1
|
Drácz B, Czompa D, Müllner K, Hagymási K, Miheller P, Székely H, Papp V, Horváth M, Hritz I, Szijártó A, Werling K. The Elevated De Ritis Ratio on Admission Is Independently Associated with Mortality in COVID-19 Patients. Viruses 2022; 14:v14112360. [PMID: 36366457 PMCID: PMC9692894 DOI: 10.3390/v14112360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 02/01/2023] Open
Abstract
Liver damage in COVID-19 patients was documented as increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels or an elevated AST/ALT ratio, known as the De Ritis ratio. However, the prognostic value of the elevated De Ritis ratio in COVID-19 patients is still unknown. The aim of our study was to evaluate the prognostic value of the De Ritis ratio compared to other abnormal laboratory parameters and its relation to mortality. We selected 322 COVID-19 patients in this retrospective study conducted between November 2020 and March 2021. The laboratory parameters were measured on admission and followed till patient discharge or death. Of the 322 COVID-19 patients, 57 (17.7%) had gastrointestinal symptoms on admission. The multivariate analysis showed that the De Ritis ratio was an independent risk factor for mortality, with an OR of 29.967 (95% CI 5.266-170.514). In ROC analysis, the AUC value of the the De Ritis ratio was 0.85 (95% CI 0.777-0.923, p < 0.05) with sensitivity and specificity of 80.6% and 75.2%, respectively. A De Ritis ratio ≥1.218 was significantly associated with patient mortality, disease severity, higher AST and IL-6 levels, and a lower ALT level. An elevated De Ritis ratio on admission is independently associated with mortality in COVID-19 patients, indicating liver injury and cytokine release syndrome.
Collapse
|
2
|
Teszák T, Király Á, Hartyánszky I, Müllner K, Tajti B, Merkely B, Sax B. Intractable Gastrointestinal Bleeding Events After Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
3
|
Zalatnai A, Tőke J, Huszty G, Müllner K, Tóth M. A peculiar pancreatic lesion: nodular foci of trilineage differentiation and diffuse islet cell hyperplasia. Orv Hetil 2021; 162:227-232. [PMID: 33550275 DOI: 10.1556/650.2021.31989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/16/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A szerzők egy különleges pancreaselváltozás esetét ismertetik, melyben az acinusok neuroendokrin jellegű transzformációja diffúz, atípusos megjelenésű szigetsejtes hyperplasiával társult, valamint a pancreas mindhárom sejtvonalát (acinaris, ductalis, insularis) tartalmazó nodulusok képződtek. A komplex megjelenés ellenére a kórfolyamat nem járt endokrin tünetekkel. Esetünkben a kiváltó ok hátterében a struktúrák kóros progenitorsejt-differenciációja állhatott. Az irodalomban ilyen közlés eddig nem ismert. Orv Hetil. 2021; 162(6): 227-232. Summary. The authors present a case of a peculiar pancreatic lesion, in which the neuroendocrine transformation of the acini was associated with a diffuse, atypical insular hyperplasia, and micronodules exhibiting trilineage differentiation. Despite the complex alteration, no endocrine symptoms were noted. The case may represent the result of an abnormal pancreatic differentiation raising the possibility of reprogramming of the progenitor cells. To the best of our knowledge, this is the first report of such a lesion in the literature. Orv Hetil. 2021; 162(6): 227-232.
Collapse
|
4
|
Bor R, Fábián A, Matuz M, Szepes Z, Farkas K, Miheller P, Szamosi T, Vincze Á, Rutka M, Szántó K, Bálint A, Nagy F, Milassin Á, Tóth T, Zsigmond F, Bajor J, Müllner K, Lakner L, Papp M, Salamon Á, Horváth G, Sarang K, Schäfer E, Sarlós P, Palatka K, Molnár T. Real-life efficacy of vedolizumab on endoscopic healing in inflammatory bowel disease – A nationwide Hungarian cohort study. Expert Opin Biol Ther 2019; 20:205-213. [PMID: 31782939 DOI: 10.1080/14712598.2020.1699529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
5
|
Müllner K, Miheller P, Herszényi L, Tulassay Z. Probiotics in the management of Crohn's disease and ulcerative colitis. Curr Pharm Des 2015; 20:4556-60. [PMID: 24180407 DOI: 10.2174/13816128113196660727] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 10/10/2013] [Indexed: 11/22/2022]
Abstract
Probiotics are nowadays frequently used by patients with inflammatory bowel disease, however literature data are conflicting related to their importance. In mild to moderate ulcerative colitis probiotics can be used effectively in induction and maintaining remission, and prevention of pouchitis. As the other side of the shield, there is not sufficient evidence to support the use of probiotics in daily clinical practice in Crohn's disease. The aim of the present review is to provide help for clinicians about the probiotic use in patients with inflammatory bowel disease. The comparison of literature data is limited by the large number of probiotic strains, various combined preparations, and different doses applied in the clinical studies. Small number of comparable protocols and lack of standardization encumber the analysis of study results.
