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Biomedical subjects

J Skalski

Publications and source records attributed to J Skalski.

At least 19 recordsLinked to original sources

[The first Polish report on congenital diaphragmatic hernia and visceral malrotations].

The forgotten throughout the years the doctor dissertation from 1837 of the Polish physician Ludwik Przybyłko entitled De pravo organorum situ ("About malposition of the human organs") was presented. This paper, excessively modern in its epoch, contains the compendium of the contemporary medical science of the organs' dislocation and malrotation (including heart malposition and coexisting defects). First of all, however, it is the well-scientifically documented case report on the diaphragmatic hernia in the newborn. The summarized historical review of scientific report on diaphragmatic hernia places a special emphasis on the reports that had been published before the dissertation of Przybyłko and before the Bochdalek's historical report in 1848, since then the posterolateral defects of the diaphragm have been defined with that name. The extensive fragments of the dissertation translated from Latin into Polish have been cited. Ludwik Przybyłko presented not only the clinical report and details of precise anatomopathological description of the newborn with diaphragmatic hernia, but he also cited the relevant literature and discussed the issue with thorough knowledge. Numerous clinical and anatomopathological remarks of the author, based on his own experience and accordingly applied literature, have been current until today. The case report is completed with four engraved illustrations (woodcut) that document the autopsy examination. The work contains extremely interesting and revolutionary for that time considerations on the evolution (22 years prior to the famous work of Darwin) with an attempt to locate the etiology of congenital diaphragmatic hernia in the evolution. The authors of this paper suggest that the dissertation of Ludwik Przybyłko should be interesting for paediatric surgeons and, especially because of its unusual and original contents, ought to take constant place in the history of Polish and world's medicine.

Academic Dissertations as Topic↗

A congenital defect of the pericardium.

Ten patients with congenital defects of the pericardium were treated in Departments of Cardiac Surgery, Silesian School of Medicine in Zabrze and Katowice between 1989 and 1998. There were eight children and two adults, eight males and two females. In each case the pericardial defect was discovered intraoperatively during surgery for congenital heart defect. There were no cases with clinical symptoms that could be clearly related to the defect of the pericardial sac. In the case of a child with a complete absence of the left pericardial wall the heart was significantly rotated contrary to the defect. The final outcome of the congenital heart defect surgery was satisfactory in each case. An abbreviated historical review of the diagnosis and treatment of the pericardial defects is presented with special attention placed on therapeutic management. Surgical correction of pericardial defects is concluded to be justified in patients with clinical symptoms. In most cases pericardial defects are discovered intraoperatively, but when they are large the said defects do not require any treatment.

Adult↗

[Bland-White-Garland syndrome co-existing with ventricular septal defect and patent ductus arteriosus--diagnostic difficulties].

A case of a 14 month-old boy suffering from unrecognized Bland-White-Garland syndrome with no typical clinical and electrocardiological features was reported. Diagnostic difficulties were caused by ventricular septal defect and patent ductus arteriosus co-existing with the anomaly of left coronary artery. Death caused by myocardial ischemia occurred after surgical closure of VSD and PDA.

Abnormalities, Multiple↗

The use of exogenous creatine phosphate for myocardial protection in patients undergoing coronary artery bypass surgery.

