[Penetrating Injuries of the Heart and Great Vessels - Fifteen Years of Experience of the Cardiac Surgery Service as a Part of the Major Trauma Centre]. / Penetrující poranení srdce a velkých cév ­ patnáctiletá zkusenost kardiochirurgického servisu v rámci primárního traumacentra.

PURPOSE OF THE STUDY Outcome analysis of penetrating cardiac and great vessels injury within the 15-year existence of the cardiac surgery service as a part of the major trauma centre of the University Hospital Olomouc MATERIAL AND METHODS Retrospective analysis of a group of a total of 16 patients who underwent a surgery for penetrating cardiac and great vessels injury since II/2002 to XI/2016. The dominant causes of penetrating trauma were stab injuries (15 patients, 94%), in one patient only (6%) it was a gunshot injury. The mean age of the patients included in the group was 42.9 ± 16.1 years, with men significantly prevailing (13 patients, 81%). A total of 7 injured persons (44%) were haemodynamically stable when admitted, 9 injured persons (56%) were unstable or in critical condition. The average transfer distance was 48.8 ± 34.5 km; the injured were admitted on average 115.9 ± 154.8 minutes after being injured. Preoperatively, all the injured suffered from pericardial effusion (>5 mm) confirmed by TTE (81%) or CTA (19%). In 4 patients (25%) pericardial drainage for cardiac tamponade was performed before surgery. RESULTS All the penetrating cardiac and great vessels injuries were repaired by cardiac surgeon, in one case only (6%) the extracorporeal circulation support was used. The injury of coronary arteries was in one case managed by CABG and in the other case by ligation of the peripheral part of the coronary artery. In 4 patients (25%) also a penetrating injury of other organs was simultaneously managed. The mean ICU stay reached 85.8 ± 91.9 hours, on average 5.6 ± 9.3 units of red blood cells were administered during the in-hospital stay which lasted on average 7.1 ± 2.4 days. In the group a nonsignificant increase of left ventricular ejection fraction (44.1 ± 4.7 vs. 49.3 ± 3.2, p = 0.882) was reported at discharge of the injured patients. One patient died on the 78 th day of hypoxic brain damage (6% three-month mortality). The long-term survival analysis showed 94% one-year and 88% five-year cumulative survival in the group. DISCUSSION The incidence of the penetrating cardiac and great vessels injury is directly dependent on the crime level in the respective countries and regions. A cardiac arrest, severe hemodynamic instability, unconsciousness, serious concomitant injury, gunshot injury, multiple or atrial injury represent independent predictors of death in these injuries. The total three-month mortality in penetrating cardiac and great vessels injury ranges from 18 to 42%, the presence of vital signs at the time of hospital admission is associated with 78-92% probability of survival. The surviving patients show excellent long-term results with the exception of those who suffered a severe damage to valve apparatus or with significantly depressed left ventricular function. CONCLUSIONS Our experience proves a high survival rate of patients with penetrating cardiac and great vessels injury. The centralisation of the care into the major trauma centre with a cardiac surgery background, a unified treatment algorithm, and a vital interdisciplinary cooperation are the key goal of successful management of these injuries. Key words:penetrating injury, cardiac injury, great vessel injury, outcome. Práce byla podporena programem institucionální podpor.

Impact of methylprednisolone in priming solution of cardiopulmonary bypass on anti-inflammatory CD163 receptor during cardiac surgery.