Collapse
|
6
|
Mandel MD, Miheller P, Müllner K, Golovics PA, Lakatos PL. Have biologics changed the natural history of Crohn's disease? Dig Dis 2014; 32:351-9. [PMID: 24969279 DOI: 10.1159/000358135] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Crohn's disease (CD) is a progressive condition, with most patients developing a penetrating or stricturing phenotype over time. The introduction of anti-tumor necrosis factor (TNF) therapies over the past 10-15 years, which was supported by accumulating evidence both from trials and clinical practice, has led to a significant change in patient management, monitoring, and treatment algorithms. Anti-TNF therapy was demonstrated to be effective for both luminal and fistulizing disease. Regular therapy with both infliximab and adalimumab was shown to increase the likelihood of clinical remission and mucosal healing, as well as to reduce the need for surgery and hospitalization in both clinical trials and clinical practice, especially in patients with pediatric-onset CD, shorter disease duration, and when used in combination with immunosuppressives. This has led to new treatment goals and to the use of early aggressive medical therapy in a selected group of patients with a worse prognosis. Exploratory clinical trials are underway to determine if further optimization of therapies and treatment beyond clinical remission leads to superior disease outcomes. However, more long-term clinical data are needed to assess whether an early, aggressive therapeutic strategy employing anti-TNF, alone or in combination with biologicals, can further improve long-term disease outcomes in both pediatric patients and young adults.
Collapse
|
7
|
Hagymási K, Müllner K, Herszényi L, Tulassay Z. Update on the pharmacogenomics of proton pump inhibitors. Pharmacogenomics 2011; 12:873-88. [PMID: 21692617 DOI: 10.2217/pgs.11.4] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Proton pump inhibitors (PPIs) are widely used for the treatment of gastroesophageal reflux disease as well as other acid-related disorders. PPIs are metabolized primarily via the CYP2C19 and CYP3A4 isoenzymes; their activity is influenced both by exogenous and endogenous (pharmacogenetic) factors. The CYP2C19 polymorphism affects the metabolism of PPIs, causing large individual pharmacokinetic variations. Differences in the CYP2C19-mediated metabolism can produce marked interpatient variability in acid suppression, in drug-interaction potential and in clinical efficacy. Understanding the pharmacokinetic properties of PPIs and examining the pharmacogenetic alterations may help clinicians optimize PPI therapy and administer individual treatment, especially to nonresponder patients with gastroesophageal reflux disease or ulcer or after failed eradication therapy.
