Egy La Tène-kori szövőház Üllő környékéről

In my study, I analyzed a weaving house of the settlement Üllő Site 5 from the Late Iron Age. Firstly, because the finds of the weaving house were not sufficient for the dating, I collected typical pottery from other features, which helped to define the settlement’s dating to LTC2–LTD1 period. Afterward, I analyzed the weaving house itself. This was a semi-subterranean rectangular house with rounded corners, with two post holes on the short sides. It had a roof construction with two posts and purlin, as well as an ascending wall. The area of the house was 4×3.2 m. The feature had a wall seat on the northwest side, which proves the house was a workshop-type pithouse. This conclusion is based on the new research of the Late Iron Age houses by Lőrinc Tímár and Zsolt Gallina. Roof construction probably was covered by a canopy or a vaulted roof, which was supported by the post in the wall seat. The weaving house’s pottery finds consisted of handmade pieces. This kind of pottery was commonly used in the Late Iron Age, its dating is not solved. I found an odd rim fragment, which differs from the finds of the age, concerning both its shape and material. I studied the weights found in the house, that probably belonged to looms. There were two separate looms in the house showing differences in their dimensions. Presumably, the first weaving loom was in the state of disassembly, when the house started to collapse. The weaving house of Üllő provides new data for the research of the Late Iron Age craftsmanship in the Carpathian Basin

Superior Ventriculo-Arterial Coupling with Decellularized Allografts Compared with Conventional Prostheses

Background To date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts. Methods After preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group). Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure- conductance catheter. From the hemodynamic variables end-systolic elastance (Ees), arterial elastance (Ea) and ventriculoarterial coupling were calculated. Characteristic impedance (Z) was assessed by Fourier analysis. Results While Ees did not differ between the groups and over time (4.1±1.19 vs. 4.58±1.39 mmHg/mL and 3.21±0.97 vs. 3.96±1.16 mmHg/mL), Ea showed a higher increase in the prosthesis group (4.01±0.67 vs. 6.18±0.20 mmHg/mL, P<0.05) in comparison to decellularized allografts (5.03±0.35 vs. 5.99±1.09 mmHg/mL). This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5±50.9 vs. 3.9±23.4%). Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6±8.3dyn·sec·cm−5 vs. 32.4±2.0dyn·sec·cm−5, P<0.05). Conclusions Total aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance thereby improving ventriculoarterial mechanoenergetics after aortic arch replacement

Total Aortic Arch Replacement: Superior Ventriculo-Arterial Coupling with Decellularized Allografts Compared with Conventional Prostheses.

BACKGROUND: To date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts. METHODS: After preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group). Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure-conductance catheter. From the hemodynamic variables end-systolic elastance (Ees), arterial elastance (Ea) and ventriculoarterial coupling were calculated. Characteristic impedance (Z) was assessed by Fourier analysis. RESULTS: While Ees did not differ between the groups and over time (4.1+/-1.19 vs. 4.58+/-1.39 mmHg/mL and 3.21+/-0.97 vs. 3.96+/-1.16 mmHg/mL), Ea showed a higher increase in the prosthesis group (4.01+/-0.67 vs. 6.18+/-0.20 mmHg/mL, P<0.05) in comparison to decellularized allografts (5.03+/-0.35 vs. 5.99+/-1.09 mmHg/mL). This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5+/-50.9 vs. 3.9+/-23.4%). Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6+/-8.3dyn.sec.cm-5 vs. 32.4+/-2.0dyn.sec.cm-5, P<0.05). CONCLUSIONS: Total aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance thereby improving ventriculoarterial mechanoenergetics after aortic arch replacement

A szubakut de Quervain-thyreoiditis. A kórismézés sarokpontjai négy eset kapcsán | De Quervain thyroiditis. Corner points of the diagnosis