We evaluated the influence of methylprednisolone in cardiopulmonary bypass fluid on scavenger receptor for hemoglobin CD163 molecule expression on monocytes of patients who underwent elective coronary artery bypass grafting with cardiopulmonary bypass with either exposure to methylprednisolone present in the cardiopulmonary bypass fluid (20 patients), or without methylprednisolone in the cardiopulmonary bypass fluid (22 patients) and operated on without cardiopulmonary bypass (42 patients). The dynamics of CD163 expression was also followed in patients operated on without cardiopulmonary bypass. This study was a retrospective analysis of a comparison of two studies. The expression of CD163 was determined quantitatively by standardized flow cytometry technique. The similarities in the dynamics of CD163 monocyte expression, comparing the patients operated on with or without cardiopulmonary bypass, were found. Compared to the preoperative level, CD163 monocyte expression was significantly elevated on the 1(st) postoperative day. Monocyte CD163 expression on the 1(st) postoperative day was evidently similar in both groups of patients operated without cardiopulmonary bypass (median value of mean fluorescence intensity (MFI) 18,896; interquartile range from 27,538 to 57,711; median value of MFI 18,863; interquartile range from 16,514 to 26,559; n.s.), suggesting high reproducibility of our flow cytometric method; the monocyte CD163 expression was significantly higher (median value of MFI 37,902; interquartile range from 27,538 to 57,711) on the 1(st) postoperative day in patients exposed to methylprednisolone compared to patients without this exposure (median value of MFI 20,995; interquartile range from 16,321 to 29,623) (p<0.001). We concluded that the expression of hemoglobin scavenger receptor CD163 on monocytes of cardiac surgical patients is induced by methylprednisolone present in cardiopulmonary bypass fluid.

Direct oxymetric peripheral tissue perfusion monitoring during open heart surgery with the use of cardiopulmonary bypass: preliminary experience.

BACKGROUND: Regional hypoperfusion has been associated with the development of postoperative organ dysfunction in cardiac surgery involving cardiopulmonary bypass (CPB). Direct tissue oxymetry is a potentially new method for monitoring the quality of the peripheral tissue perfusion during CPB. The aim of this study was to assess the effects of CPB in skeletal muscle oxygenation when measured in the deltoid muscle by direct oxymetry during perioperative period. METHOD: Seven patients underwent on-pump coronary artery bypass grafting. Direct oxymetry was performed by an optical cathether introduced into the deltoid muscle. Continuous measurement was made during the surgical procedure and the postoperative period. Mean arterial blood pressure, blood flow during CPB, laboratory markers of tissue hypoperfusion, blood gases and body temperature were also recorded. RESULTS: Interstitial muscle tissue oxygen tension (pO(2)) decreased after the introduction to anaesthesia and, more significantly, during CPB. After the disconnection from CPB at the end of the operation, the pO(2) returned to pre-anaesthetic values. During the first hours after admission of the patients to the intensive care unit, the pO(2) progressively decreased, reached a minimum value after four hours, and increased slowly thereafter. There was a significant correlation of pO(2) with mean arterial blood pressure and blood flow during that time. CONCLUSION: The result of this first measurement seems to demonstrate that the standard technique of conducting cardiopulmonary bypass produces low muscle oxygen tension and, thus, little perfusion of skeletal muscle. The data also indicate that both high mean arterial blood pressure and high flow are necessary during CPB to ensure skeletal muscle perfusion. The investigation is continuing.

The effect of a cardiopulmonary bypass system with biocompatible coating on fibrinogen levels determined by the TEG--functional fibrinogen method: preliminary results.

When cardiopulmonary bypass (CPB) is used, the blood comes into contact with foreign surfaces. To diminish this impact, various types of biocompatibly coated surfaces have been developed. The study assessed the effects of heparin-coated CPB systems on the level and function of fibrinogen as measured by thromboelastography (TEG), as compared with non-coated systems. No statistically significant differences between both groups were revealed by comparing paired data. In our study, heparin-coated CPB circuits had no significant effect on either fibrinogen level or its function.

[The effect of preoperative administration of heparin on the heparin resistance development]. / Vliv predoperacního podání heparinu na vznik heparinové rezistence.

