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P Sebesta

Publications and source records attributed to P Sebesta.

At least 19 recordsLinked to original sources
PubMed2005

[Harms technique of C1-C2 fixation with polyaxial screws and rods].

PURPOSE OF THE STUDY: The Harms technique of stabilizing C1-C2 by fixation with polyaxial screws and rods is a further option for atlantoaxial fixation from the dorsal approach. Harms and Melcher published this method in 2001, but the operation had first been performed by Harms in August 1997. The aim of this study is to evaluate the first results and try to assign the Harms C1-C2 fixation an appropriate standing in the in broad range of options for stabilization of the atlantoaxial complex. MATERIAL: Between December 2002 and January 2004 we carried out the Harms fixation of C1-C2 on 22 patients admitted to the Department of Spine Surgery, Motol University Hospital, 2nd Medical Faculty in Prague. Out of these, 18 patients were included in this study, 10 men and 8 women between 23 and 84 years of age (average, 55.4 years) followed-up longer than 6 months. In 14 patients we used the Harms technique as a permanent fixation of C1-C2 in order to achieve atlantoaxial arthrodesis and, in four patients, we applied it only for a period of 4 to 6 months without the use of bone grafts or their substitutions. We employed the permanent fixation to treat the following conditions: fracture of the atlas in three patients, type IIA comminuted fracture of the dens base in three patients, fracture of C2 categorized as "other" in two patients, atlantoaxial vertical instability in one patient with rheumatoid arthritis, malunion of the fractured dens in one patient, and complicated trauma to C1-C2 in four patients. The temporary fixation was used for type III displaced fractures of the dens in two and fixed atlantoaxial rotatory dislocations also in two cases. Only one patient showed signs of Frankel C neurological deficit on admission, the rest were without neurological findings. METHODS: All screws were inserted under an image intensifier always in lateral projection. First we retracted the greater occipital nerve in a caudal direction towards C2 with a fine raspatory and, using an awl, marked the entry point in the C1 lateral mass; a pilot hole, reaching through the anterior cortical bone, was made with a 2.5 mm drill. It followed a straight or slightly convergent trajectory in an anterior-posterior direction and parallel to the plane of the C1 posterior arch in the sagittal direction. Individual anatomical variations in the atlantoaxial complex of every patient were respected. The hole was tapped through the entire vertebral body, with the exception of osteoporous bone in which only the posterior cortical bone was treated with a screw tap. At this stage profuse bleeding usually arose from dissection around the epidural venous plexus along the C1-C2 joint. This was effectively controlled by a quick insertion of a screw and compression of the venous plexus with the screw head. To control bleeding by bipolar electrocautery is difficult and is always associated with a risk of nerve injury. Screws 3.5 mm thick, with polyaxial heads, were inserted bicortically into the lateral mass of C1. Subsequently, the intervertebral C2-C3 joint was localized and its medial border in the spinal canal was palpated. The entry point for placement of a C2 pedicle screw was marked with an awl at the point of intersection at a distance of 2 mm from the medial border and 5 mm from the caudal border of the C2 articular process. Under an X-ray intensifier in lateral projection, a hole was drilled approximately parallel to the screws inserted in C1, i. e., at an angle of 20 to 30 degrees cranially, up to and through the anterior cortical bone. In the transversal plane, the screws were situated in a convergent direction at an angle of 20 to 25 degrees. After all screws had been inserted, we reduced the antlantoaxial complex in the correct anatomical position by manipulating the patient's head or by directly adjusting the screws. Connecting 3.0-mm rods were then applied and fastened by cap nuts or inner nuts according to the instrumentation used. RESULTS: Operative time ranged from 35 to 155 min, with an average of 81 min. Intra-operative blood loss ranged from 50 to 1500 ml, with an average of 560 ml. The X-ray intensifier was used for a period of 0.4 to 2.6 min, with an average of 0.9 min. A total of 36 screws were inserted in the atlas; their length ranged from 16 to 34 mm (average, 30.6 mm). All screws were positioned correctly in the C1 lateral mass; two screws did not reach up to the anterior cortical bone and one protruded over it, but without causing clinical problems. Thirty-six screws were inserted in the axis. Their length ranged from 28 to 36 mm (average, 31.7) mm). Twenty-seven screws were correctly applied through the isthmus into the C2 anterior cortical bone, three were too short to reach it and five were placed too close to the vertebral artery canal. Of these, two protruded into the artery canal, but without clinical consequences. One screw inserted too medially passed into the spinal canal, but this also was without clinical response. Of the 36 screws inserted in C2, three (8.3 %) were malpositioned. Bony fusion at C1-C2 was the goal of this operation in 14 patients. At 6 weeks post-operatively, it was achieved in two patients, at 12 weeks in 12 patients and at 6 months in all 14 patients. The C1-C2 segment was stable at 12 weeks in all 18 treated patients. Four patients reported restriction of motion in rotation by 10 to 25 % after removal of the instrumentation. DISCUSSION: Operative time, longer at the beginning than with the Magerl technique, gradually shortened to between 45 and 60 min. Similar trends were seen when intra-operative blood loss and X-ray exposure were evaluated. Using the Harms and Melcher procedure we saved the greater suboccipital nerve. In contrast to these authors, however, we did not resect the atlantoaxial joint. Solid fusion was achieved in all our patients. Of the total of 72 screws inserted, only three (4.2 %) were assessed as malpositioned; however, when related to the 36 screws inserted in C2, this was 8.3 %, which indicates that insertion of screws in C2 was more difficult. We did not observe any clinical consequences in any of these cases. CONCLUSIONS: The Harms fixation of C1-C2 is a very effective technique for stabilizing the atlantoaxial complex. It enables us to provide temporary fixation without damage to atlantoaxial joints and to reduce the vertebrae after the screws and rods had been inserted, which is unique. These advantages compensate for a higher cost of the implant.

