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Biomedical subjects

J Pirk

Publications and source records attributed to J Pirk.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Personal experience with use of Claforan in the form of a "protected coagulum" in patients after kidney transplantation].

Prophylaxis by means of antibiotics in the form of a so-called "protected coagulum" is an important part of prevention of postoperative infections in renal transplantations. The antibiotic is selected with regard to its effectiveness against the most frequent pathogens, tissue penetration, undesirable effects (in particular nephrotoxicity). The authors investigated a group of 450 renal transplantations with cefotaxime prophylaxis. During the four-week follow-up period after operation infection of the surgical wound (abscess, purulent secretion) occurred in 15 patients (3.33%). The mentioned results indicate that cefotaxime is suitable for use as a protected coagulum also in patients with postoperative immunosuppression.

Adolescent↗
PubMed1996

[Causes of failure in surgical treatment of acute dissection of the ascending aorta (type A)].

In 27 patients with acute dissection of the ascending aorta where during 1988-1995 for reconstruction of the affected portion of the aorta an intraluminal prosthesis was used, a retrospective analysis of some factors was made to evaluate their importance for the final result of the operation. The analysis proved the fundamental importance of complications present before operation. Among them, in association with the extent of the dissection, the most important one proved to be cardiac tamponade, impaired renal function and a state of shock. More detailed analysis revealed the unequivocal relationship of the development of these complications with the protracting time interval between the development of the dissection and the surgical operation. Because symptoms of dissection of the thoracic aorta are very closed to clinical manifestations of AIM, it is useful, if the latter is ruled out, to consider this possibility and focus the further procedures on the most rapid possible confirmation or at least justified suspicion of this disease and to contact without delay a cardiosurgical department. Only in this way we can improve the results which so far do not correspond the possibilities of surgical and anaesthesiological care.

Acute Disease↗
PubMed1995

An alternative to cardioplegia.

A new method of cardioplegia using an ultrashort beta 1-selective blocker is described. The method is especially useful in reoperation in patients with a patent internal mammary artery. Four patients have been operated on using this method.

Adrenergic beta-Antagonists↗
PubMed1994

[Surgical therapy of serious heart rhythm disorders].

The author summarizes his experience with operations in 40 patients. Twenty-one were operated on account of W-P-W syndrome, 9 on account of ventricular tachycardia due to IHD and in 10 patients an automatic defibrillator was implanted. None of the patients died and the results of surgery are satisfactory.

Defibrillators, Implantable↗
PubMed1994

[100 renal transplantations with intravesical implantation of the ureter].

Transplantation of the kidney is nowadays a common therapeutic method. During the past 30 years in the transplantation centre of IKEM more than 1200 transplantations were performed. The authors present a group of 100 patients where the ureter of the transplanted Kidney was attached to the urinary bladder of the recipient by intravesical technique. With regard to the low incidence of fistulas and the easy solution of complications this technique can be widely used in clinical transplantation programmers.

Humans↗
PubMed1994

[Special features of anesthesia during surgery for acquired heart valve defects].

The authors describe some special features as regards anesthesia with large opioid doses in patients operated on account of acquired valvular disease. They emphasize in particular the importance of adequate knowledge of pathophysiological changes associated with the damage of different orifices and their interpretation in the anaesthesiological procedure which is the basis of its success. In the conclusion the authors describe basic haemodynamic changes in combined simultaneous affection of several valves.

Anesthesia↗
PubMed1993

Use of a thin retrocardial drain to prevent pericardial effusion.

A thin (3.125 mm) drain was placed retrocardially in 21 patients undergoing cardiac surgical procedures and its efficacy in the prevention of the formation of pericardial effusions was determined with two-dimensional echocardiography. Some 29 patients without such a drain acted as controls. No effusions developed in patients with a retrocardial drain. Nine of 29 (31%) patients without a retrocardial drain had an effusion of 7-18 mm. The effusions were most commonly found behind the left ventricle. Using Fisher's exact test as a contingency table, the results were significant (P = 0.05). Insertion of a thin retrocardial drain may prevent the incidence of pericardial effusions in the early postoperative period and is not associated with local complications.

Coronary Artery Bypass↗
PubMed1993

[Transseptal approach to the left atrium].

The authors present their first experience with trans-septal access to the left atrium, employed in 22 procedures of mitral valve surgery and in 4 myxoma extirpations. The majority of cases were re-operations or combined procedures, performed most often in connection with tricuspid valve annuloplasty. There were two deaths (7.6%), serious arrhythmias or signs of an intra-atrial shunt were not seen in any of the patients undergoing surgery. Trans-septal access allows thorough orientation in the left atrium, and the authors find it useful especially in re-operations or combined procedures.

