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.

[Acute abdomen after cardiac surgery]. / Náhlé príhody brisní po kardiochirurgických výkonech.

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.

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.

[Less invasive approaches in surgical treatment of aortic valve defects]. / Méne invazivní prístupy v chirurgické lécbe aortálních chlopenních vad.

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.

[Aortocoronary bypass without extracorporeal circulation]. / Aortokoronární bypass bez pouzití mimotelního obehu.

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.

[Treatment of a pancreatic fistula after pancreatic transplantation using the obliterative technic]. / Resení pankreatické pístele po transplantaci slinivky brisní obliteracní technikou.

The authors present the case-record of a patient after combined transplantation of the pancreas and kidney who developed a chronic duodenocutaneous fistula. The case was resolved by elimination of the duodenocystoanastomosis of the transplanted pancreas and by obliteration of the pancreatic duct of the graft by a polymer. One year after surgery the patient has no complaints and the function of both transplanted organs is satisfactory.

[Long-term home parenteral nutrition using a totally implanted cannulation system]. / Dlouhodobá domácí parenterální výziva cestou totálne implantovaného kanylovaného systému.

A 29-year-old patient suffering from stenosis of the rectum and a periproctal fistula due to a severe form of Crohn's disease was completely fed by the parenteral route for 15 months, incl. 13 months at home, via a totally implanted cannula system Implantofix, Braun Co.. The patient felt throughout the period of parenteral nutrition very well, he worked and the secretion from the fistula stopped after four weeks. After 15 months of complete parenteral nutrition and elimination of oral food intake a marked improvement of the local finding in the rectum was observed. All laboratory findings (haemogram, liver tests, urea, creatinine, transferrin, albumin, cholinesterase and pre-albumin, serum levels of sodium, potassium, chlorides, calcium and phosphates) were throughout the observation period within a normal range. The body weight of the patient increased during the 15 months by 1 kg. The described case is the first one where domiciliary parenteral nutrition was used in Czechoslovakia under ambulatory conditions.

Detection of nuclear cytomegalovirus antigen in cell culture as compared to classical virus isolation.

Rapid detection of human cytomegalovirus early nuclear protein in human diploid cells by immunofluorescence (IF) using commercial (Du Pont) monoclonal antibody was compared with the classical virus isolation in these cells. From 30 specimens tested early nuclear protein was detected in 16 cases but the virus was isolated out of 4 samples only.

[Initial experience with the use of monoclonal antibodies in the detection of cytomegalovirus early antigens in patients with transplants]. / První zkusenosti s vyuzitím monoklonální protilátky k detekci casného cytomegalovirového antigenu u transplantovaných nemocných.

10 diabetics with kidney and pancreas transplantation (6) and with isolated kidney transplantation (4) underwent examination with the aim to produce evidence of cytomegalovirus excretion (CMV) by the urine. To prove the presence of CMV antigen, the authors used monoclonal antibody produced by DuPont. CMV was found to be present in the urine of 4 patients. The examination lasts max. 48 hrs. It yielded no evidence of interdependence between viruria and the serum levels of the CMV antibodies. Tests for CMV in biological material by means of monoclonal antibody is a modern and quick method which, unlike conventional virological procedures (serology, virus cultivation), plays an important part in clinical medicine.