[Surprising findings during thoracic revision due to gunshot injury - a case report]. / Prekvapivý nález pri revizi hrudníku pro strelné poranení - kazuistika.

INTRODUCTION: Gunshot thoracic injuries are not very common in our geographical location, occurring most frequently in the context of criminal activity or as a result of suicidal behavior. CASE REPORT: The authors report the case of a patient who, in a suicidal attempt, caused himself a combined penetrating gunshot injury of the chest with laceration of the lung and a heart gunshot hole, which was diagnosed peroperatively. CONCLUSION: Therapy of gunshot injuries in the era of modern medicine should be comprehensive in multidisciplinary cooperation.Key words: thoracic trauma gunshot injury lung injury heart injury thoracotomy.

Non-recognized cause of intrathoracic bleeding.

The authors present a case report of bleeding from the small dissection of descending aorta. Patient, 71 year old woman, with severe comorbidities (nephrotic syndrome based on membraneous glomerulonephritis, diabetes mellitus, lung emphysema, hepatopathy, polyneuropathy and others). One month after last stay in hospital chemotherapy et corticotherapy. In while on heparin during hospitalization at nephrologic department, patient developed right side haemothorax and haemomediastinum. An urgent transfer to surgical department with cardiopulmonary resuscitation was performed. The suspection of aneurysm on CT angioscan was non confirmed. The damage of oesophagus due to previous endoscopy (for chest pain) was non confirmed, too. During surgery masive sanquine effusion of mediastinum and right side haemothorax was found. The drainage and redrainage of the chest was performed. The cause of bleeding was not found. Critically ill patient had died and on autopsy a small dissection of thoracic aorta was found as a cause of bleeding. The problems of diagnosis and therapy are discussed. (Fig. 2, Ref. 7.)

[Main clinical and surgical determinants of in-hospital mortality after surgical revascularization of left main coronary artery stenosis: 2 year retrospective study (1998-1999)]. / Les facteurs cliniques et opératoires associés à la mortalité hospitalière après chirurgie d'une sténose du tronc commun de l'artère coronaire gauche. Analyse rétrospective de janvier 1998 à décembre 1999.

UNLABELLED: Stenosis of left main coronary artery (LMCA) is a common finding on coronary angiographies (7 to 10%). Mortality is very high for conservative therapy in comparison with surgery, which provides very good long-term outcome and is accepted as the standard therapy of this condition. Over the last few years, percutaneous coronary intervention (PCI) has become a new alternative in selected patients. AIM OF THE STUDY: To assess in hospital mortality in subjects referred to our surgical unit for coronary artery bypass grafting (CABG) and to identify the main clinical and surgical determinants of in-hospital mortality. METHODS: Two year retrospective analysis (1998-1999) of in-hospital mortality and morbidity of patients having left main stenosis referred for CABG. RESULTS: Among a group of 1443 patients operated for coronary heart disease, LMCA stenosis was found in 330 patients (22.9%). The mean age was 63 +/- 8.6 years. Elective surgery was done in 173 patients (52.4%), and acute operation (i.e. urgent, emergent or desperate) in 157 patients (47.6%). The total in-hospital mortality was 4.2% (14/330). Elective surgery in-hospital mortality was 1.7% (3/173) and urgent surgery in-hospital mortality was 7% (11/157). The main risk factors of in-hospital mortality were age > 68 years, low ejection fraction (LVEF<0.4), history of myocardial infarction, gender (female) and urgency of the operation. CONCLUSION: The proportion of patients undergoing CABG for left main stenosis is relatively high in our center and their mortality is quite low especially for elective operations. As the mortality of patients treated by PCI for LMCA stenosis is similar to surgery in high-risk patients, we postulate that this approach can be a real alternative treatment for such patients. Because of its potential benefit, combined revascularisation is also an alternative that should be considered in some cases. Furthermore, as a new generation of coated stents has emerged in the treatment of restenosis after PCI, we hypothesize that this method can in the near future be accepted as equivalent to surgery. However several randomized clinical trials must first be conduced prove this point.

[Myocardial revascularization via a median sternotomy without cardiopulmonary bypass in 250 patients--midterm results and study of graft patency]. / Revaskularizace myokardu ze strední sternotomie bez pouzití mimotelního obehu u 250 nemocných--strednedobé výsledky a studie pruchodnosti stepu.