Adult↗
PubMed1993

[Surgical problems in heart transplantation].

Today, heart transplantation is a generally recognized method for managing an otherwise uncontrollable heart failure. The surgical technique of transplantation has become standardized in recent years. There are no substantial differences in postoperative care and the rate of surgical complications between a heart transplant recipient and a patient undergoing routine cardiac surgery. The only problem to be handled is the recipient's elevated pulmonary resistance. Late complications are caused by infection related to immunosuppression and/or antirejection therapy.

Heart Transplantation↗
PubMed1993

[The patient after heart transplantation].

The data of the first 100 patients undergoing heart transplantation in the period between January 1984 and May 1993 were analyzed. Of this group, 57 patients are alive. Out of the total of 43 deaths, 14 patients died from graft failure within the first postoperative days, 6 died from surgical complications, 11 from infection, 10 deaths were due to accelerated coronary atherosclerosis, and 2 patients died from tumours. Early mortality rates (within 30 days since surgery) were 37% and 17% in patients operated on between 1984-88 and between 1989-93, respectively. The health condition of heart transplant recipients is affected by side effects of immunosuppressive therapy. Forty per cent of patients re-develop systemic hypertension within the first post-transplantation year. Five years after transplantation, hypertension is detected in 60% of patients. Elevated serum creatinine levels are present in 70% of patients by the end of the first post-transplantation year. In the ensuing period, there is no progression in renal function impairment, which does not require cyclosporin withdrawal and is not associated with the development of hypertension. In the first post-transplantation year, 45% of patients are markedly obese. All patients with overweight and obesity show markedly raised levels of serum cholesterol. Another undesirable effect (mainly due to corticosteroid therapy) is the development of ulcers in 16% of patients. Heart transplantation has become an established method at the Institute for Clinical and Experimental Medicine in Prague. Despite the above pitfalls, heart transplantation substantially prolongs the life of patients and dramatically alters the quality of their life.

Adolescent↗
PubMed1993

[Infectious complications in patients after heart transplantation].

The incidence of infectious complications was monitored in a group of the first 100 patients undergoing orthotopic heart transplantation at the Institute for Clinical and Experimental Medicine from January 1984 through May 1993. The definition of an infectious complication was a clinically manifest infection requiring treatment. Cytomegalovirus infection and Epstein-Barr virus infection were evaluated by the development of antibody against IgM. A total of 168 infectious complications were detected in 80 patients. The infectious complications were fatal in 11 patients; hence, infections were implicated in 26% of all deaths following heart transplantation. The spectrum of infections markedly varies depending on the interval since the procedure. The most frequent infections within the 30 postoperative days are bacterial (often nosocomial) infections. In the later period (30 days onward), viral infections account for 72% of cases. Of the rarer types of infections, the pulmonary form of aspergillosis was identified in 3 cases, nocardiosis and legionellosis in one case each. Infectious complications were the main cause of deaths in the period of 1 to 4 months post-transplantation, and the spectrum and rate of complications were not different from data reported by other centres.

Heart Transplantation↗
PubMed1993

[Coronary disease in patients after heart transplantation].

Coronary artery lesions are evaluated in a group of 43 patients surviving for more than 3 months after heart transplantation. An angiographic finding was obtained from 35 patients, autopsy findings were available in eight cases. Angiography demonstrated coronary artery lesions in 12 out of the 35 patients whereas autopsy findings were positive in five out of the eight post mortem examinations. Overall, lesions were found in 40% of patients at a mean follow-up interval of 3.5 years. While the finding of a coronary artery lesion was not related to the classic risk factors for atherosclerosis, an association to a previous cytomegalovirus or Epstein-Barr virus infection was demonstrated. The data suggest that infection caused by the two above viruses is an important factor in the development of vascular lesions in the heart transplant.

Adult↗
PubMed1993

[Hemodynamic effects of enoximone in patients with low left ventricular ejection fraction in surgery for ischemic heart disease].

Acute heart failure following cardiac surgery in extracorporeal circulation (EC) still poses a formidable problem requiring intensive pharmacological therapy and, often, also mechanical support. Preoperatively reduced left ventricular (LV) function raises the risk for the development of this complication. In their pilot study, the authors evaluated the haemodynamic effects of enoximone, a selective phosphodiesterase III inhibitor, administered at a dose of 1 mg/kg b.w. to 15 patients with a preoperative LV ejection fraction < or = 35% 15 minutes before weaning from EC after an elective myocardial revascularization procedure. All patients were weaned from EC at first attempt without any problems and left the operating theatre in good condition. Enoximone administration led, in the monitored period (45 minutes after administration), to statistically significant increases in cardiac index (+68%; p < 0.01), oxygen supply (+75%; p < 0.01) and oxygen saturation in mixed venous blood (+10%; p < 0.1) and statistically significant decreases in pulmonary and systemic vascular resistance indexes (-52% and -48%, respectively; p < 0.001) and in oxygen extraction (-31%; p < 0.001). These changes were associated with decreases in central venous, mean pulmonary artery, and pulmonary capillary wedge pressure (n.s.). No serious side effects were seen, and the authors conclude enoximone can be the drug of first choice in high-risk patients following heart surgery in EC and requiring inotropic support.

