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V Sadony

Publications and source records attributed to V Sadony.

At least 19 recordsLinked to original sources
PubMed2001

[AIDS and non-Hodgkin's lymphoma: initial cardiac manifestations of highly malignant B-cell lymphoma 18 years after HIV infection].

HISTORY AND FINDINGS: A 35-year-old man who, as a result of intravenous drug abuse, had become infected with HIV 18 years previously, was admitted with signs of right-heart failure. Three months earlier a systolic murmur had first been heard in the 5th intercostal space parasternally. INVESTIGATIONS: Transesophageal echocardiography (TEE) demonstrated a 3 x 2 cm right atrial tumour, moderate to severe tricuspid regurgitation and pulmonary hypertension. Blood cultures grew Streptococcus. DIAGNOSIS, TREATMENT AND COURSE: Endocarditis with atrial thrombi and recurrent pulmonary emboli was diagnosed and treated with antibiotics and anticoagulants. Three weeks later the TEE showed an increase in the atrial tumour. Computed tomography of skull, thorax and abdomen did not demonstrate any significantly enlarged lymph nodes. Exploratory thoracotomy revealed an infiltrating highly malignant centroblastic non-Hodgkin's lymphoma (NHL) of almost the entire free wall of the right atrium. After two courses of chemotherapy (CHOP protocol) the size of the tumour had significantly decreased. CONCLUSION: The differential diagnosis of a right atrial tumour can be difficult in patients with HIV or AIDS. Even if the site is atypical and there is no lymphadenopathy, a lymphoma should be considered. In case of doubt a histological diagnosis via an exploratory thoracotomy should be performed.

Adult↗
PubMed2001

Rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm documented by transesophageal echocardiography.

A case of bacterial aortitis of the ascending aorta caused by Staphylococcus aureus progressed to an aortic mycotic aneurysm. Transesophageal echocardiography was the diagnostic approach of choice. The different stages of the disease from the initial aortic wall infection to formation of an abscess that communicated with the aortic lumen were documented by transesophageal echocardiography.

Aneurysm, Infected↗
PubMed1998

Cardiac troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery.

OBJECTIVE: The definition of a reliable and generally accepted diagnostic standard for perioperative myocardial damage is desirable. Cardiac troponin I (cTnI) is highly specific for myocardial tissue and can be measured rapidly. The aim of our study was to evaluate the diagnostic potential of cTnI for myocardial lesions in patients undergoing coronary artery bypass surgery (CABG). METHODS: A total of 119 patients with diffuse coronary artery disease were operated on using blood cardioplegia. Serial blood samples drawn before and after surgery were analyzed for the activity of creatine kinase MB isoenzyme (CKMB) and the concentrations of CKMB mass, cardiac troponins T and I. On the basis of the biochemical results (except cTnI) and the findings of electrocardiography/echocardiography, patients were classified and cTnI was studied for each group separately: group I, minor myocardial damage; group II, non-transmural infarction; group III, transmural infarction; and group IV, preoperative non-transmural infarction. RESULTS: In 87 patients of group I (73.1%) cTnI levels remained low; 19 patients (16.0%) were assigned to group II, 8 patients (6.7%) to group III, and 5 patients (4.2%) to group IV. For discrimination of patients without and with perioperative myocardial infarction (PMI) by one cTnI determination, the use of cutoff values of 6.5 ng/ml at 8 h, 9.8 ng/ml at 12 h, and 11.6 ng/ml at 24 h after aortic unclamping resulted in a diagnostic efficiency of 88, 94 and 98%). Especially, a cTnI value at 24 h had a sensitivity of 100% and a specificity of 97%. Cardiac troponin levels at 24 h were found to correlate closely with the well-recognized 2-48 h area-under-the-curve (P < 0.0001; R = 0.993), making serial determinations unnecessary. CONCLUSIONS: cTnI qualifies as a marker for diagnosis of PMI and quantitation of the amount of myocardial damage, because of the availability of a quick diagnostic test with high specificity, the high diagnostic efficiency, and especially the sufficient information gained by a single determination 24 h after aortic unclamping.