Collapse
|
8
|
Lorinczy K, Lakatos G, Müllner K, Hritz I, Lakatos PL, Tulassay Z, Miheller P. Low bone mass in microscopic colitis. BMC Gastroenterol 2011; 11:58. [PMID: 21595910 PMCID: PMC3111400 DOI: 10.1186/1471-230x-11-58] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 05/19/2011] [Indexed: 12/04/2022] Open
Abstract
Background Microscopic colitis presents with similar symptoms to classic inflammatory bowel diseases. Osteoporosis is a common complication of Crohn's disease but there are no data concerning bone metabolism in microscopic colitis. Aims The aim of the present study was to evaluate bone density and metabolism in patients with microscopic colitis. Methods Fourteen patients microscopic colitis were included in the study, and 28 healthy persons and 28 age and gender matched Crohn's disease patients were enrolled as controls. Bone mineral density was measured using dual x-ray absorptiometry at the lumbar spine, femoral neck and the radius. Serum bone formation and bone resorption markers (osteocalcin and beta-crosslaps, respectively) were measured using immunoassays. Results Low bone mass was measured in 57.14% patients with microscopic colitis. Bone mineral density at the femoral neck in patients suffering from microscopic colitis and Crohn's disease was lower than in healthy controls (0.852 ± 0.165 and 0.807 ± 0.136 vs. 1.056 ± 0.126 g/cm2; p < 0.01). Bone mineral density at the non-dominant radius was decreased in microscopic colitis patients (0.565 ± 0.093 vs. 0.667 ± 0.072 g/cm2; p < 0.05) but unaffected in Crohn's disease patients (0.672 ± 0.056 g/cm2). Mean beta-crosslaps concentration was higher in microscopic colitis and Crohn's disease patients than controls (417.714 ± 250.37 and 466.071 ± 249.96 vs. 264.75 ± 138.65 pg/ml; p < 0.05). A negative correlation between beta-crosslaps concentration and the femoral and radius t-scores was evident in microscopic colitis patients. Conclusions Low bone mass is frequent in microscopic colitis, and alterations to bone metabolism are similar to those present in Crohn's disease. Therefore, microscopic colitis-associated osteopenia could be a significant problem in such patients.
Collapse
|
9
|
Abstract
Sedative and analgesic premedication is frequently used during gastrointestinal endoscopy. Sedation improves patient's compliance, helping the examinations and their safe completion, but it lengthens the procedures, increases the costs, and complications can occur. Sedative drugs are applied during upper and lower gastrointestinal endoscopy, and also at ERCP. The review summarizes the different forms of sedation, drugs, future techniques and possibilities of improvements. Moreover, sedation practice in Hungary is also described.
Collapse
|
10
|
Igaz P, Müllner K, Hargitai B, Igaz I, Tömböl Z, Rácz K, Tulassay Z. Marked chromogranin A elevation in a patient with bilateral adrenal incidentalomas, and its rapid normalization after discontinuation of proton pump inhibitor therapy. Clin Endocrinol (Oxf) 2007; 67:805-6. [PMID: 17608816 DOI: 10.1111/j.1365-2265.2007.02957.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
11
|
Richtig E, Langmann G, Schlemmer G, Müllner K, Papaefthymiou G, Bergthaler P, Smolle J. Verträglichkeit und Wirksamkeit einer adjuvanten Interferon-alfa-2b-Behandlung beim Aderhautmelanom. Ophthalmologe 2006; 103:506-11. [PMID: 16763868 DOI: 10.1007/s00347-006-1350-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE In this manuscript, the safety and efficacy of adjuvant interferon alfa 2b treatment of uveal melanoma is described. PATIENTS AND METHODS A total of 39 patients (23 male and 16 female, mean age 56.5 years, range 35-78 years) with uveal melanoma were treated with interferon alfa 2b, 3 million units three times a week subcutaneously for 1 year after therapy of the primary tumor. In all patients age, gender, primary melanoma data, therapeutic interventions, treatment side effects and outcome were documented. RESULTS Of the 39 patients, 31 (80%) finished the treatment as scheduled after 1 year. In 18 patients (46%) the initial dose had to be reduced due to leucopenia, thrombopenia, cardiac symptoms, elevated of liver function or vertigo (WHO grade I-III). In eight patients, therapy had to be withdrawn because of serious side effects (five patients) and the appearance of metastases (three patients). Neither a univariate approach nor a multivariate approach could show a protective effect of interferon treatment on survival. CONCLUSIONS Adjuvant treatment of uveal melanoma with interferon alfa should be abandoned until the question of dose and administration for cutaneous melanoma is solved.
