Biomedical subjects

T Kural

Publications and source records attributed to T Kural.

At least 19 recordsLinked to original sources

PubMed2005

[The importance of measuring intraabdominal pressure in cases of severe acute pancreatitis].

AIM: Evaluating the importance of intraabdominal pressure measurement in cases of severe acute pancreatitis and its use in determining indication for surgery. METHODS: A retrospective evaluation of the treatment of patients with severe acute pancreatitis hospitalised at the Department of Surgery or the Department of Anaesthesiology and Resuscitation of the Charles University hospital in Pilsen during the last two years (from January 1 (st), 2002 to December 31 (st), 2003) was performed. RESULTS: During this period, 63 patients with severe acute pancreatitis were hospitalised at both departments, among which 18 patients underwent an operation (28.6 %), eight of them died (12.7 %). In four of the 18 patients who underwent an operation the surgery was indicated due to progression of abdominal compartment syndrome (ACS) and all of these patients survived. CONCLUSIONS: At present, basic treatment of severe acute pancreatitis is considered to be conservative. The only generally accepted indication for surgery is an established infection of the necrotic tissue. In our presentation, we draw attention to those cases where the general condition of the patient deteriorates combined with a progression of ACS and where a decompressive laparotomy can improve the prognosis of the disease.

Abdomen↗

PubMed2004

Cardioprotection with resveratrol pretreatment: improved beneficial effects over standard treatment in rat hearts after global ischemia.

OBJECTIVE: The major objective of the present study is to evaluate the potential role of resveratrol (RVT), a natural antioxidant found in grapes and red wine, in protecting the myocardium from the deleterious effects of ischemia-reperfusion (I/R) injury using isolated rat hearts. METHODS: Langendorff perfused isolated rat hearts were subjected to 60 min of global ischemia following 60 min of reperfusion. RVT was given according to chronic pretreatment and/or acute treatment protocols. Animals received RVT at the dose of 20 mg/kg via an intragastric tube for 14 days before the experiment and/or at the infusion concentration of 10 microM for 30 min before the onset of ischemia. The myocardial postischemic recovery was compared using hemodynamic data (peak systolic pressure, end diastolic pressure, and +dP/dtmax), coronary flow, biochemical parameters (LDH, CK-MB, cTnI, myoglobin) from coronary effluent, and oxidative stress markers (MDA, GSH, carbonyl) from heart tissue homogenates in each group. RESULTS: RVT pretreatment and treatment protocols have provided increased preservation in myocardial recovery following global ischemia compared to a non-treated group. Furthermore, the ischemic damage of myocardium was significantly lower in chronic pretreated rats than in the acutely treated group. In contrast, no significant difference was observed in cardioprotective effects of RVT between the only pretreated group, and both the pretreated and treated group throughout reperfusion. CONCLUSION: The findings from this study indicate that RVT has potent cardioprotective properties against I/R injury in rat hearts. The study also highlighted that the administration of RVT, as pretreatment, has amplified the beneficial effects over the standard treatment.

Analysis of Variance↗

PubMed2000

Assessment of left ventricular systolic function in patients with idiopathic mitral valve prolapse using dobutamine stress echocardiography.

BACKGROUND: Some previous studies performed with radionuclide ventriculography and thallium scintigraphy reported that patients with idiopathic mitral valve prolapse (MVP) had some degree of left ventricular (LV) systolic dysfunction and that this dysfunction was more commonly found in symptomatic patients. HYPOTHESIS: The aim of the present prospective study was to investigate LV systolic function and its relationship with symptoms in patients with MVP with dobutamine stress test without associated certain mitral regurgitation and coronary artery disease. METHODS: Thirty-three patients with echocardiographically diagnosed idiopathic MVP were enrolled into the study and were divided into two groups as symptomatic (MVP-s) and asymptomatic (MVP-a). Patients underwent dobutamine stress echocardiography (DSE) to determine wall motion abnormalities and ejection fraction (EF) changes during rest state and increased heart rates. Results were compared with the DSE findings of 25 healthy individuals. RESULTS: Symptomatic patients (MVP-s) had lower EFs during the pretest period than the control group (59.0 +/- 4.8% and 68.3 +/- 5.7%, respectively, p < 0.05). Basal wall motion abnormalities were found in one patient in the MVP-a group (6%) and in two patients in the MVP-s group (12%). During DSE, new wall motion abnormalities (inferoapical dyskinesia) occurred in two patients in the MVP-s group at submaximal heart rates. For EF values calculated when patients reached submaximal heart rate, the MVP-s group showed only a 2.7 +/- 3.1% increase from baseline values. This increase was 5.1 +/- 3.8% in the MVP-a group and 9.3 +/- 4.3% in the control group (p < 0.05 between MVP-s and control groups). CONCLUSION: There is a close relationship between symptoms and ventricular function in patients with idiopathic MVP, and although many asymptomatic patients had nearly normal LV function, a subgroup of symptomatic patients showed diminished LV function and wall motion abnormalities.