Adult↗
PubMed2005

[Combined atlantoaxial fractures].

PURPOSE OF THE STUDY: Combined fractures of the atlas and epistropheus account for 3 % of all acute injuries to the cervical spine. In relation to all C1 and C2 injuries this is 43 % and 16 %, respectively. The aim of this study is to evaluate a group of patients with combined C1-C2 fractures and to suggest an effective therapeutic procedure. MATERIAL: In the years 1996 to 2003, a total of 16 patients with trauma to the atlantoaxial complex were treated at the Orthopedic Department of the Third Faculty of Medicine, Charles University, Prague (1996-2001) and the Department of Spinal Surgery of the University Hospital in Motol, Prague (2001-2003). These injuries included a combined fracture of the dens (Anderson and D'Alonzo type II) and of the atlas posterior arch in six patients, a type II dens fracture combined with Jefferson fracture in two patients, a type III fracture of the dens with a lateral mass fracture in two patients, hangman's fracture with posterior arch fracture in three patients, a type II fracture of the dens with anterior arch fracture in one patient, a fracture of the C2 body with Jefferson fracture in one patient and a fracture of the C2 body with fracture of the lateral mass in one patient. Two patients were treated conservatively and 14 underwent surgery. On admission neurological deficit was found in five patients. METHODS: Fourteen patients were operated on. Direct osteosynthesis of the dens, with motion in the atlantoaxial complex preserved, was performed in five patients. Seven patients underwent C1-C2 fixation that, in one, involved the C1-C3 segments; five patients were treated by Harms fixation with polyaxial screws from the posterior approach, two by the Magerl or Gallie techniques and one patient required occipito-cervical fixation of C0-C2. The patient with a hangman's fracture combined with fracture of the atlas posterior arch was treated by discectomy of C2-C3, tricortical graft from the iliac crest and plate application. The patients used Philadelphia collars for 6 to 12 weeks according to the type of injury and their bone quality. RESULTS: Three patients (two undergoing direct osteosynthesis of the dens and one with occipito-cervical fixation) reported intermittent upper neck pain that required taking analgesics. The patient treated by occipito-cervical fixation repeatedly complained of restriction of rotational head movement by about 50 %. Radiograms of the cervical spine in both flexion and extension taken at 12- to 14-week follow-up all showed stable C0-C1 and C1-C2 segments. In the five patients undergoing direct osteosynthesis of the dens, complete bony union was found on X-ray and CT examination by 6 to 24 weeks postoperatively. Similarly, full instrumented fusion was achieved by 12 to 24 weeks postoperatively in the seven patients treated by dorsal fixation. The patient with anterior C2-C3 fixation showed, on X-ray images, a completely remodeled segment at 24 weeks after surgery. There was one intraoperative complication involving management of profuse bleeding from the venous plexus along the greater occipital nerve. No other complications related to the surgical procedure were recorded and no injury to the spinal cord, nerve roots or the vertebral artery was observed. None of the patients experienced any deterioration of neurological findings during the early postoperative period. One patient had to undergo resuturing of the operative wound from the posterior approach, because of subcutaneous necrosis that had failed to heal. No instrumentation failure or infection, regarded as late complications, were recorded. DISCUSSION: At our Department we prefer early operative treatment involving spondylodesis in the shortest segment possible, with special emphasis on preserving rotational C1-C2 movement. Therefore, in some cases, we use only temporary stabilization with removal of instrumentation after 3 to 4 months. In this group the most frequent fractures were those combined with type II fractures of the dens. In such cases we always prefer direct osteosynthesis of the dens or, if this is not possible, the Harms technique of C1-C2 fixation, possibly only temporary. We believe, in agreement with Guilot and Fesser, that a potential failure of conservative therapy may result in a longer convalescent period and that patients should always be informed about these issues. In contrast to Guilot and Fesser we treat combined hangman's fractures from the anterior approach, by discectomy, tricortical graft and plate application. CONCLUSIONS: Combined atlantoaxial fractures are serious, life-threatening injuries which, because of their diversity, require an individual approach to each patient. Early surgery is recommended with increasing frequency, particularly in the cases with persisting dislocation or instability. At the same time it is necessary to ensure that motion restriction of the cervical spine be minimal.

