[Academician Jan Bedrna--founder of the Surgery School in Hradec Králové].
Explore the source record for details and available documents.
Czech Republic↗
Biomedical subjects
J Dominik
Publications and source records attributed to J Dominik.
[The endovascular treatment of the aortic trauma].
BACKGROUND: Traumatic injuries of the thoracic aorta are very frequent during motor vehicle accidents with sudden deceleration. Spiral CT has become the modality of choice for evaluating significant blunt trauma and grading system for aortic injury has been developed. Immediate diagnosis, introduction of antihypertensive therapy and endovascular treatment by means of stentgraft give a better chance for patients with blunt aortic injury. AIM: Prospective evaluation of results of endovascularly treated patients with blunt aortic injury. MATERIALS AND METHODS: We prospectively followed patients after endovascular treatment of acute aortic injury. Diagnosis was based on chest x-ray and CT examination. Stentgrafts were placed under fluoroscopic guidance and patients were routinely followed by CT and clinical visit. RESULTS: Between December 1999 and September 2004 we endovascularly treated seven patients (6 men, 1 woman, mean age 41.7 years) for blunt aortic injury of the thoracic aorta. Stentgraft was implanted between 5 hours and 6 days (mean 3.2 days) after injury. Seven stentgrafts were implanted in 7 patients in total. One patient died due to failure of endovascular technique for collapsed stentgraft. A new onset of lower legs paraparesis was detected in one patient. Other five patients are regularly followed (3-55 months, mean 30.7 months) without any complications. CONCLUSION: Endoluminal technique can be used successfully in the immediate repair of aortic trauma. At present time in our center, treatment by means of the stentgraft placement is the first line therapy in injured patients. It allows rapid stabilization of aortic trauma and further treatment of other injuries.
Absorptiometry, Photon↗
Environmental impact of early Basque mining and smelting recorded in a high ash minerogenic peat deposit.
More than four metres of core, covering almost 5000 years of deposition, were collected in a high ash minerogenic peat deposit located in the High Aldudes valley (Basque country), an area well known for its mineral abundance, exploited from Roman Times at least. Although minerogenic peatlands are not generally considered as the best archives to reconstruct past atmospheric metal deposition history, lead isotopic geochemistry demonstrates the integrity of the Pb record at least within the three upper meters; that is to say over the last four millennia. Zn, Cd and Cu may have been widely redistributed either by biological cycling, advective groundwater movements, or diffusional processes. Anthropogenic lead input phases are clearly pinpointed by positive shifts in Pb/Sc ratios with concomitant sharp drops in (206)Pb/(207)Pb ratios. They are often accompanied by significant declines in tree taxa, interpreted as increasing demand for wood to supply energy for local mining and/or metallurgical operations. Periods of mining and/or smelting activity are identified during Antiquity and Modern Times, and are also confirmed by textual and field evidence. Inputs from the Rio Tinto (Southern Spain), often invoked as a major lead contributor to the European atmosphere during Roman Times, were not detected here. This remote source was probably masked by local inputs. Other mining and/or smelting phases, only suspected by archaeologists, are here identified as early as the Bronze Age. Although the durations of these phases are possibly overestimated because of detrital inputs consequent to the release of lead from polluted soils over a long period of time after major pollutant inputs, the periods at which pollution peaks occur are in good agreement with archaeological knowledge and palaeo-botanical data. The combination of geochemical and palaeo-botanical techniques with field archaeology, therefore provides a powerful tool in studying the interaction of early human societies with their environment, as regards early mining and smelting.
Archaeology↗
History and environmental impact of mining activity in Celtic Aeduan territory recorded in a peat bog (Morvan, France).
