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Biomedical subjects

D Dragojevic

Publications and source records attributed to D Dragojevic.

At least 19 recordsLinked to original sources
PubMed1989

The mechanism of angioplasty--endoscopic and morphometric investigations in an experimental model.

The effect of angioplasty using two different sizes of balloon catheter were examined by angiography and angioscopy before and after dilatation. A significant increase in the outer and inner diameters was seen accompanied by a decrease in the cross sectional area of the stenoses as well as the thickness of the vascular wall. Angioscopy revealed typical longitudinal tears of the plaque edges which are pressed during flow against the vessel wall. Turbidity of saline could be seen after dilatation indicating possible rupture of the atheromatous plaque. These findings are discussed in the light of the mechanisms of angioplasty and the possible reasons for the good early and long-term results.

Angioplasty, Balloon↗
PubMed1983

[Long-term results following resection and esophageal reconstruction in esophageal cancer].

Between 1968 and end of 1981 162 patients, aged 30 to 77 years (mean 59,9 years) underwent esophageal resection and digestive tract reconstruction for carcinoma of the esophagus and cardia. There were 102 squamous cell- and 60 adenocarcinomas which were located in 8 patients in the upper thoracic third, in 67 patients in the middle third and in 87 patients in the lower thoracic third including the cardia. Esophago-gastrostomy was performed in 138 cases whereas colon was used in 18 and jejunum in 6 cases. Overall hospital mortality was 14.8% and was reduced to 9.4% during the period from 1976 to 1981. Survival rates at two years and 5 years were 31.8% and 5.6% resp. However, for patients with seemingly "curative" resections, i.e. when the carcinoma was limited to the esophageal wall and the lymph nodes were found uninvolved, these rates were 73.2% and 23.7% resp. Follow-up studies in 103 patients revealed typical functional sequelae such as anastomotic stenosis and reflux in less than 20% of the patients. The incidence of such symptoms was higher in patients with a low subhilar anastomosis than in patients with a high supraaortic anastomosis. It is concluded that esophageal resection and reconstruction of intestinal passage for carcinoma may significantly prolong survival and may warrant a fairly acceptable quality of life. More than 70% of the investigated long-term survivors were leading a normal life also resuming an improved nutritional status.

Adenocarcinoma↗
PubMed1983

Functional surgery of bullous emphysema.

Multiple large and small emphysematous bullae were resected in 27 patients with chronic obstructive lung disease (COLD). Twenty-two patients were operated on one side, and 5 patients underwent bilateral consecutive operations. Twenty-five patients were male, 2 female, and they were between 22 and 67 years old (mean 49.5 years). All patients had a follow-up examination between 3 and 48 months postoperatively. As operative techniques, resection by means of a clamp, plication of cysts according to Nissen, resection with homologous dura plasty (7 patients) and pericardial plasty (7 patients) were used. In 19 patients preoperative and postoperative pulmonary function was compared. Functional improvement occurred in 17 patients - including all of the 5 bilateral procedures. Postoperative improvement was more pronounced with decreasing preoperative pulmonary function, measured as VC, RV, IGV and Raw. Partial pulmonary insufficiency could be improved in 9 patients and global pulmonary insufficiency was improved in 5. In 16 cases physical work capacity was increased. The hemodynamics of the pulmonary circulation were improved in all patients with increased preoperative pulmonary artery pressure (latent pulmonary hypertension in 7 patients, overt pulmonary hypertension in 5). FEV1 was least influenced by surgery, especially in patients more than 50 years old. The long-term prognosis, thus has to be judged cautiously. One patient died postoperatively (mortality 4%). The technique of dura and pericardial plasty, aiming at functional adaptation, is described. Sutures inverting or folding pulmonary tissue are avoided. The aspect of at least temporary (up to 3 years) functional improvement leads us to advocate the use of extended criteria of operability.