Adult↗

PubMed2000

The effectiveness of ischemic preconditioning on myocardial protection and comparison with K(+) cardioplegia.

The purpose of this study is to investigate the effects of ischemic preconditioning on myocardial protection and to compare this method to K(+) crystalloid cardioplegia. Langendorff perfused isolated working rat hearts were used in the following groups. After 20 min of stabilisation, 30 hearts were divided into three groups. In group I (control, n=10), hearts were arrested with cold (+4 degrees C) Krebs-Henseleit (K-H) solution, in group II (cardioplegia, n=10) hearts were arrested with cold K(+) cardioplegia solution, and in group III (preconditioning, n=10) hearts were subjected to 5 min normothermic ischemia followed by 5 min reperfusion then arrested with cold K-H solution. All hearts were subjected to 30 min of global ischemia (24 degrees C) and 40 min of reperfusion. Hemodynamic measurements were performed with a left ventricular latex balloon using a data acquisition system. Creatine kinase (CK-MB) washout and Troponin I (cTnI) levels were determined from the coronary effluents. There was no significant difference among the three groups in any of the parameters (hemodynamic and biochemical) measured at the end of stabilisation period. During reperfusion, functional recovery and coronary flow were significantly improved in K(+) cardioplegia and preconditioned groups compared with control group. CK-MB washout and cTnI levels were significantly lower in groups II and III compared with group I at the reperfusion. However no significant difference was observed between K(+) cardioplegia and preconditioned groups among biochemical and hemodynamic parameters and coronary flow at the post-ischemic period. In conclusion, ischemic preconditioning is as effective as K(+) cardioplegia on myocardial protection and recovery of myocardial function during reperfusion.

Animals↗

PubMed2000

Value of dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch blockage.

BACKGROUND: Left bundle branch blockage (LBBB) is a strong predictor of cardiovascular mortality. Non-invasive tests such as exercise-stress testing and scintigraphy studies have no diagnostic value for diagnosis of coronary artery disease (CAD) in patients with LBBB. OBJECTIVE: To study the role of dobutamine stress echocardiography (DSE) in identification of CAD in patients with LBBB. METHODS: Thirty patients (19 men and 11 women, mean age 60 +/- 8 years) with permanent, complete LBBB were studied prospectively with DSE and coronary angiography. RESULTS: Results of DSE were compared with results of coronary angiography for left anterior descending artery and either left circumflex or right coronary artery territories, or both. Significant CAD was found in left anterior descending coronary arteries in 11 patients by coronary angiography; nine of whom were identified by DSE. Significant left circumflex or right coronary artery disease, or both, was found in nine patients; eight of whom were identified by DSE. The sensitivity, specificity and accuracy of DSE for identifying CAD in left anterior descending coronary artery territory were 82, 95 and 90%, respectively. For identifying CAD in the circumflex and right coronary artery territories sensitivity, specificity and accuracy were 88, 96 and 93%, respectively. CONCLUSION: We concluded that DSE is a very sensitive, specific and accurate non-invasive test for identification of CAD, both in left anterior descending and in left circumflex and right coronary artery territories of patients with LBBB.

Aged↗

PubMed2000

Comparison of low-dose dobutamine echocardiography and thallium-201 reinjection for the determination of myocardial viability in the early post myocardial infarction period.

