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Biomedical subjects

Z Straka

Publications and source records attributed to Z Straka.

14 recordsLinked to original sources
PubMed2004

[Huge sinus of Valsalva aneurysm in patient with cystic medial necrosis of the aorta].

In this case we present a patient with unruptured non-coronary sinus of Valsalva aneurysm associated with diverse clinical findings, caused by acquired degenerative changes of the aortic wall. A previously healthy 36-year-old female was admitted to the neurological clinic of our hospital having suffered from an episode of unconsciousness prior to admission, with accompanying seizures. For the preceding two months she had also been suffering from dyspnoea and palpitation. Neurological examination, computed tomography of the head and electroencephalography were with normal findings. Thereafter, due to paroxysm of supraventricular tachycardia she was referred to cardiology clinic. On routine physical examination a diastolic murmur was detected and the patient was referred for transthoracic echocardiography. This examination revealed a large, unruptured noncoronary sinus of Valsalva aneurysm, which was thereafter confirmed by transoesophageal echocardiography a angiography. The patient was indicated for surgical correction with aortic valve and aortic root replacement by Bentall procedure. Histological examination of the part of resected aneurysm found cystic medial degeneration of the aortic wall, also called cystic medial necrosis.

Adult↗
PubMed2003

Higher content of 18:1 trans fatty acids in subcutaneous fat of persons with coronarographically documented atherosclerosis of the coronary arteries.

AIM: To identify the total content of trans fatty acid (TFA) isomers and C18:1 trans isomers in subcutaneous fat samples from persons with atherosclerosis of the coronary arteries, as an indicator of dietary exposure. METHODS: Using capillary gas chromatography, the authors determined total content of TFA isomers and C18:1 trans isomers in the subcutaneous fat of 34 patients with ischemic heart disease who had undergone aortocoronary bypass surgery and in 46 patients with no sign of coronary disease. RESULTS: On average, the total TFAs in cardiac patients were 2.88 +/- 1.19% of all fatty acids, in noncardiac patients 2.56 +/- 0.89%. However, the difference is not statistically significant. The average concentration of C18:1 trans in cardiac patients (2.31 +/- 1.09%) was statistically significantly higher (p = 0.05) than in the noncardiac group (1.95 +/- 0.77%). CONCLUSIONS: The results obtained indicate a lower TFA load in comparison with previous studies in other countries. A higher concentration of 18:1 TFAs in the subcutaneous fat of patients with coronary disease might be an impulse to correct the dietary habits of this very high-risk population.

Adipose Tissue↗
PubMed2003

Protracted infection of pacemaker leads with development of large vegetations: three years follow up. Case report.

A case history of a patient with permanent pacemaker reports inaccurate diagnosis of inflammation at the site of operation wound and a protracted infection of pacemaker leads. Inadequate therapy led to protracted inflammation with the leads fixed in the superior vena cava and the development of large vegetations in the right heart. Finally, the condition was resolved by surgical explantation and long-term antibiotic therapy. This case history describes infectious complications related to the implantation of a permanent pacemaker and the role of echocardiography in diagnosis of vegetations and points out the surgical treatment as a method of choice.

Aged↗
PubMed2003

Tranexamic acid reduces bleeding after off-pump coronary artery bypass grafting.

AIM: To assess the ability of tranexamic acid, compared with an untreated control group, to decrease bleeding and transfusion requirements in patients undergoing coronary artery bypass grafting on the beating heart. METHODS: Forty-nine randomly selected patients were enrolled to elective coronary artery bypass grafting without the use of cardiopulmonary bypass. Of these, 23 received tranexamic acid (bolus of 1 g before surgical incision, followed by infusion 200 mg/hour during surgery) and 26 patients were enrolled into a control group. Preoperative hematological variables, postoperative blood loss at 4 and 24 hours, transfusion requirements of packed red blood cells,and postoperative thrombotic events such as a myocardial infarction, stroke and pulmonary embolism were recorded. RESULTS: The two groups were similar in terms of patients' characteristics. Postoperative bleeding was significantly lower in the tranexamic acid group compared with the control group (median [25th-75th percentiles]): 115 [92-148] vs 230 [170-260] mL at 4 hours, p<0.001; 420 [330-523] vs 550 [500-650] mL at 24 hours, p<0.01). Transfusion requirements were lower in the tranexamic acid group compared with the control group (RBC 9% vs 28%), but the difference was not statistically significant. Treatment with tranexamic acid was not associated with a higher incidence of myocardial ischemia or other thrombotic events. CONCLUSION: Tranexamic acid reduces postoperative blood loss after coronary artery bypass grafting on the beating heart. Evaluation of transfusion requirements warrants further study.

Antifibrinolytic Agents↗
PubMed2002

Value of first day angiography/angioplasty in evolving Non-ST segment elevation myocardial infarction: an open multicenter randomized trial. The VINO Study.