The present study aims to document historical mining and smelting activities by means of geochemical and pollen analyses performed in a peat bog core collected around the Bibracte oppidum (Morvan, France), the largest settlement of the great Aeduan Celtic tribe (ca. 180 B.C. to 25 A.D.). The anthropogenic Pb profile indicates local mining operations starting from the Late Bronze Age, ca. cal. 1300 B.C. Lead inputs peaked at the height of Aeduan civilization and then decreased after the Roman conquest of Gaul, when the site was abandoned. Other phases of mining are recognized from the 11th century to modern times. They have all led to modifications in plant cover, probably related in part to forest clearances necessary to supply energy for mining and smelting. Zn, Sb, Cd, and Cu distributions may result from diffusional and biological processes or from the influence of groundwater and underlying mineral soil, precluding their interpretation for historical reconstruction. The abundance of mineral resources, in addition to the strategic location, might explain why early settlers founded the city of Bibracte at that particular place. About 20% of the anthropogenic lead record was accumulated before our era and about 50% before the 18th century, which constitutes a troublesome heritage. Any attempts to develop control strategies in accumulating environments should take into account past human activities in order to not overestimate the impact of contemporary pollution.
Archaeology↗
Assessment of water quality and toxicity of polluted Rivers Fez and Sebou in the region of Fez (Morocco).
Water quality assessment in the region of Fez based on the physicochemical and ecotoxicological investigations is presented. The results indicate that sites located close to the most urbanized and industrialized areas are severely impaired. The major water quality problems are: low dissolved oxygen (DO), high turbidity, organic matter and ammonia contents, severe chromium and copper pollution and high acute and chronic toxicity. This results in the loss of the aquatic life which is still flourishing in the Fez River upstream from the Fez Medina. Remote sites downstream show signs of physicochemical recovery. However, even there, bioassays showed significant acute and chronic toxicity. Well water in the region of Fez has moderately poor water quality with nitrate and metal enrichments. Use of water for drinking or for agriculture from the rivers or from some wells without treatment may expose the population to health risk.
Biological Assay↗
Organic colloid separation in contrasting aquatic environments with tangential flow filtration.
The use of tangential flow filtration (TFF) for size fractionation of natural dissolved organic matter was investigated. The performance of regenerated cellulose membrane with a nominal molecular weight cut-off of 1 kDa was examined on 20 samples from lake, river and estuary systems, characterised by contrasting dissolved organic carbon (DOC) contents and conductivity. The evaluation was based on absorbance, fluorescence and DOC measurements. Detailed protocols of membrane cleaning and conditioning nation are proposed. The ultrafiltration membrane can efficiently be cleaned to provide low carbon blank (<0.01 mg/L). Fluorescence measurements confirmed that the higher molecular weight compounds were isolated in the retentate and the lower molecular weight remain in the permeate. Mass balance for natural samples show good recovery for DOC (109 +/- 12%, n = 20) and fluorescence measurements (106 +/- 9%, n = 13). No relation between factors of concentration (fc) and mass balance quality was observed for the fc range 1.5-11. Moreover, high ionic strength and high DOC contents did not enhance membrane fouling. These findings demonstrate that reliable fractionations by TFF of natural organic colloids in aquatic systems can be achieved.
Carbon↗
[Surgical myocardial revascularization in a female patient with bilateral occlusion of the common carotid arteries].
Concurrent stenosis of the coronary and carotid circulation is one of the most serious disease. The authors describe the case of a 74-year old female patient with ischaemic heart disease with concurrent bilateral occlusion of the common carotid arteries. Surgical revascularization of the myocardium was made using extracorporeal circulation under general normothermia with protection of the heart muscle from ischaemia by the method of warm blood cardioplegia. In the discussion the authors analyze contemporary possibilities of surgical treatment of ischaemic disease (MIDCAB, OPCAB, operations with extracorporeal circulation) and emphasize the advantages and risks of different procedures.
Aged↗
Use of chelating resins and inductively coupled plasma mass spectrometry for simultaneous determination of trace and major elements in small volumes of saline water samples.
For some saline environments (e.g. deeply percolating groundwater, interstitial water in marine sediments, water sample collected after several steps of fractionation) the volume of water sample available is limited. A technique is presented which enables simultaneous determination of major and trace elements after preconcentration of only 60 mL sample on chelating resins. Chelex-100 and Chelamine were used for the preconcentration of trace elements (Cd, Cu, Pb, Zn, Sc) and rare earth elements (La, Ce, Nd, Yb) from saline water before their measurement by inductively coupled plasma mass spectrometry. Retention of the major elements (Na, Ca, Mg) by the Chelamine resin was lower than by Chelex; this enabled their direct measurement in the solution after passage through the resin column. For trace metal recoveries both resins yield the same mass balance. Only Chelex resin enabled the quantitative recovery of rare earth elements. The major elements, trace metals and rare earth elements cannot be measured after passage through one resin only. The protocol proposes the initial use of Chelamine for measurement of trace and major elements and then passage the same sample through the Chelex resin for determination of the rare earth elements. The detection limit ranged from 1 to 12 pg mL(-1). At concentrations of 1 ng mL(-1) of trace metals and REE spiked in coastal water the precision for 10 replicates was in the range of 0.3-3.4% (RSD). The accuracy of the method was demonstrated by analyzing two standard reference waters, SLRS-3 and CASS-3.