BACKGROUND: Heparin resistance is relatively frequent problem in cardio surgery. We were try to determine real occurrence heparin resistance before operation. AIM OF THE STUDY: Purpose of the project--to find the real frequency of heparin resistance in patients who will undergo a cardio surgical operation. To find out the dependence between the pre-operational application of heparin and the development of heparin resistance. METHODS: We recorded pre-operative administration heparin in patients. If the dose of heparin was 5 mg/kg and more then we insert patients to the group heparin resistant. RESULTS: In our collection was heparin resistance in 203 patients from 624, it was 32.5%. Test agreement relative frequency with 22% was throw out--p < 0.001--heparin resistance in our group statistically different from 22% heparin resistance was higher than hypothesis. Heparin before operation was administrate 181 patients, which make to 29%. For administration of heparin was hypothesis of independence thrown (p < 0.001). CONCLUSION: Results of our works confirmed statistically significant occurrence of heparin resistance in patients that was administration heparin pre-operative. Heparin resistance occurred against presumption 22% in 32.5% in our group. It is statistic significant difference.

Endoscopic versus minimally invasive vein harvesting. Impact on leg-related morbidity in coronary artery bypass surgery: one-year follow-up of a prospective trial.

AIM: We sought to compare the impact of endoscopic and minimally invasive great saphenous vein harvesting on leg-related patient morbidity after coronary artery bypass grafting. METHODS: From February 2004 to July 2006, 120 patients underwent minimally invasive vein harvesting, and 180 patients underwent endoscopic vein harvesting for coronary artery bypass grafting. Patients were evaluated prospectively for wound-healing disturbances, residual leg edema, pain intensity and saphenous neuropathy at seven days, three months and one year after surgery. RESULTS: Both harvesting techniques were associated with a low incidence of wound-healing disturbances; nevertheless, endoscopic vein harvesting was associated with a significantly lower incidence of residual edema (12% vs 28%, P<0.05 seven days postoperative; 6% vs 19%, P<0.001 three months postoperative), pain (9% vs 20%, P<0.05; 6% vs 10%, P<0.05) and saphenous neuropathy (6% vs 23%, P<0.001; 3% vs 14%, P<0.05) during follow-ups. Endoscopic vein harvesting was also associated with a significantly lower incidence of neurological disturbances at one-year follow-up (2% vs 8%, P<0.05). Mean harvesting time (43.9+/-10.2 vs 40.6+/-15.5 min, P=0.09), conversion rate (2% vs 3%, P=0.71) and injury per conduit (0.3+/-0.1 vs 0.3+/-0.2, P=0.91) were comparable for both groups. CONCLUSION: EVH is superior to MIVH in terms of reduction in pain intensity, residual leg edema and saphenous neuropathy at seven days and again at three months postoperative. A significantly lower incidence of neurological disturbances is still presented one year after surgery.

[Transcription factor KLF2 (Krüppel-like factor 2) and natural defence of vascular endothelium]. / Transkripcní faktor KLF2 (Krüppel-like factor 2) a prirozená ochrana cévního endotelu.

Vascular endothelium, monocytes and T-lymphocytes belong to the key cellular populations, which take an active part in the host's defence reactions. A successful course of these reactions is determined by a meticulous control of all phases since the very first steps until final healing of all incurred wounds. Any failure of the control mechanisms may lead to the development of chronic inflammatory diseases with an autoimmune component, such as the rheumatoid arthritis or atherosclerosis. An inflammatory reaction which is already under way is regulated by anti-inflammatory cytokines. However, of equal importance is the maintenance of cellular participants of inflammatory reactions in a quiescent state while no pro-inflammatory stimuli are present. One of the most important endogenous mediators, which prevent a self-initiated activation of endothelial cells, monocytes and T-lymphocytes, is represented by the transcription factor Krüppel-like factor 2. Its impact on the mentioned cells is almost identical with the so-called pleiotropic effects of inhibitors of the enzyme HMG CoA reductase or statins. This review article offers an insight into basic preventive mechanisms exerted by KLF2, notably those related to atherosclerosis.

[Cardiac surgery operations and their influence on serum level of antiinflammatory cytokine interleukin-10]. / Kardiochirurgické operace a jejich vliv na sérovou hladinu protizánetového cytokinu interleukinu-10.