Aged↗
PubMed1998

Intravascular ultrasound (IVUS) examination reverses therapeutic decision from percutaneous intervention to a surgical approach in patients with alterations of the left main stem.

Intravascular ultrasound (IVUS) represents a new method to assess vessel lumen and wall morphology. To prospectively evaluate the usefulness of IVUS for further therapeutic decisions in left main stem (LM) lesions with unclear angiographic definition, this study was launched. We studied 56 patients with significant stenosis of the LAD and/or LCX arteries and questionable LM morphology. 30-MHz IVUS catheters with 2.9 or 3.2 F outer diameters were used. A significant luminal reduction of the left main stem was defined as an area stenosis greater than 50% or a minimal luminal diameter smaller than 3 mm as determined by IVUS. 36 of 56 patients (61%) fulfilled these criteria. Additionally, 12 patients showed a ruptured plaque within the LM. 30 of these 36 patients were originally thought to be candidates for angioplasty. After positive IVUS 34 of these 36 patients were sent to surgery. No perioperative ischemic complications occurred. In angiographically unclear left main stem findings. IVUS establishes a definitive diagnosis. After IVUS confirmation of significant left main stem pathology operative management should be the preferred approach as compared to transluminal coronary interventions. However, prospective randomized studies are needed to define the most efficient approach.

Angioplasty, Balloon, Coronary↗
PubMed1997

Influence of coronary artery bypass surgery on thyroid hormone parameters.

UNLABELLED: The postoperative period after cardiac surgery with cardiopulmonary bypass (CPB) is associated with a low T3 syndrome, i.e. low T3 and fT3 concentrations in the presence of normal T4 and TSH concentrations. So far, results from studies evaluating thyroid function during and after CPB are rather conflicting. We therefore evaluated prospectively thyroid function in 28 patients before, during and up to 3 days after coronary artery bypass surgery. We could demonstrate the most significant changes in thyroid hormone concentrations on day 1 after CPB (low T3 and fT3 concentrations, elevated rT3 concentrations in the presence of a significant fall of TSH). T3 fell from 1.93 to 0.6 nmol/1 and fT3 from 5.5 to 1.42 pmol/1. Those patients with low cardiac output syndrome after surgery had significantly lower T3 concentrations than patients without this complication. Moreover, those patients, who already had significant lower T3 values prior to CPB, also demonstrated low T3 concentrations on day 1 after CPB. Cortisol usually has a suppressive effect on TSH secretion. However, the effect of cortisol on TSH in patients undergoing CPB seems to be not that important: those patients with high endogenous cortisol concentrations on day 1 after CPB had similar TSH values to those patients with only slightly elevated cortisol concentrations. Also, the application of high doses of catecholamines seems to have only minor effects on TSH secretion, because those patients requiring high doses of dopamine over a prolonged time period had essentially the same TSH values after CPB. Patients who had been exposed preoperatively to high doses of iodine did not demonstrate significantly different thyroid hormone concentrations. IN CONCLUSION: We could demonstrate that CPB induces a low T3 syndrome up to 3 days after surgery. Those patients with low T3 concentrations prior to surgery demonstrate postoperatively a more severe degree of nonthyroidal illness (NTI). Catecholamines and cortisol seem to have only minor effects on the TSH secretion after CPB. The influence of a previous iodine contamination is negligible.

Aged↗
PubMed1994

Surgical management of Wilms tumor with intracardiac neoplastic extension.

