Biomedical subjects

M Perić

Publications and source records attributed to M Perić.

At least 19 recordsLinked to original sources

PubMed2001

[Use of the internal thoracic artery in repeat myocardial revascularization surgery].

The incidence of redo myocardial revascularization is increasing lately. These procedures are accompanied by the higher operative risk, and the use of internal thoracic artery graft may have additional negative impact on early-rization. Mortality and morbidity in this group did not differ significantly compared to a group where only venous grafts were used. Independent predictors of the unfavorable outcome (for both groups) were the presence of the chronic pulmonary disease, age over 65 and NYHA functional class IV. In the group with internal thoracic graft it was the age over 65, while in the group with only vein grafts it was chronic pulmonary disease. We have discussed potential problems during the redo procedure in patients in whom internal thoracic graft was used during the first procedure.

Aged↗

PubMed2001

[Assisted circulation. I. Systems with short-term mechanical circulatory support].

The concept of artificial circulatory support has been established almost 200 years ago. It has only been within the last four decades that physicians and engineers have developed mechanical assist devices that can temporarily support the circulation until the native heart recovers from a reversible injury. If the heart does not recover sufficient function to maintain adequate hemodynamics, long-term circulatory support or permanent replace (biologically--heart transplant or permanent mechanical circulatory support) is needed. In this paper we describe the devices (intraaortic balloon pump, roller, centrifugal and axial pumps), that are in current clinical use for temporary (short-term) mechanical circulatory support.

Assisted Circulation↗

PubMed2000

Active infective endocarditis: low mortality associated with early surgical treatment.

BACKGROUND: Early surgical treatment is important for successful outcome in selected cases of active, either native (NVE) or prosthetic valve endocarditis (PVE). The aim of this study was to evaluate the early results of the surgical treatment of active NVE and PVE. METHODS: During a 3-yr period (January 1 1996-December 31 1998), 57 out of 60 patients (pts) with active, either NVE (46 pts) or PVE (11 pts) underwent surgical treatment. There were 11 women (23.9%), average age of the group being 43.3+/-9.1yr (18-73). They were operated on 12-35days, mean 17.7+/-7.5days (for NVE) and 5-33days, mean 13.2+/-10.1days (for PVE) after the diagnosis of endocarditis was first suspected. All pts had at least one absolute indication for early surgical treatment, the most frequent being (in NVE) worsening heart failure (19 cases) and inability to control the infection (10 cases), while in PVE it was valve dehiscence (8 cases). In 8 cases of NVE and 2 cases of PVE fresh, antibiotic sterilized aortic homograft was used to replace the aortic valve. RESULTS: Operative mortality was 1.8% (1/57) and hospital mortality 5.2% (3/57). Three pts with PVE died before they were operated on, giving an overall mortality of 10% (6/60). Postoperative morbidity included valve dehiscence in two pts (probable late onset recurrent endocarditis - 3.5%), three episodes of acute renal failure (5.3%), four cases of respiratory insufficiency (7.0%) and one chronic pleural effusion (1.8%). All pts that were discharged from the hospital (54/60), are still alive and well 1-35months postoperatively (mean 20.3+/-9.6months), including pts with recurrent endocarditis and valve dehiscence, after they were successfully reoperated. CONCLUSIONS: Along with early diagnosis and appropriate antibiotic treatment, aggressive surgical attitude is of importance for the successful outcome in this group of seriously ill patients. Our data indicate that early surgical treatment in cases of active endocarditis may be associated with low mortality and morbidity.

Adolescent↗

PubMed2000

[History of surgical treatment of atherosclerosis of the coronary arteries--the first 100 years].

Atherosclerotic coronary artery disease is the most common cause of morbidity and mortality. The incidence of cardiovascular morbidity and mortality has been doubled in our country during the period 1980 through 1996. Surgical treatment of the atherosclerotic coronary artery disease is already a century old, ever since Francois-Franck (in 1899) tried to achieve sympathetic denervation of the cervical ganglion. After the interim period of indirect myocardial revascularization, during the last 30 years, direct surgical revascularization has reached excellent early and long-term results, and became one of the most frequently performed procedures in the surgical practice. Use of arterial grafts and, introduced recently, procedures on the beating heart, minimally invasive procedures and, so called, port-access procedures became a daily routine in many centers. Surgical revascularization of the ischaemic cardiac muscle is the rapidly changing entity, along with diagnostic, technical and other improvements. We present a brief historical overview of the efforts of cardiac surgeons to combat the "disease of the century" atherosclerotic coronary artery disease.