Adult↗
PubMed2005

[Allografts in the vascular surgery].

The use of allografts represents one of the therapeutic options in the treatment of vascular prosthetic infection. Close cooperation with a transplant center is unconditional for successful graft harvest and storage. Although the transplantation programme in the Czech Republic is handled in several centers across the country the use of vascular allografts is still exceptional. During multiorgan harvest procedures arterial or venous grafts have been removed and stored in antibiotic solution at 4 degrees C till implantation. Cardioplegic and short-term organ preserving solution Custodiol was used in our cohort. At the Department of Vascular Surgery of the Na Homolce Hospital in Prague fresh arterial allografts were used in 14 patients in the years 2001-2004. In all, absence of usable autologous graft was the common denominator. In ten cases previous synthetic vascular grafts were infected. Of these, critical limb ischaemia and imminent amputation due to the poor outflow tract occurred in three patients. Once, false femoral artery aneurysm infected with methicilin-resistant Staphylococcus aureus (MRSA) led to several hemorrhagic episodes. There was no early mortality but one early occlusion with subsequent major amputation. In 11 patients (79%) the procedure was uneventful at the short-term follow-up. All patients were treated with cyclosporine.

Aged↗
PubMed2005

[Surgical treatment for disorders of the cervicothoracic junction region].

PURPOSE OF THE STUDY: The complex anatomy of the cervicothoracic junction region makes a reliable assessment of plain radiographs in lateral projection difficult or even impossible, which may result in failure to detect fracture or other pathology in this region of the spine. The aim of this study was to evaluate the patients with spinal disorders in the region of the seventh cervical to the third thoracic vertebrae treated at our department. MATERIAL: During the period from November 2001 to June 2004, 34 patients with disorders of the C7-T3 region were treated surgically at the Department of Spinal Surgery, Motol Teaching Hospital, which accounted for 2.1% of the 1537 patients treated for spinal diseases in this period. Instability of the cervicothoracic junction was caused by tumors in 15 and by injury in 14 patients. Other diagnoses included deformity associated with rheumatoid arthritis (RA) in two patients, spondylodiscitis in one, and hemivertebral deformity at C7 and T1, each in one patient. The group included 16 women and 18 men between 8 and 75 years, with the mean of 52.3 years (after excluding the two children with hemivertebral deformity aged 8 and 9 years, respectively). The trauma subgroup had a significantly lower mean age (43.6 years) than the tumor subgroup (59.9 years). METHODS: We placed the patients in three groups according to the etiology of cervicothoracic junction disorder, namely, 1. tumors and spondylodiscitis; 2. injuries; 3. others. Group 1 included 16 patients, 15 with tumors and one with spondylodiscitis. Two patients were treated by dorsal stabilization, one by ventral stabilization and the rest underwent combined surgery. Of 14 patients in group 2, three were treated from the posterior approach, six from the anterior approach and five by the combined approach. All group 3 patients underwent surgery from the posterior approach, with two patients being treated without instrumentation. RESULTS: Of the 34 patients, only 33 were included; one was lost to follow-up soon after the operation. In group 1, no excellent, five very good, five satisfactory and two unsatisfactory outcomes were recorded. No intraoperative complications such as injury to the major vessels or nerve structures occurred; in one patient, profuse bleeding from arteries supplying a metastatic tumor had to be arrested. Late complications included loosening of the dorsal