The Efficiency of Selected Green Solvents and Parameters for Polyphenol Extraction from Chokeberry (Aronia melanocarpa (Michx)) Pomace

Chokeberry pomace is a potential source of natural colourants, antimicrobial agents, and anti-senescence compounds due to its high polyphenols content. Therefore, this study assessed the efficiency of green solvents (50% ethanol, 50% glycerol, and 100% distilled water, all acidified with 1% citric acid or 1% formic acid) for anthocyanin and total phenolic content (TPC) extraction from lyophilised chokeberry pomace. Extraction was performed in a water bath at 40, 50, and 60 °C for 60 and 120 min, followed by ultrasonic treatment for 15 and 30 min. Based on the results, 50% ethanol + 1% citric acid yielded significantly higher total anthocyanin content in the case of both spectrometric and HPLC measurements (1783 ± 153 mg CGE/100 g DW and 879.5 mg/100 g DW) at 50 °C for 60 min. Citric acids seem more effective compared to formic acid. The highest values of TPC were obtained with 50% glycerol + 1% formic acid at 50 °C for 60 min (12,309 ± 759 mg GAE/100 g DW). This study provides evidence that a substantial quantity of polyphenols, which can potentially be used as a natural food additive, can be efficiently extracted with 50% ethanol + 1% citric acid or 50% glycerol at 50 °C for 60 min from chokeberry pomace.

Assessment of Berries of Some Sea Buckthorn Genotypes by Physicochemical Properties and Fatty Acid Content of the Seed

Sea buckthorn (Hippophae rhamnoides L.) is consumed mainly in its processed form. Therefore, the investigation of the physicochemical properties of its berries is a current task in the aspect of food processing. The aim of this study was to determine the physicochemical parameters (soluble solid content, total titratable acidity, sugar/acid ratio), color characteristics (L*, a*, b*) and fatty acid profile of five varieties ('Askola', 'Clara', 'Habego', 'Leikora', 'Mara') and one Hungarian candidate, R-01, to establish a basis for experiments on the processability of the whole berries (e.g., drying). The weight of the berry of 'Leikora' (0.64 g) was significantly higher than the other investigated fruits. The differences between the values of soluble solid content (6.3-10.84 °Brix) and titratable acid (1.4-3.7%) content of berries were significant. 'Mara' had the highest sugar/acid ratio. Regarding the fatty acid profile, the amount of unsaturated fatty acids was measured between 72.6-83.4%, including polyunsaturated fatty acids, which were between 32.3-58.1%. The seeds of the tested samples contained high concentrations of linoleic acid (17.0-33.2%) and linolenic acid (15.3-24.9%), mainly in the case of the 'Mara', 'Clara' and 'Askola' varieties. Candidate R-01 could be used as a raw material for functional foods due to its significant content of palmitoleic acid and a favourable omega-6/omega-3 ratio.

Effect of ascorbic acid and acerola juice on some quality properties of aseptic filled apple juice

Quality and storability are crucial factors in production of apple juice. The main goal of this study was investigation of the effects of ascorbic acid and acerola juice on the changes of some sensorial parameters and bioactive compounds of aseptically filled and industrial scale produced apple juice during storage for 12 months. While the viscosity and pH of apple juice did not change significantly, the ΔE* peaked (20–30) at month 6 of the storage period. The colour of apple juice was lighter than at the beginning of storage. Maximum total phenolic contents were 1,100, 1,400, and 1,250 mg L−1 in the control, ascorbic acid supplemented, and acerola added samples, respectively. Other parameters (antioxidant capacity, ascorbic acid, browning index, etc.) peaked in month 4. Acerola was a good alternative anti-browning and antioxidant agent for the treatment of apple juice in the processing. The antioxidant capacity of apple juice treated with acerola was higher than with ascorbic acid. The results were obtained with industrial samples, thus, they can serve as a very good base for the optimisation process and industrial production without the need for scale-up.