OBJECTIVES: To evaluate mid-term results and one-year graft patency of less invasive coronary artery bypass grafting through a median sternotomy. METHODS: From January 1, 1998, to December 31, 1999, 250 patients had coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) through a median sternotomy. The patient base of 188 men and 62 women averaged 61.7 years, mean ejection fraction (EF) was 55.1%. An average of 2.7 (range 1 to 5) distal anastomoses per patient was achieved. Results are compared with a CPB subgroup of patients operated on through a median sternotomy in the same time (N = 1126). In a random subgroup of 100 patients (50 per group) an angiographic control of graft patency was done. RESULTS: A non-CPB group showed lesser occurrence of postoperative acute myocardial infarction (p = 0.038), atrial fibrillation (p = 0.029) and lower incidence of renal (p = 0.033) complications. We observed lower operative mortality (p = 0.019), as well as the occurrence of low cardiac output syndrome (p < 0.001) in the off pump group. The follow-up is 36 +/- 12 months and the number of patients with recurrent angina (5.4%), late AMI (0%) and late death (0.4%) is acceptable. We did not find an inordinate number of vein grafts occlusions (2.2%) and stenoses (7.8%) at anastomotic sites. None of the arterial grafts in both groups were occluded. CONCLUSIONS: We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group. Angiographic assessment displayed an excellent run-off in both groups of patients. Off-pump coronary bypass grafting is associated with sufficient short-term graft patency and mid-term clinical outcomes.

[A nontraditional method of surgical treatment of an aortocaval fistula. Case report]. / Netradicní zpusob chirurgické lécby aortokavální pístele. Kazuistika.

Unusual method of aortocaval fistula and venous aneurysm repair is discussed and possible advantages of this type of surgery are cleared up. The aortoiliac prosthetic substitution and exclusion of the region, where aorta and inferior vena cava communicate without direct suture of the fistula makes the operation safer and lowers the risk of postoperative bleeding. In authors' opinion, this method is effective even in acutely rising aortocaval fistulas.

[Comparison of the effectiveness of crystalloid and warm blood cardioplegia in patients with significant left ventricular dysfunction]. / Srovnání úcinnosti krystaloidní a krevní teplé kardioplegie u pacientu s významnou dysfunkcí levé komory srdecní.

UNLABELLED: In a group of 84 patients undergoing elective coronary artery bypass surgery and with the ejection fraction lower than 40% two types of myocardial protection were studied. Group I (41 cases) was given intermittent cold crystalloid cardioplegia and group II (43 patients) was given intermittent warm blood cardioplegia followed by normothermic reperfusion. Preoperative, intraoperative and postoperative data were retrospectively collected. There were no differences between the two groups except more rhythm disturbances in group I and higher incidence of neurological complications in group II. CONCLUSIONS: Warm blood cardioplegia is an effective, cheap and practical myocardial protection technique.

[Surgery of infectious complications in prostheses in the abdominal aorta]. / Chirurgické resení infekcních komplikací náhrady brisní aorty.

The authors describe the successful solution of a serious and feared complication, i.e. infection of a vascular prosthesis. A hitherto not used procedure was adopted-concurrent removal of the infected prosthesis and restoration of the blood flow into both extremities by an extra-anatomical axillobiiliac bypass. The authors draw attention to the advantages of this method in context with possible future solutions; and with regard to the hitherto not complicated postoperative course they assume that this type of treatment could be final. At the same time they draw attention to the complexity of the problem from the diagnostic and therapeutic aspect.

Teratogenic effects of bilirubin--a study using chick embryotoxicity screening test (CHEST).

Using the Chick Embrotoxicity Screening Test (CHEST), two samples of bilirubin of different commercial origin were tested on 2, 3 and 4- day old chick embryos. Water soluble Bilirubin Lachema (containing 20 mg albumin per 1 ml) had no teratogenic effect. On the opposite, Bilirubin Merck (containing 8 mg albumin per 1 ml) manifested an apparent teratogenic potential when single doses 0.2 and 0.6 micrograms were administered intraamniotically on day 4. Dose-dependent malformations of brain and eyes, cleft beak and reduction deformities of limbs were observed. No such effects could be produced by administration of Bilirubin Merck on either day 2 and 3. A tentative explanation of the difference between teratogenic properties of Merck and Lachema bilirubin preparations may be sougth in the different proportion of the free and albumin bound fractions.

The immunosuppressive effects of bilirubin.

The strong effects of bilirubin on various levels of the immune system are multifactorial. Concerning the mechanisms of these effects, we hypothesize that the primary causes of the described actions of bilirubin are the direct interaction of bilirubin molecules with cell membranes.