A key component in the development of ischemic functional and structural myocardial injury during cardiosurgical procedures is an inadequate cellular energy supply which occurs as a consequence of the cessation of oxidative metabolism. In such conditions high energy phosphates are rapidly depleted. As they play a critical role in the maintenance of cell viability and postischemic recovery of contractile function, their conservation is therefore a primary objective in any procedure designed to reduce ischemic injury. Exogenous administration of phosphocreatine (CP) has been suggested as being beneficial to the ischemic heart. The aim of present study was to evaluate the possible cardioprotective effect of exogenous CP during coronary artery surgery (CABG). Forty patients undergoing CABG procedure were randomly assigned to receive creatine phosphate-enriched (group I) or standard-St. Thomas' Hospital (group II) cardioplegic solution; each group comprised 20 patients. Group I received: 6.0 g of exogenous CP (Neoton) daily in two 20-min intravenous infusions during 3 days preoperatively; during surgical procedure they were administered standard cardioplegic solution enriched in CP at the concentration of 10 mmol/l and -- 2 days postoperatively -- 4.0 g CP daily in two intravenous injections. Group II did not receive CP at all In both groups were analysed. Haemodynamic parameters. Continuous 48-h ECG recording (Holter monitoring) outcome. Laboratory values of serum CK and CK-MB. Inotropic support required (drugs, mechanical support). Ultrastructural findings (biopsy data). Statistical analysis was carried out using Student's "t"-test and the chi2 test. Values of p<0.05 were taken as the criterion of significant difference. The results of the study were: Significantly lower average number and energy of DC-shocks needed to restore cardiac function after cardiopulmonary bypass procedure in group 1. Statistically significant beneficial effect on the presence of ventricular arrhythmias during surgery and in early postoperative period in group I. Significantly lower requirements for inotropic drugs postoperatively in group I. Statistically significant lower degree of sarcolemmal damages in myocardial biopsies in group I. Concluding, the authors wish to state that: Exogenous phosphocreatine (Neoton) perioperative administration in coronary artery bypass patients reduced the need for inotropic drugs, which is clinically manifested in lower frequency of low cardiac output syndrome. Perioperative administration of exogenous CP improves electrophysiological stability of the myocardium. Advantageous clinical and electrophysiological effect of exogenous CP may result from its properties to protect sarcolemma of the cardiomyocytes.

Bicarbonates↗

[Collagen metabolism disturbances with experimentally increased pulmonary flow--experimental model of left to right shunt with congenital heart defects in children].

The studies carried out on young piglets were to demonstrate that experimentally increased pulmonary flow resulted in collagen hyperproduction in the pulmonary tissue. In 14 piglets a modified Blalock-Taussig anastomosis was performed, 9 animals constituted the controls. The survivors included 9 experimental and 8 control piglets. In direct lung biopsies the biochemical collagen content was assessed, whereas histopathology confirmed the development of vascular lesions characteristic for pulmonary hypertension. A significant increase of collagen level in the pulmonary tissue was demonstrated in experimental animals. Determinations were also made of serum and urine hydroxyproline values. A significant increase was observed in serum and urine hydroxyproline values in experimental animals in comparison to the controls when determinations were made 7 days to 3 months after the anastomosis had been performed (p < 0.01). The authors showed that an increase of pulmonary flow in piglets results in collagen metabolism disturbances which are seen both in an increased collagen level in the tissue and in increased serum and hydroxyproline levels.

Anastomosis, Surgical↗

[Hydroxyproline in serum and urine in children with pulmonary hypertension in the course of congenital heart defects].

In accordance to contemporary views on the pathology of biochemical changes in the fibrotic process at pulmonary hypertension, the authors took a trial to investigate the convection of excessive blood flow through lungs and changes of collagen metabolism in lungs. The possibility of following the metabolism of collagen through naming its metabolites (hydroxyproline-Hp) made us to connect the intended surveys with practical trail of its use, and diagnostic methods at children with congenital shunt cardiac defects. The survey was taken up in three groups of children with different levels of pulmonary advancement hypertension process: 39 children with dynamic elevation of pulmonary artery pressure (I st and II nd group age range: 12 months to 2 years), and 17 children with marks of pulmonary vascular obstructive disease. III rd group age range: 12 months to 6 years. It was stated, that between children from the first and second group before operational treatment, clear growth of Hp contents in serum and in urine returned to its correct value within the 1 to 6 months observation period since the cardiac defect has been corrected. In the third group, in spite of surgical treatment, the increased Hp content remained in the post operative period, therefore testifying the non-retreated fibrotic changes. It was stated, that Hp content control in serum and excretion in urine can possess clinical usage as an auxiliary exam estimating the advancement of pulmonary hypertension before surgical treatment and at the post-operative monitoring of the lungs.

Child↗

[Tetralogy of Fallot in children--management and results of treatment].

The authors present the results of surgical treatment obtained in 288 children with tetralogy of Fallot. In 127 children palliative procedures (pulmonary-systemic anastomoses) were employed, whereas 161 patients were subjected to total surgical corrections of the defect, performed in cardiopulmonary bypass. In 127 (79%) belonging to the latter group the correction was a single stage procedure, and in 34 (21%), it followed pulmonary-systemic anastomoses. Perioperative mortality rate in children subjected to single stage procedures was 12%, being lightly lower than the rate observed in patients subjected to two stage procedures. The analysis of operative results corrected for age revealed a higher mortality rate in children operated when less then two years of age (17%) in comparison to older patients (11%).

Adolescent↗