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Biomedical subjects

V Kucera

Publications and source records attributed to V Kucera.

At least 19 recordsLinked to original sources
PubMed1997

Primary repair of interrupted aortic arch and associated heart lesions in newborns.

Primary repair of interrupted aortic arch and associated heart lesions was performed in 13 patients aged from 1 to 85 days. The surgery was performed through the midline sternotomy approach in extracorporeal circulation and deep hypothermia. Hypothermic circulatory arrest at 14 to 19 degrees C was used for reconstruction of the aortic arch. In all patients it was possible to perform a direct anastomosis between the ascendent and descendent aorta. At the same time closure of the ventricular septal defect was performed in 11 patients, closure of the atrial septal defect in 4, correction of persistent truncus arteriosus in 3, resection of subaortic stenosis in 2, arterial switch repair of transposition of the great arteries in 1, correction of double outlet right ventricle in 1 and patch closure of aortico-pulmonary window in 1 patient. Three (23.1%) newborns died in the early postoperative period: two from sepsis and one from multiple organ failure. Ten patients (76.9%) were followed up for 1 to 29 months postoperatively. All of them are in very good condition with a nonrestrictive aortic anastomosis. Primary one-stage repair of interrupted aortic arch and associated heart lesions is preferred to the two-stage repair in all newborns with this critical congenital heart disease.

Aorta, Thoracic↗
PubMed1996

[Is lithium a teratogen?].

Beginning with the seventies literature has brought a series of publications drawing attention to possible effects of lithium on the origin of congenital malformations. The discussion on the teratogenic effects of lithium in world literature has not come to final conclusion yet. The paper reviews some knowledge from home and foreign literature, dealing with the problems of lithium teratogenicity. A series of information has been provided on the basis of metaanalysis of data having been published until 1994 in the review systems MEDLINE, TOXLINE and Lithium Information Center database. The aim of the contribution has been to review the published data on this question. The available literature has shown that teratogenicity of lithium has not been proved univocally. Last studies rather suggest that lithium is not a strong teratogen. In view of the fact that teratogenicity of lithium cannot be safely excluded, the paper recommends that this kind of risk should be taken into account, if lithium administration is considered to be applied in pregnant women, especially during the first three months of pregnancy.

Abnormalities, Drug-Induced↗
PubMed1996

[Radical anatomic correction of transposition of great arteries in neonates. A new program of treatment of critical congenital heart defects].

METHODS AND RESULTS: From the group of 110 neonates born with transposition of the great arteries during 1991-1994 that were referred for the treatment to Kardiocentrum, University Hospital Prague-Motol, 46 neonates with simple transposition were operated on according to the criteria for anatomical correction (arterial switch) at the mean age of 9 days (4-20 days). Fourteen infants with transposition and large ventricular septal defect were corrected with arterial switch at the mean age of 2.5 months (5 weeks-9 months). Fifty neonates that did not meet criteria for arterial switch procedure were indicated for correction at the atrial level (Senning procedure) that has been performed at the mean age of 5 months (1-10 months). Out of 46 operated neonates 10 died following the operation and one child died 2 months later after surgery. There were 2 death out of last 20 neonates (10%). Thirty five children surviving 1-4 years after anatomical arterial correction of transposition are without complaints in excellent condition, NYHA class I. CONCLUSIONS: The procedure of the anatomical correction at the level of the great arteries (arterial switch) according to Jatene, that has been successfully introduced at Kardiocentrum, University Hospital Prague-Motol, has been reproducible and became the method of choice for operations of transposition of the great arteries in neonates with the suitable anatomy.

Cardiac Surgical Procedures↗
PubMed1996

Platelet membrane receptors during short cardiopulmonary bypass--a flow cytometric study.

To elucidate a mechanism of platelet dysfunction during extracorporeal circulation, we performed a study on the surface expression of platelet adhesive receptors (GPIb, GPIIb-IIIa) and activation markers (GMP140, GP53) during short cardiopulmonary bypass (CPB). Ten paediatric patients, age 6-13 years, with atrial or atrioventricular septal defects were studied. The mean CPB time was 52 min (21-110 min). During CPB, a significant drop in platelet count was observed, but not below 130 x 10(3)/microliter. The expression of platelet GPIb decreased slightly during CPB and the decrease was not significant. The decrease of GPIIb-IIIa was significant, but only in samples collected either at the end of CPB (89 +/- 13%, p < 0.05) or before leaving the operating room (74 +/- 14%, p < 0.05). The value of surface expression of platelet activation markers (GMP140, GP53) during CPB was in the range of values for resting platelets. Our results suggest that generalized CPB-induced defects of primary haemostasis are not directly connected to circulation of activated degranulated platelets or to loss of platelet adhesive receptors GPIb-IX and GPIIb-IIIa.

