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K Kubat

Publications and source records attributed to K Kubat.

At least 19 recordsLinked to original sources
PubMed1993

Histological study of the internal mammary artery with emphasis on its suitability as a coronary artery bypass graft.

The internal mammary, musculophrenic, and superior epigastric arteries were unilaterally harvested from 11 individuals (aged 49 to 83 years; mean age, 67 years) and were examined histologically at 1-cm intervals. In 2 individuals the media of the entire internal mammary artery was elastic, whereas in the other 9 individuals we observed an alternating histological pattern in the media of the internal mammary artery, that of the proximal and distal segments being elastomuscular and that of the mid segment being elastic. In 4 of the latter 9 individuals the distal 10% to 20% of the media of the internal mammary artery was muscular with rare elastic lamellae. The media of the first 1 to 2 cm of the musculophrenic and superior epigastric arteries was elastomuscular or muscular with rare elastic lamellae, whereas more distally the media was purely muscular. The degree of intimal hyperplasia was significantly greater in arterial segments with a purely muscular media (25.6%) than in those with elastic (16.7%), elastomuscular (15.3%), and muscular (with rare elastic lamellae) (17.5%) types of media (p < 0.01). The mean cross-sectional luminal area of the elastic segment (1.9 mm2) and proximal and distal elastomuscular segments (1.9 and 1.2 mm2, respectively) of the internal mammary artery was significantly greater than that of the muscular segments of the musculophrenic artery (0.9 mm2) and the superior epigastric artery (0.7 mm2) (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Prevention of adhesion formation around the internal mammary artery pedicle by Gore-Tex surgical membrane. An experimental study in goats.

The effects of wrapping the internal mammary artery in Gore-Tex surgical membrane on the formation of adhesions were investigated. In seven goats both internal mammary arteries were dissected free from the thoracic wall. In six goats the internal mammary arteries were wrapped in Gore-Tex surgical membrane. In the remaining animal both arteries were removed and used as controls. After 6 months the goats were reoperated and it was found that the wrapped segments of all arteries were completely free of adhesions, whereas the non-wrapped segments showed severe adhesion formation. Histologic examination could not detect differences between the wrapped arteries and the controls. One of the 12 wrapped arteries was occluded by a longer existing thrombus, which is attributed to the surgical technique and the fact that postoperatively no anticoagulation was given. The beneficial effect of the use of Gore-Tex surgical membrane on the prevention of adhesion formation is excellent and this implies that it could be used in coronary artery bypass operations, thus reducing the chance of damage to the bypass in case of reoperation.

Animals↗
PubMed1993

Quality control in fatally injured patients: the value of the necropsy.

OBJECTIVE: To identify the contribution of necropsy results to the audit care of severely injured patients. DESIGN: Retrospective study. SETTING: University Hospital in The Netherlands. SUBJECTS: 56 patients who died of severe trauma or its complications during the 10 year period, 1977 to 1987. MAIN OUTCOME MEASURES: Correlation between clinical and necropsy findings. RESULTS: The clinical and necropsy findings corresponded in 31 patients (55%). The necropsy brought to light errors in diagnosis or treatment that might have affected survival in eight cases (14%). The most common missed diagnoses were bronchopneumonia and severe haemorrhage, and the most common cause of death was sepsis. Age, length of stay in hospital, and time between admission and operation were not correlated with accuracy of diagnosis or adequacy of treatment. CONCLUSION: Necropsies in patients who die after severe injuries make a useful contribution to the audit of the care of patients admitted with such injuries.

Adolescent↗
PubMed1993

The usefulness of the lactate dehydrogenase macroreaction in autopsy practice.