[Surgery without boundaries]

Surgery at the turn of the century and at the millennium is characterised by an extremely rapid development. There are no boundaries anymore among the different branches of medicine, in different anatomical regions of the human body, between the living human and the artificial tissues, between the reality and the virtual reality. Nanotechnology and robotics offer new possibilities for minimally invasive procedures. By the introduction of telepresence surgery there are no more surgical limits among countries and continents, between Earth and Space as well. A new chapter in history of medicine is the Cyber Surgery. The future has already arrived. Even in this new world we have to follow the ethical requirements summarised in the Hyppocrates Oath.

[Antireflux procedures at our unit (1990-1999)]

A retrospective analysis was carried out to evaluate the changing attitude of antireflux surgical practice of the authors. Between 1990 and 1994 24 antireflux procedures were performed. Laparoscopic antireflux surgery was introduced in 1995. Since then 41 laparoscopic and 23 open repairs have been performed. Indication for surgery was always based on thorough preoperative examination protocol including functional tests of the esophagus. Each patients had undergone endoscopic and X-ray examinations. The patients are under continuous follow-up surveillance. During the postoperative follow-up studies more than 2/3 of the patients (61 patients) agreed to carry out the functional tests postoperatively.

RESULTS

The demographic data of patients of the two study periods proved to be comparable. The length of history was 10.5 years in the first group, while it was 8.9 years in the second group. In both groups the surgical repair caused significant reflux control confirmed by decrease of reflux index and number of reflux episodes furthermore by increase of resting lower esophageal sphincter pressure. Actually 4 recurrences are known in the first group and 2 in the second group. One of the 4 recurrences observed in the first period was treated by redo surgery. The patients having recurrences in the second period can easily be managed by medical therapy. There was no mortality and severe morbidity during the study periods. Few patients reported mild temporary dysphagia.

CONCLUSIONS

In a given proportion of reflux patients the individually planned and perfectly performed antireflux surgery offers an acceptable definitive treatment option. The availability of endoscopic surgery enhances this trend, which can be seen all over the world. An increase can be seen in the number of procedures: nearly three times more patients were operated on during the second period. The early clinical results of laparoscopic antireflux procedures are good enough. Good long-term results can be expected if we accept and apply the basic technical principles determined during the open surgery era.

[Repeat vascular surgeries on lower limbs]

The authors present the results of 85 redo operations, which were performed in the 3rd Surgical Department of Semmelweis University and the Surgical Department of St. Borbála Hospital in Tatabánya. The period under survey lasted for five years from 01 January 1996 to 31 December 2000. 783 vascular reconstruction were performed in authors' departments during this period. The authors call attention to the fact that they consider the possibility of redo operations at the planning of the first operation, therefore it is recommended to make only the necessary operation and provide the opportunity for further operations. In their material ten percent of the reconstructive vascular operations were redo operations.

Surgical aspects of gastro-esophageal reflux disease--indication for surgery. An update

Gastro-esophageal reflux disease is regarded as the single most common foregut disorder mainly in Western countries. The pathophysiological background of the disease is multifactorial. The primary aim of the management of gastro-esophageal reflux disease is relieving heartburn and healing esophagitis. The therapeutic objectives are alleviating symptoms, preventing complications and avoiding recurrence. Besides the effective medical treatment nowadays we possess the minimal invasive anti-reflux surgery which gives comparable, even better results than medical therapy does, in cases of patients who are suitable for anti-reflux surgery. The key question is the appropriate patient selection. In order to achieve the most adequate patient selection, diagnostic tools like endoscopy, radiotherapy, esophageal body and sphincter manometry, 24-hour esophageal pH monitoring and occasionally 24-hour bile exposure monitoring and gastric emptying studies are mandatory to carry out preoperatively. On the basis of the results of these tests the tailored concept of anti-reflux surgery can be applied. The importance of experienced surgeon should be pointed out, too.

