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Biomedical subjects

G Acsády

Publications and source records attributed to G Acsády.

17 recordsLinked to original sources
PubMed2005

Changes in the plasma concentration of soluble thrombomodulin in patients with severe carotid artery stenosis after eversion endarterectomy.

OBJECTIVE AND DESIGN: The purpose of the study was to investigate the putative role of soluble thrombomodulin (sTM) in severe carotid artery stenosis. MATERIALS AND METHODS: We prospectively studied 64 patients who were undergoing carotid endarterectomy (2001-2003). Plasma sTM concentration was determined in each patient before surgery and at 14 months postsurgery. -308 TNF-alpha promoter polymorphism was also determined. RESULTS: Strong negative correlation was found between the preoperative duplex scan values and the plasma sTM concentrations (R = -0.418, p = 0.0006). Patients with 308 A TNF-alpha genotype had significantly lower (p = 0.0415) preoperative sTM values than their counterparts with no such polymorphism. Soluble TM concentrations measured in plasma samples taken at the end of the postsurgical follow-up period of 14 months duration were significantly higher compared to the preoperative values (p < 0.0001). CONCLUSIONS: Our present findings indicate that sTM may be adsorbed to the atherosclerotic plaques or inflamed endothelium in carotid arteries. The pathological significance of this adsorption remains to be determined.

Adsorption↗
PubMed2004

Marked decrease in the levels of two inflammatory markers, hs-C-reactive protein and fibrinogen in patients with severe carotid atherosclerosis after eversion carotid endarterectomy.

OBJECTIVE AND DESIGN: To study changes in the levels of two acute phase proteins, plasma fibrinogen and serum C-reactive protein (hs-CRP) in patients with severe carotid stenosis after eversion endarterectomy. MATERIAL AND SUBJECTS: A total of 117 consecutive patients who underwent eversion endarterectomy were included in the study. Blood samples for acute phase protein measurement were taken before operation as well as 5.7 weeks and 13.8 months (median) post-surgery. Plasma fibrinogen and serum hs-CRP concentrations were promptly determined. RESULTS: During the follow-up period sharp, highly significant (p < 0.0001) drop occurred in the serum concentrations of both acute phase proteins. The drop in the hs-CRP levels during the follow up period was mainly due to decrease in patients with highest baseline CRP levels. CONCLUSIONS: Our present findings indicate that removal of atherosclerotic plaques from the carotid arteries markedly decreases the production of two acute phase proteins due to the decrease of the inflammatory burden or the removal of the advanced plaques able to produce these proteins.

Arteritis↗
PubMed2001

[Anatomical and extra-anatomical reconstructions in aorto-iliac occlusive diseases].

PURPOSE: In the case of the aorto-iliac arteries occlusion there are two different operative reconstructive possibilities. As an anatomical reconstruction the open desobliteration of the iliaca arteries, the retrograde half-closed desobliteration or the aorto/ilio-femoral bypasses can be mentioned. As an extraanatomical solution ilio/femoro-femoral crossover bypass can be implanted. We compared the results of these two types of operations. PROCEDURE: Between 1 January 1998 and 31 December 1999 at the Cardiovascular Surgical Department of the Semmelweis University Budapest 239 primary, reconstructive operations were done because of the iliac arteries occlusion. We made 175 anatomical and 64 extraanatomical operations. We controlled the results of this operation in this retrospective study. RESULTS: Since the operation 12 patients died, most of them because of cardial reasons. Hundred sixty seven survival patients could be involved in the study. There was no significant difference regarding the age and the Fontaine stadium of the patients in the two groups. Two-third of the patients underwent anatomical, the others extraanatomical operations. The patency rate in the anatomical group was 92.8%, with the extraanatomical patients 90%. In the view of the postoperative function after the anatomical reconstruction the claudication distance was longer. There were two limb amputations, one of them because of distal progression of the atherosclerosis, in the other case the reason was reocclusion of the graft. DISCUSSION: In this study we examined patients who underwent an operation about 3 years ago. The preoperative stadium of the two non-selected groups was similar. The postoperative patency rate was quite similar, but the postoperative function after the anatomical reconstruction was significantly better. In our opinion the results of the two different types of the reconstruction used by proper indication were the similarly satisfactory.

Aorta↗
PubMed2001

[Thrombolytic therapy as pretreatment before vascular operations and radiologic interventions].

The authors describe their 60 cases of thrombolysis with steptokinase (SK). Thrombolysis was required in 55 patients because of arterial, while in 5 patients because of venous side thrombosis. The 73% of the patients with arterial occlusion where thrombolysis was applied belonged Fountain stage IV, while 27% to Fountain stage III. Graft occlusion occurred in 60% of all cases and the acute or subacute thrombosis of the native vessels required thrombolysis in 40%. The thrombolysis alone was sufficient in 26 patients, while it was completed with PTA in 9, with PTA and implantation of stent in 1 and with vascular surgical procedure in 10 cases. Reconstruction surgery was the final solution in 4 patients, for whom the thrombolysis was inadequate. Amputation was unavoidable in 8 cases. The thrombolysis therapy was successful in 77% in our experience. The high number of hemorrhagic complications was due to the bleeding of puncture hole. It needed surgical suture in 10 cases.