In the management of Wilms tumor (nephroblastoma) with intracardiac extension (ICE) an interdisciplinary approach is mandatory. The three cases reported here reflect the impressive improvements of both diagnostic facilities and surgical strategies over the last 16 years as evidenced in the literature. Nowadays, prerequisite for a well-planned, safe, and successful operation is the exact delineation of the intravasal tumor extension and the use of the combined techniques of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). In the first child (1976) only tumor nephrectomy was performed. Under chemotherapy fatal massive pulmonary embolism occurred. In the second child (1980) ICE was removed after tumor nephrectomy on an emergency basis using CPB. The third child (1987) was operated on electively using the concepts of CPB+DHCA. Now, both children are doing well without evidence of disease 13 years (case 2: stage III) and 6 years (case 3: stage IV) after an aggressive adjuvant-therapy regimen of multiagent chemotherapy and radiation. In conclusion, in children with nephroblastoma and ICE an aggressive surgical approach and subsequent multiagent chemotherapy are advocated.

Chemotherapy, Adjuvant↗
PubMed1994

Diagnosis and therapeutic consequences of intramural aortic hematoma.

The classical triad of sudden devastating chest pain, electrocardiographic absence of acute myocardial infarction, and identification of an upstream flap in the ascending aorta by transesophageal echocardiography (TEE) indicates aortic type A dissection requiring emergent surgery. Among 34 patients presenting with clinical signs and symptoms of an aortic dissection, three did not show the mandatory flap in the upstream aorta. The only echocardiographic finding was aortic wall thickening indicating an intramural hematoma. Two of these patients showed early aortic ectasia and one showed a pericardial effusion. Despite the missing flap echocardiographically, surgery was performed in all three patients. The surgical approach was the same as that for patients with a type A dissection. Two patients are doing well after the procedure, and one patient died after reoperation. The postoperative histologic work-up confirmed that there was no intimal tear or dissection of the intimal layer. We conclude that the echocardiographic finding of an intramural hematoma combined with typical clinical signs of chest pain, with myocardial infarction ruled out, requires emergent surgical intervention.

Adult↗
PubMed1994

Wilms tumor with intracardiac neoplastic extension.

A rare case of a Wilms tumor with intracardiac neoplastic extension is presented. The good prognosis of even extensive nephroblastoma is the reason for attempting a radical surgical approach to patients with intracardiac tumor thrombus. The exact preoperative delineation of the intracasal tumor extension is essential for a safe and successful operation. Ultrasonography in combination with echocardiography is the preferred modality for detecting intracardiac extension.

Child, Preschool↗
PubMed1993

Inotropic actions of BDF 9148 and DPI 201-106 and their enantiomers in guinea-pig, rat and human atria.

The positive inotropic effects of the sodium channel modulators, DPI 201-106 and BDF 9148, were tested in atrial preparations from guinea-pig, rat and man. In rat, the racemate and S enantiomer of both DPI 201-106 and BDF 9148 displayed the same efficacy as did increased extracellular Ca2+, but in guinea-pig and man, the efficacy varied between 60 and 90% of the maximum Ca2+ response. In all three species, BDF 9148 was significantly more potent than DPI 201-106 by approximately one order of magnitude. The same was evident for the S enantiomers. The R enantiomers did not inhibit the effects of the S enantiomers. We have shown pronounced differences in the efficacy and potency of the enantiomers of DPI 201-206 and BDF 9148, which may be useful for future radioligand binding studies.

Animals↗
PubMed1991

Quantitation of hypoxanthine in plasma from patients with ischemic heart disease: adaption of a high-performance liquid chromatographic method.