BACKGROUND: Cardiac surgical operation is followed by the development of inflammatory reaction. This reaction is regulated in many ways including the production of antiinflammatory cytokines such as IL-10 to avoid potentially harmful effects of inflammation. METHODS AND RESULTS: We compared serum levels of cytokines IL-10, IL-6, and IL-13 in the group of patients undergoing cardiac surgical operation using either cardiopulmonary bypass (CPB, n=17) or surged on the beating heart (n=17). We found significant elevation in the serum level of IL-10 during surgery with the peak immediately after finishing surgery in CPB patients and at the first postoperative day in non-CPB patients, respectively. There is statistically significantly higher level of IL-10 in CPB patients in comparison with non-CPB patients at the end of surgery. Serum level of IL-6 is elevated in both groups during surgery reaching maximum immediately after surgery in CPB patients and at the first postoperative day in patients without CPB, respectively. The serum levels of IL-13 are only nonsignificantly changed during operation and in postoperative period in both groups. CONCLUSIONS: The intensity of inflammatory response in CPB patients which is enhanced by massive contact activation of blood and extensive ischemia-reperfusion injury is regulated by the production of antiiflammatory IL- 10 cytokine.

Complex gunshot injury to the heart as a consequence of suicide attempt in a schizophrenic patient.

INTRODUCTION: Self-inflicted gunshot injury to the heart is uncommon in Western Europe countries. However it is considered to have a high mortality through cardiac tamponade or exsanguination and concomitant chest or abdominal cavity injury. CASE PRESENTATION: We present a 39-year-old schizophrenic woman who attempted suicide with the aid of a 6.35mm caliber handgun, after self-discontinuing of antipsychotic treatment. Lower third of sternum, right heart atrium and ventricle and inferior caval vein were hit by the bullet which consequently got lodged in the right paravertebral muscle mass at the lower thoracic vertebral level. As she was hemodynamically unstable due to hemopericardium and a huge right hemothorax, she underwent emergent surgery. Heart and inferior vena caval injuries were repaired on extracorporeal circulation. The postoperative course was uneventful and she was transferred to a psychiatric facility on the 7th postoperative day. One year after the surgery she is well, compliant to antipsychotic medications and on periodic follow-up by psychiatrists. CONCLUSION: This case represents management of complex self-inflicted gunshot cardiac injury in a schizophrenic patient who discontinued antipsychotic medication. Liaison between themedical rescue service and high level trauma center essentially reduced injury-to-surgery time. Complex heart injury was successfully repaired on extracorporeal circulation.

[Shared pathogenesis of infectious and cardiovascular diseases--year 2005's view]. / Spolecné patogenetické mechanizmy infekcních a kardiovaskulárních chorob: pohled roku 2005.

Entry of microorganisms into the blood stream provokes a decline in the contractile function of the cardiac muscle. Lipopolysaccharide of Gram-negative bacteria sets off production of pro-inflammatory cytokines including bactericidal concentrations of nitric oxide which set up the first defence line against bacteremia. At the same time, however, the performance of the cardiovascular system is negatively affected. The immediate menace resides in the occurrence of septic shock, while chronic infectious diseases that are accompanied by low-grade inflammation have been suspected to take an active part in the initiation and progression of atherosclerosis. This hypothesis, as attractive as it may appear, has not yet been accepted unequivocally. The article offers an up-to-date review of the signalling cascades which permit activation by lipopolysaccharide of the target cells. The same holds true for cellular activation by non-infectious stimuli. An emerging paradigm seems plausible that the same biologic events which serve to combat acute infection might be in the long run involved in the pathogenesis of atherosclerosis.

Colicinogeny in colorectal cancer.