OBJECTIVE: Determination of viability in the infarction zone in the early post Ml period is an important parameter in clinical decision making. METHODS: In an attempt to compare the places of low-dose dobutamine echocardiography (LDDE) and thallium-201 reinjection SPECT (TI-SPECT) in the determination of viability in dyssynergic myocardial segments, 17 patients (mean age: 54.6 +/- 12.8 years, 16 male, 1 female) with a recent myocardial infarction and an uneventful early clinical course underwent both tests within 5-13 days of infarction. The 16-segment model was utilised to evaluate the left ventricular wall motion and each segment was graded as 1) normokinetic, 2) hypokinetic, 3) akinetic and 4) dyskinetic or aneurysmal on a 4-scale basis. A dyssynergic segment of myocardium was considered to be viable by LDDE if it showed an improvement in wall motion of at least one grade with low-dose dobutamine infusion (10 microg/kg/min). On the other hand, mild to moderate (< 50%) fixed perfusion defects and reversible (at least a 10% improvement in perfusion on either redistribution or reinjection images) severe (50% or more) perfusion defects were considered positive for viability by TI-SPECT. RESULTS: Of the 76 segments with resting dyssynergy (10 dyskinetic/aneurysmal, 33 akinetic, 33 hypokinetic), 51 (67%) were shown to be viable by LDDE and 61 (80%) by TI-SPECT. There was an agreement of 76% (p = 0.03, K = 0.63) between the two methods. CONCLUSION: This study disclosed a moderate degree of agreement between LDDE and TI-SPECT for the determination of viability in dyssynergic myocardial segments in the early post-myocardial infarction period.

Adult↗

PubMed1999

Serum paraoxonase activity and phenotype distribution in Turkish subjects with coronary heart disease and its relationship to serum lipids and lipoproteins.

Recently, biochemical studies of paraoxonase in the serum of humans have shown that much of this enzymes' activity is associated with high-density lipoprotein (HDL) and paraoxonase may play a role in lipid metabolism preventing the accumulation of the lipoperoxides. In this study, a possible relationship between coronary heart disease (CHD) and paraoxonase activity were investigated. Serum triglycerides, total cholesterol, HDL-cholesterol and paraoxonase activity were measured in unrelated healthy donors and CHD patients. It was found that paraoxonase activity was trimodally distributed in both groups but no statistically significant difference was found between phenotype distributions of controls and CHD patients (gene frequencies; 0.632 and 0.382 of controls, 0.702 and 0.298 of patients for the A and B alleles, respectively). However, in CHD group, a high possibility was found to be phenotype A compared with the control group. A relative risk of 1.48 (95% confidence intervals (CI), 0.986-2.227) was found for the relation between CHD and the paraoxonase activity. Patients' HDL-cholesterol values were lower and triglycerides were higher than controls (P<0.001). It may be concluded from the present study that although no statistically significant difference was found between paraoxonase phenotype distributions of controls and CHD patients, a decrease in paraoxonase activity could become a risk factor for this disease.

Adult↗

PubMed1999

Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting.

BACKGROUND: The aim of the present study was to evaluate potential myocardial protection by trimetazidine by measurement of the cardiac marker protein troponin T (TnT) during coronary bypass operations. METHODS: We conducted a double-blind, placebo-controlled study on 30 randomized patients who had aorta-coronary artery bypass operations. The TMZ group was composed of 15 patients and the placebo group of 15 patients in New York Heart Association class III or IV. Pretreatment was started 3 weeks preoperatively with trimetazidine (60 mg orally per day) or the placebo. In the trimetazidine TMZ group, there were 2 women and 13 men with a mean age of 57.1+/-2.2 years and mean cross-clamp time of 44+/-1.8 minutes. In the placebo group, there were 5 women and 10 men with a mean age of 58.4+/-1.2 years and a mean cross-clamp time of 42+/-2.4 minutes. Serial blood samples were collected before and after the operation, and serum concentrations of cardiac TnT were measured. RESULTS: The preoperative serum concentration of TnT was 0 to 0.39 ng/mL in all patients. The mean TnT levels were measured 5 minutes after completion of cardiopulmonary bypass (1.5+/-0.3 ng/mL) and 12 (1.4+/-0.1 ng/mL), 24 (0.9+/-0.1 ng/mL), and 48 hours postoperatively (0.1+/-0.1 ng/mL) in the trimetazidine group. Troponin T levels in the placebo group measured at the same time periods were 4.4+/-0.4, 4.8+/-0.7, 2.8+/-0.4, and 0.7+/-0.1 ng/mL. In the trimetazidine group, TnT levels were significantly less than those of the placebo group (p < 0.001). The levels of TnT were tested by creatine kinase-MB levels of both groups. Mean cardiac index was evaluated in all patients preoperatively and postoperatively. There was no significant difference in perioperative hemodynamics (blood pressure and cardiac index) between groups. CONCLUSIONS: These results obtained by measurement of cardiac TnT suggested that pretreatment with trimetazidine reduces ischemic-reperfusion damage during coronary bypass operations but did not affect postoperative hemodynamics.