A high-performance liquid chromatographic method is described for the separation and quantitation of several purine compounds, including hypoxanthine. The isocratic separation of a standard mixture of nine compounds is achieved within 20 min on a reversed-phase Nucleosil 100-5C18 column, with a mobile phase of KH2PO4 (300 mM, pH 4.0)-methanol-acetonitrile-tetrahydrofuran (97.9:1:1:0.1, v/v). Uric acid, guanine, hypoxanthine, uridine, xanthine, allopurinol, inosine, guanosine and 7-methylxanthine were almost completely baseline-separated, with detection limits in the range 0.5-1.2 pmol per injection. The influence of the concentrations of buffer and tetrahydrofuran on the quality of separation are described. The within-day and the day-to-day precision were satisfactory (e.g. coefficients of variation of less than 1.5 and ca. 6.0%, respectively, for peak heights). The recovery of [3H]hypoxanthine added to samples was 86 +/- 1%. Hypoxanthine was quantified in human plasma samples obtained at various times during coronary artery bypass grafting. The hypoxanthine levels measured immediately after release of the aortic cross-clamp were significantly higher than those determined under control conditions (18.8 +/- 7.0 and 3.4 +/- 1.0 microM, respectively).

Allopurinol↗
PubMed1991

Functional and structural impairment in human, rat and guinea-pig atrial muscle in response to in vitro calcium overload: a cytochemical study on cellular calcium distribution.

Critical accumulation of cellular calcium in ischaemic myocardium is involved in irreversible cell damage. In human right atrial trabeculae and in rat and guinea-pig left atria, we investigated whether direct calcium overload by increasing the extracellular calcium concentration, [Ca2+]o, leads to similar impairment of function and ultrastructure as observed after ischaemia. The force of contraction was measured during two consecutive cumulative increases in [Ca2+]o (1-25 mmol/l) separated by 30 min of incubation at low [Ca2+]o. Compared to the first Ca2+ challenge, the positive inotropic effect of increasing [Ca2+]o was depressed during the second one and the after-contractions, and the increase in resting tension developing with high [Ca2+]o tended to be larger. The ultrastructure of the tissue fixed immediately after excision was well preserved. When fixed after the second Ca2+ challenge, half of the cells were severely damaged with various signs of cellular Ca2+ overload similar to those observed after ischaemic damage: the sarcolemma lost its Ca(2+)-binding properties, sarcomeres showed contraction band necrosis, the mitochondria had disrupted cristae and contained either large clusters of Ca2+ precipitate or amorphous densities (Jennings granules). In many cells, calcium precipitates were present in the cytoplasm. The morphological and functional changes were similar in the three species studied. Our results suggest that the deterioration of atrial myocardium after challenge with high [Ca2+]o or after severe ischaemia may be traced back to a common mechanism, i.e. the sarcolemma loses its competence as a permeable barrier for Ca2+ and therefore facilitates excessive Ca2+ entry. However, for the direct demonstration of calcium precipitates as a sign of cytosolic Ca2+ overload, high [Ca2+]o are required with are not normally present in the myocardium.

Animals↗
PubMed1990

Diagnosis of perioperative myocardial necrosis following coronary artery surgery--a reappraisal of isoenzyme analysis.

Although the routine determination of CK-MB activity is widely used after coronary artery bypass grafting (CABG), the diagnosis of a perioperative myocardial necrosis remains arbitrary. The intention of the present study was to develop discriminative enzymatic parameters of CK-MB activity in a collective of 710 patients following CABG. Patients were grouped according to their postoperative electrocardiogram (ECG). For each patient, the time activity curve of CK-MB was determined. The total amount of CK-MB was calculated by integrating the area beneath the CK-MB activity curve. Patients presenting with an unchanged postoperative ECG (group I) or a new bundle branch block with uncompromised haemodynamics (group IIa) had an uniform and low profile of CK-MB activity. Serial CK-MB activities as well as the integrated CK-MB area of these two collectives were significantly different (P less than 0.001) from values determined for patients with bundle branch block and low cardiac output (group II b) or patients with new Q waves (group III). After 24h, the 90th percentile of serial CK-MB activities of group I had declined to 18 U/l and was clearly exceeded by 90% of all patients that belonged to either group IIb or III. The 90th percentile of CK-MB areas for group I showed a value of 801 U/l x h. CK-MB areas above 801 U/l x h were seen in about 50% of all patients of group IIa.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1990

[Diagnosis and therapy of acute traumatic aortic rupture].

