Biomedical subjects

J Dominik

Publications and source records attributed to J Dominik.

At least 37 records · Page 2Linked to original sources

PubMed1999

Thoracic electrical bioimpedance versus thermodilution in patients post open-heart surgery.

Thoracic electrical bioimpedance cardiography is a non-invasive, continuous and low-cost method of estimation of cardiac output and other haemodynamic parameters. Though subject to continuous technological refinement controversial opinions exist on its validity in subsets of critically ill patients, patients with heart disease or after cardiac surgery. A comparison study between thermodilution (TD) and bioimpedance (TEB) was performed in 28 patients undergoing elective cardiac surgery (CABG, aortic or mitral valve replacement or combined procedures). 128 pairs of cardiac index estimates at specific time points during 20 hours at the postoperative ICU were evaluated. A poor correlation (r = 0.26, p < 0.05, bias -0.07 l.min-1.m2, precision + 1.1 l.min-1.m-2, 95% limits of agreement -2.27-2.13 l.min-1.m-2) between TD and TEB cannot support the routine use of TEB monitoring in early postoperative period after open-heart surgery. Possible reasons of lack of agreement in this population are discussed. Further studies with technically improved bioimpedance cardiographs will be needed.

Cardiac Output↗

PubMed1999

Topical use of aprotinin in coronary artery bypass surgery.

OBJECTIVE: The internal mammary artery (IMA) ranks among excellent, widely used conduits for surgical coronary revascularization. Its harvesting and its using may cause other surgical and technical problems and complications and increase postoperative bleeding from wound surface after the IMA harvesting with significantly greater incidence of blood transfusion. The aim of this study was to get to know how much it increases postoperative bleeding losses and if the local application of aprotinin (to the wound surface after the IMA harvesting and into the pericardial cavity) can reduce them and thus decrease the number of blood transfusions. METHODS: In this study there are compared groups of patients (n = 275) operated at the University Department of Cardiac Surgery in Hradec Králové on account of ischemic heart disease. In the first part of this study results of operations of 200 patients were comprised retrospectively. Group A1 comprised 50 patients where for revascularization of the myocardium venous grafts were used. Group B1 comprised 50 patients where also the internal mammary artery was used. Group C1 was formed by 50 patients where after preparation of the IMA aprotinin (100,000 KIU) was administered locally to the wound surface after the IMA harvesting. Group D1 was formed by 50 patients where aprotinin (500,000 KIU) was administered locally to the wound surface and poured into the pericardial cavity before closure of the median sternotomy. The postoperative blood losses and the number of the administered blood transfusions were compared between these groups. RESULTS: The authors provided evidence that the using of the IMA increases significantly the postoperative blood losses (in group A1 675 ml +/- 352.9, in group B1 1232 ml +/- 336.5) and increases the number of required transfusions (in group A1 2.44 +/- 1.7, in group B1 3.45 +/- 1.0). By local aprotinin application to the wound surface after the IMA harvesting the blood losses and the number of administered transfusions were reduced in group C1 (896 ml (231.9, 2.74 +/- 0.8). In group D1 (local aprotinin application to the wound surface and into the pericardial cavity) the blood losses and the number of transfusions were increasingly reduced than in group C1 (797 ml +/- 280.5, 1.74 +/- 1.3). In the second, prospective randomised part of this study 3 groups of patients were compared. Group A2 comprised 25 patients where venous grafts for revascularization of myocardium were used. Group B2 was formed by 25 patients where also the IMA was used. Group D2 comprised 25 patients where aprotinin (500,000 u.) was administered locally to the wound surface after the IMA harvesting and poured into the pericardial cavity before closure of sternotomy. The postoperative blood losses and the number of administered blood transfusions were again compared between these groups. The total postoperative blood losses were 778 ml +/- 304.2 in group A2, 1072 ml +/- 391.8 in group B2 and 754 ml +/- 197.9 in group D2. There were compared blood losses after 6, 12 and 24 hours, too. There were the statistically significant differences among these groups during the whole postoperative period. The number of blood transfusions were 2.8 +/- 2.3 in group A2 and 2.04 +/- 1.1 in group B2. The use of aprotinin decreased this number in group D2, 1.44 +/- 1.1. CONCLUSIONS: The authors provided evidence that the harvesting and the using of the internal mammary artery for myocardial revascularization increases significantly the postoperative bleeding and increases the number of required transfusions. By local application of aprotinin the author reduced the blood losses and need of transfusions.