instrumentation in two patients, who required repeat operations. In group 2, there were six excellent, four good, two satisfactory and one poor outcomes. Late complications in one patient included loosening of the ventral instrumentation, followed by repeat surgery. Group 3 showed two excellent and two satisfactory outcomes; the latter were in the RA patients. Late complications involved one loosening of the dorsal instrumentation requiring repeat surgery. No injury to the major vessels or nerve structures was recorded in either group 2 or group 3. No deep infection was recorded in any of the three groups. DISCUSSION: The results of our evaluation are in agreement with those of other authors and, similarly to them, we had to deal with the difficult issues of diagnosis. Currently, we prefer, in addition to conventional X-ray examination, CT scans including sagittal and frontal reconstruction, recently completed with magnetic resonance imaging, in all patients with cervicothoracic junction disorders. This policy allows us to avoid delays in making correct diagnosis and to provide conditions for effective treatment. In stabilization from the posterior approach we use rod-screw fixation that, in the majority of cases, is not combined with thoracic fixation. Previously, we have inserted screws in the articular processes at the C7 level, but now we prefer transpedicular fixation. Complicated anterior surgical procedures, such as complete or partial sternotomy, are always performed with the assistance of a thoracic surgeon. A noticeably high number of patients with neurological deficit was seen also in our group. Postoperative care is always provided in cooperation with the spinal unit of our hospital. Intensive inter-disciplinary cooperation has an important role in that our patients have a minimum of complications in comparison with the literature data. CONCLUSIONS: Injuries and diseases of the spine at the cervicothoracic junction present a complex issue with a high potential for mistakes and complications. The principle of success lies in a high-quality X-ray examination, CT scans with sagittal and frontal reconstruction, and magnetic resonance imaging of the region affected. The complex anatomy of that region requires demanding surgical procedures, which can be performed only by a highly qualified and specialized team with appropriate facilities.

Adolescent↗
PubMed2004

[Bacterial aortitis].

A cohort of 14 patients with bacterial destruction of various segments of the aortic wall is presented. The Salmonella enteritidis strain was predominantly responsible. Most patients had typical history of symptomatic trias of sepsis, abdominal and/or back pain and positive blood cultures. CT scan showed pseudoaneurysm within the thoracic, subphrenic or subrenal aorta as well as acute hemorrhage in three patients. One of these was excluded from invasive treatment due to hopeless prognosis. In one patient primary aortoduodenal phistula was responsible for GI bleeding. Five patients were operated and prosthetic replacement of subrenal or iuxtarenal aortic portion together with aortorenal bypass in a couple of cases was performed. In eight patients stentgrafts (SG) of various types were deployed completed with femorofemoral crossover bypass when necessary. All patients were subject to long-standing antibiotic therapy. Two patients expired following SG insertion, all operated patients survived. Average follow-up has been 1 year (1-22 months) so far. A groin abscess was later drained in one patient. Neither CT nor isotope scanning showed persistent or recurrent infectious or hemorrhagic foci in any survivors whatsoever. The authors review and consider the doubtful indication of aortic SG deployment into the septic terrain in selected cases. Midterm results might justify its use in overly debilitated patients otherwise not eligible for radical operation due to its prohibitive risk.