Collapse
|
12
|
Richtig E, Langmann G, Müllner K, Richtig G, Smolle J. Calculated tumour volume as a prognostic parameter for survival in choroidal melanomas. Eye (Lond) 2004; 18:619-23. [PMID: 15184927 DOI: 10.1038/sj.eye.6700720] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Tumour diameter, tumour height, and tumour volume are considered important prognostic indicators of survival in choroidal melanomas. In this study, we investigated the prognostic impact on survival of the easily calculated volume estimate based on the assumption of a half-rotation ellipsoid. METHODS The largest tumour diameter and tumour height were measured by ultrasound A- and B-scan in 93 patients with choroidal melanoma. Tumour volume was calculated by the half volume of a rotation ellipsoid formula, rotated around the y-axis, and compared to tumour diameter and tumour height. All parameters were correlated to the clinical outcome of the patients. RESULTS At the time of diagnosis, the mean diameter was 10.4 mm (range 4.1-18.9 mm), and the mean height was 5.7 mm (range 1.74-14.9 mm). The range of the calculated tumour volume was between 11 and 628 mm(3) (mean volume 190 mm(3)). Among all patients, distant metastases occurred in 10 patients (10.8%). In a univariate approach using Mantel-Haenszel log-rank test, the calculated tumour volume at the time of diagnosis was the best prognostic indicator of survival followed by tumour diameter and tumour height (P=0.028). When tumour volume, horizontal and vertical tumour diameter, age, sex, and primary tumour therapy were considered in a multivariate approach using Cox proportional Hazard model, only tumour volume turned out as a significant prognostic parameter (P=0.001). CONCLUSIONS Calculated tumour volume is a better prognostic indicator of survival of patients with choroidal melanomas than the largest tumour diameter and tumour height, and might be established in daily routine.
Collapse
|
13
|
Richtig E, Langmann G, Müllner K, Smolle J. Ocular melanoma: epidemiology, clinical presentation and relationship with dysplastic nevi. Ophthalmologica 2004; 218:111-4. [PMID: 15004500 DOI: 10.1159/000076146] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2003] [Accepted: 07/17/2003] [Indexed: 11/19/2022]
Abstract
PURPOSE Ocular melanoma is a rare entity compared to cutaneous malignant melanoma. We examined the frequency of the tumor in a defined geographic region, its clinical presentation and its relationship with dysplastic nevi in 136 patients. METHODS 136 patients (64 men and 72 women; mean age 61.7 years, range 20-92 years) with ocular melanoma were treated at the University Hospital of Graz between June 1996 and December 2001. 129 had primary uveal melanoma in one eye (117 choroidal melanomas, 11 melanomas of the ciliary body and 1 of the iris), 2 patients had uveal melanoma in both eyes, 4 patients had conjunctival melanoma and 1 patient had a melanoma of the lacrimal sac. Epidemiology, history, potential risk factors, clinical presentation and relationship with dysplastic (= atypical) nevi were documented. RESULTS 48 patients (35.3%) showed more than five dysplastic nevi, compared to only 1.2% in the general population (chi(2) test: p < 0.001). 5 (3.7%) had additional cutaneous melanoma and 7 (5.1%) had a family history of melanoma. The lifelong risk for the occurrence of an additional primary cutaneous melanoma was 2.9%, which is significantly higher than the usual estimate of 1% for the general population. CONCLUSIONS Patients with primary ocular melanoma have an increased risk to develop cutaneous melanoma and should therefore be examined regularly by dermatologists.
Collapse
|
14
|
Rónai AZ, Kató E, Al-Khrasani M, Hajdú M, Müllner K, Elor G, Gyires K, Fürst S, Palkovits M. Age and monosodium glutamate treatment cause changes in the stimulation-induced [3H]-norepinephrine release from rat nucleus tractus solitarii-dorsal vagal nucleus slices. Life Sci 2004; 74:1573-80. [PMID: 14738902 DOI: 10.1016/j.lfs.2003.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In nucleus tractus solitarii-dorsal vagal nucleus slices prepared from young adult rats (180-260 g) 10(-3) M L-glutamate and 10(-5) M baclofen caused a 2-3-fold increase of field stimulation-induced [3H]-norepinephrine release without affecting the resting release. In slices prepared from rats treated neonatally with monosodium glutamate neither L-glutamate nor baclofen had any effect on stimulation-induced norepinephrine release, tested between postnatal days 74-99 (350-530 g). In untreated littermates used in the same period (460-580 g) L-glutamate was fully effective whereas baclofen was ineffective. The tritium content in tissue extracts did not differ significantly in the three experimental groups. It is concluded that i) the loss of GABA(B) receptor-mediated disinhibitory stimulation of norepinephrine release is an age-related phenomenon and ii) neonatal monosodium glutamate treatment causes a damage in the local neural circuitry characterized by the loss of glutamate receptor-mediated mechanism that stimulates the release of norepinephrine.