Functional and immunocytochemical evidence that galanin is a physiological regulator of human jejunal motility

The neuropeptide galanin has species-dependent effects on intestinal motility. It has a contractile effect on rat jejunal muscle while it relaxes guinea-pig ileum by inhibiting cholinergic transmission. Its effect on human gut motility has been unknown. Extensive work led to the discovery of selective galanin analogues such as M15 [galanin(1-12)-Pro-substance-P(5-11)], M35 [galanin(1-12)-Pro-bradykinin(2-9)-amide] that competitively inhibit various actions of galanin in the central nervous system. The present study was designed to examine the effect of galanin, M15 and M35 on longitudinal jejunal smooth muscle strips isolated from humans and rats, and to localize galanin-immunoreactivity in human jejunum. Galanin and ACh were equally effective in stimulating contractions of the isolated jejunal muscle: sigmoid curve fitting showed that maximal contractile response to galanin and ACh were 25.7+/-11.1 mN and 23.7+/-9.7 in humans, while 8.0+/-0.6 and 8.1+/-0.3 mN in rats, respectively. These effects of galanin were not inhibited by either atropine (5 x 10(-6) M) or tetrodotoxin (3 x 10(-6) M). The potency of galanin inducing the contractile actions were similar in humans and rats. Interestingly, neither M15 nor M35 (up to 10(-7) M) were able to inhibit the responses of the smooth muscle to galanin. However, both putative galanin receptor antagonists showed agonist effects in our experimental models. In accordance with the functional studies, both the longitudinal and the circular muscle layers were abundant in nerve fibers and varicosities showing galanin immunoreactivity. Our data suggest that galanin is a potent physiological regulator of jejunal contractions in humans. Its action on the jejunum, however, is mediated by galanin receptors that are different from those located in the central nervous system.

Effects of putative galanin antagonists M35 and C7 on rat exocrine pancreas

Galanin is a neuropeptide having a wide range of biological actions. Recently selective galanin receptor antagonists such as M35 [galanin(1-12)-Pro-bradykinin(2-9)-amide] and C7 [galanin(1-12)-Pro-spantide-amide] have been described. These antagonists have blocked the actions of galanin on flexor reflex, glucose-induced insulin secretion, and acetyicholine release from hippocampus. Our present aim was to investigate whether M35 and C7 can affect galanin-induced inhibition of pancreatic enzyme secretion in rats. Pancreatic enzyme secretion was studied in urethane-anesthetized rats supplied with jugular vein catheter and pancreatic cannula. Amylase secretion evoked by submaximal CCK-8 stimulation was inhibited dose-dependently by galanin in anesthetized rats. Surprisingly, neither M35 nor C7 was able to inhibit the responses of the exocrine pancreas to galanin. However, both putative galanin receptor antagonists behaved as agonists in our experimental models. Our data suggest that the effects of galanin on pancreatic enzyme secretion are not mediated by M35- or C7-sensitive galanin receptors. Therefore, these galanin receptors are different from those described in the central nervous system.

Intraabdominal abscess managed successfully via the laparoscopic approach

A rare complication of laparoscopic fundoplication-an intraabdominal abscess located between the fundus and the caudate lobe of the liver-is described. A 41-year-old man had undergone a laparoscopic Nissen-Rossetti fundoplication for longstanding gastroesophageal reflux disease. On the 5th postoperative day, the patient's general condition became worse, and he developed intermittent-remittent fever (40 degrees C), an elevated white blood cell count (WBC), and an accelerated sedimentation rate. Evidence of leakage was excluded by Gastrografin swallow. The diagnosis was finally revealed by means of ultrasound and computed tomography (CT) scan, which showed an intraabdominal fluid collection with an air cap of ~10 cm in diameter situated between the diaphragmatic crura, the caudate lobe of the liver, and the gastric fundus. The location did not allow semi-invasive management of the abscess, such as ultrasound or CT-guided puncture and drainage. On the 8th postoperative day, a laparoscopic exploration was performed utilizing the previous port sites. The adhesions were easily dissected, and evacuation of ~300 ml of white, dense fluid, and lavage and drainage were performed without intraabdominal dissemination of pus. The patient was discharged on the 12th postoperative day free of symptoms. Microbiological examination of the pus showed the presence of Peptostreptococcus. The patient remained symptom free. At 8 weeks postoperatively, barium swallow, endoscopy, 24-h pH monitoring, and stationary manometry of the esophagus yielded normal results. Because there was no direct evidence of leakage at the fundus, the development of the abscess was concluded to be due to the use of deep transmucosal stitches rather than seromuscular ones to create the wrap. The nonabsorbable multifilament suture material passing through the entire gastric wall could have facilitated bacterial contamination of the operative field.