Coronary Artery Disease↗

PubMed2000

[Occlusion of a calcified ascending aorta with a Foley catheter in aortocoronary bypass--case report].

Heavily calcified ascending aorta predisposes to aortic injury and distal embolization during total or partial cross-clamping, during the performance of open-heart procedures. Placement of the arterial cannula may be particularly difficult, occasionally virtually impossible using the standard technique, while placing the clamp on such aorta may be extremely risky. We present a case where we have used a Foley-balloon catheter to occlude the densely calcified ascending aorta, during a aorta-coronary bypass procedure, thus completely avoiding the use of the total aortic clamp.

Aorta↗

PubMed2000

Safety of simultaneous resections of colorectal cancer and liver metastases.

Liver resection is the only potentially curative method for patients with colorectal cancer metastases and 5-year survival rates are 20%-40%. Simultaneous resection of colorectal cancer and synchronous liver metastases has been recommended if minor hepatectomy is indicated. The purpose of this paper is to analyze the treatment of hepatic colorectal secondaries and to assess the safety of simultaneous and delayed liver resections and relations of morbidity to the extensiveness of hepatectomy and perioperative factors. Analyzed were 21 patients with liver metastases from colorectal cancer operated between 1997 and 1999 in the Clinical Hospital "Sestre milosrdnice". Operating time for simultaneous colorectal and liver resections was not significantly longer compared to liver resections alone. No significant difference in complication rate was found after simultaneous procedures and liver resection alone (38% vs. 31%). Complication rate after major liver resections was not significantly greater than after minor resections (38% vs. 31%). No statistically significant differences were found in operation time and blood replacement between patients who developed postoperative complications and those who did not. In conclusion, simultaneous resections of primary colorectal cancer and liver metastases may be considered safe. Morbidity rates are not significantly different from those after liver resections alone, nor depend significantly upon the extensiveness of liver resection, providing that the operation time and blood loss are within the range observed in this study.

Adult↗

PubMed2000

[Myocardial revascularization using the internal thoracic artery: pro and con].

Internal thoracic artery (ITA) has superior histological, physiological and pharmacological properties over the venous grafts, and it is considered to be the graft of choice for myocardial revascularization. It has low incidence of late atherosclerotic lesions, and excellent long-term patency. Usage of ITA yields improved clinical results in all subgroups of patients with coronary artery disease, including patients with poor left ventricular function (EF%), left main stenosis, diffuse coronary artery disease and octogenarians. Since superior long-term results (to be expected only 10-15 years after the operation) may be outweighed with slightly higher incidence of early morbidity and mortality, many cardiac surgeons are reluctant to use it routinely. However, this attitude is difficult to justify, since early operative results in patients that have received ITA graft are superior as well, compared to patients that have received vein grafts only.

Humans↗

PubMed1999

Chromosome aberrations in operating room personnel.

BACKGROUND: Long-term occupational exposure to volatile anesthetic agents may result in various adverse health effects. Additionally, certain surgical procedures involve exposure to the other agents such as X rays. Identification of chromosome damages in peripheral blood lymphocytes serves as a useful indicator of exposure to mutagenic agents. METHODS: The frequency of chromosomal aberrations was assayed in peripheral lymphocytes obtained from 129 subjects working in operating theatres and 41 control subjects. RESULTS: The results show an increased rate of chromosome aberrations in the exposed subjects. The differences in frequency of chromosome aberrations between particular job tasks were not distinct. Acentric fragments in anesthesiologists and dicentrics in surgeons seem to stand out. CONCLUSIONS: As the findings do not differ significantly between the exposed groups, one can hardly distinguish radiation and anesthetics effects from one another.

Adult↗

PubMed1998

Combined carotid and coronary artery surgery: what have we learned after 15 years?