Collapse
|
15
|
Rónai AZ, Gyires K, Barna I, Müllner K, Reichart A, Palkovits M. Gyrus cinguli transection abolishes delta-opioid receptor-induced gastroprotection and alters alpha 2 adrenoceptor activity in the lower brainstem in rats. Brain Res 2002; 947:90-9. [PMID: 12144857 DOI: 10.1016/s0006-8993(02)02912-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previously, using the acidified ethanol-induced ulcer model in rats, we demonstrated that the mainly vagus-dependent gastroprotective effect of intracerebroventricularly injected clonidine was mediated by beta-endorphin release in the lower brainstem. Presently, retroarcuate transections were used to evaluate the contribution of forebrain beta-endorphinergic projection in this mechanism. Since the transection trajectory affected the cingulate cortex and other forebrain structures, matching lesions were also performed. In control and sham-operated rats intracisternal injection of clonidine and the direct opioid receptor (delta type) stimulant peptide (D-Ala(2), D-Leu(5))-enkephalin caused a potent and fully naloxone-reversible (i.e. opioid receptor-mediated) protection against acidified ethanol-induced mucosal damage. In gyrus cinguli-transected rats (as well as in groups with midline hippocampal, thalamic and hypothalamic lesions) gastric mucosal protection induced centrally by direct delta-opioid receptor stimulation in the lower brainstem was completely abolished. The protective effect of clonidine was significantly reduced but it was still present in these animals. The residual protection by clonidine was naloxone-resistant, i.e. independent of an opioid mediation. Transections of the cingulate gyrus as well as thalamic but not the retroarcuate transections elevated plasma corticosterone levels. The changes seen in the clonidine/opioid-induced gastroprotection did not show any correlation with the changes in plasma corticosterone levels. It was concluded that (i) the transection of the cingulate cortex strongly influences the neural input to the nucleus tractus solitarii-dorsal motor vagal nucleus complex that is required for the activation of gastroprotective vagus outflow by delta-opioid receptor stimulation; (ii) the transection uncovers a direct, clonidine-induced gastroprotective pathway which is probably suppressed in intact animals.
Collapse
|
16
|
Langmann G, Müllner K, Kleinert R, Reich E, Faulborn J. Wirkungs- und Nebenwirkungsprofil eines Kalium-Titanium-Phosphat(KTP)-Lasers — Untersuchung am Melanomauge. SPEKTRUM DER AUGENHEILKUNDE 2002. [DOI: 10.1007/bf03164320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
17
|
Langmann G, Mosböck G, Stücklschwaiger G, Müllner K, Lechner H, Faulborn J. Über den Stellenwert der Ruthenium-106- Brachytherapie bei der Therapie von Aderhautmelanomen. SPEKTRUM DER AUGENHEILKUNDE 2002. [DOI: 10.1007/bf03164265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
18
|
Müllner K, Rónai AZ, Fülöp K, Fürst S, Gyires K. Involvement of central K(ATP) channels in the gastric antisecretory action of alpha2-adrenoceptor agonists and beta-endorphin in rats. Eur J Pharmacol 2002; 435:225-9. [PMID: 11821030 DOI: 10.1016/s0014-2999(01)01572-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The intracerebroventricularly (i.c.v.) injected presynaptic alpha2-adrenoceptor agonists, clonidine and oxymetazoline, exerted a dose-dependent inhibition on the gastric acid secretion in pylorus-ligated rats; the ED50 values were 20 and 7.5 nmol/rat, respectively. Moreover, beta-endorphin, given i.c.v., also decreased acid secretion (ED50=0.25 nmol/rat i.c.v.). The antisecretory effect of these compounds was highly reduced by glibenclamide (10 nmol/rat i.c.v.), a selective blocker of K(ATP) channels. These results suggest that K(ATP) channels in the central nervous system are likely to be involved in the centrally initiated antisecretory action of both alpha2-adrenoceptor agonists and beta-endorphin.