Colicins, bacteriocins of Escherichia coli and related bacteria of Enterobacteriaceae family, form a very heterogeneous group of antibiotically active substances of proteinaceous material. Antitumorous effect of colicins have also been demonstrated experimentally. The large bowel has been found to be a site of their native action. Therefore, our work has been aimed at investigating colicinogenicity in patients with colorectal carcinoma. From a total number of 77 patients with colorectal carcinoma, colicinogenic Escherichia coli was found in 32 persons (41.6%), whereas from a total of 160 control clinically healthy persons, colicinogenic Escherichia coli was found in 102 persons (63.8%). The difference is statistically significant (p less than 0.05). The absence of colicinogenic Escherichia coli may be one of the factors contributing to the origin and development of colorectal carcinoma in some of the patients studied. Studies of patients with adenomatous polyps, members of colon cancer families, and large prospective studies of the general population will be necessary to prove this hypothesis.

Topical use of aprotinin in coronary artery bypass surgery.

OBJECTIVE: The internal mammary artery (IMA) ranks among excellent, widely used conduits for surgical coronary revascularization. Its harvesting and its using may cause other surgical and technical problems and complications and increase postoperative bleeding from wound surface after the IMA harvesting with significantly greater incidence of blood transfusion. The aim of this study was to get to know how much it increases postoperative bleeding losses and if the local application of aprotinin (to the wound surface after the IMA harvesting and into the pericardial cavity) can reduce them and thus decrease the number of blood transfusions. METHODS: In this study there are compared groups of patients (n = 275) operated at the University Department of Cardiac Surgery in Hradec Králové on account of ischemic heart disease. In the first part of this study results of operations of 200 patients were comprised retrospectively. Group A1 comprised 50 patients where for revascularization of the myocardium venous grafts were used. Group B1 comprised 50 patients where also the internal mammary artery was used. Group C1 was formed by 50 patients where after preparation of the IMA aprotinin (100,000 KIU) was administered locally to the wound surface after the IMA harvesting. Group D1 was formed by 50 patients where aprotinin (500,000 KIU) was administered locally to the wound surface and poured into the pericardial cavity before closure of the median sternotomy. The postoperative blood losses and the number of the administered blood transfusions were compared between these groups. RESULTS: The authors provided evidence that the using of the IMA increases significantly the postoperative blood losses (in group A1 675 ml +/- 352.9, in group B1 1232 ml +/- 336.5) and increases the number of required transfusions (in group A1 2.44 +/- 1.7, in group B1 3.45 +/- 1.0). By local aprotinin application to the wound surface after the IMA harvesting the blood losses and the number of administered transfusions were reduced in group C1 (896 ml (231.9, 2.74 +/- 0.8). In group D1 (local aprotinin application to the wound surface and into the pericardial cavity) the blood losses and the number of transfusions were increasingly reduced than in group C1 (797 ml +/- 280.5, 1.74 +/- 1.3). In the second, prospective randomised part of this study 3 groups of patients were compared. Group A2 comprised 25 patients where venous grafts for revascularization of myocardium were used. Group B2 was formed by 25 patients where also the IMA was used. Group D2 comprised 25 patients where aprotinin (500,000 u.) was administered locally to the wound surface after the IMA harvesting and poured into the pericardial cavity before closure of sternotomy. The postoperative blood losses and the number of administered blood transfusions were again compared between these groups. The total postoperative blood losses were 778 ml +/- 304.2 in group A2, 1072 ml +/- 391.8 in group B2 and 754 ml +/- 197.9 in group D2. There were compared blood losses after 6, 12 and 24 hours, too. There were the statistically significant differences among these groups during the whole postoperative period. The number of blood transfusions were 2.8 +/- 2.3 in group A2 and 2.04 +/- 1.1 in group B2. The use of aprotinin decreased this number in group D2, 1.44 +/- 1.1. CONCLUSIONS: The authors provided evidence that the harvesting and the using of the internal mammary artery for myocardial revascularization increases significantly the postoperative bleeding and increases the number of required transfusions. By local application of aprotinin the author reduced the blood losses and need of transfusions.

Sternobronchial fistula--uncommon complication after coronary surgery (a case report).

The authors describe a case of a 46-year-old man with ischemic heart disease who underwent coronary surgery. After some time span an inflamed wound, several skin fistulae and the system of substernal fistulae appeared. One of these fistulae communicated with the left bronchial tree.