UNLABELLED: Optimal surgical strategy in patients with concomitant coronary and carotid artery disease is debatable. We have analysed 15-years of experience (January 1981-August 1996) with 195 consecutive patients in whom we have used two different surgical approaches. Group A consisted of 48 patients who underwent a single-stage surgical procedure, and group B (147 patents) underwent a two-stage procedure, either as carotid endarterectomy followed by coronary artery bypass surgery (group B1, 97 patients), or as coronary artery bypass surgery followed by carotid endarterectomy (group B2, 50 patients). Overall, there were 40 (20.5%) patients with left main coronary artery disease, 49 (25.1%) with poor left ventricular function, 128 (65.6%) with previous myocardial infarction, 134 (68.7%) were in New York Health Authority (NYHA) functional class III or IV, and bilateral carotid involvement was present in 57 patients (29.2%). Unstable angina was more frequent in groups A and B2 (P < 0.0001), NYHA class III-IV was more frequent in group A (versus B1, P = 0.001 and versus B2, P = 0.02), low ejection fraction (EF) was more frequent in groups A and B2 (P < 0.0001 for both), bilateral carotid stenosis in groups A and B1 (P = 0.02 and P = 0.0001, respectively) and ulcerated plaque in group B1 (versus A, P = 0.0001). These differences dictated the surgical strategy, which resulted in different protocols for clinical and operative management. RESULTS: Early mortality for the entire group was 4.6% (9/195-6.2% in group A, 6.2% in group B1 and 0% in group B2, respectively P > 0.05). Serious morbidity occurred in 7.3% of patients (14/195-8.3% in group A, 7.2% in group B1 and 6% in group B, respectively P > 0.05). Univariate analysis revealed only bilateral carotid stenosis as a predictor of outcome (P = 0.04). Follow-up was completed for 156 patients (80.0%) and averaged 84.1 +/- 13.3 months (range 1-180 months). Kaplan-Meier survival estimate for the entire group was 81% and event-free survival was 76% at 5 years. Actuarial and event-free survivals were similar for all groups. Early and late outcome in these patients were influenced more by their preoperative clinical status than by the surgical strategy itself. It is therefore concluded that surgical approach should be individualized for the majority of patients.

Actuarial Analysis↗

PubMed1997

Cardiac events after combined surgery for coronary and carotid artery disease.

OBJECTIVE: To evaluate serious cardiac events after combined (either single or two stage) coronary artery surgery (CAS) and carotid endarterectomy (CEA) for concomitant coronary and carotid artery disease. METHODS: We have analyzed our 15 year experience (January 1981-September 1996) with 201 consecutive patients operated on using both approaches. Group A consisted of 48 patients with the single-stage procedure, while in group B (153 patients), two stage procedure was carried out, either as carotid endarterectomy (CEA), followed by coronary artery bypass surgery (CAS) (group B1- 103 patients), or as CAS followed by CEA (group B2- 50 patients). Five patients from B1 group died after the CEA procedure, but were included, despite the fact they never reached the second stage. Left main coronary artery disease was found in 41 patients (20.4%), poor left ventricular function in 49 (24.4%) previous MI in 133 (66.2%), while 136 (67.7%) were in NYHA functional class III or IV. Bilateral carotid involvement was present in 61 patients (30.3%). Unstable angina was more prevalent in groups A and B2 (P < 0.0001). NYHA class III/IV in group A (versus B1, P = 0.001 and versus B2, P = 0.02), low ejection fraction in groups A and B2 (P < 0.0001), bilateral carotid stenosis in group B1 (versus A, P = 0.003 and versus B2, P < 0.0001), and ulcerated plaque in group B1 (P < 0.0001). These differences dictated the surgical strategy, which resulted in different protocols for clinical and operative management. RESULTS: Early mortality for the entire group was 5.5% (11/201) 6.2% in group A, 7.8% in group B1 and 0% in group B2, respectively; (P > 0.05). Serious morbidity occurred in 7.5% of patients (8.3% in group A, 7.8% in group B1 and 6% in group B2, respectively; P > 0.05). Univariate analysis revealed only bilateral carotid stenosis to influence early outcome (P = 0.04). CONCLUSION: Patients with concomitant coronary and carotid artery disease have relatively good immediate operative results, providing all existing lesions are corrected. Despite it did not reach the statistical significance, cardiac events were less frequent in groups A and B2 indicating possible protective effect of prior CAS in patients with concomitant disease.

Aged↗

PubMed1997

The effects of levcromakalim and pinacidil on the human internal mammary artery.