Administration, Topical↗

PubMed1999

[Kinetics of ceftazidime in prophylactic administration during cardiopulmonary bypass].

Serum ceftazidime levels were followed in 21 patients in which routine coronary bypass surgery with cardiopulmonary bypass was performed. Each patient received one gram of ceftazidime intravenously with anesthesia induction. Antibiotic concentrations were estimated using the microbiologic assay diffusion plate method. The average operation time was 220 +/- 41 minutes (range 130-310). The start of cardiopulmonary bypass was 86 +/- 21 minutes and the full flow time was 104 +/- 21 minutes after starting of ceftazidime application. It can be stated that the decline of ceftazidime serum levels after starting of cardiopulmonary bypass was faster in comparison with standard serum curves of this antibiotic. The concentrations of ceftazidime at the end of some operations were under the supposed minimal inhibitory concentrations for some microorganisms possibly implicated. No infection was recorded.

Cardiopulmonary Bypass↗

PubMed1999

[The post-perfusion syndrome after operations performed with extracorporeal circulation].

Postperfusion syndrome (PPS) is a dreaded complication of cardiac surgery operation in extracorporeal circulation (ECC). Four factors play a key role in its pathophysiology: 1. contact of blood with the material of ECC, 2. release of activated leucocytes from pulmonary bed after the release of aortic cross-clamp, 3. translocation of endotoxin due to gut ischemia and its consequent reperfusion, 4. activation of coagulation, fibrinolytic, kallikrein-kinin and complement systems. The occurrence of PPS can be limited by reducing the ECC time and/or cross-clamp time, by using membrane oxygenator in the system of ECC, by using polyester or polypropylene in the set of ECC, by using heparin-coated set or leucocyte filter in the system of ECC, by application of pharmacological dosis of corticosteroids prior to the ECC, by early enteral nutrition. In eligible patients it is possible to eliminate the risk of PPS completely by using the operation without ECC. The experience of the authors with above mentioned problems is given and confronted with literature.

Cardiac Surgical Procedures↗

PubMed1998

How long can the previously assembled cardiopulmonary bypass circuit stay sterile?

The sterility of previously assembled cardiopulmonary bypass circuits was investigated for 100 extracorporeal circuits. The closed circuits were assembled using aseptic technique and remained in the pump room until time of use. The mean time from point of setup to point of priming for the 100 consecutive circuits was 32 hours, with a range of 19 to 89 hours. Circuits were primed with the calculated volume of priming solution, circulated for 5 minutes and tested for microbial contamination by withdrawing 20 ml of the priming solution and 10 days incubated in Thioglycolate and Sabouraud culture mediums. All were found to be free of microbial contamination. The results of this investigation demonstrate that the sterility of the extracorporeal circuit, pre-assembled in advance of actual priming, can be maintained over an extended interval when standard aseptic technique is used. This allows the utilization of a pre-assembled circuit for emergency cardiopulmonary support.

Cardiopulmonary Bypass↗

PubMed1997

[Valve replacement in congenital aortic stenosis].