Concomitant coronary and asymptomatic carotid artery disease in patients prior to myocardial revascularization.

The authors report on the results of ultrasound examinations of the carotid arteries in 525 patients with ischemic heart disease, hospitalized at the Department of Cardiac Surgery in Hradec Králové, prior to myocardial revascularization. Only 213 patients (40.6%) had intact carotid bed. The remaining 312 patients (59.4%) were found to have asymptomatic sclerotic changes of varying degrees of severity. Haemodynamically significant stenoses of over 50% were found in 64 cases (12.2%). 19 patients (3.6%) had critical stenoses of over 85% or occlusions of one or both internal carotid arteries. Comparison between patients younger than 65 and older than 65 showed significant increase of sclerotic changes in the older group. The authors prefer to perform myocardial revascularization procedure in hypothermic CPB with alpha-stat regime before carotid artery surgery. Combined procedures are preferred only in cases with concomitant neurologic and coronary symptomatology or in cases with severe carotid stenoses or occlusions of both arteries.

Contribution to technique of endarterectomy of the right coronary artery.

We present our technique of performing endarterectomy of coronary arteries by means of injecting cardioplegic solution into the plane of dissection of the endarterium. This simple and gentle technique in combination with manual endarterectomy helps in separation of the core far into the periphery of the diseased vessel and thus helps to perform revascularization in patients with diffuse atherosclerotic changes. During the last 6 years (1991-1996) endarterectomy in coronary revascularization was used in 116 cases (it was 5.7 % (116/2031) of all myocardial revascularization procedures). On right coronary artery endarterectomy was used in 82 patients. Mortality rate in our group of patients was 4.88 % (4/82) and perioperative myocardial infarction developed in 4.88 % (4/82). According to our own experience with this technique of endarterectomy on right coronary artery we are convinced that in desperate patients with diffuse coronary artery disease our method can bring better and wider application of surgical treatment.

How long can the previously assembled cardiopulmonary bypass circuit stay sterile?

The sterility of previously assembled cardiopulmonary bypass circuits was investigated for 100 extracorporeal circuits. The closed circuits were assembled using aseptic technique and remained in the pump room until time of use. The mean time from point of setup to point of priming for the 100 consecutive circuits was 32 hours, with a range of 19 to 89 hours. Circuits were primed with the calculated volume of priming solution, circulated for 5 minutes and tested for microbial contamination by withdrawing 20 ml of the priming solution and 10 days incubated in Thioglycolate and Sabouraud culture mediums. All were found to be free of microbial contamination. The results of this investigation demonstrate that the sterility of the extracorporeal circuit, pre-assembled in advance of actual priming, can be maintained over an extended interval when standard aseptic technique is used. This allows the utilization of a pre-assembled circuit for emergency cardiopulmonary support.

Morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery.

BACKGROUND AND AIM: Due to the constantly improving results of surgical revascularization for coronary heart disease even the elderly patients are offered more frequently this type of treatment. Since older age is a harbinger of reduced vital capacity and increased morbidity the results of coronary artery bypass grafting (CABG) in elderly as well as long-term benefit deserve a careful examination. MATERIALS AND METHODS: 1475 isolated CABG procedures performed between 1995 and 1997 in a university hospital cardiac surgery unit, divided in group I (age below 70, n = 1324) and group II (age 70 and over, n = 151). A retrospective analysis of pre-operative, peri-operative and post-operative data. RESULTS: Significant differences (lower BMI and BSA, advanced NYHA and CCS stage, higher prevalence of diabetes, renal dysfunction and extracardial atherosclerotic lesions) were found in elderly. CABG was performed in both groups with no differences in technique of procedure (only slightly longer duration of CPB in group II). However, there was markedly higher mortality (2.3 vs. 7.3%, p < 0.005), incidence of NearMiss+ (18.4 vs. 36.4%, p < 0.005) and post-operative morbidity (34.6 vs. 56.3%, p < 0.005) in the older group, which was also expressed in a longer ICU stay and postoperative hospitalization. CONCLUSION: Coronary revascularization can be performed in elderly with higher but still acceptable risk. Higher mortality and associated morbidity is caused by higher preoperative prevalence of known risk factors as well as generally reduced vital capacity. Surgical procedure should not be denied to elderly population because of the age alone but a careful evaluation of an individual patient is required.