AIMS: Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. METHODS: One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). RESULTS: All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2% vs 22.3% (P<0.001). Six month mortality in the first day angiography/angioplasty group was 3.1% vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs. 14.9% (P<0.02). CONCLUSIONS: First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy.

Aged↗
PubMed2002

[Acute abdomen after cardiac surgery].

Acute abdomen after cardiosurgery accounts for a minor group of complications, however, they are associated with a high mortality and morbidity. In 2001 in the authors department 940 cardiac operations were performed. In four patients (0.43%) during the early postoperative period acute abdomen developed which called for urgent surgical intervention. Two patients died. Only early diagnosis and subsequent urgent laparotomy can have a positive impact on the prognosis of this group of patients.

Abdomen, Acute↗
PubMed2001

Thoracic epidural anesthesia for off-pump coronary artery bypass without intubation.

Thoracic epidural anesthesia without intubation was used in 10 patients undergoing off-pump coronary artery reconstruction performed through median sternotomy. Considering the preoperative finding of impaired pulmonary function, all were moderate-risk patients for surgery using conventional general anesthesia with intubation. All patients had an uneventful postoperative course. In indicated cases, we regard thoracic epidural anesthesia as a suitable method again modifying the term "minimally invasive" in cardiac surgery.

Aged↗
PubMed2001

[Less invasive approaches in surgical treatment of aortic valve defects].

Longitudinal median sternotomy is even nowadays the standard approach to operations of the aortal valve. The authors summarize in the submitted paper their experience with operations in 60 patients where replacement of the aortal valve was performed either from a small transverse sternotomy in the second intercostal space or from upper ministernotomy from the jugulum to the fourth (third) intercostal space. One patient died. The low incidence of serious postoperative complications, the rapid rehabilitation of patients and short subsequent period of hospitalization indicate the advantages of this approach. The authors use at present upper ministernotomy as the surgical approach in the majority of operations of the aortal valve.

Adult↗
PubMed1999

[Emergency myocardial revascularization during a developing myocardial infarct].

In 1996-1998 in our Cardiocentre urgent revascularizations were made in 28 patients with developing acute myocardial infarction (AIM) with manifestations of different grades of acute circulatory failure up to developed cardiogenic shock and cardiac arrest. In all patients complete revascularization with a mean number of 2.9 bypasses per patient was made, in one patient at the same time a rupture of the interventricular septum was closed and in two patients an insufficient mitral valve was replaced. From the whole group two patients died during the early postoperative period, two were revised on account of postoperative haemorrhage and two had signs of low cardiac output. Twenty-two patients had a postoperative course without complications. Urgent surgical revascularization in patients developing AIM and circulatory deterioration is the method of primary and definite treatment when primary PTCA is not suitable.

Adult↗
PubMed1998

[Direct myocardial revascularization from an upper median laparotomy in a reoperation].

Case-history of a patient with IHD, six months after the first revascularization operation, performed on account of occluded venous grafts and relapse of anginous complaints, successfully reoperated from upper median laparotomy. From this surgical approach an anastomosis of the right gastroepiploic artery on the ramus interventricularis posterior (RIVP) of the right coronary artery was made. Six months after operation the patient is free from angionous complaints and lives a full life. Control coronarograpy indicates patency of the graft.

Arteries↗
PubMed1998

[Plastic surgery of the thoracic wall as a method of thoracic wall reconstruction after complete surgical wound disintegration after sternotomy].

During the period between January 1996 and July 1998 in our department 1920 patients were operated on account of heart disease from median sternotomy. In 17 patients, i.e. in 0.9% during the early postoperative period the surgical wound disintegrated incl. dehiscence of the sternum and the development of postoperative mediastinitis. In 14 of these patients the authors reconstructed the defect of the thoracic wall by their own modification of Jurkiewicz plastic operation using the pectoral muscles. One patient from this group died, in the remaining 13 patients the wound healed without deformity of the chest and without signs of instability, without restriction of movement and function.

Aged↗
PubMed1998

[Aortocoronary bypass without extracorporeal circulation].

Extracorporeal circulation is nowadays part of the standard technique of aortocoronary reconstruction. The authors summarize in their paper their experience with operations in 45 patients where an aortocoronary bypass was made on the beating heart without the use of extracorporeal circulation. None of the patients died. The incidence of postoperative complications was low. Rapid rehabilitation of the patients and a shorter period of hospitalization makes this method an alternative standard technique of aortocoronary reconstruction.

Aged↗
PubMed1994

[100 renal transplantations with intravesical implantation of the ureter].

Transplantation of the kidney is nowadays a common therapeutic method. During the past 30 years in the transplantation centre of IKEM more than 1200 transplantations were performed. The authors present a group of 100 patients where the ureter of the transplanted Kidney was attached to the urinary bladder of the recipient by intravesical technique. With regard to the low incidence of fistulas and the easy solution of complications this technique can be widely used in clinical transplantation programmers.

Humans↗