A pajzsmirigy gyulladásos megbetegedései klinikai megjelenésük alapján heveny, szubakut és krónikus formákba oszthatók. A de Quervain- (más néven óriássejtes vagy granulomatosus) thyreoiditis a szubakut csoportba sorolható, a pajzsmirigy betegségeinek mintegy 5%-át teszi ki. Eredete pontosan még nem tisztázott, rendszerint két héttel a felső légúti virális infekciót követően jelentkezik. A klinikai képet típusos esetben nyelési, illetve a fül felé sugárzó fájdalom uralja, a pajzsmirigy kifejezett tapintási érzékenységével. Jellemző a jelentősen gyorsult süllyedés, amely nem feltétlenül társul leukocytosissal és a C-reaktív fehérje emelkedésével. Lefolyásában négy fázis figyelhető meg: a destruktív gyulladásos folyamat átmeneti hyperthyreosissal jár, majd annak mérséklődése, illetve megszűnése euthyreoid állapotot eredményez. Utóbbit átmeneti hypothyreoid fázis követi, végül, a regeneráció beindulását követően, ismét normofunkció észlelhető. Az ultrahangos képen diffúz hypoechogen szerkezet látható, nem ritka azonban göbök előfordulása sem. A kórkép gyakran felismeretlen marad, vagy kezdeti szakaszát tévesen, hyperthyreosisként véleményezik és kezelik. Antitestvizsgálatok, pajzsmirigy-szcintigráfia, göbök fennállása esetén finomtű-aspirációs citológiai mintavétel segíthet a kórisme felállításában. Speciális kezelést általában nem igényel, a fájdalom enyhítésére átmenetileg nem szteroid gyulladáscsökkentő, esetleg szteroid adható. A szerzők négy, részben eltérő klinikai megjelenésű esetük bemutatásával a kórismézés és az elkülönítő diagnózis sarokpontjaira kívánják felhívni a figyelmet. Orv. Hetil., 2014, 155(17), 676–680. | Inflammatory disorders of the thyroid gland are divided into three groups according to their duration (acute, subacute and chronic). De Quervain’s thyroiditis (also termed giant cell or granulomatous thyroiditis) is a subacute inflammation of the thyroid, which accounts for 5% of thyroid disorders. The etiology is unknown, it usually appears two weeks after an upper viral respiratory infection. The clinical feature includes neck pain, which is aggraviated during swallowing, and radiates to the ear. On palpation, the thyroid is exquisitely tender. The erythrocyte sedimentation rate is markedly elevated, the leukocyte count, C-reactive protein are normal or slightly elevated. The natural history of granulomatous thyroiditis involves four phases: the destructive inflammation results temporarily in hyperthyroidism followed by euthyroidism. After a transient hypothyroidism the disease becomes inactive and the thyroid function is normalised. Ultrasonographic findings are diffuse hypoechogenic structures, but nodules may also occur. The disease often remains unrecognised, or the first phase of the disease is diagnosed and treated as hyperthyroidism. The diagnosis can be confirmed by the presence of the thyroid autoantibodies, radioiodine uptake and fine needle aspiration cytology. There is no special treatment, non-steroid anti-inflammatory drugs or steroid should be given to relieve the pain. The aim of the authors is to shed light the key points of diagnosis and differential diagnosis by the presentation of four slightly different cases. Orv. Hetil., 2014, 155(17), 676–680

Wernicke-encephalopathia linitis plasticában | Wernicke encephalopathy accompanying linitis plastica

A Wernicke-encephalopathia (vagy más leírásokban: Wernicke–Korsakoff-encephalopathia) a belgyógyászati gyakorlatban ritkán felismert kórkép, amit B1-vitamin-hiány okoz. Típusos formáját jellegzetes triász kíséri (zavartság, szemmozgászavar, ataxia), gyakoribb azonban, hogy e tünetekbol csak a zavartság van jelen. Leggyakrabban krónikus alkoholfogyasztókon figyelheto meg, de társulhat – más kórképek mellett - végstádiumú tumoros betegségekhez is, ahol a zavart viselkedésnek számtalan egyéb oka is lehet. A szerzok idos, elorehaladott gyomortumorban szenvedo férfi betegen észlelt Wernicke-encephalopathiás esetüket ismertetik, felhívva a figyelmet a kórismézés és a differen­ciáldiagnosztika nehézségeire. Orv. Hetil., 2014, 155(1), 30–33. | Wernicke encephalopathy (or Wernicke–Korsakoff encephalopathy) is a rarely diagnosed neurological disorder, which is caused by vitamin B1 deficiency. In the classical form it is characterized by a typical triad (confusion, oculomotor disturbance and ataxia), however, in the majority of the cases only confusion is present. It can be frequently observed in subjects with chronic alcohol consumption, but it may accompany different pathological states of which end stage malignant diseases are the most importants, where confusion may have different backgrounds. The authors present the case of an old male patient with advanced gastric cancer recognised and treated vitamin B1 deficiency, and they draw attention to difficulties of the diagnosis of Wernicke’s disease. Orv. Hetil., 2014, 155(1), 30–33

