Biomedical subjects

M Krejca

Publications and source records attributed to M Krejca.

6 recordsLinked to original sources

PubMed2000

Necrobiotic xanthogranuloma presenting as a solitary tumor.

We report on a 60-year-old overweight white woman who presented with an asymptomatic flat, hard, yellow-brown subcutaneous plaque on her right hip. A total excision was performed. Histopathologic examination showed all the major features of a necrobiotic xanthogranuloma (NX) involving the entire dermis and subcutis, including areas of necrobiosis with cholesterol clefts, granulomatous infiltrate with some bizarre giant cells, numerous Touton cells, foamy cells, lymphoid follicles with germinal centers, foci of plasma cells, and "Touton cell panniculitis." A laboratory investigation revealed only slightly increased titers of cholesterol, strong positivity of anti-Borrelia antibodies, and diffuse skeletal osteoporosis with fractures of seven vertebrae. After 4 years of close follow-up, the osteoporosis was improved, and there were no signs of paraproteinemia, malignancy, or new skin lesions. The authors suggest that this case could represent a solitary clinical variant of NX without paraproteinemia.

Female↗

PubMed2000

Long term left ventricular systolic function assessment following CABG. A prospective, randomised study. Blood versus cristalloid cardioplegia.

BACKGROUND: In an effort to define the role of blood cardioplegia delivered in antegrade/retrogade fashion in patients with either good or poor left ventricular function undergoing elective coronary artery bypass surgery, we initiated a prospective randomised study in which postoperative hemodynamics besides clinical data were compared in patients administered antegrade/retrograde crystalloid cardioplegia. METHODS: To compare the efficiency of two methods of myocardial protection--cold crystalloid ante/retro cardioplegia and cold blood ante/retro cardioplegia in two groups of patients with high and low LVEF--we randomised 122 patients for CABG. The potential improvement in left ventricular systolic function assessed by echocardiography and the same clinical data were the end points of the study. Patients were divided into group I (47 patients, LVEF <40%) and group II (75 patients, LVEF >40%). Pathologic antecedents and preoperative clinical conditions were similar in both randomised subgroups Ia, IIa (crystalloid cardioplegia) and subgroups Ib, IIb (blood cardioplegia). The following parameters were measured: left atrium diameter (LA), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), left ventricular wall motion score index (WMSI), and area asynergy (AA). All patients underwent echocardiography: A--prior the CABG, B--2-6 weeks postoperatively, C--3 months postoperatively, D--6 months postoperatively, E--1 year postoperatively. RESULTS: The results of clinical assessment in both groups showed improvement of quality of life. The constant improvement of LVEF and WMSI was observed in group I in contrast to group II. There were no significant differences in postoperative left ventricular systolic function between subgroups Ia and Ib or IIa and IIb. CONCLUSIONS: The use of blood cardioplegia, instead of crystalloid cardioplegia, when used in the ante/retrograde fashion during CABG has no influence on postoperative left ventricular systolic function. The improvement in left ventricular systolic function following CABG is greater in patients with low LVEF in contrast to patients with high LVEF.

Adult↗

PubMed1999

Cardiac troponin T release during coronary surgery using intermittent cross-clamp with fibrillation, on-pump and off-pump beating heart.

OBJECTIVE: Troponin T is a unique marker which might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. The aim of the study was a comparison between intra-operative release of troponin T (TnT) during three different myocardial protection strategies. METHODS: Thirty-eight PTS undergoing myocardial revascularization were randomised into 3 groups in whom procedure was performed with intermittent cross-clamp (Group I; n = 13), beating-heart on pump without aortic cross-clamp (Group II; n = 12), beating-heart without use of extracorporeal circulation (Group III; n = 13). Serial venous blood samples were collected for TnT measurement prior surgery, 1, 4, 12, 24, 48, 72 h after the procedure. Haemodynamic measurements were made using a thermodilution PA catheter. RESULTS: The groups were similar with respect to age, sex, preoperative LV function, number of grafts, potential risk factors. There were no hospital deaths and no myocardial infarction (MI) in three groups, postoperative haemodynamic measurements showed no significant differences. TnT serum levels were significantly higher in group I when compared to groups II and III. TnT levels were significantly lower in group Ill when compared to group II following 48-h post-operation. CONCLUSIONS: Coronary bypass grafting without aortic cross-clamping and without CPB offers superior myocardial protection.