Aged↗
PubMed2004

[Minilaparotomy as an access route to vascular reconstruction procedures in the aortoiliac region].

Following the example of general surgical procedures, also vascular surgery gradually minimizes the size of its surgical entrances. Miniinvasive surgical procedures significantly reduce postoperative complaints and shorten the patients recovery rates. Minilaparotomy, either a hand-assisted or a laparoscopy-assisted procedure, a procedure conducted fully via laparoscopy or thoracoscopy and a robot-assisted procedure, all of the above are contemporary options for miniinvasive procedures in the vascular surgery. The authors introduce their initial experience with the use of minilaparotomy in the aortoiliac region. From November 2002 to April 2004, 29 procedures were performed for the abdominal aortic aneurysm repair or for aortoiliac occlusive disease. In 15 cases the abdominal aortic aneurysm was managed and in 14 cases the aortoiliac occlusive disease was managed.

Aged↗
PubMed2001

[Thoracoscopic thoracic sympathectomy--personal experience].

The authors present a group of 48 thoracoscopic thoracic sympathectomies they performed in 35 patients between November 1997 and March 2000. A favourable effect was recorded in all operated patients where the defect healed or the blood supply of the upper extremities improved. Twice thoracoscopic resympathectomy was performed in a patient 15 years after classical upper thoracic sympathectomy [2] from the supraclavicular space. Twice a relapse was recorded one year after the operation. The complaints are substantially smaller than before operation. The authors emphasize the advantages of thoracoscopic thoracic sympathectomy which is associated with a minimal risk of complications.

Adult↗
PubMed2001

[An unusual extensive thrombus in the abdominal aorta of a young female patient after recurrent embolisms in the pelvis and lower extremity].

The authors present a case of an uncommon based thrombus of the abdominal aorta, which partly obturated its lumen and caused repeated embolization of the left pelvic circulation and left lower extremity. Even detailed modern diagnostic methods (angiography, CT, NMR) were unable to rule out before surgery anotheretiology of the obturating process in the aorta. Only removal of the thrombus from the abdominal aorta and subsequent histological examination elucidated the diagnosis and led to final cure.

Adult↗
PubMed2000

[Surgical procedures on the external carotid artery].

A clinical series of five patients operated on for symptomatic cerebral blood flow deterioration is discussed. They presented with either hemispheral symptoms (hemiparesis, amaurosis fugax) or signs of diffuse cerebral hypoxia. In the presence of unilateral or bilateral internal carotid artery (ICA) occlusion a critical stenosis of the external carotid artery (ECA) was confirmed either by duplex ultrasound or angiography. In all these cases ECA was reconstructed by means of common vascular surgical techniques. The use of intraluminal (i.l.) shunt was mandatory. There were neither early nor late deaths in this group. In one patient a transient stroke occurred three days following standard carotid endarterectomy performed after ECA surgery on the contralateral side. After the mean follow-up of 46 months all patients remain neurologically asymptomatic. In selected cases the ECA reconstruction offers an effective and beneficial tool for surgical management of critical cerebral perfusion impairment.

Adult↗
PubMed1999

[Diagnostic significance of mild hyperhomocysteinemia in a population of children with parents or grandparents who have peripheral or coronary artery disease].

BACKGROUND: A rise of the homocysteine plasma level--mild hyperhomocysteinaemia--is considered an independent risk factor for the development of vascular damage. It is due to hereditary deficiency of 5,10-methylene-tetrahydrofolate reductase with accentuation of vitamin deficiency (folic acid, vitamin B6 and B12). In previous studies the authors confirmed this fact in the population of patients with aortocoronary or peripheral arterial bypasses. The assumed autosomal recessive transmission of this deficiency should make it possible to detect carriers of this metabolic deviation already in childhood. By selective screening of the child population at risk it would thus be possible to detect affected subjects in time and prevent the development of vascular disease by preventive folate administration. METHODS AND RESULTS: In a group of 38 children and grandchildren from risk families where at least one of the parents or grandparents was operated on account of vascular obliterating disease the total homocysteine plasma level was examined by the chromatographic method. An increase of total homocystein (8.7 +/- 2.7 mumol/l) was found as compared with children from the non-risk population (5.4 +/- 1.8 mumol/l), (p < 0.001). The total homocysteine values however were dependent on the child's age and were more marked in children above 12 years of age. In the parental population mild hyperhomocysteinaemia was present in 38% of those with aortocoronary bypasses and in 43% of those with peripheral arterial bypasses. CONCLUSIONS: The authors found significantly elevated total homocysteine levels in the child population from risk families with obliterating vascular disease. The total homocysteine level depends on the child's age and is more markedly expressed in children above 12 years of age.

