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Biomedical subjects

J F Csicsko

Publications and source records attributed to J F Csicsko.

11 recordsLinked to original sources
PubMed1981

Immediate postoperative digitalization in the prophylaxis of supraventricular arrhythmias following coronary artery bypass.

Regimens of acute preoperative digitalization have been evaluated previously in the prophylaxis of supraventricular tachycardias (SVT) following coronary artery bypass operations, with equivocal results. This study assesses the effectiveness of immediate postoperative digitalization on the incidence of arrhythmias in 407 consecutive patients recovering from myocardial revascularization. In 137 patients treated by our regimen, which begins digitalization within 4 hours postoperatively, the incidence of supraventricular tachyarrhythmias was 2%, while the corresponding figure for 270 untreated patients was 15%. Digitalization reduced the incidence of supraventricular arrhythmias significantly (p less than 0.01), whereas death, ventricular ectopy, and infarction rates were similar in the two groups. The few patients who did have supraventricular arrhythmias while receiving prophylactic digoxin were no more easily treated than patients in the undigitalized group. The timing of administration of digoxin for SVT prophylaxis may be more important than previously recognized. Immediately postoperative digitalization, theoretically preferable to preoperative regimens, is a safe, effective way to reduce the incidence of supraventricular arrhythmias following myocardial revascularization.

Arrhythmias, Cardiac↗
PubMed1980

Signet-ring cell carcinoma of the breast: a clinicopathologic study of 24 cases.

Twenty-four cases of signet-ring cell carcinoma of the breast are presented. These represented 4.5% of 535 cases of surgically treated breast cancer at Indiana University Medical Center. Twelve cases were associated with ductal carcinoma, nine with lobular carcinoma, one with colloid carcinoma, and four were pure signet-ring cell carcinoma. The mortality rate, incidence of axillary lymph nodal metastases, and number of involved lymph nodes were greater in cases of signet-ring cell carcinoma than with other forms of mammary carcinomas without signet-ring cells. It is proposed that signet-ring cell carcinoma can manifest as a pure lesion or as a variant of ductal, lobular, or colloid carcinoma, and that it is an aggressive histologic variant of mammary carcinoma.

Adenocarcinoma, Mucinous↗
PubMed1978

A critical evaluation of the Duhamel operation for Hirschsprung's disease.

Eighty-nine patients with Hirschsprung's disease were treated from 1972 to 1977. Of the patients, 70 were boys, 85 were the result of full-term pregnancy, and four had Down's syndrome. There were 23 children, 32 infants, and 34 neonates including seven (20%) with enterocolitis. Early mortality was 8.8% in neonates and 3% in infants. After initial diversion (colostomy or enterostomy), 66 patients had "classic" (ten), modified (52), or "long" (four) Duhamel pull-through procedures at age 1 year. Operative mortality was zero. Three late deaths occurred; two of them were mongols. Fecaloma occurred in eight of ten classic cases that required revision. Postoperative enterocolitis occurred in three of four long procedures done for total colonic aganglionosis. The modified Duhamel procedure was associated with a low complication rate and good function. There were no instances of anastomotic leak, anal stricture, or genitourinary problems. These data indicate that the modified Duhamel operation is a highly acceptable procedure in the management of Hirsch sprung's disease.

Adolescent↗
PubMed1977

Increased hepatic synthesis of cholesterol following jejunoileal bypass.

Fatty infiltration of liver and formation of cholesterol stones are significant problems following jejunoileal bypass for morbid obesity. This report evaluates hepatic lipid metabolism and fat absorption in genetically obese, bypassed, and lean Zucker rats. Ninety percent jejunoileal bypass was performed in 12 (500 grams) obese rats (BP). Similar numbers of unoperated "fat rats" (FR) and lean litter mates (LR) were controls. Food consumption, weight gain or loss, and fecal fat were evaluated. At 4 weeks serum triglycerides, hepatic cholesterol, total lipids, triglycerides, and hepatic synthesis of fatty acids and cholesterol were measured in vivo. Food intake was excessive in FR's (23.8 +/- 0.7 gm/day), decreased in BP (18.3 +/- 2.3 gm/day), and lowest in LRss ( less than 0.05) and excessive fecal fat excretion (p less than 0.05). Serum triglycerides were elevated in FR's (284 +/- 32 mg/dl), reduced in BP rats (148 +/- 20 mg/dl) (p less than 0.05), and low in LR's (86 +/- 16 mg/dl). Total hepatic lipids, triglycerides, and hepatic synthesis of fatty acids were elevated in FR's (p less than 0.05) and were unchanged by bypass. Hepatic cholesterol was similar in all groups. Hepatic synthesis of cholesterol, however, was increased significantly in bypassed rats (p less than 0.05), (BP--102 +/- 22 micronnmole/"C2"/minute/gm, FR--39 +/- 6.0, LR--30 +/- 4.0). Jejunolileal bypass in FR's results in weight loss, decreased food intake, increased fecal fat, decreased serum triglycerides, and increased hepatic synthesis of cholesterol. Bypass had little effect on reducing elevated hepatic lipids, triglycerides, or fatty acid synthesis in FR's. These data suggest that following bypass increased hepatic cholesterol synthesis (as a precursor for bile acids) is related to interruption of the enterohepatic circulation and bile salt pool depletion. This implies that excess synthesis of hepatic cholesterol results in supersaturation of bile which is choletithocenic and may explein in part the increased incidence of gall stones observed following jejunoileal bypass.