Collapse
|
19
|
Kölli H, Dexl A, Langmann G, Müllner K. Glaskörperblutung als ungewöhnliche Erstmanifestation eines malignen Melanoms der Aderhaut. SPEKTRUM DER AUGENHEILKUNDE 2001. [DOI: 10.1007/bf03162960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Langmann G, Müllner K, Lechner H, Mossböck G, Papaefthymiou G, Feichtinger K, Pendl G, Faulborn J. Transpupillare Thermotherapie (TTT), Ruthenium 106 Brachytherapie oder Leksell® Gamma Knife Radiochirurgie. Eine Standortbestimmung. SPEKTRUM DER AUGENHEILKUNDE 2001. [DOI: 10.1007/bf03162923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Müllner K, Wolf G, Luxenberger W, Hofmann T. [Laser-assisted transcanalicular dacryocystorhinostomy. Initial results]. Ophthalmologe 2001; 98:174-7. [PMID: 11263044 DOI: 10.1007/s003470170180] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Endoscopes for direct examination of the mucosa and disorders of the lacrimal drainage system have been available for four years. This had led to the wish to be able to treat lacrimal disorders by endoscopes and laser. PATIENTS AND METHODS Since September 1997 we have treated 48 patients by laser-assisted transcanalicular dacryocystorhinostomy (DCR) using a KTP laser, including all those with stenosis to the nasolacrimal duct and all those with postsaccal stenosis. A bony window with diameter of 5 x 5 mm was created. Bicanalicular intubation into the nose was performed and was left for 3-6 months. RESULTS We found 40 patients to have patent lacrimal pathway and no symptoms, 4 watering in cold weather, and 4 a restenosis. CONCLUSIONS The KTP-laser is sufficiently powerful to create bony windows at least 5 mm in diameter, and a transcanalicular laser-assisted DCR is therefore possible.
Collapse
|
22
|
Müllner K, Gyires K, Furst S. Involvement of the opioid system in the central antisecretory action of alpha-2 adrenoceptor agonists in rat. JOURNAL OF PHYSIOLOGY, PARIS 2001; 95:209-14. [PMID: 11595439 DOI: 10.1016/s0928-4257(01)00027-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of the present study was to analyse the role of the central alpha-2 adrenoceptors in the regulation of gastric acid secretion in pylorus ligated rats. It was found that the intracerebroventricularly (icv.) injected presynaptic alpha-2 adrenoceptor agonist clonidine and the alpha-2A adrenoceptor subtype selective stimulant oxymetazoline exerted a dose dependent inhibition on gastric acid secretion. The antisecretory ED(50) values for clonidine and oxymetazoline were 20 and 7.5 nmol/rat icv., respectively. The antisecretory effect of these compounds was antagonised by the presynaptic adrenoceptor antagonist yohimbine (50 nmol/rat icv.) indicating that the action is mediated through central presynaptic alpha-2 adrenoceptors. Moreover, naloxone (50 nmol/rat icv.)--non-selective opioid antagonist--and naltrindole (0.5 nmol/rat icv.)--delta-opioid receptor selective antagonist--also decreased the antisecretory effect of clonidine and oxymetazoline suggesting that the endogenous opioid system is likely to be involved in the central antisecretory action of alpha-2 adrenoceptor stimulants.