[Result of Panzytrat 25000 therapy following total gastrectomy]

Thirteen patients who had undergone total gastrectomy because of gastric cancer in 11 cases and gastric lymphoma in 2 cases (6 female, 7 male) at the 3rd Department of Surgery, Semmelweis University, Medical School have been followed up. The length of follow up period varied between 7.5 months and six years. Vitamin B12 substitution was applied in each case (300 micrograms/month). In 6 cases early temporary iron substitution was necessary. Regular pancreatic enzyme substitution (pancreatin) was used during meals in these patients. At the beginning Kreon (Chinoin) or Neo-Panpur (Egis) treatment was applied. Since April 1996 the patients have been treated by Panzytrat 25,000 (Knoll) which has higher enzyme content comparing with the previous ones. Following gastrectomy the digestion and absorption improved due to pancreatic enzyme substitution and the body weight increased. The serum albumin and cholesterol levels elevated significantly, while the serum uric acid levels did not changed. The iron absorption improved, patients did not require iron substitution later, except two cases. One of them needed transitoric and the other continuous iron substitution. Side effects were recorded in six cases. One of the 13 patients stopped application of Panzytrat 25,000 because of epigastric pain among other side effects (2 epigastric pain, 2 hyperuric state, 2 frequent discharge of stool) and returned to well tolerated Neo-Panpur.

MAO inhibitory side effects of neuroleptics and platelet serotonin content in schizophrenic patients

In order to study the putative monoamine oxidase (MAO) inhibitory side effect of neuroleptics and simultaneous changes in platelet serotonin content both MAO-B activity and serotonin (5-HT) content in platelets of 30 healthy volunteers and 50 schizophrenic patients treated with neuroleptics were investigated. Our results have shown significantly lower MAO-B activity (15.26 +/- 6.81 S.D. vs. 8.63 +/- 3.82 mmol/hour/10(9) platelets) and higher platelet 5-HT content (906.19 +/- 285.33 vs. 1,727.85 +/- 947.40 ng/10(9) platelets) in the schizophrenic group. Platelet MAO-B activity was considerably lower in paranoid and residual schizophrenics compared with other patients, however, no difference was found in platelet 5-HT content between different subtypes of schizophrenia. Various neuroleptic treatments did not produce different effects either on platelet serotonin content or platelet MAO-B activity.

Platelet MAO-B activity and serotonin content in patients with dementia: effect of age, medication, and disease

This study aimed at determining the effect of drug therapy, age and type of dementia on biological markers. Both platelet monoamine oxidase type B (MAO-B) activity and serotonin content of 57 demented patients and 20 control subjects were determined. Platelet MAO-B activity was measured using [14C]tyramine as substrate. Serotonin content was determined by HPLC-EC method. Increased platelet serotonin content and platelet count was found in patients with dementia compared to controls. A positive correlation was experienced between platelet MAO-B activity, platelet serotonin content and age. Platelet MAO-B activity was higher in the haloperidol treated group, compared with patients treated with anxyolitics. The main original finding of the present study is that platelet serotonin content is increased in demented patients with delusions compared to dementia without complications (p = 0.006). It seems, that platelet MAO-B activity is influenced mainly by drug therapy, while serotonin content rather reflects clinical characteristics in dementia.

Biliary tract complications in laparoscopic cholecystectomy. A multicenter study of 148 biliary tract injuries in 26,440 operations

BACKGROUND

The higher risk of biliary tract injury is considered the most significant disadvantage of laparoscopic cholecystectomy.

METHODS

A national multicenter retrospective study was performed to determine the frequency, etiology, and treatment of biliary tract injuries between January 1, 1991, and December 31, 1994. Follow-up was by questionnaire.