Adolescent↗
PubMed1999

[Upper thoracic thoracoscopic sympathectomy as the method of choice for reoperation of the thoracic sympathetic nerve].

The authors present in their paper the possibility of thoracoscopic thoracic sympathectomy as the method of choice for reoperation of the thoracic sympathetic nerve 14 years after classical surgical upper chest sympathectomy, as the original effect had receded. They mention the possibility of reoperation of the sympathetic nerve with a subsequent favourable effect by the endoscopic method which reduces the risk of complications to a minimum.

Female↗
PubMed1998

[Spontaneous dissection of the left main coronary artery. Case report].

The case report of a 59 years old woman present with spontaneous dissection of the left main coronary artery including origins of its major branches is described here. The patient had emergency surgery and a triple ACEG was performed. The postoperative course was uneventful and a control angiogram proved both complete graft patency and absence of previous dissection. Six months following surgery the patient is doing well except for a minor effort dyspnea. The available literary experience with this rare and potentially fatal coronary condition is discussed in comments.

Aortic Dissection↗
PubMed1998

[A comprehensive approach to the treatment of popliteal artery aneurysms--personal experience].

UNLABELLED: During a five-year retrospective follow-up period the authors treated a group of 46 patients with the diagnosis of aneurysm of the popliteal artery (AAP). The group comprised 42 men (91%) and 4 women (9%). The mean age was 62 years. In 32 patients (69%) AAP was on both lower extremities, in the remaining 14 (31%) it was unilateral. Forty-one patients (90%) had surgery and a total of 48 AAP were operated. The remainder was treated by conservative methods (10%). The first symptoms of AAP in the investigated group were: claudication in 17%, thromboembolic complications in 46%, rupture of the AAP in 4%. An asymptomatic aneurysm was detected in 33%. RESULTS: The authors did not record any death or occlusion of the reconstruction during hospitalization. When using a vein the primary patency is 100%. When a prosthesis (PTFE) is used the results are worse but still satisfactory and the five-year secondary patency is 85%. Five patients with thromboembolic complications of AAP were successfully treated by i.a. fibrinolysis. In all exclusion of the aneurysm and revascularization of the extremity followed. In the conclusion the authors emphasize the necessity of early surgical treatment as soon as the condition is detected, before the development of thromboembolic complications of AAP. If they develop it is essential to attempt local fibrinolysis and in the second stage revascularization of the extremity, if possible by a vein.

Adult↗
PubMed1998

[Comprehensive surgical treatment of mixed crural ulcers with femoropopliteal distal bypass and endoscopic elimination of Cockett's perforating veins].

The authors present an account on a successful cure of a mixed crural ulcer using combined therapy by a classical vascular surgical method and endoscopic surgery of the venous perforators of the leg. In the described case this combined treatment is the method of choice because it was not possible to use the classical Linton operation and also to protect a vascular prosthesis from infection.

Humans↗
PubMed1998

Ruptured abdominal aortic aneurysm: role of initial delay on survival.

