in contrast to bacterio-opsin expressed in E. coli, which cannot be functionally reconstituted with retinal unless it is first denatured, and then renatured in vitro. These studies demonstrate that the bacterio-opsin expressed is correctly folded and show that localization of a heterologously expressed membrane protein in the endoplasmic reticulum does not necessarily imply that it is misfolded.
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Affiliation(s)
- J Heymann
- Department of Biological Chemistry, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205, USA
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Bock I, Melegh B, Nagy A, Losonczy H, Csete B, Schröder W, Kardos M, István L, Jager R, Tóth AM, Tóth A, Falko H, Mózsik G. [Molecular biologic study and the factor VIII gene in hemophilia A]. Orv Hetil 1996; 137:2573-5. [PMID: 9005386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Results of inversion in the intron 22 region of the VIII factor gene studied by Southern blot are presented. Inversion was found in 20 of 46 patients. In 14 cases (70%) distal and in 6 cases (30%) proximal type of inversion was detected. The significance of the positive result in genetic counseling and in presymptomatic diagnosis of Haemophilia A is emphasized.
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Affiliation(s)
- I Bock
- Pécsi Orvostudományi Egyetem Gyermekklinika
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Blomley M, Jager R, Albrecht T, McBride A, Mohammedtagi S. Functional renal perfusion imaging with color mapping: Is it a useful adjunct to spiral CT? Acad Radiol 1995. [DOI: 10.1016/s1076-6332(05)80580-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chaudhuri KR, Jager R, Bridger J, Fusi L, Thomas DG, Frackowiak RS. Hemiplegia in pregnancy due to metastatic cerebral angiosarcoma. Eur Neurol 1994; 34:295-7. [PMID: 7995309 DOI: 10.1159/000117062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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McLoughlin J, Jager R, Williams G. Stone formation on a self-expanding metallic stent. Br J Urol 1992; 69:430. [PMID: 1581818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J McLoughlin
- Department of Urology, Hammersmith Hospital, London
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Abstract
Some aspects of the stimulus control of peck localization in the pigeon were examined using conditioning paradigms, visual occlusion procedures, and 'touch-screen' technology. Birds were reinforced for pecks made to a small circular (target) stimulus projected upon a computer monitor and located within an electronically defined contingency area. The terminal location of each peck was monitored under binocular and monocular viewing conditions and when using either the frontal or lateral visual fields. Peck localization was highly accurate under either binocular or monocular viewing conditions or with the frontal field alone; there were no systematic differences between the right and left eyes and differences between monocular and binocular localization performance, though significant, were minimal. When viewing with the lateral field alone, subjects were initially unable to locate the food hopper and, even after retraining, conditioned peck localization was profoundly disrupted. The results confirm previous reports of functional differences between the frontal and lateral visual fields, but suggest that monocular cues are sufficient for highly accurate peck localization.
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Affiliation(s)
- R Jager
- Biopsychology Program, Hunter College, CUNY
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Abstract
A series of 54 men, 25 with acute urinary retention and 29 with cytometrically proven bladder outflow obstruction (BOO), underwent dilatation of the prostatic urethra using a 35 mm fixed diameter, low compliance balloon. In 42 patients this was performed under cystoscopic guidance and in 12 patients under fluoroscopic control. Three months following dilatation, 13/27 patients (48%) with BOO who returned for review were rendered unobstructed and 19/27 (70%) were symptomatically improved. By 6 months only 3 remained unobstructed but 15 remained symptomatically improved. Nine months after dilatation 14 patients retained symptomatic improvement but only 2 remained unobstructed. Of the 25 patients treated for acute retention only 6 voided spontaneously, 1 of these relapsing into retention at 2 months and another at 4 months. No patient was rendered unobstructed but 2 patients (who declined prostatectomy) noted an improvement in their obstructive symptoms at both 3 and 6 months. No patient developed retrograde ejaculation following dilatation. Balloon dilatation to 35 mm has no role in acute urinary retention but may have a role in younger men with BOO who wish to avoid prostatectomy and the risk of retrograde ejaculation. In these patients careful follow-up is required.
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Affiliation(s)
- J McLoughlin
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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McLoughlin J, Jager R, Abel PD, el Din A, Adam A, Williams G. The use of prostatic stents in patients with urinary retention who are unfit for surgery. An interim report. Br J Urol 1990; 66:66-70. [PMID: 1697492 DOI: 10.1111/j.1464-410x.1990.tb14867.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Under local anaesthesia, 19 patients (18 with acute and 1 with chronic urinary retention) underwent insertion of an expandable stainless steel tubular "stent" into their prostatic urethra under fluoroscopic control. All were considered to be at major risk from prostatic surgery. The 18 patients with acute retention voided spontaneously following the initial stent procedure, but the patient with chronic retention required a period of suprapubic catheterisation. Following the endoscopic insertion of an additional stent this patient also voided spontaneously. During a follow-up period of 3 to 7 months (mean 4), 4 patients were lost to follow-up. The remaining 15 patients all void spontaneously. Recurrent asymptomatic urinary tract infections were seen in all but 1 patient initially, but none of those who were followed up for over 5 months had evidence of infection. Although the follow-up period is limited, the results to date demonstrate that the insertion of an expandable prostatic stent is a safe and reliable method of treating acute urinary retention in patients unfit for surgery. Further follow-up is required to assess long-term safety and to exclude late complications.
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Affiliation(s)
- J McLoughlin
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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Williams G, Jager R, McLoughlin J, el Din A, Machan L, Gill K, Asopa R, Adam A. Use of stents for treating obstruction of urinary outflow in patients unfit for surgery. BMJ 1989; 298:1429. [PMID: 2502278 PMCID: PMC1836576 DOI: 10.1136/bmj.298.6685.1429] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- G Williams
- Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London
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