BACKGROUND: Hemodynamically significant congenital aortic stenosis is usually surgically solved by valvotomy, infrequently aortic valve replacement is necessary. The aim of this retrospective study (period 1979-1995) is to find reasons for valve replacement, frequency of these procedures and early and long term results after aortic valve replacement for congenital aortic stenosis. METHODS AND RESULTS: Congenital aortic stenosis was solved by aortic valvotomy in 82 patients and by aortic valve replacement in 18 patients. Aortic valve replacement was performed 6x for congenital valvar aortic stenosis with mean aortic gradient 53.7 +/- 13.9 mm Hg and aortic valve area 0.42 +/- 0.04 cm2/m2 and 4x for valvar and subvalvar stenosis with mean aortic gradient 87.0 +/- 31.3 mm Hg, valve area 0.45 +/- 0.03 cm2/m2 and associated regurgitation 44.7 +/- 25.6%. In the remaining 8 patients aortic valve replacement was performed as reoperation after aortic valvotomy (after 20 +/- 8.4 years). In this group mean aortic gradient was only 32.2 +/- 13.8 mm Hg but regurgitation was 54.0 +/- 15.8%. Infective endocarditis occurred in 8 patients (44.5%) preoperatively. There were two hospital deaths (sudden death and multiorgan failure) and one death 3 years after operation (prosthetic endocarditis). Remaining 15 patients are in very good condition (NYHA I.-II.) 1-13 years after aortic valve replacement. CONCLUSIONS: Severely calcified aortic valve, endocarditis and associated incompetence are indications for valve replacement in patients with congenital aortic valve disease. Prevention of infective endocarditis is necessary pre and postoperatively, too. Long-term results after valve replacement for aortic valve stenosis are very good.

Adult↗

PubMed1997

[Results of open valvotomy in congenital stenosis of the aortic valve].

Between 1977 and 1992 at the Cardiosurgical Clinic of the Faculty Hospital in Hradec Králové on account of congenital valvular aortic stenosis 142 patients were subjected to catheterization. Valvotomy of a stenotic aortic valve was performed in 69 patients. The submitted paper evaluates the progression of aortic stenosis based on investigations of the aortic gradient and the area of the aortic orifice in repeatedly catheterized patients before and after valvotomy and evaluates also the results of surgery after a 1-15-year interval after surgery.

Adolescent↗

PubMed1997

[Coronary revascularization in diffuse atherosclerosis of the anterior descending coronary artery].

The authors present surgical possibilities of treatment of diffuse atherosclerotic changes of the left anterior descending coronary artery. In such serious disease they choose the procedure of endarterectomy performed from long arteriotomy under direct eye control followed by reconstruction by long bypass anastomosis. Endarterectomy of the left anterior descending artery was performed in 32 patients during the period between 1988-1996. This represents 1.38% of patients operated for ischemic heart disease during that period (32/2324). Two patients died in consequence with the operation (6.25%), also there was one myocardial infarction as a perioperative complication (3.1%). Endarterectomy of the diffusely diseased left anterior descending coronary artery can, when carefully indicated and using proper technique, contribute to complete revascularization in patients with end-stage coronary artery disease.

Adult↗

PubMed1996

[Results of pericardiectomy in the treatment of constrictive pericarditis].

Between 1981 and 1990 at the Cardiosurgical Clinic in Hradec Králové pericardectomy on account of chronic constrictive pericarditis was performed in 20 patients. The authors evaluated the duration of complaints, preoperative symptomatology, surgical procedure and results of the operation. Symptoms of right-sided cardiac congestion were recorded in 80% of the patients. Calcifications of the pericardium were found in 70% of the patients. During the postoperative period one patient died (5%). The long-term results evaluated at least three years after operation were very good in 65% of the operated patients. Treatment of chronic constrictive pericarditis is surgical and involves subtotal pericardectomy from medial sternotomy.

Adult↗

PubMed1996

[Effect of local administration of aprotinin on surgical blood loss after myocardial revascularization].