A gestatiós diabetes szűrésére ajánlott két nemzetközi eljárás hatékonyságának összehasonlítása | Comparison of the effectivity of two internationally recommended screening methods for the recognition of gestational diabetes

Bevezetés: A terhességi cukorbetegség időben történő felismerése és megfelelő kezelése az anya és a magzat számára egyaránt kiemelkedő fontosságú. Noha nemzetközi és nemzeti szaktársasági állásfoglalások születtek az időben történő felismerés módszertanáról, az esetek egy része az Egészségügyi Világszervezet által ajánlott (1. ajánlás) s ma legáltalánosabban használt módszerrel is rejtve maradhat. Több vizsgálatban összefüggést találtak az anyai vércukorszint és a halvaszülések, a praeeclampsia-előfordulás, illetve a születési időre számított nagy súlyú újszülöttek világrahozatala között, a legnagyobb visszhangot a Hyperglycemia and Adverse Pregnancy Outcomes vizsgálat hozta. Megállapításai nyomán a Diabéteszes Terhességgel Foglalkozó Munkacsoportok Nemzetközi Szövetsége a 75 grammos cukorterhelésen alapuló, de az 1. ajánlásban szereplőtől eltérő kritériumrendszerű szűrést javasolt (2. ajánlás). Célkitűzés: A vizsgálat célja várandósok terhességi kimenetelének elemzésével a két szűrési eljárás hatékonyságának összevetése volt. Módszerek: Egyszeres terhességet hordozó 1107 várandóst, 831 normális glükóztoleranciájú és 276, a két szűrés valamelyikével gestatiós diabetesesnek minősülő terhest vizsgáltak, részletesen elemezve a terhességi kimenetel anyai (koraszülés, túlhordás, sectio caesarea, toxaemia) és magzati mutatóit (születési súly, újszülöttkori hypoglykaemia). Eredmények: A születési időre számított nagy súlyú magzatok prevalenciája kivételével – melynek csökkentésében a 2. ajánlás, illetve az ennek alapján megkezdett gondozás hatékonyabbnak bizonyult – a két szűrési eljárás eredményességében érdemi különbség nem volt kimutatható. Következtetés: Az új ajánlás szerinti szűrés a glükózanyagcsere-zavar biztonságosabb felismerését eredményezheti, az egyértelmű állásfoglalás azonban nagyobb esetszámú további vizsgálatokat igényel. Orv. Hetil., 2013, 154, 776–783. | Introduction: Early diagnosis and adequate care of gestational diabetes is of great importance for both the mother and her fetus. Although several national and international guidelines are known on the methodology for screening gestational diabetes, a not negligible part of the cases remain unrecognized when applying even the most widely used criteria recommended by the World Health Organization (1st recommendation). A connection has been found between the maternal blood glucose values and the prevalence of still-birth, preeclampsia and large for gestational age neonates in several studies, from which the Hyperglycaemia and Adverse Pregnancy Outcomes study has come into prominence. According to conclusions of this study the International Association of Diabetic Pregnancy Study Groups suggested new numeric criteria for the evaluation of the 75-gramm oral glucose tolerance test (2nd rercommendation), which differs from the evaluation used in the afore mentioned screening system. Aims: The aim of the study was to compare the effectiveness of the two screening systems by evaluation of the pregnancy outcomes. Methods: By following non-twin pregnancies of 1107 pregnant mothers (831 with normal glucose tolerance, 276 with gestational diabetes based on any of the applied screening methods) the maternal (pre- and postterminal birth, caesarean section, toxaemia) and newborns pregnancy outcomes (infants small and large for gestational age, hypoglycaemia) were analysed. Results: With the exception of the prevalence of large for gestational age infants – which was higher among women screened by the new evaluation – no substantial difference in the efficacy of the two investigated methods was found. Conclusion: The decision whether the screening of gestational diabetes using the new criteria results in safer recognition of the disturbances of glucose metabolism during pregnancy requires further investigations including a large number of cases. Orv. Hetil., 2013, 154, 776–783