Cardiopulmonary Bypass↗

PubMed1999

The effects of methylprednisolone on complement, immunoglobulins and pulmonary neutrophil sequestration during cardiopulmonary bypass.

In this study, the authors administered high dose (30 mg/kg body weight i.v.) methylprednisolone before cardiopulmonary bypass to observe the effects on complement, immunoglobulins and pulmonary neutrophil sequestration. Fifty patients undergoing valve replacements were included in this study. Patients were divided into two groups: group I (20 patients) served as control and did not receive methylprednisolone, group II (30 patients) received methylprednisolone. Blood samples for complements (C3c and C4) were taken, before cardiopulmonary bypass, at 5, 10 and 30 min intervals from the end of cardiopulmonary bypass, after reversal of heparin with protamine infusion, and after skin closure. Blood samples for immunoglobulins were taken before cardiopulmonary bypass, 30 min after onset of cardiopulmonary bypass and after skin closure. After onset of cardiopulmonary bypass, all C3c and C4 levels decreased in both groups. There was a significant decrease in C4 levels at end of cardiopulmonary bypass and after protamine infusion in group I compared with group II (P < 0.05). C3c levels in group I decreased significantly compared with group II after 30 min of cardiopulmonary bypass and after protamine infusion (P < 0.05). All immunoglobulin (IgG, IgM, IgA) levels were decreased in both groups, but the decrease in IgG was statistically significant after skin closure in group I compared with group II (P < 0.05). Pulmonary neutrophil sequestration was higher in the control group compared with the methyl-prednisolone group (P < 0.05). In conclusion, methylprednisolone administration before cardiopulmonary bypass may prevent the harmful effects of complement activation, immunoglobulin denaturation and neutrophil sequestration in the pulmonary capillary system.

Adult↗

PubMed1999

Clinical, biochemical and histochemical assessment of pretreatment with glucose-insulin-potassium for patients undergoing mitral valve replacement in the third and fourth functional groups of the New York Heart Association.

In this study, the potentially beneficial effects of preoperative treatment with glucose, insulin and potassium in a randomized series of 30 consecutive patients undergoing mitral valve replacement, who were in the third and fourth functional groups of the New York Heart Association scale, were investigated. Fifteen patients received glucose, insulin and potassium, and 15 patients received the same volume of normal saline. The characteristics of the groups did not differ. Papillary muscle-biopsy samples were obtained at the time of surgery and analysed for glycogen, both biochemically and histochemically. The clinical course of all patients was monitored closely during the first 24 hours after surgery. The patients receiving glucose, insulin and potassium had higher glycogen levels (43 +/- 13.54 micromol/g) (P < 0.001). In addition, they required less inotropic pharmacological support (scored by the Gradinac method), had fewer ventricular arrhythmias and exhibited improved haemodynamic indices: cardiac output increased (P < 0.025 to P < 0.005), while systemic vascular resistance decreased (P < 0.001). Pretreatment with glucose, insulin and potassium did not, however, affect the patients' postoperative wedge pressure and mortality. The results of this study suggest that glucose, insulin and potassium pretreatment may be beneficial in unfit patients undergoing mitral valve replacement.

Adult↗

PubMed1997

Septal myectomy in hypertrophic obstructive cardiomyopathy: late results with stress echocardiography.

BACKGROUND: This study was performed to assess the functional capacity of the survivors of septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy in long-term follow-up as assessed by dobutamine stress echocardiography. METHODS: Sixty-nine patients with hypertrophic obstructive cardiomyopathy underwent septal myectomy between 1975 and 1996. The mean age was 25.4 +/- 13.6 years (range, 6-58 years), and 10 of the patients were women. The early mortality was 4.3%. Hospital survivors (95.7%) were followed up for a mean of 43.8 +/- 28.7 months (range, 6-114 months). RESULTS: The postoperative mean functional capacity of the group was 1.47 +/- 0.56. No late deaths were reported. Forty-nine patients (74.2%) were evaluated with standard echocardiographic techniques, and 29 (43.9%) patients underwent dobutamine stress echocardiography. There was a significant decrease in the thickness of the interventricular septum after surgery. The mean preoperative and postoperative septal thickness was 1.99 +/- 0.59 cm (range, 1.3-3.8 cm) and 1.55 +/- 0.41 cm (range, 0.96-2.8 cm), respectively (p < 0.004). The mean posterior wall thickness was significantly less than the preoperative value (p = 0.008) and the left ventricular end-diastolic diameter was slightly greater in the postoperative measurements, but the difference was not significant (p = 0.162). Postoperative left ventricular outflow systolic gradients were reduced significantly when compared with preoperative values (preoperative mean, 78.4 +/- 33.6 mm Hg, range, 50-212 mm Hg versus postoperative mean, 17.9 +/- 15.9 mm Hg: range, 0-40 mm Hg; p < 0.0001). CONCLUSION: Septal myectomy for patients with hypertrophic obstructive cardiomyopathy is a safe procedure with excellent clinical and functional results in the long-term follow-up.