The detection of recent myocardial damage by means of the macroscopic lactate dehydrogenase reaction (LDHr) linked to nicotinamide adenine dinucleotide diaphorase (NADHd), conducted in a liquid medium is greatly insensitive to postmortal autolysis. In 10 heart cones (i.e., cardiac ventricles severed underneath the coronary sulcus) stored at 6 degrees C for up to 114 h after death, no autolytic artifacts appeared on freshly cut apical surfaces of transverse myocardial slices. In 10 cones kept at room temperature for up to 95 h after death, no artifacts appeared in eight cases; in two cases the LDHr was impaired by postmortal bacterial spread and decomposition of the myocardium. Intravital perfusion of injured myocardium increases the sensitivity of the LDHr. Postmortal stand-still of circulation is decisive in preserving dehydrogenase activities in undamaged myocardium. An artificial decrease in enzyme activity always appeared on the nonrecent, basally facing cut surfaces of slices exposed to air and fluid oozing out of the myocardium for long periods, even if the exposed surface of the cone was kept at 6 degrees C and wrapped in plastic. In normal practice, when bodies are stored in a refrigerating unit, the LDHr may still indicate myocardial damage more than 114 h after death.

Adolescent↗
PubMed1992

Autopsy analysis in surgical patients: a basis for clinical audit.

An autopsy study was performed to quantify diagnostic fallibility in clinical surgery. Autopsy results in 312 surgical patients were compared with clinical findings. The primary clinical diagnosis was correct in 93 per cent of patients; complications had been correctly diagnosed in 60 per cent and error in treatment was found in 16 per cent. Error in treatment had an adverse impact on the course of disease in 11 per cent of patients. Infective complications such as abdominal sepsis and bronchopneumonia were encountered most often. Sensitivity was low for the clinical diagnosis of pulmonary embolism, bronchopneumonia, myocardial infarction and terminal haemorrhage. Statistical analysis showed that sudden unexpected death is the most obvious condition in which a high yield is expected from a post-mortem examination. Autopsy remains a valuable means of quality control in clinical surgery and could be a basis for surgical audit.

Adolescent↗
PubMed1992

Autopsy analysis in patients with vascular diseases.

An analysis of autopsy findings in 68 patients who died with vascular surgical disorders was performed. Incorrect diagnoses and therapy were evaluated. It was found that complications of the primary disease or its treatment were frequently missed clinically (41%). Septic complications and severe hemorrhage were common in examinations of morbidity and mortality. In 13% of cases a treatment error with adverse impact on survival was detected. It is concluded that postmortem examination is a valuable tool in the final evaluation of patient care in a vascular surgical unit. A repeated plea for the autopsy is supported by this study.

Aged↗
PubMed1992

The effect of chemotherapy on osteosarcoma.

The aim of this study was to evaluate the effect of chemotherapy on osteosarcoma by comparing the histologic pattern of primary tumors with that of their metastases. Therefore the primary tumors and metastases in 11 patients were macroscopically and histologically classified according to the Enneking and Broder systems as well as our own method. Three of 11 patients developed metastases with a less malignant pattern, 8 patients developed metastases which were as malignant as the primary tumor. The chemotherapeutics used had either an insubstantial effect or none at all on the differentiation of immature tumorous structures in the metastases and treatment did not lead to the expected improvement. Only the patients in whom, according to our own system, the primary tumors were classified as less malignant, are still alive.

Adolescent↗
PubMed1992

The results of autopsy of patients with surgical diseases of the digestive tract.

The results of autopsy of 77 patients who died because of surgical disease of the digestive tract were compared with antemortem findings. An analysis was performed to identify missed diagnoses and incorrect therapy. Primary diagnoses had not been frequently missed, but many complications of the primary disorder or treatment had been overlooked. Many patients died because of septic conditions. Error in treatment, with an adverse impact on the course of the disease as assessed by the postmortem examination, occurred in 9 percent of the patients. The most common error had been failure to reoperate upon patients with an intra-abdominal complication. Unexpected death was significantly associated with incorrect diagnosis; failed or inadequate diagnostic methods were significantly associated with treatment failure (chi-square tests). The autopsy remains a valuable procedure in clinical operation. Selection of patients for autopsy, as indicated by decreasing autopsy rates, is not justified.

Adult↗
PubMed1990

Comparative anatomic studies of various arterial conduits for myocardial revascularization.