Adult↗
PubMed1993

[Czech heart surgery in 1992].

A total of 163 operations in extracorporeal circulation per one million population (i.e., below 50% of the European average) were performed in the Czech Republic in 1992. While the most critical situation exists in the treatment of IHD, it is relatively favourable in the treatment of congenital heart defects. To improve the current state, it is imperative to recruit more nurses and to install better technology in medical facilities.

Cardiac Surgical Procedures↗
PubMed1993

Anatomical interrelation between the phrenic nerve and the internal mammary artery as seen by the surgeon.

Paresis of the diaphragm (especially left-side paresis) is a relatively frequent finding following cardiac surgery. While, usually, it is a rather benign condition, in exceptional cases it may lead to severe impairment to death of the patient. The supposed causes of damage to the phrenic nerve include: local myocardial cooling by ice slush; opening of the pleural cavity in connection with local cooling; cross clamp length; total hypothermia; central venous cannulation; traction-related damage; mammary artery harvesting. Perhaps the commonest cause of damage to the phrenic nerve, i.e., the effect of local myocardial cooling by ice slush, and the mode of phrenic nerve protection have been studied in considerable detail. The authors focused their attention on the interrelation between the phrenic nerve and the proximal segment of the mammary artery. Using anatomical preparations, the authors demonstrate the very intimate relationship of the above entities. The interrelation of the two anatomical structures basically differs depending on whether the left or right side is concerned. 1) On the left: The phrenic nerve, on entering the thorax, runs between the subclavian artery and vein laterally from the mammary artery crossing it medially; it parts the latter and continues in mediastinal adipose tissue to run on the pericardium toward the diaphragm. 2) On the right: The phrenic nerve passes between the subclavian vein and artery medially from the mammary artery. For another 3-4 cm, it runs along the medial and dorsal edges of the mammary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Surgical Procedures↗
PubMed1993

Do preoperative branched-chain amino acids have a beneficial effect on the heart after cardiac surgery?

To verify the hypothesis, formulated on the basis of data emerging from animal experiments, that branched-chain amino acids (BCAA) exert a protective effect on the heart during ischaemia, eight patients immediately before aortocoronary reconstruction were provided 400 ml of a 3% BCAA solution. A control group comprised another eight patients. Per- and postoperative myocardial status and myocardial enzyme levels were assessed. Myocardial biopsy was performed during surgery to determine glycogen levels. Creatine kinase (CK) levels were invariably higher in the BCAA group, with statistically significant differences in samples obtained immediately after surgery (10.6 +/- 3.35 mu kat/l vs. 4.07 +/- 0.59, p < 0.0004), in the evening after surgery (14.2 +/- 5.92 vs. 5.91 +/- 2.21, p < 0.06) and in the morning of the first postoperative day (18.0 +/- 10.1 vs. 7.5 +/- 4.76, p < 0.025) when aspartate aminotransferase (AST) levels were likewise higher (1.35 +/- 0.28 vs. 1.00 +/- 0.26, p < 0.035). There were no differences between the groups in the number of defibrillations after ischaemia, myocardial glycogen content, peroperative ischaemia, incidence of arrhythmia and catecholamine support. We conclude that BCAA at the above indicated doses did not raise myocardial glycogen content or improve myocardial status after cardiac surgery. Their administration resulted in a rise in CK and AST in the postoperative period.

Amino Acids, Branched-Chain↗
PubMed1993

[The Williams syndrome in adulthood].

A case report of a 45-year-old woman with Williams syndrome who was indicated, because of increasing problems, for surgery of a supravalvular stenosis of the ascending aorta. In addition to lesions on the aorta, examination revealed multiple stenoses of branches of the pulmonary artery. The patient showed no facial changes or signs of mental retardation. The operation was performed in extracorporeal circulation by suturing a Dacron flap into the stenotic segment of the aorta, and reimplantation and reconstruction of the stenosed aortic arch branches. The procedure was uneventful and, four months after surgery, the patient is completely free of problems.

Aortic Valve Stenosis↗