Iatrogenic coronary artery fistula in a patient with a single coronary artery.

Here, we report on a case of coronary artery fistula that developed following the repair of a double-outlet right ventricle (DORV) with infundibular pulmonary stenosis in a patient who has a single coronary artery. The major concern in this case was that of reduction of coronary blood flow from the patient's only coronary artery to the myocardium distal to the fistula.

KARMEN time anomaly: search for a neutral particle of mass 33.9 MeV in pion decay

We have searched for the pion decay pi(+)-->&mgr;+X, where X is a neutral particle of mass 33.905 MeV. This process was suggested by the KARMEN Collaboration to explain an anomaly in their observed time distribution of neutrino induced reactions. Having measured the muon momentum spectrum of charged pions decaying in flight, we find no evidence for this process and place an upper limit on the branching fraction eta

[High-frequency ventilation in neonates with pulmonary hemorrhage]. / Primjena visokofrekventne ventilacije (HF) kod novorodencadi sa plucnom hemoragijom.

The high-frequency ventilation (HFV) has been in use in the World since early 70s, on patient (RDS, MPH, PPHN, etc.) who did not respond well as it was expected, on conventional mechanical ventilation (IPPV/IMV). At our Clinic we started to use this type of ventilation two months ago, and throw this work it was presented our first experience. In case report was showed massive pulmonary hemorrhage (MPH) in premature newborn 30 GW, where we applied HFV. Immediately after the bird conventional mechanical ventilation has been applied with positive pressure (IPPV) and surfactant has been given because RDS. After the MPH appeared we successfully applied HFV.

[Acute renal insufficiency in children]. / Akutna renalna insuficijencija kod djece.

Acute renal failure (ARF) is not rare in hospitalized children, especially in newborns and infants. Sudden disorganization of a glomerular and tubular function is the most often transitory and require a quick make of diagnosis and early therapy in order to obtain a adequate kidney function recovery and to reduce mortality. In this article 51 children with ARF were included from newborn period to 16 years of age (25 female: 26 male). We described the most often causes of ARF, diagnosis procedures and nondialytic treatments. The diagnosis was made by history, physical examination, laboratory and radiology findings. Causes of ARF were divided on prerenal, renal and postrenal. The treatment of ARF in all cases was conservative with good success in 45 patients and in 6 children followed death because of the nature of primary diseases. The results of study show that the accent is on the prevention, early diagnosis and early therapy of diseases which lead to ARF. We conclude that a multidisciplinary therapeutic approach is imperative for successful management of ARF.

Indirect demonstration of the lifetime function of human thymus.

The aim of this study was to test the hypothesis that human thymus maintains its function as the site of early T cell development throughout life, but to a progressively diminishing extent. Mononuclear cell suspensions prepared from the samples of 39 human thymuses were analysed for the total number of cells per gram of thymus tissue, percentage of single marker-positive CD2, CD4 and CD8 cells, percentages of double-positive CD4CD8 and CD2CD8 cells, double-negative CD4CD8 cells, absolute numbers of these cells per gram of tissue, and extent of the in vitro proliferation upon stimulation with concanavalin A (Con A), phytohaemagglutinin (PHA) and pokeweed mitogen (PWM) mitogens. The main outcome measures were flow cytometric data on thymus lymphoid cell composition (according to CD classification), expressed as percentages and numbers of cells per gram of thymus tissue. The total number of mononuclear cells expressed per gram of thymus tissue exponentially decreased with age. The slope of none of the analysed cell subpopulations differed from the slope of the line constructed for age-related decline of the total number of mononuclear cells (-0.024 on a semilogarithmic scale). The thymuses of all ages contained all analysed cell subpopulations in approximately the same proportions: percentages of these cell subpopulations did not change with age, except for all CD4+ (P=0.017) and double-positive CD4+CD8+ (P=0.016) cells, which tended to decrease with age. The extent of proliferation of thymus cells upon stimulation with T and B cell mitogens was unrelated to age. We conclude that the thymus retains its function as the site of differentiation of T lymphocytes throughout life. With respect to the number of involved lymphoid cells, the function exponentially decreases with age.

The cardiac migration of a Kirschner wire. A case report.

In June of 1995, a 48-year-old woman was admitted to an outlying hospital with a history of stomach pain several weeks in duration. A few years before, she had undergone orthopedic surgery because of bilateral coxarthrosis. Total endoprosthesis had been implanted at both hips. Chest radiography showed a metal foreign body (apparently a Kirschner wire) in the heart, whereas right-hip radiography showed no Kirschner wire. Echocardiography indicated that the wire was in the right ventricle. The patient underwent open-heart surgery, and the 5-cm-long Kirschner wire was removed from the right ventricle through a right atriotomy. To the best of our knowledge, this is the only reported instance of intracardiac embolization of a Kirschner wire.

Cardiac myxoma: diagnostic approach, surgical treatment and follow-up. A twenty years experience.