Comparison was made between the morphologic condition of the left anterior descending artery and four arterial conduits: the internal mammary, right gastroepiploic, inferior epigastric, and radial arteries, harvested from 17 patients (aged 15 to 85 years, mean 64 years) who had died of nonvascular diseases. Proximal, mid, and distal segments were examined microscopically. The internal mammary artery was elastic, but the others were muscular. In all four conduits, atherosclerosis was absent to mild, the internal elastic lamina showed only minimal defects, and the vasa vasorum were confined to the adventitia. In all cases the left anterior descending artery showed mild to severe atherosclerosis and substantial defects in the internal elastic lamina with penetration of the vasa vasorum into the media and intima. Comparison of the mean distance (+/- standard deviation) from the lumen to the outermost portion of the media for the left anterior descending artery (320 +/- 63 microns) with the four conduits gave comparable values for the internal mammary artery (350 +/- 92 microns); p = not significant) and the right gastroepiploic artery (291 +/- 109 microns; p = not significant), versus 529 +/- 52 microns; p less than 0.002) for the radial artery and 249 microns (+/- 87 microns) (p less than 0.04) for the inferior epigastric artery (Kruskal-Wallis and Mann-Whitney U tests). The relatively scanty presence of smooth muscle cells in the thin-walled media of the internal mammary artery combined with a well-formed internal elastic lamina, even at advanced age, may be an important cause for its low susceptibility to atherosclerosis and a major determinant in its superior long-term patency as a coronary artery bypass graft. This finding emphasizes the justification of continued use of the ideally matching internal mammary artery, either as in situ or free graft, in coronary artery bypass grafting. In contrast to the thick-walled radial artery, which may be relatively prone to ischemia, an acceptable long-term patency of the inferior epigastric artery and right gastroepiploic artery, if harvested as pedicled grafts, is anticipated.

Adolescent↗
PubMed1989

Chylopericardium and chylothorax, resulting from a catheter to the left subclavian vein: an autopsy report.

A 47-year-old woman with long-standing myelofibrosis and thrombocytosis whose spleen was removed 9 days prior to death, died of a heart tamponade. Subsequent autopsy revealed the development of chylothorax and chylopericardium due to the existence of a thrombus obstructing the ostium of the left thoracic duct, as a consequence of the particular location of a central venous catheter in the left subclavian vein in the proximity of the confluence of the left thoracic duct in the afore-mentioned vein.

Cardiac Tamponade↗
PubMed1988

Whole-body inflammation in trauma patients. An autopsy study.

In a review of autopsy specimens and reports in 35 trauma cases, we found signs of generalized inflammation and tissue damage with increases in organ weights in organs not primarily injured. These abnormalities occurred independent of the time of death and were also found in patients who died of brain injury alone. The most pronounced signs of inflammation and increases in organ weights were found when the adult respiratory distress syndrome, hypovolemic shock, or multiple organ failure were the causes of death. These findings are similar to those found in several organs of rabbits after four hours of complement activation in combination with 20 minutes of hypoxia. Therefore, the autopsy findings in this series of trauma patients might represent the morphologic features of adult respiratory distress syndrome and multiple organ failure in an early, preclinical stage.

Adolescent↗
PubMed1988

Histochemistry of cerebral lesions in mice infected with Plasmodium berghei.

The brains of mice with established symptoms of Plasmodium berghei erebral malaria were investigated histochemically and histologically. The activity of mitochondrial, lysosomal, glyco/glycogenolytic, hydrolytic and oxidizing enzymes as well as enzymes of the Krebs cycle and the pentose cycle was studied during the course of the infection. For comparison cryostate sections were also stained with haematoxylin and eosin, and according to Kluver-Barrera. Changes in enzyme activity, particularly of the vascular endothelium suggest a functional alteration of the blood-brain barrier which precedes the histochemically detectable lesions of the brain parenchyma. Decrease and total loss of enzyme activity in circumscript areas, also of ependymal cells were indicative of an early ischemic lesion. A population of small, non-phagocytozing, granuloma-like cells frequently accumulating in the frontobasal regions and in the subependymal zones were probably immature astrocytes. During early infection, these cells apparently fail to differentiate and turn to necrosis at the end of the second week. The results of this study support the concept of a triggering role of an initial vascular lesion and a functional breakdown of the blood-brain barrier in susceptible areas of the brain, in the pathogenesis of experimental malaria.

Animals↗
PubMed1987

Hereditary mitochondrial hypertrophic cardiomyopathy with mitochondrial myopathy of skeletal muscle, congenital cataract and lactic acidosis.