RESULTS

Some 148 biliary tract complications were observed during 26,440 laparoscopic cholecystectomies. There was no significant correlation found between the number of LCs performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage, but in the 2nd year of practice, the incidence of both complications decreased. In institutes with more conversions, more cases of bile leakage were also observed. A significant positive relationship was found between biliary tract injuries and postoperative bile leaks. There was no significant relationship between usage of intravenous and intraoperative cholangiography and ERCP. In univariant analysis of the type of injury, the primary treatment modality did not affect the outcome of injury or entail the necessity of reoperation. Obscure anatomy leads to significantly more main bile duct injuries. According to multivariant analysis, the outcome is significantly influenced unfavorably by the necessity of repeated interventions and advanced age.

CONCLUSIONS

The definitely higher risk of bile duct injury mentioned in early studies was not confirmed.

Long-term clinical results of highly selective vagotomy performed between 1980 and 1990

A retrospective analysis was conducted of 778 patients who underwent highly selective vagotomy between 1980 and 1990. Surgery was performed for duodenal ulcers without any complications in 485 (62.3%) patients; for duodenal ulcers with complications such as stenosis, bleeding, or perforation in 270 (34.7%); for combined duodenal and ventricular ulcers in 12 (1.5%), and for ventricular ulcers alone in 11 (1.4%). Pyloroplasty was additionally performed in the presence of complications only. The incidence of intraoperative complications proved to be as high as 1.4%, occurring in 11 patients, while postoperative complications developed in 247 patients (31.7%). Although the overall mortality was 0.6% (5 patients), the mortality rate of those patients who underwent surgery for uncomplicated ulcer disease was 0.2% only (2 patients). The patients comprised 554 men (71.2%) and 224 women (28.8%) with an average age of 41.4 +/- 0.7 years. The average duration of duodenal ulcer disease was 9.5 years, and 643 (83.2%) of the patients were able to be regularly followed up for between 3 and 13 years. Recurrence developed in 62 patients (9.6%): in the duodenum in 57 patients (91.9%), and in the stomach in 5 (8.1%). The rate of recurrence according to sex was 9.4% in men and 10.3% in women, being 42 and 20 patients, respectively. The average duration until recurrence appeared was 27.06 +/- 3.44 months. A reoperation proved necessary in 28 of these 62 patients (45.1%). The clinical results were evaluated by means of a modified Visick classification, according to which 81.8% of the patients belonged to groups 1 or 2, 7.9% to group 3, and 10.3% to group 4.

[Laparoscopic cholecystectomy causing injury to biliary tracts. Analysis of the results of 26,440 operations in Hungary]

The authors analyse the etiology, diagnosis, treatment and outcome of 148 biliary tract injuries in connection with 26,440 laparoscopic cholecystectomies performed in 89 domestic institutes between January 1st, 1991, and December 31st, 1994. There was no significant correlation between the amount of laparoscopic cholecystectomies performed in one institute and the incidence of biliary tract injuries and postoperative bile leakage (wide range of figures were found in different institutes), but in the second year of practice, the incidence of both complication decreased (there was statistically significant difference between the regression co-efficients). There was no significant correlation between the laparoscopic cholecystectomies performed and the rate of conversion, but the co-efficient of the regression curve showing the correlation of the absolute number of laparoscopic cholecystectomies and conversions significantly decreased in the second year of practice. In institutes having significantly more conversions, more cases of bile leakage was found also. There is a significantly positive relationship between biliary tract injuries and postoperative bile leakage; the more lesions are found in an institute, the more cases of bile leakage they have. There was no significant relationship between the incidence biliary tract injuries and postoperative bile leakage and the usage of intraoperative cholangiography, preoperative intravenous cholangiography and/or ERCP. The partial and complete injuries of main bile ducts were detected intraoperatively significantly more often while most of the lesions of the area of cystic duct were detected postoperatively. There was no significant difference between the types of the only postoperative recognized injuries and the time of establishing the diagnosis. Simple suture was performed in 69.2% of the partial injuries (with or without T-tube or other drainage), while 63.3% of the complete transsections were treated with biliodigestive anastomosis. In univariant analysis the type of injury, the primary treatment modality did not affect on the outcome (the ratio of cured and expired), but significantly more patients continue to have complaints following biliodigestive anastomosis than following the treatment of lesions around the cystic duct. The older the patient is, the worse the prognosis is. The primary treatment modality (biliodigestive anastomosis or biliary tract reconstruction with or without drain) did not significantly altered the necessity of reoperation. Thermic injury caused significantly more partial than complete lesion. Disturbance in identification of the anatomic structures leads significantly more partial or complete main bile duct injuries than lesion in region of the cystic duct and causes more complete transsections than partial lesions. According to multivariant analysis the outcome is significantly influenced in an adverse way by the necessity of repeated interventions and higher age.