Aortic transection is defined as complete or partial dehiscence of the aortic wall layers. Aortic transections are seen in 16% of all lethal traffic accidents. The quality of the first emergency care outside hospital and the organization of rescue systems result in an increasing number of patients (espec. with life-threatening multiple injuries incl. atypical aortic lesions) reaching a trauma-center. Guide-lines for surgical indications are: 1. emergency-operation in case of symptomatic transection incl. simultaneous surgery of concommitant lesions. 2. Urgent operation following primary hemodynamic stabilisation in cases of isolated or asymptomatic transection. 3. In cases of concommitant lesions with surgical priority, delayed operation of asymptomatic transection. The perioperative letality claims up to 20%. Next of operative complication paraplegia remains the most deleterious problem. Despite different methods of protection on the spinal cord the incidence of paraplegia persists in the range of 5-10%.

Aorta, Thoracic↗
PubMed1989

Acquired coarctation due to calcified thrombus in atherosclerosis of the descending thoracic aorta. Two cases and a review.

An extremely rare manifestation of atherosclerosis is described. Two women, aged 57 and 55, presented with upper extremity hypertension and diminished femoral pulses. Plain radiography and total angiographic visualization of the aorta demonstrated focal highly obstructing intraluminal masses containing heavy flocculent calcification in the upper descending thoracic (case 1) and the thoracoabdominal aorta (case 2) producing a significant pressure gradient. The acquired coarctation due to calcified thrombus was relieved by resection and graft replacement in one and placement of a thoracoabdominal bypass graft in the second patient.

Aorta, Thoracic↗
PubMed1988

Unusual cause of recurrent arterial embolism: floating thrombus in the aortic arch surgically removed under hypothermic cardiocirculatory arrest.

A 46-year-old fully active, asymptomatic man suffered two episodes of major peripheral arterial embolism within 2 months. Heart disease was ruled out by appropriate investigations. Further diagnostic evaluation (angiography, CAT scan) revealed the extremely rare finding of a "floating mass" in the transverse aortic arch suspected to be the source of embolization. This mass was successfully removed using the technique of hypothermic cardiocirculatory arrest. The histological diagnosis was an aged intraluminal thrombus and moderate atherosclerosis of the thoracic aorta. For prevention of recurrent arterial embolism in cases without an initially apparent cause and site of origin, a thorough diagnostic, and in a given patient, an aggressive surgical approach for the elimination of the embolic source are advocated.

Aorta, Thoracic↗
PubMed1986

Long-term results following surgical removal of pulmonary metastases in children with malignomas.

Between 1972 and June 1983, 21 children (mean age 9 years, range 20 months to 16.5 years) were operated on for pulmonary metastatic disease. Primary malignant tumors were Wilms-tumor (7 patients), osteogenic sarcoma (7 patients), Ewing's sarcoma (4 patients), hepatoblastoma (2 patients), and rhabdomyosarcoma (1 patient). The surgical intervention was part of a therapeutic pediatric oncological concept with curative purpose including chemotherapy and/or radiation in different combinations. Ten out of these 21 children survived disease-free 3 years and more after pulmonary metastasectomy. An aggressive surgical approach towards pulmonary metastatic disease in children thus appears to be justified.

Adolescent↗
PubMed1982

[The value of ultrasound evaluation in the diagnosis and therapy of abdominal aortic aneurysms. A review (author's transl)].

Facilities and limitations of ultrasonography (US) applied to the abdominal aorta are demonstrated. The importance of US in establishing the diagnosis of abdominal aortic aneurysm (AAA) is assessed and compared with the results of other imaging diagnostic procedures. In cooperation with the vascular surgeon the value of these different diagnostic approaches and its influence to therapeutic decisions is outlined. Based on a modern surgical approach the range of order for the use of the various diagnostic methods depending on the clinical stage of AAA is presented. The cost-benefit relationship will be considered also.

Aortic Dissection↗