Actuarial Analysis↗

PubMed1997

Comparison of exercise stress testing with dobutamine stress echocardiography and exercise technetium-99m isonitrile single photon emission computerized tomography for diagnosis of coronary artery disease.

To compare the value of exercise electrocardiography with dobutamine stress echocardiography and exercise technetium-99m isonitrile single-photon emission computed tomography for coronary artery disease, 70 patients with either suspected or proven coronary artery disease underwent dobutamine stress echocardiography, exercise technetium-99m isonitrile single-photon emission computed tomography (mibi-SPECT) and treadmill exercise electrocardiography (ECG). Dobutamine echocardiography and exercise mibi-SPECT revealed a higher overall sensitivity than exercise testing (90 vs 57%, p < 0.001; 96 vs 57%, p < 0.001, respectively). Dobutamine stress echocardiography showed a higher specificity than both exercise mibi-SPECT and treadmill exercise electrocardiography (90 vs 71%, p > 0.05; 90 and 62% p < 0.05, respectively) but the difference between dobutamine stress echocardiography and exercise mibi-SPECT was not statistically significant. Diagnostic accuracy of dobutamine stress echocardiography and exercise mibi-SPECT was higher than that of exercise testing (90 vs 59%, p < 0.001; 89 vs 59%, p < 0.001, respectively). Dobutamine stress echocardiography and exercise mibi-SPECT have superiority over exercise testing in the diagnosis of coronary artery disease and dobutamine stress echocardiography is an alternative for exercise mibi-SPECT.

Adult↗

PubMed1996

Prevalence and predictors of atrial fibrillation in rheumatic valvular heart disease.

The highest frequency of AF in RHD occurs in those with mitral stenosis, mitral regurgitation, and tricuspid regurgitation in combination. AF, while occurring in 29% of patients with isolated mitral stenosis and in 16% with isolated mitral regurgitation, is an infrequent finding (1%) in patients with aortic valvular disease. Left atrial diameter by univariate analysis, and age and left atrial diameter by multivariate analysis have been shown to be the most important parameters to determine the occurrence of AF in patients with RHD.

Adolescent↗

PubMed1996

Effects of aprotinin on plasma levels of neutrophil elastase and postoperative blood loss in cardiac surgery.

This study evaluated the effects of aprotinin on plasma levels of elastase, platelet count, fibrinogen levels and postoperative bleeding. Thirty cardiac surgery patients were randomly chosen for this study. The protease inhibitor aprotinin was given in high doses to 20 patients before and during cardiopulmonary bypass; 10 patients served as the control group. Mean patient age and body weight was similar in both groups. There were no significant inter-group differences in the total cardiopulmonary bypass and cross-clamp times. Mean (s.e.m.) elastase levels were significantly raised in the control group (161.9(2.57) micrograms/l) compared with the treated group (148.2(3.29) micrograms/l) at 30 min of cardiopulmonary bypass (P < 0.01) and rose even further at the end of cardiopulmonary bypass, after protamine infusion, and 24 h postoperatively (P < 0.001). Platelet counts decreased more in the control group (P < 0.001). Serum fibrinogen levels were significantly lower in the controls during and just after cardiopulmonary bypass (P < 0.01). Postoperative blood loss was significantly less in the aprotinin-treated patients (315(25) ml) compared with the controls (589(154) ml) (P < 0.05). Aprotinin appears to inhibit elastase release and decrease postoperative blood loss.

Adult↗

PubMed1996

Comparison of exercise stress testing with simultaneous dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computerized tomography for diagnosis of coronary artery disease.