Animals↗
PubMed1976

Adverse effects of jejunoileal bypass on growth and development.

Ninety percent jejunoileal bypass was performed in 20 growing (100 gram) male Sprague-Dawley (SD) and 15 male, genetically obese, growing (125 gram) Zucker "fat rats" (FR). Twenty SD and 15 FR unoperated rats of similar age and weight served as controls. Animals were evaluated for weight gain or loss, complications, and survival. At death (4 months), caliper measurements of long bones, vertebral column, pelvis, and skull were obtained, and brain, liver, spleen, and kidneys were excised and weighed. Liver and gonadal histology were obtained. The "fat fat" was more fragile, with a 20 percent anastomotic leak rate and a 33 percent mortality rate. The mortality rate was 5 percent (SD) and zero in controls. Bypassed animals showed growth retardation with weight of SD rats 31 percent (p less than 0.05) and FR's 19 percent of controls (p less than 0.05). Organ weights (liver, spleen, kidneys) were similar, except for a smaller brain in bypassed rats [SD 1.06 +/- 0.08 to 1.83 +/- 0.08 Gm. control (p less than 0.05), FR 1.2 +/- 0.12 to 1.68 +/- 0.09 control (p less than 0.025)]. Skeletal development was retarded significantly in bypassed rats [vertebral column, 125.9 +/- 3.5 to 138.3 +/- 3.9 mm. in controls (p less than .025); ilium, 39.4 +/- 1.1 to 46.2 +/- 1.5 mm. in controls (p less than 0.05); skull circumference, 20.2 +/- 0.03 to 22.5 +/- 0.05 mm. in controls (p less than 0.025)]. No increase in fatty infiltration of liver was observed. Spermatogenesis was diminished 30 percent (p less than 0.05) in bypassed (SD) animals. The data document significant morbidity and mortality rates, growth retardation, and diminished spermatogenesis in bypassed "adolescent" rats. These results imply that jejunoileal bypass may affect intellectual, skeletal, and reproductive development adversely and question the advisability of these procedures in growing subjects.

Animals↗
PubMed1975

Gastrointestinal tube stent plication in infants and children.

Twenty cases of intestinal obstruction in infants and children were managed by gastrointestinal tube stent plication. The mean age was 2.6 years, and ten patients were infants. Previous (often multiple) abdominal operations were performed in 18 patients with a variety of anomalies. Tube plication was used at initial operation in two neonates with malrotation. Following lysis of adhesions, a No. 12 or No. 16 tube (usually a Baker tube) was inserted by gastrostomy and advanced distally into the colon. The tube was kept in place for ten days, with caloric needs supplied by parenteral alimentation. Barium tubogram showed distal patency, and the tube was removed. Eighteen patients survived (90%), and obstruction was relieved in each instance. These observations suggest that gastrointestinal tube stent plication is a useful adjunctive procedure in carefully selected cases or recurrent adhesive intestinal obstruction in infants and children.

Age Factors↗
PubMedDate not supplied

Double cardiac valve replacement: a community hospital experience.

The morbidity and mortality of double cardiac valve replacement were assessed in a community hospital setting. Four hundred twenty-two cardiac patients undergoing valve replacement from 1977 to 1991 were analyzed. Forty-two patients underwent double valve replacement. The clinical variables associated with increased operative mortality (early and late) were determined. The overall operative mortality rate for valve replacement was 7.87% (29 of 422 patients). The mortality rate was 9.09% (3/33 patients) for double valve replacement and 11.11% (1/9 patients) for double valve replacement in conjunction with coronary bypass. The clinical variables associated with increased mortality were: significant reduction in preoperative left ventricular ejection fraction (< 35%); advanced age (> 60); presence of ischemic mitral valve disease; and preoperative functional class (New York Heart Association Functional Class IV). The results of this study suggest that strategies to diminish operative mortality should include assessment of risk preoperatively as well as anticipation of high mortality in selected subgroups.

Adult↗