Adult↗
PubMed1982

[Use of the TDMAC heparin shunt for operations on the descending thoracic aorta (author's transl)].

This report summarizes our experience with the TDMAC heparin shunt for aortic bypass in descending thoracic aortic surgery. Between 1977 and 1981 twenty-four operations were performed with this shunt (19 men, 4 women, mean age 42 age). Indications for surgery were acute traumatic aortic rupture (6 patients), chronic aortic rupture (6 patients), acute aortic dissection (1 patient), chronic aortic dissection (4 patients), atherosclerotic aneurysms (3 patients), aortic aneurysms combined with PDA (1 patient), aortic aneurysm secondary to coarctation repair (1 patient), and infection of a vascular prosthesis (1 patient). Four patients died (hospital mortality 16.7%). One patient suffered perioperative paraplegia. In this patient the small size (7 mm) shunt hat been used. Therefore we suggest the large bore (9 mm) shunt be applied whenever possible, since even this larger size device displays a significant pressure gradient. When insertion of the shunt into the left subclavian artery is difficult, the ascending aorta or the apex of the left ventricle may be cannulated instead. In our cases we did not encounter any complications arising from shunt cannulation. The advantages of the TDMAC heparin shunt focus on the reduction of bleeding complications more common under systemic heparinization, and on less pronounced hemodynamic and metabolic sequelae following aortic clamping and declamping. With this shunt nearly all possible ischemic organ damage can be avoided.

Adult↗
PubMed1980

Surgery for traumatic rupture of the thoracic aorta.

Between 1975 and 1980, 9 patients with traumatic rupture of the thoracic aorta were operated at our institution. All patients showed additional multiple limb and internal organ injuries. Leading symptoms of aortic rupture were mediastinal widening (8), left-sided hemothorax (6), and acute aortic coarctation (2). Aortic rupture was proven by angiography in 8 patients and during exploratory thoracotomy in another. The time interval between trauma and operation was one to 48 hours, in 6 patients less than 4 hours. Atrio-femoral bypass was used in 3 patients, TDMAC-heparin shunt in 4 patients and 2 patients were operated without bypass. Prosthesis interposition was required in 3 patients while direct suture was possible in 6 patients. Long-term survival was achieved in 7 patients, one patient died from shock sequelae and another had suffered inoperable multiple rupture along the ascending and transverse aorta. It is concluded that patients with traumatic aortic rupture have a relatively good prognosis if diagnosis is established immediately and if surgery is feasible. The operative result is influenced substantially by the degree of preoperative shock and the presence of additional injuries.

Accidents, Traffic↗
PubMed1978

[Left ventricular dynamics with exercise after revascularization in advanced coronary heart disease (author's transl)].

66 patients with 2 and 3 vessel coronary heart disease were studied before and after complete successful revascularization. Hemodynamic measurements and biplane left ventricular angiograms were obtained at rest and during supine bicycle exercise.--After operation a significant overall decrease of LVEDP with exercise was seen; exercise LVEF increased in cases with left main disease and in most cases with double vessel disease and double bypass. Inconsistant response was present in 3 vessel disease. Improvement of left ventricular dynamics with exercise in advanced coronary disease after complete revascularization can be expected mainly in 2 vessel disease and left main coronary disease.

Angiocardiography↗
PubMed1978

[Efficiency of sequential aorta-coronary vein-bypass (author's transl)].

From 1976 to 1977 308 patients were treated with multiple aorto-coronary vein-bypass. Fiftytwo patients receiving sequential bypasses were compared with 256 patients in whom conventional multiple anastomoses were performed. The rate of postoperative bypass failure did not differ significantly in the two types of anastomoses: 16 per cent in sequential as compared to 18 per cent in conventional bypass. In both cases the circumflex-system was afflicted by bypass failure more frequently (20 per cent each). The practical and theoretical advantages and disadvantages of the two procedures are discussed. Sequential aortocoronary vein-bypass is considered the method of choice for certain combinations of coronary stenoses and also if an adequate length of vein can not be obtained.