Angioplasty↗
PubMed2001

[Treatment options for complications in vascular surgery].

The authors processed the patients' data of the last 10 years and present their experience in treating septic complications in the field of vascular surgery. They analyzed the therapeutic possibilities and reviewed the literature. They suggest the following treatment alternatives for the infection related complications, that they consider the best options these days: 1. Identification of the causative agent by microbiologic methods and determination of the antibiotic susceptibility. 2. In the cases of occluded grafts it is recommended to remove the whole graft and to apply a suction-irrigation drainage. 3. In the cases of patent grafts: (a) If the infections starts in the immediate postoperative period it is suggested to spare the graft, open the wound, perform debridement and apply a suction-irrigation drainage. (b) Late suppurations, confined to the trunk of the graft without affecting the anastomoses, requires extensive debridement and lavage, and the graft could be left in place. (c) Anastomosis infection calls for graft removal, in situ reconstruction and suction-irrigation drainage in one setting. (d) Extraanatomic bypass is indicated when culture proves bacteria producing extraprotease enzymes because in these cases the incidence of repetitive septic bleedings are significantly higher, so in situ reconstructions are not recommended.

Adult↗
PubMed1997

[Striking increase in mortality from venous diseases in Hungary].

The statistical data of the World Health Organisation were studied from 1970 to 1990 to evaluate changes in mortality caused by venous diseases in 9 European countries and in the USA. The data were analysed in process and mortality rates in Hungary and in other countries were compared. In 1970 data based on general population of Hungary indicated medium incidence of mortality due to vein pathology (10.8/100,000) compared to the economically more developed countries. Unfortunately by 1990 mortality due to venous diseases almost had doubled (19.8/100,000). During this 20 years period mortality rates caused by venous diseases gradually decreased in the USA and in most European countries, e.g. by 80% in Austria and by 70% in Finland. Even the relatively high mortality caused by venous diseases in Switzerland (10/100,000) comprises only 50% of that demonstrated in Hungary. While the significance of modern thromboprophylaxis was recognised in the Western European countries and the USA in the early seventies, a delay of the introduction of prophylaxis with low-dose heparin was observed in Hungary. Socio-economic and nutritional causes could have been contributed to the high mortality rates caused by venous diseases as well. Further epidemiologic investigations focusing on venous morbidity factors and wide scale application of organised preventive programme are suggested.

Adolescent↗
PubMed1997

Proximal bleeding control obtained by a balloon catheter in the surgical repair of a left supraclavicular traumatic arteriovenous fistula.

Endovascular procedures offer various methods for the treatment of posttraumatic arteriovenous fistulas. We report the treatment of a posttraumatic arteriovenous fistula between the left subclavian artery and internal jugular vein combined with a large subclavian false aneurysm. To avoid left thoracotomy we attained control of arterial bleeding by means of a transfemorally introduced balloon catheter advanced into the left subclavian artery. We found that the combination of endovascular procedures with classical surgery can reduce the risks in the treatment of arteriovenous fistulas.

Aged↗
PubMed1996

An overview of vascular surgery in Hungary.

The practice of vascular surgery in Hungary was initiated in 1952 and its progress can be seen as beginning with a "trial" stage from 1952 to 1960. During the period from 1960 to 1980, the first of the operations known today were performed, and since 1991, vascular surgery has become routinely practiced, with the number of vascular reconstructions each year exceeding 6,000. From a population of 10 million inhabitants in Hungary, a total of 6,892 arterial reconstructions were carried out during 1990 by 150 vascular surgeons, with a total of 400 allocated beds.

Humans↗
PubMed1992

[Regulation of blood circulation in the extremities in intermittent claudication].

UNLABELLED: The study was aimed to investigate the characteristics of the limb circulation in patients suffering from intermittent claudication. The study group consisted of 71 patients with intermittent claudication. As control served the data of 60 patients with intact peripheral circulation and 24 patients suffering from rest pain, too. The limb blood flow was measured by the venous isotope dye-dilution method. RESULTS: 1. The limb blood flow will be diminished in intermittent claudication already in resting state. The decrease of the limb blood flow is more expressed in severe claudication (with short claudication distance). 2. The pathological condition of the limb circulation in intermittent claudication can be characterized by the elevation of the limb vascular resistance. 3. The O2 consumption of the limb tissues will decrease in intermittent claudication. The data of the study are indicating that the regulation of the limb circulation will pathologically be changed in claudication. The reserves of the peripheral circulation are diminished and the insufficiency of the limb circulation will be manifested on walking.

Adult↗
PubMed1990

Histomorphological and pathobiochemical changes of varicose veins. A possible explanation of the development of varicosis.

