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Biomedical subjects

Theodor Tirilomis

Publications and source records attributed to Theodor Tirilomis.

7 recordsLinked to original sources
PubMed2005

Congenital coronary artery fistulas in adults: surgical treatment and outcome.

BACKGROUND: Congenital coronary artery fistulas, a subgroup of anomalies of the coronary arteries, are an extremely rare cardiac defect. Most patients are asymptomatic, and if symptoms are presented, they depend on the underlying anatomy. Knowledge of those fistulas is important for prognosis and management. METHODS: Thirteen adult patients with congenital coronary fistulas (8 male, 5 female) were operated in our department during the last decade (1990-1999). Mean age was 61.5+/-10.8 years. Diagnosis was made by coronary angiography, and 15 congenital coronary artery fistulas were found. RESULTS: All patients were symptomatic with clinical symptoms depending on the associated cardiac disorder. Coronary artery fistulas originated from the proximal left descending artery (n=10), left main stem (n=3), circumflex artery (n=1), right coronary artery (n=1), and drained into the main pulmonary artery (n=14) and left ventricle (n=1). Nine fistulas (60%) were interrupted on the outside of the heart, and six fistulas (40%) were closed through the opened pulmonary artery. There was no surgical death and no fistula-related complication. CONCLUSIONS: Surgical closure of congenital coronary artery fistulas in adults can be performed with a very low risk, and closure is recommended to prevent complications.

Adult↗
PubMed2005

Intraoperative hemofiltration in adults: prevention of hypercirculatory syndrome?

Hypercirculatory syndrome (HCS) after cardiac surgery may be a sequela of extracorporeal circulation due to hemodilution and release of inflammatory mediators. The aim of this study was to investigate the influence of intraoperative hemofiltration (HF) on the incidence of HCS. A prospective cohort study of 80 patients scheduled for elective coronary bypass was performed. The patients were randomized to two groups: in the conventional (CONV) group 40 patients were treated conventionally and in the HF group 40 patients underwent intraoperative HF. There was no perioperative mortality. The incidence of HCS was comparable in both groups (32% in CONV group versus 40% in HF group; n.s.). Mean cardiac output was higher and systemic vascular resistance lower in CONV group patients than in HF group patients, however these differences did not reach statistical significance. According to this data intraoperative HF does not prevent postoperative HCS induced by cardiopulmonary bypass. Further studies are required to identify the etiology of HCS, and to prevent it occurring after open-heart surgery.

Aged↗
PubMed2003

Comparison of continuous cardiac output measurements in patients after cardiac surgery.

OBJECTIVE: To investigate in a direct comparison accuracy and precision of continuous cardiac output measurements assessed by continuous pulmonary artery thermodilution technique (TDCCO), continuous pulse contour analysis (PCCO), and noninvasive partial CO(2)-rebreathing technique (NICO) in patients after coronary artery bypass grafting (CABG) during the postoperative period. DESIGN: Prospective, controlled clinical study. SETTING: University hospital. PARTICIPANTS: Twenty-two patients undergoing elective CABG surgery. INTERVENTIONS: Hemodynamic measurements were performed after admission to the ICU and in sequence every 2 hours during the subsequent 6-hour period. Simultaneously, cardiac output (CO) was measured using a TDCCO, PCCO, and NICO. After the continuous cardiac output measurements were read, bolus thermodilution-derived cardiac output was obtained from thermodilution curves detected in the pulmonary artery (TDBCO(pa)). Four intermittent consecutive boli consisting of 10 mL of ice-cold saline were randomly injected over the ventilatory cycle. MEASUREMENTS AND MAIN RESULTS: The comparison between the continuous cardiac output measurement methods TDCCO versus PCCO showed a bias of -0.12 L/min, between TDCCO versus NICO -0.17 L/min, and between PCCO versus NICO -0.44 L/min. The comparison to the reference technique between TDBCO(pa) versus TDCCO revealed a bias of -0.28 L/min, between TDBCO(pa) versus PCCO -0.40 L/min, and between TDBCO(pa) versus NICO -0.64 L/min. CONCLUSIONS: The results of this clinical investigation show agreement between TDCCO and PCCO to satisfy clinical requirements in a setting of postoperative patients after cardiac surgery. In contrast, the NICO monitor is of very limited use in these patients.

Aged↗
PubMed2002

Pulmonary Langerhans' cell histiocytosis (histiocytosis X) following metastasizing malignant melanoma.

BACKGROUND: Pulmonary Langerhans' cell histiocytosis (histiocytosis X) is an uncommon, diffuse interstitial lung disease of unknown cause, mostly presenting in young smokers. Association of pulmonary Langerhans' cell histiocytosis with a malignant neoplasm is rare. CASE DESCRIPTION AND RESULTS: We present and discuss the case of a 48-year-old man (ex-smoker) with metastasising malignant melanoma. A few months after chemotherapy and a modified Whipple procedure for retroduodenal metastasis of a malignant melanoma, computer tomographic scans revealed intrapulmonary "ring-shaped structures". Endobronchial biopsies and bronchioalveolar lavage showed no evidence of neoplasm or inflammation. Open-lung biopsy was performed and revealed pulmonary Langerhans' cell histiocytosis. CONCLUSION: To our knowledge this is the first reported case of pulmonary Langerhans' cell histiocytosis in association with malignant melanoma. Chemotherapy for malignant melanoma may be related to the development of pulmonary Langerhans' cell histiocytosis.

Histiocytosis, Langerhans-Cell↗