Adolescent↗
PubMed1995

[Combined methods for economic blood utilization in cardiac reoperations in children].

During 47 re-operations on the open heart the authors used the method of autotransfusion, predeposition of the patient's blood and intravenous administration of aprotinin to reduce postoperative haemorrhage and blood consumption. The patients were classified according to the methods or their combinations used into three groups and the authors compared, using statistical methods the blood losses, blood consumption, haemolysis, renal function and the effect of the methods used on the morbidity. The results were compared with a control group where the mentioned methods of economizing on blood were not used. The authors recorded significantly higher haematocrit values in all three groups where economic methods were used at the end of the extracorporeal circulation (EC), as compared with the control group. The volume of the administered blood transfusion was significantly lower in group 1 where an autotransfusion apparatus Cell saver was used. The volume of the administered blood transfusion in the other groups did not differ when evaluated by statistical methods. The filling of the apparatus for extracorporeal circulation was blood free in 90% in group 1, in 75% in group 2, in 92.2% in group 3 and in 75% in the control group. Blood losses via thoracic drains did not differ significantly in different groups though there was a wide range of recorded values. In both groups 2 and 3 where patients were given aprotinin haemoglobinuria was more frequent, as confirmed by laboratory tests. The authors observed also a greater diuresis, without laboratory evidence of impairment of renal function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Tactics and technique of primary correction of aortic arch interruption using a median sternotomy].

Primary correction of an interrupted aortic arch was performed in seven neonates aged 2 to 26 days. The operation was performed from median sternotomy with extracorporeal circulation using hypothermic arrest of the circulation for reconstruction of the aortic arch. In all neonates it proved possible to make a direct anastomosis of the ascendent and descendent aorta. At the same time in six children a defect of the ventricular septum was closed, in two the common arterial trunk was corrected, in one resection of subaortic stenosis was performed and in another child correction of the aortopulmonary window. After the operation three neonates died from sepsis and multiorgan failure. At present four patients are alive who, 10 to 20 months after operation, are in a good condition. All have a non-restrictive anastomosis of the aorta. Primary correction of an interrupted aortic arch and associated defects is preferred by the authors to two-stage surgery.

Aorta, Thoracic↗
PubMed1995

[Anatomic correction of transposition of the great arteries in the neonatal period].

In Cardiocentrum of the University Hospital in Prague-Motol in 1988-1994 anatomical correction of transposition of the great arteries (arterial switch) was performed in 47 neonates aged 4 to 20 days. The aorta and pulmonary artery were transferred into the appropriate ventricle concurrently with reimplantation of the coronary arteries. The surgical technique was modified with regard to the anatomy of the coronary arteries and the presence of associated cardiac defects. Eleven of the 47 neonates (23%) died during the early postoperative period, one patient died two months after operation. Of the last 20 operated neonates only two died (10%) and both had an abnormal insertion of the coronary arteries. Thirty-five children are followed up for 2-45 months following anatomical correction. All are in a very good clinical condition without serious residual findings. The authors describe the protocol of the diagnostic and therapeutic procedure in transposition of the great arteries. They consider anatomical arterial correction in the neonatal period as the method of choice for this disease. The optimal age for anatomical correction in isolated transposition is between the 7th and 14th day and in transpositions with a major defect of the ventricular septum at the age of one month. The surgical results are steadily improving with accumulating experience. The medium-term results of anatomical correction of transposition of the great arteries are very favourable.

Cardiac Surgical Procedures↗
PubMed1994

[Heart surgery in neonates (experience with surgery in 420 neonates)].