The authors should like to contribute to the unsettled problem of the development of varicose venous disease with their own experience. They evaluate parallel the histomorphological observations and certain pathobiochemical changes which can be recognized in exstirpated varicose veins. Fourty five stripped saphenas have been studied. They were divided into two groups: a macroscopically normal and a varicose one. The varicose patients were divided again into two subsamples according to the occurrence or lack of thrombophlebitis in their medical case history. The authors were looking for the appropriate pathobiochemical changes of the vessel walls running parallel to the usual histopathological changes. It seems quite possible that the effect which triggers the development of the disease could be anything which causes hypoxia, alters the energy metabolism of the otherwise bradytrophic vascular tissues. Accumulation of proteoglycans, as well as collagen and elastic fibers in place of the smooth muscle cells may cause a decrease in the elasticity of the veins and may produce favourable conditions to thrombus formation and local inflammation.

Carbon Dioxide↗
PubMed1990

Regulation of circulation in congestive heart failure.

Regulation of extremity (limb) circulation was studied in 21 patients suffering from congestive heart failure. In 11 cases the peripheral circulation was intact, while 10 patients also suffered from peripheral obliterative arterial disease. Data of 75 patients with normal cardiac condition served as control: 35 subjects with intact peripheral circulation and 40 patients suffering from peripheral obliterative arterial disease. Limb blood flow was measured by using venous isotope dilution technique. Cardiac output was determined by the dye dilution method. In chronic heart failure the limb circulation characteristically deviated from the normal; the limb blood flow and the limb oxygen consumption slightly decreased, while the limb vascular resistance markedly increased. The diminution of the limb blood flow and the increase in the limb vascular resistance due to obliterative arterial disease were more pronounced in patients suffering from congestive heart failure. The pathological increase in the peripheral vascular resistance due to chronic heart failure proved mostly reversible; on the administration of vasodilator drugs the elevated limb vascular resistance markedly decreased and the limb blood flow significantly increased.

Adult↗
PubMed1989

The characteristics of the peripheral-limb-circulation in congestive heart failure.

The regulation of the peripheral-limb circulation was investigated in 21 patients suffering from chronic cardiac failure (NYHA stage II and III). In 11 patients the extremital circulation was intact, while 10 patients suffered from peripheral obliterative arterial disease, too (intermittent claudication or rest pain). The control group consisted of 75 subjects with normal cardiac condition. In 35 of the control subjects the peripheral circulation was intact, the remaining 40 suffered from extremital venous isotope dilution technique. In congestive heart failure the limb blood flow and the limb oxygen consumption slightly diminished, but remained in the normal range. The limb vascular resistance significantly increased. In patients suffering from intermittent claudication or rest pain, the marked diminution of the limb blood flow and elevation of the vascular resistance was more pronounced in congestive heart failure than in healthy subjects. The pathologically elevated limb vascular resistance decreased and the limb blood flow significantly increased in congestive heart failure on administration of vasodilator drugs. A pathological and mostly reversible increase in extremital vascular resistance is the most characteristic sign of the peripheral circulation in congestive heart failure.

Adult↗
PubMed1986

Thermographic study of haemodynamic changes due to arteriovenous shunt.

The authors made thermographic studies on the haemodynamic changes due to arteriovenous shunt in animal experiments under different conditions. The effects due to acute and chronic fistulas in reaction-free and inflammatory environments were registered. Observations of diagnostic value were made on the haemodynamic changes due to arteriovenous shunt. These are of differential diagnostic importance also in human medical practice, therefore thermography is recommended to be used as new noninvasive diagnostic tools.

Animals↗
PubMed1985

Application of a vascular graft material (Solcograft-P) in experimental surgery.

The implantation and post-implantation behaviour of a Solcograft-P vascular prosthesis in the aortic, aorto-iliac, carotid and vena caval positions in dogs was studied up to 100 d post-surgery in order to assess the suitability of this vascular material for use in man. Solcograft-P is prepared from the carotid arteries of calves by crosslinking the collagen stroma using adipyl dichloride. During the postoperative follow-up period of 3 month, 100% of the aortal grafts, 80% of the aorto-iliac bypasses, 60% of the vena caval grafts and 35% of the carotid implants remained patent. The biochemical properties of the Solcograft-P are better than those of Solcograft, its predecessor. The intimal lining was consistently smooth and homogeneous in grafts of biological origin, and no aneurysm was observed. Infection and early thrombosis occured no more frequently than with other grafts. The new Solcograft-P, crosslinked via ester and amide groups, seems to represent a real improvement over Solcograft. Our results suggest that Solcograft-P should prove valuable in various cases of reconstructive vascular surgery of the lower limb, especially when the autologous vena saphena magna is not available, and its mechanical properties may well prove suitable for both arterial and venous replacement.

Animals↗
PubMedDate not supplied

Development and treatment of false aneurysm following vascular intervention.

The development and treatment of false aneurysm after cardiovascular intervention is discussed. At the Cardiovascular Surgical Clinic of Semmelweis Medical University (Budapest) 6900 reconstruction operations were performed. Ninety-five false aneurysms were operated on. According to the cause leading to the complication the patients are classified into 8 groups. To treat the false aneurysm 14 types of operation were carried out. Operative mortality was 12.6 per cent, but the outcome was successful in 70 per cent of the patients. The technique of surgical treatment is described. A review of the literature is presented.

Aneurysm↗