Angiocardiography↗
PubMed1977

[Intracardiac correction of congenital heart anomalies in 104 infants (author's transl)].

From 1974 to 1976 104 infants (under 1 year of age) underwent intracardiac correction for congenital heart diseases. Mean age and body weight were 6.6 +/- 3.6 months resp. 5.66 +/- 1.4 kgs. The diagnoses and mortality rates were: transposition of the great arteries (TGA) with intact ventricular septum 27 (0), TGA plus associated anomalies 9 (0), ventricular septal defect (VSD) 20 (1), VSD plus associated anomalies 6 (1), total anomalous pulmonary venous drainage 9 (5), pulmonary stenosis and pulmonary atresia with intact ventricular septum 9 (2), aortic stenosis 7 (3), ASD I or II 7 (0), and miscellaneous 10 (3). Intracardiac correction was performed either on cardiopulmonary bypass and moderate hypothermia or in deep hypothermia with or without total circulatory arrest. The early mortality in the first group was 7% (6 out of 90), in the second group 64% (9 out of 14). With increasing experience, cardiopulmonary bypass has proven to be a save method for intracardiac correction of congenital heart anomalies in infancy even in the youngest age group under three months of age and under emergency conditions.

Age Factors↗
PubMed1977

[Dysphagia as a symptom of idiopathic fibrous mediastinitis].

A case of idiopathic chronic fibrous mediastinitis accompanied only by dysphagia is reported. Symptoms, etiology, and differential diagnosis are discussed with reference to the literature reviewed. The various conservative and operative methods of treatment are presented. In this case, attempts to mobilize the oesophagus were unsuccessful. Therefore, the oesophagus was bypassed via the colon.

Adult↗
PubMed1976

[Observations in two cases of primary fibrosarcoma of the lung (author's transl)].

Two cases of primary fibrosarcoma of the lung are reported. The different clinical findings as well as the different courses in both patients reveal problems in diagnosis and treatment of this rare pulmonary lesion. The diagnostic aspects are given and discussed with regards to bronchial carcinoma. It is believed that lobectomy is the rational treatment of primary fibrosarcoma although pneumonectomy must be considered in the indifferentiated typ. The doubtful prognosis requires an exact postoperative follow up in order to have the change of early surgical treatment or irradiation if metastasis or recurrence of the tumor occurs.

Adult↗
PubMed1975

[The diagnostic value of the 67gallium-scintigraphy in malignant melanoma (author's transl)].

In 24 melanoma patients body regions with suspicion of metastatic spread were scanned with 67Ga-Citrate. Twenty-two out of 28 melanoma metastases (79%) could be scintigraphically visualized. Falsely negative scans were particularly frequent with small, indurated skin metastases, whereas falsely positive scans were not observed in this study. By means of in vitro experiments it was shown that the uptake of 67Ga into a human melanoma cell line was temperature dependent and reached a maximal value at 37 degrees C after 2 hrs of incubation. Furthermore, it was found that under the same in vitro conditions our melanoma cells bound and released 67Ga differently from 51Cr. From the release studies it was concluded that 67Ga unlike 51Cr does not form a stabile intracellular complex with cell proteins.

Axilla↗
PubMed1975

Complications of permanent transvenous cardiac pacing.

Clinical experience with permanent transvenous pacing during a 6 year period at Hannover Medical School is presented. A total of 1,376 pacemaker operations were performed in 799 patients, with a mortality rate of 1.1 per cent. The most common complications were premature battery failure, dislocation of endocardial electrodes, infections of the generator and/or electrodes, and skin ulcerations. In our cumulative follow-up period of 1,225 years, a complication necessitating a reoperation is to be expected after an average function-time of 31 months. Including normal battery exhaustion in this calculation will make reoperation necessary every 21.9 months.

Adult↗