A six day old boy died from an hereditary hypertrophic cardiomyopathy which was associated with mitochondrial myopathy of skeletal muscle, congenital cataract and lactic acidosis. In heart and skeletal muscle identical mitochondrial abnormalities were found: paucity and abnormal arrangement of cristae, formation and extrusion of vesicle-like structures and crystalline inclusions in the matrix compartment. Electron-cytochemistry revealed that only part of the mitochondria reacted positively for cytochrome oxidase activity. Morphometric analysis indicated that the cardiomegaly was due to cellular hypertrophy, which might be caused by an increase in the mitochondrial mass. The cardiac hypertrophy in this syndrome can be classified histopathologically as mitochondrial hypertrophic cardiomyopathy.

Acidosis, Lactic↗
PubMed1987

Improved myocardial capillarisation in spontaneously hypertensive rats treated with nifedipine.

The effect of long term administration of nifedipine on myocardial capillarity was studied in spontaneously hypertensive rats. Nifedipine was given for 20 weeks, mixed into commercial rat chow (0.3 g per 1 kg). Untreated spontaneously hypertensive rats had higher arterial blood pressure and developed cardiomegaly when compared with Wistar-Kyoto rats used as controls. Nifedipine administration in spontaneously hypertensive rats lowered the arterial blood pressure and reduced cardiac weight; however, both values remained far above those for controls. Myocardial capillarity was determined using the recently introduced method of capillary domains. Hearts from untreated spontaneously hypertensive rats were characterised by greater and more variable intercapillary spacing than those from controls. The treatment of spontaneously hypertensive rats with nifedipine resulted in normalisation of morphometric indices characterising capillary spacing, probably as a result of stimulation of capillary growth as indicated by a significant decrease in myocyte to capillary ratio. Thus, despite persistent hypertension and cardiomegaly the treatment of spontaneously hypertensive rats with nifedipine restored mean intercapillary distance and index of heterogeneity of capillary spacing to normal values.

Animals↗
PubMed1987

Resorbable suture support for ventricular aneurysmectomy.

The edge of tissue left after ventricular aneurysmectomy requires very careful placement and tying of the sutures. The use of Teflon felt as a support appears to redistribute the pressure and thus prevent the sutures from cutting through the vulnerable tissue. In many cases, Teflon felt reinforcement is preferred to direct unsupported closure because of perioperative of immediately postoperative bleeding complications. However, the unavoidable full immobilization of the sutured area, the possible risk of foreign body infection, and the extensive adhesions and calcification in the long term compelled us to search for a better alternative, combining the convenience of both methods and limiting the risks. PDS (polydioxine) resorbable pledgets and strips, provided by Ethicon GmbH, were used as a suture support during the past 2 years for closure of 29 ventricular aneurysmectomies and four ischemic ventricular septal defects, all except one in combination with coronary bypass grafting. The PDS material was easy and efficient to apply and caused no complications during and after the operation. In one case, we had the opportunity to review the supported scar during a second operation for new coronary grafts after 18 months. The formerly feared "linear scar petrification," usual after use of Teflon felt, was absent. The scar was free from difficult adhesions. Our initial experience suggests the further extensive use of this resorbable material as a support for various sutures at risk.

Heart Aneurysm↗
PubMed1987

Whole body inflammation in trauma patients; an autopsy study.

The autopsy reports of 35 trauma patients were reviewed. We found signs of generalized inflammation and tissue damage with increases in organ weights. Organs not primarily injured by trauma were also affected. These abnormalities were found in patients who died within 24 hours after trauma, as well as in patients who died of mere brain injury. The most pronounced signs of inflammation and increases in organ weights were found especially when the "Adult Respiratory Distress Syndrome" (ARDS), hypovolemic shock or "Multiple Organ Failure" (MOF) were the causes of death. Our findings are similar to those found in the lungs of humans suffering from ARDS and in several organs of rabbits after 4 hours of complement activation in combination with 20 minutes of hypoxia. Therefore, the autopsy findings in this series of trauma patients might represent the morphologic features of ARDS and MOF in an early-even preclinical-stage. We interpret these syndromes as the clinical expression of an uncontrolled inflammatory response to trauma, mediated by massive activation of the complement system.

Adolescent↗