In the years 1990 to 1997, 103 patients with RAAA were operated on at the Department of Vascular Surgery of the Hospital Na Homolce in Prague. Men outnumbered women, mean age was 70 years. The mean delay between onset of symptoms and hospital admission was 25 hours. Prior to transportation 85 patients were submitted to at least one confirmative evaluation test (CAT, ultrasound, angiography) and 33 patients to a combination of two or more herementioned examinations. Twenty-eight patients were referred via two or more hospital departments. In 71% of patients profound shock with oligoanuria and hypotension was found upon admission. Anuria/hypotension proved to occur in a significantly lower rate in later survivors compared to later non-survivors (S vs. NS = 30% vs. 92.1%, p < 0.002) and preoperative hematocrite and S-creatinine values copied the clinical trend. At surgery, persistent hypotension together with necessity of resuscitation steps as well as finding of free blood within the abdominal cavity showed up as further significant death predictors. Postoperatively, acute renal and/or multiorgan failure occurred in 36 patients and significantly prevailed in the NS vs. S group (48.3% vs. 22.5%, p < 0.03). Both early hemorrhage and myocardial infarction infavorably influenced the outcome. Seven patients (6.8%) expired during operation. The total of 63 patients died (61.2%) fifty-eight patients within the 30-day period (56.3%). Within the first five days 58.7% of all deaths occurred particularly related to hemorrhagic shock. The latter fatalities (41.3%) were caused by both organ failure and septic complications. In our cohort regardless of age, type or extent of surgery, outcome was determined by status upon admission. Delay in surgical treatment caused both by time consuming confirmative evaluation and patient's lengthy transfers is responsible for ominous protraction of the original shock. Especially in intraperitoneal rupture, the irreversible sequels of devastating hemorrhage only rarely do not lead to a fatal end albeit the patients survive the aortic reconstruction.

Aged↗
PubMed1997

[Hyperhomocysteinemia. A risk factor for the development of vascular diseases not associated with lipid levels].

BACKGROUND: Elevated total homocysteine plasma levels are considered a significant factor of vascular damage. As they are encountered in more than half the patients with atherosclerotic vascular damage the importance as a lipid-dependent or lipid-independent risk factor in the promotion of pathophysiological processes is discussed. METHODS AND RESULTS: In a group of 100 healthy subjects and 529 patients with indication for an aortocoronary or peripheral arterial bypass and in patients from the lipid clinic the mutual relation between total plasma homocysteine levels and selected indicators of the lipid metabolism was investigated. The following results more obtained: for total cholesterol a correlation coefficient of r = 0.26, for HDL-cholesterol r = 0.20, for LDL-cholesterol r = 0.21, for triacylglycerols r = 0.29, apolipoprotein A-I r = 0.06, apolipoprotein B r = -0.12 and for Lp(a) r = -0.03. To ensure correct evaluation of the homocysteine levels simultaneously also folate levels were examined (correlation coefficient r = 0.28), vitamin B12 r = (0.03) and fibrinogen r = (0.09). CONCLUSIONS: The authors did not detect an unequovical relationship between the total homocysteine level and selected lipid indicators in any of the patient groups (p < 0.05).

Adult↗
PubMed1996

[Ruptured abdominal aortic aneurysm].

In the years 1990-1994, 43 patients with ruptured abdominal aortic aneurysms (RAAA) were operated on at the Department of Vascular Surgery of the Na Homolce Hospital in Prague. Men outnumbered women, average patient age was 70 years. The mean delay between onset of symptoms and hospital admission counted 27 hrs. Prior to transportation, one half to two thirds of patients went through at least two types of confirmative evaluation (CAT, ultrasound, angiography) and/or were referred via two or more hospital departments. In two thirds of patients profound shock with oligoanuria and hypotension were found. Anuria/hypotension proved to occur in a significantly lower rate in later survivors compared to later dead (11.8% vs. 23.5%: p < 0.05). Persistent hypotension during surgery together with eventual resuscitation as well as free blood found within the abdominal cavity showed up as further ominous factors. Renal failure was the leading postoperative complication (51.2%) with 27.9% of patients requiring hemodialysis after repair. Sepsis (25.6%), pneumonia (20.9%) and hemorrhage (13.9%) followed. Twenty-six patients were lost (60.5%) either within the first hours and days after surgery because of irreversible hemorrhagic shock or between the second and fourth week due to the sequels of organ failure and sepsis. In our cohort, regardless of age, sex, concomitant disease or the type of surgery, the patient's status on admission determined his/her further destiny. Urgent transfer to a specialized center going hand in hand with prompt and effective reanimation steps are the patient's only hope for survival.

Aged↗