Buffers↗
Factors controlling 7Be and 210Pb atmospheric deposition as revealed by sampling individual rain events in the region of Geneva, Switzerland.
Bulk atmospheric deposition of 7Be and 210Pb has been measured at Versoix, close to Geneva, Switzerland. Collectors were continuously deployed from November 1997 through November 1998 for periods from 1 to 22 days depending on the frequency of rain. The activities of 7Be and 210Pb integrated over the sampling interval were moderately well correlated with rainfall (r2 of 0.66 and 0.55, respectively; p < 0.001) and well correlated one with the other (r2 of 0.91; p < 0.001). The 7Be/210Pb activity ratio is close to 13.5, except for samples collected in the periods of very low precipitation which have a distinctly lower ratio. A simple model accounting for rainfall, seasonal variations and reload of the local atmosphere after a rain event explains 90% of the variance of 7Be and 210Pb deposition. Concentrations of 210Pb and Ca++ in rain were correlated with transport time of air masses over the continent as indicated by reconstruction of air mass trajectories over three days.
Air Pollutants, Radioactive↗
Paraplegia as an unusual manifestation of aortic coarctation.
In this report, we present an unusual case of a 20-year-old man whose first symptom of aortic coarctation was sudden paraplegia due to spinal epidural hemorrhage caused by rupture of an aneurysmal collateral vessel. Now, one year after surgical correction of coarctation, the patient has had no cardiac or neurological problems. To our knowledge, this is the only clearly documented case of such an aortic coarctation complication.
Adult↗
[Primary PTCA in the treatment of acute myocardial infarct. Experience at the Faculty Hospital in Hradec Kralove].
INTRODUCTION: Primary coronary angioplasty is at present a fully accepted and worldwide method of treatment of acute myocardial infarction. As proved by a number of randomized studies, this treatment is associated with a higher rate of coronary patency, a smaller infarction focus an better clinical results as compared with thrombolytic treatment. METHOD: The authors analyzed a register of 233 consecutively treated patients with primary coronary angioplasty in the Faculty Hospital in Hradec Králové with elevation of the ST sections on electrocardiographic examination during the period from September 1997-January 2001. RESULTS: Acute success defined as a residual stenosis < 30%, normal flow through the vessel (TIMI III) and survival for the first 24 hours was 91.0% and without patients with cardiogenic shock even 96.0%. The total mortality on hospitalization was 9.1%. The mortality of patients without cardiogenic shock was only 1.9%. A high mortality was recorded in patients in cardiogenic shock (74.0%). A stent was implanted in 65.0% patients, subacute thrombosis of the stent occurred in 1.9%. During a 6-month follow up the total mortality was 10.3%. The percentage of patients without any cardiovascular even (event free survival, EFS) after discharge from hospital was 81.0%. CONCLUSIONS: The authors provided evidence that primary coronary angiolpasty is a safe and highly effective method in the treatment of acute myocardial infarction. It is associated with a total hospitalization mortality of ca 10% and a mortality of less than 2% in patients without cardiogenic shock. Cardiogenic shock, on the other hand, remains a problem despite intensive treatment such as inotropic support, mechanical reperfusion and intraortal balloon counterpulsation. In the presented work the mortality of patients with cardiogenic shock was 74.1%. Implantation of a stent does not involve a major risk for the patient, the incidence of subacute thrombosis of the stent is low and does not differ from elective procedures. The fate of patients during the follow up after primary angioplasty is favourable. In the presented work the total 6-month mortality was 10.3% and EFS was 81.0%.
Angioplasty, Balloon, Coronary↗
Morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery.