The present study was undertaken to examine the effects of pinacidil and levcromakalim, two potassium, channel openers, on human internal mammary artery (HIMA) obtained from patients undergoing coronary artery bypass surgery, and to clarify the contribution of different K+ channel subtypes in pinacidil and levcromakalim action in this blood vessel. Pinacidil and levcromakalim induced a concentration-dependent relaxation of the precontracted arterial segments (pEC50 = 5.77 +/- 0.05 and 6.89 +/- 0.03, respectively), 4-Aminopyridine (3 mM), a non-selective blocker of K+ channels, induced significant shifts to the right of the concentration-response curves for pinacidil and levcromakalim. Tetraethylammonium (6 mM), charybdotoxin (0.4 microM) and apamin (0.1 microM), blockers of Ca(2+)-sensitive K+ channels, had no effect on the pinacidil- and levcromakalim-evoked relaxation. Glibenclamide (0.1-10 microM), a selective blocker of adenosine triphosphate (ATP)-sensitive K+ channels, competitively antagonized the response to levcromakalim (pKB = 7.92 +/- 0.07). In contrast, glibenclamide, in significantly higher concentrations (3-30 microM), non-competitively antagonized the response to pinacidil. High concentrations of pinacidil (> 10 microM) relaxed arterial rings bathed by a medium containing 100 mM K+ with maximum response 83 +/- 6%. Under the same conditions, the maximum levcromakalim-induced relaxation on HIMA was almost abolished (15 +/- 2%). It is concluded that pinacidil and levcromakalim do not relax the HIMA through the same subtype of K+ channel. ATP-sensitive K+ channels are probably involved in levcromakalim- but not in a pinacidil-induced relaxation in the HIMA. In addition, in pinacidil-induced relaxation of the HIMA, K+ channel-independent mechanisms seem to be involved.

4-Aminopyridine↗

PubMed1996

Civilian medicine and war: transformation of a health centre to a war hospital in Croatia (July 1991-October 1992).

Organization of the first war hospital (War Hospital Dakovo) in the 1991/1992 war in Croatia is presented. During the 13-month period 15123 patients were examined, among them 747 wounded. Complete treatment in the hospital was provided for 334 wounded. Only 23 wounded died immediately after admission, or later on in other hospitals. Most wounds were single and caused by shrapnel. Among the wounded, 75.8 per cent were Croatian soldiers, 22 per cent civilians and 2.2 per cent enemy soldiers.

Adult↗

PubMed1995

Clinical course in 52 severely wounded patients treated in the intensive care unit during the war in Croatia.

Fifty-two severely wounded patients, admitted directly from a battlefield or after surgical treatment in a war hospital, were treated in the Surgical Intensive Care Unit of the 'Sisters of Mercy' University Hospital in Zagreb during the 1991 war in Croatia. Considering the severity of the wounds, blood loss was not as severe as expected. This can be attributed to the nature of the injuries as most of the patients were wounded by fragments of explosive devices which cause less tissue destruction than military bullets. Low serum potassium levels, metabolic acidosis, low total protein levels and consequently low serum calcium levels correlated with wound severity. Low serum potassium levels were caused by its redistribution. Reperfusion liver injury was also present. Consumption coagulopathy was one of the characteristic disturbances in this type of injury. There was a relatively big difference between fluid input and output caused by fluid loss through drain sites and large open wound surfaces. The low mortality of the severely wounded was due to their young age and the well-organized military medical service which was developed from the civilian medical service in a short time.

Acidosis↗

PubMed1994

Age-dependent haematological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of halothane and nitrous oxide.

Anaesthetic staff chronically exposed to high occupational concentrations of halothane and nitrous oxide were tested for numerous haematological and cellular function parameters at the peak of the working season and after 3 weeks vacation. The analysis of data was performed to compare differences in subjects younger and older than the age of 40 years, respectively when compared with normal controls. The analysis revealed a higher recovery of erythrocyte count in the blood of older staff, and stronger disturbance of leucocyte formation in younger staff. In contrast, monocytes appeared to be more stable in the younger staff as were the T and B lymphocyte counts. After stimulation with PHA, Con A and PWM mitogens, lymphocytes from the older age group incorporated a significantly higher amount of tritiated thymidine, but stimulation indices did not differ. Natural killer cell numbers appeared equally affected; natural killer cell activity was unaffected, but there was an increase in activity in the younger staff after the vacation. Serum immunoglobulin concentrations tended to be more affected in older individuals at the peak of the working season.