[Neonatal sepsis: bases and possibilities for immunotherapy and immunoprophylaxis. 2: Immunotherapy]. / Neonatale Sepsis: Grundlagen und Möglichkeiten einer Immuntherapie und Immunprophylaxe. Teil 2: Immuntherapie.

The physiological immunodeficiency of preterm and term newborns is the major cause of their increased susceptibility to infections. Although nonspecific and specific host defence mechanisms are morphologically intact, there are functional and quantitative defects. Supportive immunotherapy is required to equalize these immunological defects. This article reviews topical possibilities for immunotherapy of neonatal sepsis (exchange transfusion, transfusion of fresh blood or fresh plasma, granulocyte transfusion, use of immunoglobulins, fibronectin, interferon and colony-stimulating factor).

[Neonatal sepsis: bases and possibilities for immunotherapy and immunoprophylaxis. 3: Immunoprophylaxis]. / Neonatale Sepsis: Grundlagen und Möglichkeiten einer Immuntherapie und Immunprophylaxe. Teil 3: Immunprophylaxe.

This paper reviews several specific and nonspecific procedures for immunoprophylaxis to prevent bacteriological infections in preterm and term newborns. An active or passive immunization is limited necessarily by the wide range of organisms causing neonatal infections. There exist first experiences regarding the prophylactic use of intravenous gammaglobulins for high-risk neonates or pregnant women with symptoms of infection and at risk for preterm delivery. Bacterial polysaccharide vaccines are under development, but up to now far off any universal availability.

The effect of antibiotics on the function of the phagocytic system.

The present paper reviews the effect of various antibiotics (ATB) on the cells of the phagocytic system. The first part deals with an indirect mechanism of action of ATB, i.e. with changes induced in the bacterial cell which in turn renders these bacteria susceptible to phagocytosis. In the second part, the direct effect of ATB on phagocytic cells is discussed: binding of ATB to phagocytes, penetration into the cell, change in chemotactic (migratory) activity, effects on ingestion of particles, intracellular killing of bacteria and on phagocytosis-associated metabolic changes (e.g. chemiluminescence).

Phagocytosis of cadmium microcrystals by human milk macrophages in vitro.

Using an in vitro microassay (phagocytosis of cadmium microcrystals saturated with human serum albumin) the phagocytic activity of human milk macrophages and glass-adherent blood leukocytes, obtained from healthy adult women and physiological neonates, was compared. It was established that the early milk contains lower percentage of glass-adherent phagocytes than peripheral blood and, in addition, their phagocytic activity, i.e. the mean number of particles engulfed per cell, was significantly lower as compared to blood leukocytes of adult women and newborns.

[Peritoneal macrophages and their activity in sterile patients with endometriosis]. / Peritoneální makrofágy a jejich aktivita u sterilních pacientek s endometriózou.

The authors analyzed the peritoneal fluid (PF) during laparoscopic examination in 50 sterile women, incl. 27 where endometriosis was found. The control group was formed by 23 sterile women without signs of endometriosis. In both groups the volume of PF, concentration and absolute number of peritoneal macrophages and their phagocytic activity were evaluated. In the group of sterile women with endometriosis there was significantly increased volume of PF, higher concentration and absolute number of macrophages than in the group of patients without endometriosis. The phagocytic activity of peritoneal macrophages did not differ significantly in the control group and in patients with endometriosis.

In vivo interaction of bilirubin with the cells of the immune system in mice: an ultrastructural electronmicroscopic study.

Morphological evidence revealed the presence of round-shaped particles after application of bilirubin. The possibility of polymerization of bilirubin-albumin complexes is discussed.

Effects of bilirubin on murine peritoneal and spleen cells.

The effect of bilirubin on murine peritoneal and spleen cells was investigated. Bilirubin was found to have a strong and rapid effect on the expression of various kinds of Fc receptors on peritoneal macrophages. Significant changes were observed 30 min after the infection of bilirubin. The return to normal values was not observed earlier than after 24 h. The effect of bilirubin on Fc receptor expression of splenic macrophages was less pronounced. Expression of Ia antigen on macrophages was not influenced by bilirubin. The changes in percentage of sIg+ and Thy 1.2+ lymphocytes reflect a change in the ratio of T to B cells in the peritoneal cavity, as bilirubin caused 40% increase in numbers of B cells and a similar decrease in numbers of T cells. The percentage of splenic B lymphocytes was not influenced by bilirubin injection; but the ratio of T helper to suppressor cells was altered.