BACKGROUND AND AIM: Due to the constantly improving results of surgical revascularization for coronary heart disease even the elderly patients are offered more frequently this type of treatment. Since older age is a harbinger of reduced vital capacity and increased morbidity the results of coronary artery bypass grafting (CABG) in elderly as well as long-term benefit deserve a careful examination. MATERIALS AND METHODS: 1475 isolated CABG procedures performed between 1995 and 1997 in a university hospital cardiac surgery unit, divided in group I (age below 70, n = 1324) and group II (age 70 and over, n = 151). A retrospective analysis of pre-operative, peri-operative and post-operative data. RESULTS: Significant differences (lower BMI and BSA, advanced NYHA and CCS stage, higher prevalence of diabetes, renal dysfunction and extracardial atherosclerotic lesions) were found in elderly. CABG was performed in both groups with no differences in technique of procedure (only slightly longer duration of CPB in group II). However, there was markedly higher mortality (2.3 vs. 7.3%, p < 0.005), incidence of NearMiss+ (18.4 vs. 36.4%, p < 0.005) and post-operative morbidity (34.6 vs. 56.3%, p < 0.005) in the older group, which was also expressed in a longer ICU stay and postoperative hospitalization. CONCLUSION: Coronary revascularization can be performed in elderly with higher but still acceptable risk. Higher mortality and associated morbidity is caused by higher preoperative prevalence of known risk factors as well as generally reduced vital capacity. Surgical procedure should not be denied to elderly population because of the age alone but a careful evaluation of an individual patient is required.
Age Factors↗
Axillary-coronary artery bypass reconstruction as an alternative in coronary artery reoperations.
BACKGROUND AND AIMS: The increasing incidence of reoperations in coronary surgery associated with higher perioperative risks is a challenge for refinement of the surgical methods. The aim of the work is to prove the feasibility and satisfactory intermediate results of minimally invasive axillary-coronary artery bypass reconstruction in redo coronary surgery in case the left internal mammary artery had already been harvested. MATERIAL AND METHODS: Three patients (six months, two and six years after primary coronary artery bypass grafting) admitted for redo coronary surgery because of a recurrence of angina and proven malfunction of the left internal mammary artery-left anterior descending coronary artery anastomosis. An axillary-coronary venous graft was performed via left anterior small thoracotomy (LAST) on a beating heart in all three cases. RESULTS: Excellent patency of the graft was noted on control angiography within 9 days after the procedure together with good clinical improvement in midterm follow-up. CONCLUSION: Minimally invasive axillary-coronary artery bypass via LAST access in redo coronary surgery is a good alternative in cases where the left internal mammary artery cannot be used.
Aged↗
[Biopsy of the heart valves. 872 cases].
In this study, 872 heart valves surgically excised from 810 patients during a period of 5 years (1994 through 1998) were examined pathologically. There was a predominance of aortic (506 patients) versus mitral valves (246 pts.). While aortic valves came more often from men (364) than from women (142), in mitral valves the M:F ratio is 82/164. Isolated calcific aortic stenosis appeared as the most frequent valvular disease (418 pts.), with predominance of its sclerotic-senile type (238 pts.). Mitral stenosis (185 pts.) remains the classical post-rheumatic disease. The relative frequency of a subvalvular stenosing mitral lesion is stressed. The "pure" incompetence of both aortic (70 pts.) and mitral (56 pts.) valve was usually based on valvular myxoid degeneration. An aorto-mitral disease requiring replacement of both valves (51 pts.) presented typically as a post-rheumatic lesion, however, a combination of a post-rheumatic mitral with a degenerative-sclerotic aortic valve disease may be possible. In 30 patients, the valvular replacement was performed for infective endocarditis or a post-IE lesion, mostly of the aortic valve. With the almost non-existence of acute rheumatic fever and with the increasing average age of population in this country, we may expect a long-term decline in mitral valve disease and an increase in aortic valve disease, particularly in the sclerotic type of aortic stenosis.
Adult↗
Changes of the serum antibiotic levels during open heart surgery (ceftazidim, ciprofloxacin, clindamycin).