The authors compare three groups of patients operated at the cardiosurgical clinic of the Faculty Hospital in Hradec Králové on account of ischaemic heart disease. Group A comprised 50 patients where for revascularization of the myocardium venous grafts were used, group B comprised 50 patients where also the mammary artery was used/IMA/. The postoperative blood losses are compared and the number of administered blood transfusions in the two groups. Group C is formed by 50 patients where after preparation of the IMA aprotinin/100 000 u./was administered locally. The authors provide evidence that the use of IMA increases significantly the postoperative blood losses/in group A 675 ml +/- 352.9, in group B 1232 ml +/- 336.5/and increases the number of required transfusions/group A 2.44 +/- 1, group B 3.45 +/- 1/. By local aprotinin application to the wound surface during preparation of IMA the authors reduced in group C the blood losses to 896 +/- 231.9 ml and the number of administered transfusions to 2.74 +/- 0.8.

Administration, Topical↗

PubMed1996

Concomitant coronary and asymptomatic carotid artery disease in patients prior to myocardial revascularization.

The authors report on the results of ultrasound examinations of the carotid arteries in 525 patients with ischemic heart disease, hospitalized at the Department of Cardiac Surgery in Hradec Králové, prior to myocardial revascularization. Only 213 patients (40.6%) had intact carotid bed. The remaining 312 patients (59.4%) were found to have asymptomatic sclerotic changes of varying degrees of severity. Haemodynamically significant stenoses of over 50% were found in 64 cases (12.2%). 19 patients (3.6%) had critical stenoses of over 85% or occlusions of one or both internal carotid arteries. Comparison between patients younger than 65 and older than 65 showed significant increase of sclerotic changes in the older group. The authors prefer to perform myocardial revascularization procedure in hypothermic CPB with alpha-stat regime before carotid artery surgery. Combined procedures are preferred only in cases with concomitant neurologic and coronary symptomatology or in cases with severe carotid stenoses or occlusions of both arteries.

Adult↗

PubMed1996

[Surgical treatment of renal carcinoma with tumor thrombus extending into the right heart atrium].

Tumours thrombosis affecting the kidney or vena cava inferior in renal carcinoma is encountered in 4%-19% of the operated patients. Thrombosis reaching as far as the right atrium is rare. It is a very serious complication for the surgeon, but its does not imply a poorer prognosis of the disease nor shorter survival than tumours thrombosis of the inferior vena cava. Five-year survival is reported in 35-60% of the patients. Therefore radical surgery is fully indicated provided team collaboration of the urologist and cardiosurgeon is ensured. It involves removal of the tumours kidney with the tumours thrombus in an open heart and inferior vena cava, using extracorporeal circulation and arrested circulation with hypothermia. The authors present a successfully performed operation performed in a 63-year-old male [correction of female] patient.

Carcinoma↗

PubMed1996

Hibernating myocardium--mechanisms and clinical implications.

Hibernating myocardium is defined as persistently impaired myocardial and left ventricular function at rest resulting from reduced myocardial blood flow. It is postulated that despite the reduced coronary blood flow, metabolic activity is sufficient to prevent tissue necrosis. Recovery of the hibernating myocardium has clearly been shown to occur with the establishment of successful revascularization either by coronary bypass surgery or by percutaneous transluminal coronary angioplasty. The differentiation of viable, hibernating myocardium from non-viable myocardium in patients with coronary artery disease and left ventricular dysfunction is a key issue in the current era of myocardial revascularization.

Humans↗

PubMed1996

Contribution to technique of endarterectomy of the right coronary artery.

We present our technique of performing endarterectomy of coronary arteries by means of injecting cardioplegic solution into the plane of dissection of the endarterium. This simple and gentle technique in combination with manual endarterectomy helps in separation of the core far into the periphery of the diseased vessel and thus helps to perform revascularization in patients with diffuse atherosclerotic changes. During the last 6 years (1991-1996) endarterectomy in coronary revascularization was used in 116 cases (it was 5.7 % (116/2031) of all myocardial revascularization procedures). On right coronary artery endarterectomy was used in 82 patients. Mortality rate in our group of patients was 4.88 % (4/82) and perioperative myocardial infarction developed in 4.88 % (4/82). According to our own experience with this technique of endarterectomy on right coronary artery we are convinced that in desperate patients with diffuse coronary artery disease our method can bring better and wider application of surgical treatment.