Collapse
|
23
|
Gyires K, Müllner K, Rónai AZ. Activation of central opioid receptors may induce gastric mucosal defence in the rat. JOURNAL OF PHYSIOLOGY, PARIS 2001; 95:189-96. [PMID: 11595436 DOI: 10.1016/s0928-4257(01)00024-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effect of different opioid peptides on acidified ethanol- and indomethacin-induced gastric mucosal lesions was studied following intracerebroventricular (i.c.v.) administration. It was found that both the selective delta opioid receptor agonists--deltorphin II, [D-Ala(2), D-Leu(5)]-enkephalin (DADLE), [D-Pen(2), D-Pen(5)]-enkephalin (DPDPE)-, mu-opioid receptor agonist--[D-Ala(2), Phe(4), GlyT-ol]-enkephalin (DAGO)--as well as beta-endorphin inhibited the mucosal damage induced by both ethanol and indomethacin in pmolar dose range. In contrast, the gastric acid secretion was not influenced by DADLE in the dose of 16 nmol/rat and only a slight reduction (40%) was induced by DAGO in the dose of 1.9 nmol/rat. The protective effect was abolished in both ulcer models by bilateral cervical vagotomy. N(G)-nitro-L-arginine, an inhibitor of NO synthase, reduced the protective action in ethanol-induced, but not in indomethacin-induced gastric damage. The results suggest that activation of supraspinal delta and mu-opioid receptors resulted in inhibition of gastric mucosal lesions elicited by ethanol or indomethacin. The gastroprotective action is independent from the effect of opioids on acid secretion. Vagal nerve is involved in conveying the central action to the periphery. The mechanism of the gastroprotective effect of opioids is different in ethanol- and indomethacin-ulcer models: prostaglandins and nitric oxide are likely to be involved in the protective action of opioid peptides in ethanol-, but not in the indomethacin-ulcer model.
Collapse
MESH Headings
- Animals
- Brain/physiology
- Cytoprotection/physiology
- Enkephalin, Ala(2)-MePhe(4)-Gly(5)-/pharmacology
- Enkephalin, D-Penicillamine (2,5)-/pharmacology
- Enkephalin, Leucine-2-Alanine/pharmacology
- Enzyme Inhibitors/pharmacology
- Ethanol/pharmacology
- Gastric Mucosa/drug effects
- Gastric Mucosa/pathology
- Gastric Mucosa/physiology
- Indomethacin/pharmacology
- Male
- Narcotics/pharmacology
- Nitroarginine/pharmacology
- Rats
- Rats, Wistar
- Receptors, Opioid/physiology
- Receptors, Opioid, delta/agonists
- Receptors, Opioid, mu/agonists
- Vagotomy
- beta-Endorphin/pharmacology
Collapse
|
24
|
Rónai AZ, Gyires K, Barna I, Müllner K, Palkovits M. Neonatal monosodium glutamate treatment abolishes both delta opioid receptor-induced and alpha-2 adrenoceptor-mediated gastroprotection in the lower brainstem in rats. JOURNAL OF PHYSIOLOGY, PARIS 2001; 95:215-20. [PMID: 11595440 DOI: 10.1016/s0928-4257(01)00028-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neonatal monosodium glutamate treatment reduced immunoreactive beta-endorphin content in the mediobasal hypothalamus by 50% in adult, male Wistar rats as compared to hypertonic saline-treated littermates; there was also a moderate (approx. 25%) reduction in the rostral part of the nucleus of the solitary tract. In sham-treated adults the intracisternally injected alpha-2 adenoceptor stimulant clonidine (0.47 nmol/rat) and the delta opioid receptor type agonist (D-Ala(2), D-Leu(5))-enkephalin (0.8 nmol/rat) reduced acidified ethanol-induced mucosal lesions in the stomach by 84.1 and 77.5%, respectively, whereas the same doses were completely ineffective in rats treated neonatally by monosodium glutamate. The data taken together with the results of previous studies with the same substances in rats with retroarcuate knife cuts suggest that neuronal damage in the nucleus of the solitary tract region rather than in the arcuate nucleus is responsible for the changes seen in the pharmacological responsiveness.
Collapse
|
25
|
Abstract
Silicone tubing of the lacrimal pathway is used after lacrimal pathway injuries or canalicular stenosis. This procedure is often complicated by the so-called accordeon phenomenon. Far the last 3 years we have used a new system for lacrimal intubation: the Ritleng intubation set. It consists of a silcone tube which is connected to a polypropylene tube and a specially designed stainless probe for lacrimal insertion. Due to the smooth connection of the polypropylene tube and the silicone tube intubation can be performed easily and without the so-called accordeon phenomenon. In case of congenital or acquired lacrimal stenosis probing and silicone intubation can be performed in one step. We used this set in 19 lacrimal lacerations of the lacrimal pathway and in 7 cases of congenital and 12 cases of acquired lacrimal stenosis. With this specially designed lacrimal intubation set lacerated canaliculi can be quickly reapproximated. It allows probing of the lacrimal system and intubation in one procedure. In this report the technique and indications will be described and discussed.
Collapse
|