In the child cardiocentre in Prague 5-Motol in 1977-1993 a total of 420 neonates with critical inborn heart disease were operated. Obstructive defects of the left heart were found in 178 children, obstructive defects of the right heart in 87, defects with a left-right shunt with pulmonary hypertension in 75, conotruncal malformations in 73 and various operations were made in 7 children. Complete repair of the defect was achieved in 281 neonates, incl. 104 where extracorporeal circulation was used. Palliative operations were made in 139 children. Early mortality during the entire period was 26%, whereby a decrease from 40% to 16% was recorded during the last three years. At present it is possible to repair permanently critical inborn heart disease in the majority of neonates. This is made possible in particular by early non-invasive diagnosis, treatment with prostaglandins E in duct-dependent critical heart disease, optimal time for and selection of most suitable surgery, microsurgical technique, miniaturization of extracorporeal circulation and the method of deep hypothermia.

Cardiac Surgical Procedures↗
PubMed1993

[Correction of double-outlet right ventricle using the Kawashima intraventricular tunnel procedure].

Anatomical correction with an intraventricular tunnel, as suggested by Kawashima, was performed in 14 children with a double-outlet right ventricle and a subpulmonary (4) or non-committed (10) defect of the ventricular septum with one early and one late death. Nine children had previous palliative operations. Complications after radical surgery were residual ventricular defects (4), infectious endocarditis (2) and impaired rhythm (one sudden death). Twelve patients are after medium- term or long-term follow-up free from subjective complaints, ten children report good performance, in two the performance is slightly reduced. Anatomical intraventricular correction of double-outlet right ventricle restores the mitral valve and left ventricle to the systemic circulation. The prognosis of children with double-outlet right ventricle and subpulmonary or remote ventricular defect improves substantially.

Child↗
PubMed1992

Minimisation of priming volume and blood saving in paediatric cardiac surgery.

We started a programme of donor blood reduction for open heart surgery in children in 1983. At first, only meticulous surgical and perfusion techniques were used. Later, increased haemodilution was added. Miniaturisation of the perfusion circuit and introduction of blood taken prior from the patient further decreased donor blood requirements. In 1989, we used 0.89 l per patient compared to 3.2 l per patient in 1983. Miniaturisation of the circuit was tested in a pilot study on 30 children undergoing the Senning operation in 1988. Priming volume was reduced from 661 +/- 72 ml to 421 +/- 62 ml. In 1989, 167 out of 194 children (86%) received a clear prime. Ninety-seven of 100 children whose weight was over 15 kg received a clear prime: 55 did not require subsequent transfusion. Prime miniaturisation and autotransfusion can considerably reduce blood requirements for open heart surgery.

Blood Donors↗
PubMed1992

A role of autoimmunity in the etiopathogenesis of Landau-Kleffner syndrome?

Four children, 3 boys and 1 girl, with the syndrome of acquired aphasia Landau-Kleffner were followed up during the last 10 years. In 3 children an episodic form of the disease with a good response to corticosteroid treatment and with a favourable prognosis was observed. In the other 1 no improvement of speech function was observed and also epileptic fits were reduced only with difficulty. A positive autoimmune reaction to central (MOZAN) and peripheral (LISAN) myelin was observed repeatedly during the attacks of clinical worsening. On the contrary, during the periods of improvement of language disturbances during the treatment with corticosteroids this hypersensitivity to central as well as peripheral myelin disappeared. Possible changes in myelinization and the role of autoimmune reactions in the etiopathogenesis of the disease are discussed.

Adolescent↗
PubMed1992

Assessment of predispositions for endurance running from field tests.

Field tests of speed and endurance may be used to evaluate the probability of success and to create efficient training strategies for sports. Currently, both invasive and non-invasive methods are used for this purpose. While invasive methods cause some discomfort to subjects, non-invasive methods may employ practices associated with the sport itself. One such method employs the linear relationship between exercise intensity or running speed and distance covered running at that speed represented on a semi-logarithmic scale. The separation of endurance runners into three different groups can be confirmed by different values for the slope coefficient (b) of this linear relation. According to findings among top Czechoslovak endurance runners, supplemented by the data of other authors, the values of coefficient b in middle-distance runners are in the range -2.166 to -1.700, in long-distance runners -1.520 to -1.050 and in marathon runners -0.836 to -0.436. Similarly, a separation of young endurance runners into groups of middle-distance and long-distance runners must be within the range -2.158 to -1.800 and for young long-distance runners -1.700 to -1.300. Based on these findings, the optimum competitive distance for adult athletes can be established in relation to current training status. In young athletes, it is possible to select gifted runners with predispositions for middle-distance and long-distance running. For both groups of athletes, more efficient training methods can be selected to optimize their predispositions for maximal performance.

