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M Bojić

Publications and source records attributed to M Bojić.

46 records · Page 3Linked to original sources
PubMedDate not supplied

Pericardial effusion after streptokinase for acute myocardial infarction: an echocardiographic 1-year follow-up study.

Since the reported incidence of pericardial effusion following thrombolysis is highly variable, we have evaluated 80 consecutive patients with first acute myocardial infarction treated with streptokinase. Two-dimensional echocardiographic studies were performed on days 1, 2, 3, and 7, at 3 and 6 weeks, and 3, 6, and 12 months following acute myocardial infarction. Throughout the study, pericardial effusion was found in 7 of 80 (8.75%) patients, being small in 5 patients, moderate in 1, and large in 1 patient. No clinical, angiographic, or echocardiographic variable was associated with pericardial effusion formation. The incidence of pericardial effusion found in our study is almost three times lower than in other echocardiographic studies on pericardial effusion in thrombolysed patients. Whether this differences results from the beneficial effects of streptokinase is not clear.

Blood Flow Velocity↗
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[The effect of gender on vasomotor function of the vascular endothelium and cardiovascular remodelling during aging].

INTRODUCTION: Aging is correlated with decreased endothelial vasomotor influence, increased carotid intima-media thickness and stiffness, increased left ventricular mass index and increased blood pressure [1-3]. However, these changes are not expressed in the same way in both genders [4, 5]. It seems that females are more protected from cardiovascular changes during aging compared to males [1, 6]. AIM OF THE STUDY: The aim of the study was to evaluate the influence of gender on brachial vasomotor responses (reactive hyperemia test) as well as the correlation with vascular and cardiac remodelling in healthy volunteers of different ages. MATERIAL AND METHODS: The study was carried out on healthy subjects (n = 66; 37 males, 29 females) of different ages (20-82 years) with no history of cardiovascular diseases and diabetes mellitus. All subjects were normotensive, non-smokers with normal blood lipid and glucose values, were not taking any medication at the time of investigation and were asked to refrain from eating and drinking alcohol, coffee or tea 12 hours before the examination. Subjects were divided in two groups (male and female) and 5 age-related groups according to appropriate decade (20-29, 30-39, 40-49, 50-59, and above 60 years). All subjects underwent regular cardiologic examination, ECG recording and cardiac ultrasound in order to exclude valvular diseases, decreased myocardial contractility and ejection fraction. During the study blood pressure and ECG were recorded continuously. Carotid artery intima-media thickness and brachial artery diastolic internal diameter (mm) and blood flow (ml/min) values were measured continuously using high-resolution ultrasound. Brachial artery parameters were measured in baseline condition, during ischaemia and reactive hyperemia (endothelium-dependent relaxation) and after nitroglycerin administration (endothelium independent relaxation, 2 x 400 micrograms, sublingual) [7, 8]. Brachial ischaemia was induced by inflation of a pneumatic tourniquet placed at the forearm to a pressure of 300 mmHg followed by deflation after 3 min. We analyzed changes in peripheral arteries (changes in brachial artery diastolic diameter and flow during 90 sec after cuff deflation), structural changes of carotid artery, functional and structural changes of the left ventricle (19-11). We used cardiac ultrasound (Hewlett Packard Sonos 2500) with a 2.0-2.5 MHz imaging transducer and a 7.0-MHz linear array transducer for vascular measurements. Demographic and clinical characteristics of subjects are presented in Table 1. All results are expressed as mean and S.E.M. Data analysis was done by linear regression analyses, multivariate test (LSD procedure) and Student's T-test. P values less than 0.05 were considered to be significant. RESULTS: Relative changes in brachial artery diastolic diameter in reactive hyperemia in comparison to aging (with gender distribution) are shown in Graphs 1 and 2. Our study showed decrease in brachial vasodilator response to reactive hyperemia during aging (male p < 0.05, female p < 0.001). Data analysis showed a significant difference between age-related groups above 40 years and groups below 30 years of age (p < 0.001). The analysis of carotid intima-media thickness showed increased values during aging in both genders but without statistical significance (Graph 2). Analysis of relationship between carotid intima-media thickness and aging (by gender) showed a good correlation of these parameters expressed by the following formula: intima-media thickness (cm) = 0.0009 x years of age + 0.0139. ANOVA test for age-related groups showed significant correlation (p < 0.01) between all age-related groups except 30-40 vs. 40-50 year group. Student's T-test showed no significant correlation between genders. The relationship between the left ventricular mass index (LVMI) and aging (with gender distribution) is shown in Graphs 3 and 4. The left ventricular mass index was increased during aging

Adult↗
PubMedDate not supplied

[Contusion injury of the brachial artery].

We present a case of a successful repair of brachial artery after blunt trauma, almost five days after the injury. Autovenous graft (great saphenous vein) was used for the repair. The diagnosis was confirmed by angiography, and this method was indisposable in the postoperative course. Precise surgical technique is compulsory in obtaining optimal surgical revascularization.

Adult↗
PubMedDate not supplied

[Use of the internal thoracic artery in patients with stenosis of the left main branch of the coronary artery].

UNLABELLED: Internal thoracic artery (ITA) is the graft of choice in myocardial revascularization. However, superiority of the ITA graft in patients (pts) with left main coronary artery disease is still a matter of debate. PATIENTS: In the period from November 1986 through February 1999, ITA graft was used for myocardial revascularization in 2860 pts. Stenosis of the left main stem was present in 229 patients (8.0%); there were 39 women (17.0%) and 26 diabetics (11.4%). Severely depressed left ventricular function was present in 32 pts (14.0%), while the average age was 56.4 +/- 7.2 years. RESULTS: Operative mortality was 1.3% and postoperative morbidity was 5.2%. Average postoperative hospital stay was 7.9 days (6-29). There were no differences in analyzed parameters between patients who received ITA graft and similar group of 240 patients who received vein grafts only, during the same period of time. All 16 patients operated on in the period 1986-1992 (6-12 years follow-up) are alive. CONCLUSION: It is safe to use ITA graft for myocardial revascularization in patients with left main coronary artery stenosis. Early operative results are favorable and these patients should not be denied the benefit of the ITA graft, since long-term results are proved to be good as well.