The object of our study was to compare the value of exercise stress testing with simultaneous dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography for the diagnosis of coronary artery disease. Sixty-nine patients with either suspected or proven coronary artery disease underwent simultaneous dobutamine technetium-99m isonitrile single-photon emission computed tomography and stress echocardiography, and treadmill exercise electrocardiography. Dobutamine echocardiography and technetium-99m isonitrile single-photon emission computed tomography revealed a higher overall sensitivity than exercise testing (94 vs 60%, P < 0.001), but dobutamine stress echocardiography showed a higher specificity than both technetium-99m isonitrile single-photon emission computed tomography and exercise testing (86 vs 64%, P < 0.05, for both tests). In addition, the diagnostic accuracy of dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography was higher than that of exercise testing (91 vs 61%, P < 0.001; 86 vs 61%, P < 0.001, respectively). Dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography are superior to exercise testing in the diagnosis of coronary artery disease, and dobutamine stress echocardiography can act as an alternative to technetium-99m isonitrile single-photon emission computed tomography.

Adult↗

PubMed1996

Long term results of mitral valve replacement with preservation of the posterior leaflet.

BACKGROUND AND AIMS OF THE STUDY: It is commonly held that preservation of the annulo-ventricular continuity during mitral valve replacement has a beneficial effect on postoperative ventricular function. This paper presents our eight-year experience with this technique. MATERIALS AND METHODS: From 1986 to December 1992, 120 patients with rheumatic valve disease underwent mitral valve replacement (MVR) combined with preservation of the posterior leaflet of the mitral valve. The mean age was 33.87 years (range 16 to 63). The preoperative New York Heart Association (NYHA) class was III in 64% of the patients and IV in 3%. The early (30 day) mortality rate was 2.5% (3/120). Follow up was 100% complete. The total cumulative follow up was 477 patient-years (pty) with a mean 3.94 years (range: 2-8 years). RESULTS: The actuarial survival rate (including hospital mortality) was 87.6% at eight years. Advanced age (p = 0.0457), increased preoperative functional capacity (p = 0.0251), increased preoperative end-systolic diameter (p = 0.0352) and combined tricuspid reconstruction (p = 0.0001) were found to be independent parameters for a lower actuarial survival rate. Six patients (1.25%/pty) developed thromboembolic complications. Two of these were cerebrovascular accidents (0.41%/pty) and four were caused by mechanical valve thrombosis (1.83%/pty). Freedom from thromboembolic complications (including mechanical valve thrombosis) was 89.8% +/- 7.9%. Fifteen patients (3.14%/pty) developed valve failure, four (0.83%/pty) mechanical valve thrombosis and nine (1.88%/pty) bioprosthetic valve failure. Freedom from reoperation was 60.7% +/- 16.1%. One patient with a St. Jude Medical valve (0.2%/pty) suffered from prosthetic valve endocarditis. Three patients (0.62%/pty) died during the follow up period, and, freedom from all valve related complications was 51.4% +/- 16.1% at eight years. CONCLUSION: Preservation of the posterior leaflet during mitral valve replacement reduces the risk of early mortality and did not cause additional complications to the patients. Despite the beneficial effects of this technique in the long term this technique did not increase the long term survival in patients with associated impaired valvular and/or ventricular function.

Adolescent↗

PubMed1995

[Surgical problems in acute acalculous cholecystitis].

The authors report on the prevalence of acute cholecystitis in the absence of calculi with special attention paid to the development of this disease as a complication of prolonged parenteral nutrition. In 1990-1993 at the Surgical Clinic in Plzen 125 cases of acute cholecystitis were operated, incl. 14 acalculous ones (11.2%). These 14 patients comprised 5 (28.6%) who were on parenteral nutrition for a prolonged period. The authors analyze the causes of the development of acute acalculous cholecystitis. They deal with the problem of diagnosis where in severe postoperative and posttraumatic cases ultrasonography proved useful.

Acute Disease↗

PubMed1994

Hypertrophic obstructive cardiomyopathy in combination with anomalous insertion of papillary muscle directly into anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery.

This report describes an unusual case of subaortic stenosis in which hypertrophic obstructive cardiomyopathy was found in combination with both anomalous insertion of papillary muscle directly into the anterior mitral leaflet and "sawfish" systolic narrowing of the left anterior descending coronary artery. Definitive diagnosis was made on operation. We freed the left anterior descending coronary artery by incising the muscular bridge, resected both papillary muscles, and replaced the mitral valve.

Adult↗