Aged↗

PubMed1998

Evaluation of perioperative myocardial tissue damage in ischemically preconditioned human heart during aorto coronary bypass surgery.

BACKGROUND: Preconditioning myocardium with short periods of ischaemic stress interspersed with reperfusion increases its resistance to infarction. Ischaemic preconditioning protection occurred in human beings during unstable angina preceding myocardial infarction, during percutaneous transluminal coronary angioplasty and during aorto coronary bypass surgery. The purpose of this study was to test (utilised cardiac troponin T measurement) whether ischaemic preconditioning was able to protect myocardial tissue during the perioperative period and how long that protection lasted. METHODS: Patients were recruited to the preconditioned group (n=29), received 4-min of aortic cross-clamping and 6 min reperfusion prior to CABG performed with intermittent ischaemic arrest and the control group (n=27) received only an ischaemic insult of operating procedure. TnT measurements were determined from blood samples taken before surgery (A), 1 hour after onset of CPB (B), 4 hours (C), 8 hours (D), 12 hours (E), 24 hours (F), 48 hours (G) and 72 hours after CPB (H). RESULTS: Results were expressed as the median, range and standard deviation (SD) of TnT concentration (microg/l). Ischaemic preconditioning decreased TnT concentration with statistical significance 1 hour after onset of CPB (preconditioned B: median 0.12+/-0.25 vs control B: median 0.32+/-0.43, p=0.03). There were notable differences in TnT concentration in C, D, E, F, G, H blood samples between the control and the preconditioned group but with p value of no statistical significance. CONCLUSIONS: These data illustrate that ischaemic preconditioning limits myocardial damage during operative procedure and it may probably afford protection during a postoperative period.

Aged↗

PubMed1996

Coronary arteries bypass grafting with use of both internal thoracic arteries.

The internal thoracic artery is a preferred conduit for bypass grafting. While the single ITA grafting has been universally accepted -- the use of both ITA's remains controversial. The risk factors analysis based upon assessment of operative results and mid-term functional follow-up was performed. The clinical applicability of transthoracic B-mode ultrasonic imaging and Doppler spectrum analysis in the postoperative evaluation of use of two ITA's was investigated. From January 1989 to January 1993, 97 patients received bilateral ITA and additional vein or RGEA grafts at Groby Road Hospital, Leicester, UK. There were 77 men (79.4%) and 20 women (20.6%) with mean age of 52.1+/-10.1 years. 19 cases were urgent. 14.4% of patients suffered from diabetes mellitus, 8.3% -- COAD and 46.6% did not work because of angina. The average number of anastomoses per patient was 3. The operative mortality was 4.1%. Complications included: reoperation for bleeding=3.2%, sternal infection=6.5%, IABP=2.1%. There were no evidence of perioperative myocardial infarction. 80 patients were followed-up for 26,5+/-13 months. 49 patients were in angina NYHA class I while preoperatively: 7. 1 patient was in NYHA class III while preoperatively there were 40 patients. Nearly twice more patients worked, and more than three times fewer patients did not worked because of angina, comparing to preoperative period. With the use of colour Doppler technique the blood flow was measured in 78.3% of left and 74% of right ITA's. The average flow in left ITA was: 46.4+/-17 ml/min and 41.7+/-17 ml/min in right ITA. The multivariate analysis for risk factors of bilateral ITA's grafting was performed. There were no risk factors for postoperative complications of bilateral internal thoracic arteries grafting in presented material. The risk of perioperative death is higher for patients with triple vessels disease than for patients with double vessels disease. Bilateral ITA grafting procedure has positive influence on patients working abilities. Percutaneous ultrasonic assessment of flow in ITA's used for bypass appears to be useful non-invasive investigation of their function.

Coronary Disease↗

PubMedDate not supplied

Role of sensory innervation variations for wrist block anesthesia.

BACKGROUND: A variety of anesthesia techniques for hand surgery have been suggested. METHODS: Cases of single peripheral nerve block and incomplete wrist block failures are analyzed and compared with a group of patients with complete wrist block. RESULTS: According to the results of our study, in 825 cases there was a 15% rate of documented failures of incomplete wrist block, most probably due to anomalous sensory innervation. CONCLUSIONS: This clinical observation is in agreement with many published studies on neural anatomy and supports the use of complete wrist block for hand surgery.

Adolescent↗