Aged↗
PubMedDate not supplied

[Angiographic characteristics of the internal thoracic artery--anatomic variations and their surgical importance].

INTRODUCTION: The internal thoracic artery is considered the graft of choice for surgical revascularization of the ischemic myocardium. The real incidence of anatomic variations of the internal thoracic artery is not known, although it is an extremely important issue, considering surgical strategy, as well as immediate and long-term outcome. MATERIAL AND METHODS: During a period of three months (Jun. 1st-Aug. 31st 1998) we have evaluated the left internal thoracic artery (ITA) in 80 randomly selected patients (62 men, average age being 57.4 +/- 5.2). RESULTS: Typical take-off, side branches, terminal division and absence of any atherosclerotic lesions were noted in 69 patients (86.25%). Angiographically apparent atherosclerotic lesions were not noted; anomalous take-off from the left subclavian artery was noted in 9 cases (11.25%--including one case of aneurysmatic proximal portion of the ITA); there were two cases where the lateral thoracic artery was present (2.5%) and three cases where the distal division was of a trifurcation type, which is not of surgical importance (3.75%). Average diameter of the left ITA was 2.19 +/- 0.24 mm for the entire group (2.20 +/- 0.19 mm for men, and 2.10 +/- 0.21 mm for women, p = NS). DISCUSSION: Results that we have obtained are in accordance with previously published data. We did not find significant (angiographically visible) atherosclerotic lesions of the ITA, however variations in the take-off and branching were found to be frequent (11.25%). Aneurysmatic left ITA is an extremely rare finding in the literature. Angiographically found variations (capable of causing coronary steal) are impossible to be detected during operation. This raises a question of a need for routine angiographic evaluation of the ITA before operation. For some patients, routine angiographic evaluation of the ITA before myocardial revascularization is mandatory: in pts with previous myocardial revascularization, in whom ITA was not used, but could have been damaged; in pts with atherosclerotic lesions of the supraaortic vessels; in pts with previous irradiation of the anterior mediastinum (ITA could be fibrotic); in pts with actual or corrected coarctation of aorta (ITA could be aneurysmatic). CONCLUSION: The incidence of anatomic variations of the ITA (that may be of surgical importance) is not negligible (13.25%). These data indicate that routine angiographic evaluation of the ITA should be considered in all patients in need for myocardial revascularization.

Aneurysm↗
PubMedDate not supplied

[Functional characteristics of endothelium in arterial hypertension].

With findings of prostacyclin, known as a very potent antiplatelet, anticoagulant, vasodilator, a profibrinolytic and cytoprotective substance from arachidonic acid cascade, many different endothelium-derived vasoactive substances were discovered. It is known (1980) that intact endothelium is necessary for the vasorelaxant effect of acetylcholine in isolated rabbit aorta. The balance between relaxing and contracting factors of endothelial origin is very important for optimal blood vessel diameter and tissue perfusion. The existence of endothelium-derived vascular smooth muscle cells growth and proliferation factors is a new important dimension in the understanding of function of vascular endothelium.

Animals↗
PubMedDate not supplied

[Traumatic arteriovenous fistulas during a period of peace].

The aim of the study was to point out the significance of clinical vascular examination and angiography in diagnosis setting, with the presentation of the patients treated for traumatic arteriovenous (AV) fistulas, so as the significance of timely treatment of that specific traumatic entity. In the period 1985-1996 11 patients with traumatic AV fistulas were treated. The most frequent causes of injury were bullet from firearms and blunt injury. The most frequent injury localization was in upper leg (4 cases). The interval from injury till registration and/or treatment of AV fistula was from 10 days to 33 years. Murmur was noticed in nine patients, thrill in eight, and weakened or absent arterial pulsations below the place of injury were observed in five patients. The diagnosis was confirmed by classic or cine-angiography. Major blood vessels were surgically reconstructed by various techniques, and non-major were ligated or percutaneous transluminal embolization was used. It was concluded that the noticing of murmur and thrill above the place of injury pointed out the existence of traumatic AV fistula, and angiography represented reliable diagnostic method and should be used for diagnostic, as well as therapeutic purposes. In the case of major blood vessel injury, surgical reconstruction is the method of choice.

Adolescent↗
PubMedDate not supplied

[Relation of the pressure-volume loop and mechanical energy properties of the left ventricle].

New biomechanical models of the left ventricle, as well as recent technological breakthroughs, allowed a wider use of pressure/volume loop in the assessment of mechano-energetic properties of the left ventricle. The most widely used parameter derived from the pressure/volume loop is end-systolic elastance, which reflects the left ventricular contractility. Additionally, pressure/volume loop has been proved to be useful in the assessment of left ventricular diastolic function. More complex parameters of left ventricular mechanisms, such as stroke work and potential energy, can be studied by plotting pressure/volume loop and lines depicting end-systolic and end-diastolic pressure/volume relations. Similarly, the ratio of the area contained in the pressure/volume loop, that is stroke work, and the level of myocardial oxygen consumption can be used in the assessment of the efficiency by which the left ventricle converts chemical energy into mechanical energy. In conclusion, the use of pressure/volume loop and its relationship to myocardial oxygen consumption can be very effective in the analysis of cardiovascular performance in various settings.

Animals↗