Adult↗

PubMed1994

Comparison of the postoperative fibrinogen, alpha-1-antitrypsin and alpha-2- macroglobulin concentrations in the blood of wounded soldiers of Croatian Army and peacetime injured civilians.

In 10 wounded Croatian Army soldiers and in 10 civilians with accidental musculosceletal traumatisation, blood concentrations of the 3 acute phase proteins: fibrinogen, alpha-1-antitrypsin and alpha-2-macroglobulin on the 1st, 5th and 10th postoperative day were assessed. On the 5th day after injury, increased concentrations of all 3 acute phase proteins (APP) were found in all patients. The rise of the fibrinogen concentrations in the wounded soldiers was the steepest. On the 10th day after wounding, fibrinogen concentrations in the gorup of wounded soldiers were significantly lower than those in the group of injured civilians. On the 10th day after wounding there were no differences between the 2 groups in the concentrations of alpha-1-antitrypsin and of alpha-2-macroglobulin. The lower fibrinogen concentrations in the wounded soldiers could be explained by the modulation of the general reactivity of the organism to injury, proposed by Woloski, which is induced by stress and microtrauma on battlefield before the wounding.

Adult↗

PubMed1994

[Percutaneous transluminal angioplasty of the abdominal aorta using the "kissing balloon" technic].

Percutaneous transluminal angioplasty (PTA) of the distal abdominal aorta is still rarely performed procedure. Sporadic reports come from selected institutions with extensive experience in the field of PTA. Procedure is performed using so called "kissing-balloon" technique, and may be an alternative to the surgical treatment in well selected cases. We present a 45 years old woman with intermittent claudications and infrarenal abdominal aortic stenosis, treated successfully using above mentioned technique.

Angioplasty, Balloon↗

PubMed1991

Immunological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of nitrous oxide and halothane.

Immunological changes in anaesthetic personnel exposed to occupational concentrations of holothane and nitrous oxide 10-60 times greater than the advised maximum were studied during routine work and after 3-4 weeks holiday. Red cell count, haemoglobin concentration and haematocrit decreased during exposure although not significantly, in comparison with a control group, but all had increased significantly after the holidays. Other changes were altered neutrophils and lymphocyte counts. Basophils disappeared from the blood during the exposure. Monocytes were not affected during the exposure, but increased after its cessation. Percentages of CD2 and CD4 lymphocytes increased significantly, but numbers of cells in T lymphocyte subpopulations (total, helper and cytotoxic/suppressor lymphocytes) were not significantly altered. B lymphocytes were most strongly affected: they decreased during working periods and did not recover after holidays. Natural killer (NK) cells, on the other hand, decreased significantly during exposure, but fully recovered during holidays. After stimulation with mitogens, phytohaemaglutin, concanavalin A, and pokeweed, lymphocytes from exposed personnel incorporated significantly more 3H-thymidine than those from control subjects, but stimulation indices did not differ. The natural killer-cell activity, serum Ig concentrations and phagocytosis by granulocytes were not altered.

Adult↗

PubMed1990

Natural killer (NKH-1+) cell number and activity in health and disease.

The proportion of lymphocytes bearing the NKH-1 membrane marker (a natural killer-cell marker) was determined by flow cytometric analysis of the peripheral blood of 40 healthy individuals, 45 patients with multiple sclerosis and 19 with other neurological diseases. Natural killer (NK) cell activity was determined in parallel. It was shown that NKH-1-positive cells were more abundant in the lymphocytic than the mononuclear cell window on the flow-cytometric granularity versus cell size two-parameter display. NK-cell concentration did not correlate with NK-activity in any of the three groups of individuals studied. However, when the data for the three groups were compounded (i.e. when the number of samples analysed exceeded 100) significant correlations were disclosed. No correlation was found between age and NKH-1-positive cell number or activity in any of the three groups of subjects. High variability of the number and activity of natural killer cells in different individuals, and imprecision of phenotyping of the entire pool of NK-cells by means of a single marker, appeared to be responsible for poor correlations of NK-cell number and activity as observed in the study.

Adult↗