BACKGROUND: Wound, mediastinal and intracardiac infections are still very serious complications of open-heart surgery. The incidence of it is still in the range of 0.4%-5%. The aims of our study were to assess the adequacy of regimen using ceftazidim (CTZ), ciprofloxacin (CPF) and clindamycin (CLIN) as prophylactic antibiotics and to verify whether cardiopulmonary bypass (CPB) can modify the time of antibiotic serum concentrations. That is why the serum levels of them were measured during open heart procedures. METHODS: The prospective study comprised 75 consequent coronary patients randomized in to three groups receiving 1 g of CTZ or 400 mg of CPF or 900 mg of CLIN i.v. with anesthesia induction. Routine coronary surgery with left internal mammary artery harvesting, moderate body hypothermic (30 degrees C) CPB with crystaloid cardioplegia was performed. Serum antibiotic levels were determined before application, with skin incision, prior CPB induction, after cardioplegia infusion, every 20 minutes of CPB, prior end of CPB, in time of chest closure. Conventional cylinder-plate microbiological assay was used for antibiotic level measurement. RESULTS: All serum antibiotic concentrations showed a sharp decrease immediately after starting CPB and lasted until CPB ended. After initiating of CPB after cardioplegia administration serum concentrations of CTZ (105 min after initial dose) decreased by, on average 55%, CPF (97 min) by 42% and CLIN (116 min) by 78%. CONCLUSION: CPB can modify the time course of antibiotic serum concentrations. The serum levels of CTZ at the end of the longest procedures were found to be below the MICs for some of the suspected pathogens. We recommend to use higher antibiotic doses for prophylaxis and to administer the second dose with protamin sulphate to obtain maximum concentration in newly formed blood clots.
Anti-Bacterial Agents↗
Comparison between blood and crystalloid cardioplegia in patients with left ventricular dysfunction undergoing coronary surgery.
This study was done to compare the protective effect of blood and crystalloid cardioplegia in patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG). Sixty consecutive patients with left ventricular ejection fraction < 35% scheduled for CABG with the use of cardiopulmonary bypass without additional procedures were randomly divided into two groups. In the first group we used cold blood cardioplegia, in the second group cold crystalloid cardioplegia, both delivered only ortogradely. We measured hemodynamic data in early hours after operation, enzyme release and we collected other clinical data which could be influenced by perioperative myocardial protection. There was no death in either group. We also didn't find any significant difference in incidence of perioperative myocardial infarction, arrhythmias and use of intraaortic balloon pumping between both groups. In an early hours after operation in the group with blood cardioplegia we found significantly better hemodynamic data (LVSWI, RVSWI) and significantly lower enzyme release. We conclude, that cold blood cardioplegia shows superior perioperative myocardial protection resulting in earlier restoration of myocardial function. This difference could be important in patients with high degree of left ventricular dysfunction.
Aged↗
[Cardiac myxomas].
Cardiac myxoma is the most common primary tumor of the heart. Between 1970 and 1998, 33 myxomas from patients operated at the Cardiosurgical Department were submitted for pathological examination. A review of age, sex and clinical symptoms of the patients as well as of gross and histological features of the tumors is presented. Immunohistochemical examination was performed on 10 selected myxomas-reactivity to vimentin, desmin, S-100 protein, cytokeratin and FVIIIR-Ag. The necessity of histological examination of the embolectomy material is stressed.
Adult↗
Acute toxicity assessment of Polish (waste) water with a microplate-based Hydra attenuata assay: a comparison with the Microtox test.
The use of Hydra attenuata in acute toxicity assessment is a potentially useful tool in (waste) water biomonitoring. The purpose of this study was to compare the sensitivity of H. attenuata with the extensively used Microtox test on 14 (waste) water samples from the Kraków region (South Poland). To this end, specific morphological changes displayed by the freshwater cnidarian Hydra attenuata (lethal LC50s and sublethal EC50s effects) and bioluminescence of the marine bacteria Vibrio fisheri (Microtox) were compared. Clearly, the Hydra assay was the more sensitive indicator of toxicity. No relationship was found among Hydra toxicological responses and water levels of As, Cd, Co, Cu, Pb and Zn. However, it appeared that toxicity to Hydra might be due to ammonia levels. Additional studies to better circumscribe the tolerance of H. attenuata to 'natural' water characteristics are needed.
Animals↗