Adult↗

PubMed1994

[The clinical picture of stenoses of the trunk of the left coronary artery].

In 1991-1993 the authors made at the Second Medical Clinic of the Faculty Hospital in Hradec Králové 651 coronarographic examinations: in 460 patients they detected ischaemic heart disease, of the latter 44 (9.6%) suffered from stenosis of the trunk of the left coronary. During the premorbid period the authors evaluated the grade of stenocardia according to the Canadian cardiovascular classification and also the incidence, number of coronary attacks and reason for indicating coronarography. In 29 patients (66%) the authors made an ergometric examination--in 82.8% the finding was positive and in 17.2 negative. The loading test was unequivocally positive only in complete obstruction of the left coronary, in case of multiarterial affection almost in all cases. Coronarography revealed only in 4 patients (9%) isolated stenosis of the trunk of the left coronary, most frequently the finding was also on two other (36.4%) or 3 (34.1%) arteries. Complete occlusion of the trunk of the left coronary was recorded in 6.8%. An ejection fraction of 50% or more was recorded in 75% of the patients. Surgical revascularization was performed in 35 patients. Twenty-nine patients are followed up after operation on a long-term basis (on average for 7.8 months), 23 of the patients report improvement of their complaints (65.7%). The investigation provided evidence that stenosis of the trunk of the left coronary is a relatively frequent finding in the patient population with ischaemic heart disease and that it is most frequently associated with affection of two and three arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗

PubMed1993

Iatrogenic clubbing of the fingers.

We report on a 39-year-old female who had been operated on for an atrial septal defect at the age of 14 years. On operation the inferior vena cava was iatrogenically misdirected into the left atrium. The cyanotic patient, in functional group IV of the NYHA classification, with polyglobulia and clubbing of the fingers was successfully reoperated after 25 years.

Adult↗

PubMed1993

[Non-heart surgical procedures in patients with mechanical valve prostheses. Experience with surgery in 38 patients].

The authors discuss their own experience with noncardiac surgery in continuously Coumarine anticoagulant treated patients with mechanical valvular prostheses. Of 38 patients treated since 1986 were 12 operated under full Coumarine anticoagulant treatment, on eighteen patients were given Heparin preoperatively in a continual infusion, five patients were given an anti-agreggation dose of Heparin and other didn't receive any anticoagulant treatment. According to the authors' opinion it is safer to change the patients before the planned surgical treatment to intravenous Heparin. In case of urgent surgery it is, however, possible to operate also anticoagulant treated patients on. The authors in principle don't recommend K vitamin administration before surgery. Antibiotic prophylaxis before surgery is a matter of course.

Adult↗

PubMed1993

[Personal experience with management of extracorporeal circulation in patients with asymptomatic carotid arteriosclerosis].

The authors describe in following paper their own group of patients with asymptomatic but hemodynamically significant carotid disease operated under cardiopulmonary bypass on. Current studies recommend the "alpha-stat" regime as the optimal strategy of CPB conduction to ensure intraoperative cerebral protection. This study was done to verify this idea. 284 consecutive patients admitted for elective coronary surgery underwent a non-invasive Doppler scanning of extracranial carotid arteries. Twenty seven patients (10%) had significant carotid disease. All patients underwent coronary surgery as the first procedure. There was no cerebral complication in this group of patients and neurological status of these patients postoperatively was the same as it was preoperatively. This study shows that CPB in patients with hemodynamically significant carotid disease can be achieved without impairment of central nervous system with "alpha-stat" regime of perfusion.

Adult↗