Changes of the serum antibiotic levels during open heart surgery (ceftazidim, ciprofloxacin, clindamycin).

BACKGROUND: Wound, mediastinal and intracardiac infections are still very serious complications of open-heart surgery. The incidence of it is still in the range of 0.4%-5%. The aims of our study were to assess the adequacy of regimen using ceftazidim (CTZ), ciprofloxacin (CPF) and clindamycin (CLIN) as prophylactic antibiotics and to verify whether cardiopulmonary bypass (CPB) can modify the time of antibiotic serum concentrations. That is why the serum levels of them were measured during open heart procedures. METHODS: The prospective study comprised 75 consequent coronary patients randomized in to three groups receiving 1 g of CTZ or 400 mg of CPF or 900 mg of CLIN i.v. with anesthesia induction. Routine coronary surgery with left internal mammary artery harvesting, moderate body hypothermic (30 degrees C) CPB with crystaloid cardioplegia was performed. Serum antibiotic levels were determined before application, with skin incision, prior CPB induction, after cardioplegia infusion, every 20 minutes of CPB, prior end of CPB, in time of chest closure. Conventional cylinder-plate microbiological assay was used for antibiotic level measurement. RESULTS: All serum antibiotic concentrations showed a sharp decrease immediately after starting CPB and lasted until CPB ended. After initiating of CPB after cardioplegia administration serum concentrations of CTZ (105 min after initial dose) decreased by, on average 55%, CPF (97 min) by 42% and CLIN (116 min) by 78%. CONCLUSION: CPB can modify the time course of antibiotic serum concentrations. The serum levels of CTZ at the end of the longest procedures were found to be below the MICs for some of the suspected pathogens. We recommend to use higher antibiotic doses for prophylaxis and to administer the second dose with protamin sulphate to obtain maximum concentration in newly formed blood clots.

[An unusual complication of myxoma of the left atrium]. / Neobvyklá komplikace myxomu levé srdecní predsíne.

The authors give an account of a 59-year-old female patient with a myxoma of the left atrium which was complicated by repeated multiple embolizations into the systemic circulation. The cause of death after a successful operation was haemorrhage into the abdominal cavity from a ruptured spleen, as a result of a new lienal infarction after embolization of a portion of the myxoma into the lienal artery, 24 before the operation. The authors emphasize the necessity of immediate removal of an intracardiac formation as soon as it is detected.

[Frequency of occurrence of traumatic aortic rupture in automobile passengers involved in a frontal crash with a static or dynamic obstacle]. / Cetnost výskytu úrazové ruptury aorty u posádek automobilu pri celním stretu se statickou ci dynamickou protijedoucí prekázkou.

There is a lesion of aortic thoracic complex in car-passengers during the frontal clash to a static or to a dynamic antipodal obstacle is described in this study. It is a retrospective analysis. Facts were noted especially from dissectional documents. All from 298 men died. The main cause of car-passengers death was a weighty traumatic lesion of cardiovascular system in 58.7%. The aortic rupture was noted in 98 (32.9%) people, the death was in 90.8% directly on the road and 9.2% at hospital. From the whole people who were accepted to a hospital were 9 (8.9%) with a traumatic aortic rupture. But nobody of them was transported to a special center and everyone died due to traumatic lesion of cardiovascular system. Statistical significant cofactors of aortic rupture were atherosclerosis of aortic wall and intensity of clash. Therefore we can expect an aortic rupture in every third dead frontal car crash participant on a dynamic or static obstacle. Nearly 10% from men with traumatic aortic rupture were transported to a hospital. No aortic rupture was diagnosed.