[Laparoscopic cholecystectomy]

Traditional cholecystectomy has been the standard surgical treatment of the gallstone disease for more than 100 years. The technical development led to a new surgical procedure and its rapid acceptance. This is laparoscopic cholecystectomy. Its application is becoming widespread in therapy too. But most of the surgeons are lack of technical experiences in this field. Currently it restricts the indications those are anyway the same of standard cholecystectomy. Besides its many advantages, laparoscopic cholecystectomy has its own disadvantages and being an invasive procedure, there are possibilities of complications. The latest can be reduced by the adequate choice of patients, the careful learning of the operative technic and by turning to open surgery (conversion) when it is necessary. Its morbidity is nearly equal to complications of standard cholecystectomy, but mortality rate is lower (0.05-0.2%). Our morbidity of performed 300 laparoscopic cholecystectomies was 6.4%. We had no death. The hospitalization became as short as 4 days. Our early clinical results (90%) are the same of traditional cholecystectomy. Laparoscopic cholecystectomy as a new surgical procedure involves the efficiency of the standard cholecystectomy and the noninvasive endoscopic technic. Laparoscopic cholecystectomy performed by well trained surgeons is a safe surgical procedure, its early results are excellent and makes the choice of surgical treatment, used in bile surgery richer.

[Etiology, symptomatology, diagnosis, differential diagnosis and management of Crohn disease]

The non specific, chronic, inflammatory, granulomatous Crohn's disease is not common in our country. Despite wide clinical and experimental experiences, its etiology hasn't been cleared yet. Its symptoms are especially various. The diagnosis--particularly in early stages--despite the clinical feature and modern diagnostic methods, is difficult. Only histology can give exact diagnosis. However Crohn's disease often can be diagnosed only on the basis of clinical symptoms, later appearing complications featuring this disease--particularly fistula--and indirect histological changes that can be seen in biopsy. Differential diagnosis--particularly in early stages--is also difficult, as the symptoms of Crohn's disease may be similar to symptoms of any other abdominal diseases. The therapy of Crohn's disease is mainly medical, even in some of those cases, when the occurring complications don't threaten the patient's life. Remission doesn't mean total recovery. Even by supporting treatment the disease may relapse at any time. Surgical treatment in indicated only in those cases, when complication occur threatening the patient's life, when active medical treatment is insufficient, or despite medical treatment progression can be observed.

The ridge-counts of the interdigital a-b, b-c, and c-d areas in a normal sample and in cerebrally damaged patients of Thuringia, G. D. R. (East Germany)

We determined the ridge-counts and their correlations of interdigital area a-b, b-c, and c-d among 300 boys and 300 girls from Jena and 95 male and 79 female cerebrally damaged children from the Mental Hospital of Stadtroda, both in Thuringia, G. D. R. (East Germany). The mean values of the normals and the patients differ significantly only on the right hand of males in the b-c area (p smaller than or equal to 5 per cent). Bimanuar comparisons showed significant correlations in the three areas in both sexes in the normal and the abnormal children. Inter-area comparisons revealed no significant correlation between a-b and b-c areas; correlations were significant between a-b and c-d areas in both sexes in the normal group, but significant for the right hand only in cerebrally damaged children. Highly significant correlation was found between the b-c and c-d areas only in the right hand of female cerebrally damaged children. Comparative data from Bavaria and North-Rhine-Westfalia are also presented.