Adult↗
PubMed1991

[Anatomic correction of a double outlet right ventricle using the Taussig-Bing arterial switch].

Four children with double outlet right ventricle type Taussig-Bing were operated in 1988-1990 by anatomical correction-arterial switch. Primary correction of the defect was performed in one infant at the age of three months. Three children had a previous palliative operation (banding of the pulmonary artery, resection of coarctation of the aorta and ductus arteriosus). Anatomical correction of the defect was performed in a second stage at the age of 14, 15 and 19 months. One child died from Gram-negative septicaemia on the 8th day after operation. Three children are completely free from complaints and develop normally. The authors discuss some technical aspects of the arterial switch operation in infants with double outlet right ventricle.

Double Outlet Right Ventricle↗
PubMed1990

An immunological study of Lyme disease.

84 patients in the second or third stages of serologically diagnosed Lyme disease suffering from different forms of central as well as peripheral nervous system involvement were tested for the participation of autoimmune mechanisms. Cell hypersensitivity to the encephalitogenic basic protein and to antigens from peripheral myelin was evaluated on an Opton cytopherometer according to the effect of the macrophage slowing factor--liberated during short-term incubation of sensibilized lymphocytes by the respective antigen--on the mobility of tannin-treated sheep red blood cells in an electric field. Judged by the presence of autoimmune reactions. Lyme disease has come to occupy a prominent position compared with previously examined other types of neuroinfections. An explanation can be sought in disordered immunoregulating mechanisms, even though the changes in total and active T lymphocytes were not statistically significant. Data on immunological changes are relevant for the indication of immunomodulating therapy as a suitable complement to antibiotic treatment.

Adolescent↗
PubMed1990

[Miniaturized extracorporeal circulation for infants].

By using the smallest commercially available oxygenator and our own modification of an apparatus for extracorporeal circulation we achieved minimal filling. By placing the apparatus close to the operating table the set can be miniaturized and the length of the tubes can be maximally reduced, while a satisfactory overview is ensured. The authors compared a group of 10 children operated by using this miniature apparatus with a control group of 20 children where the standard set up was used. The filling of the apparatus incl. added solutions was significantly smaller in the group with the mini-apparatus--on average 420 ml, as compared with the control group (671 ml). Despite the substantially larger amount of transfused blood in the control group with the greater volume (500 ml/patient), the resulting packed cell volume was the same in both groups. The other common postoperative parameters did not differ significantly in the two groups. The minimal filling of the apparatus for extracorporeal circulation in the described set up makes possible in the majority of children and infants with an elevated packed cell volume perfusion without the use of donor blood which is consistent with contemporary trends.

Extracorporeal Circulation↗
PubMed1990

[Possible use of the autotransfusion technic in pediatric heart surgery].

Consequential miniaturization of the apparatus for extracorporeal circulation and its simple connection, by introduction of haemodilution into perfusion technique along with careful surgical technique and the introduction of the principle of autotransfusion made it possible to reduce the consumption of donor blood in our department during the last six years to 25%. Autotransfusion proved to be in children weighing more than 15 kg a safe method. In the first half of 1989 we made 194 operations of the open heart. 167 patients (i.e. 86%) of this number did not require preserved blood in the primary filling of the apparatus for extracorporeal circulation. In a group of 100 patients weighing more than 15 kg in 65% the method of autotransfusion was applied; 55% of the patients did not need donor blood in the course of hospitalization.

Blood Transfusion, Autologous↗
PubMed1989

[Immunologic study of Lyme borreliosis].

In 84 patients in the second or third stage of serologically proved Lyme borreliosis suffering from different forms of central and/or peripheral nervous system involvement the participation of autoimmunological mechanisms was investigated. The cellular hypersensitivity to encephalitogenic basic protein and to antigens from peripheral myelin was evaluated on the cytopherometer Opton according to the influence of macrophage slowing factor--liberated during the short-term incubation of the sensibilized lymphocytes with specific antigen--on the mobility of tanned sheep red blood cells in the electrical field. The frequency of positive findings in comparison with the results in other types of neuroinfections, examined previously, put the Lyme borreliosis on the first place. The explanation of this fact may be seen in the immunoregulatory disturbances, even though the changes of the total and active T lymphocytes were not significant. The knowledge of immunological changes is very important for the indication of immunomodulating procedures suitably complementing the treatment by antibiotics.

Adolescent↗