At the University Department of Cardiovascular Surgery in Zagreb, Croatia, we treated 81 patients with primary intracardiac myxoma, in a period from January 1975 to December 1994. There were 55 female and 26 male pts, in age from 1 month to 80 years, mean 46+/-15 years. Clinical manifestations varied from no symptoms and very poor or no clinical signs to various manifestations of chronic or acute congestive heart failure, syncope and arrhythmias with or without systemic findings such as high erythrocyte sedimentation rate, anaemia, leucocytosis, elevated gamma globulin, thrombocytopenia or low grade fever, as well as cerebrovascular accidents due to tumour embolization. Cardiac symptoms were predominant in 54 pts (66.6%) and cerebrovascular in 20 pts (24.7%). Seven pts (8.6%) were symptomless and discovered accidentally, mostly regarding on an unexplained heart murmur. In almost all the patients preoperative diagnosis of intracardiac myxoma was sufficiently established by echocardiography. The tumour was located in the left atrium in 62 pts (76.5%) and in the right atrium in 19 pts (23.5%). Delay from the onset of symptoms to the diagnosis was 6 months in average (range 10 days to 25 months). The average waiting for the operation was 9 days (range from 1 to 60 days). The echocardiographic diagnosis was confirmed during intraoperative examination followed by histological analysis. All pts underwent excision of myxoma using cardiopulmonary bypass with core and topical hypothermia and cold crystaloid cardioplegia. According to the additional preoperative and intraoperative findings, in 6 pts sinchronous mitral valve reconstruction, in 3 pts artificial mitral valve implantation and in 2 pts atrial wall reconstruction was performed. There was no perioperative mortality. After the operation, we could not evaluate all the patients long enough, mostly because of some paramedical circumstancies, such as war, migrations, etc. Twenty two pts undevent evaluation for at least 5 years after the operation. Among them there was no evidence of the tumour recurrence, 15 pts were asymptomatic and 7 had NYHA II class symptoms. For 17 pts with a left atrial myxoma preoperative and postoperative echocardiographic data were available for comparison, showing a significant reduction of the left atrial diameter (p<0.001) during the postoperative follow-up. Our data, presenting one of the biggest reports concerning cardiac myxomas, showed a broad spectrum of their clinical presentation, importance of echocardiography in diagnosing and postoperative follow-up and efficacy of a proper surgical intervention as a definite, curative therapy since there were no deaths and no significant cardiac dysfunction neither tumour reccurrence as well.

Wound infection after median sternotomy during the war in Croatia.

From 1990 to 1994 at Clinical Hospital Center, Zagreb, 1904 median sternotomies were performed for cardiac operations. Patients shared the same intensive care unit (ICU) with the wounded persons, admitted to the hospital from battlefield. Infection developed in 124 patients, an incidence of 6.51%. Methicillin resistant Staphylococcus aureus (MRSA) was isolated from 90, methicillin resistant Staphylococcus epidermidis (MRSE) from 19, and gram negative bacilli (GNB) from 56 patients, Pseudomonas aeruginosa in 2, and Clostridium pneumoniae in 1 case. Ninety-six patients (5.04%) developed superficial localized infection of subcutaneous tissues and they were treated with frequent dressing changes with antibiotic-soaked gauze in combination with systemic antibiotics. Twenty-eight patients (1.47%) developed mediastinitis and sternal dehiscence. They were treated by operative debridement followed by reclosure of the sternum with continuous antibiotic irrigation. We obtained satisfactory results with our method of closure of sternum which is a modification of Robicsek's technique. Nine of them required further operation. In seven cases we performed muscle flaps and in two omentoplasty. One hundred and twenty patients were discharged in satisfactory condition. The uncontrolled mediastinal sepsis caused death in 4 patients. Higher infection rate after median sternotomy during 1991 and 1992 could be possibly explained with the war circumstances in Croatia, and especially with MRSA strain becoming endemic in surgical ICU.

[Management of surgery patients with implanted cardiac pacemakers]. / Postupak s kirurskim bolesnikom--nosiocem elektrostimulatora srca.

Patients having cardiac pacemaker implanted may be subjected to various general surgery procedures. Application of electrosurgery for the purpose of resection and coagulation, provides a high frequency electric field which produces electric voltage on the electrodes of the pacing system. This voltage may be detected within the pacing system, and various arrhythmias can be provoked in correlation with underlying rhythm and mode of pacing. Preoperative patient control and proper pacemaker programming can prevent the pacing malfunctions due to the electrosurgery application. Appropriate positioning of the neutral electrode in relation to the pacing system avoids the electric fields intersection and decreases their interference.

[Causes of complications in the early postoperative period after heart surgery]. / Uzroci komplikacija u ranom poslijeoperacijskom tijeku u kardiokirurskih bolesnika.

In this study we have evaluated 32 patients who underwent open heart surgery with extracorporeal circulation. The aim of the study was to determine the influence of duration of surgical procedure, amount of bleeding after surgery, duration of assisted ventilation, need for mechanical and pharmacological assistance on the occurrence of complications in the early postoperative period. Sixteen patients who developed signs of systemic infection were evaluated. Other 16 patients had similar clinical characteristics and they were operated on the same day or within the same week as patients in the first group and they served as the controls. There was a statistically significant difference between those two groups in the duration of surgical procedure, amount of blood loss after surgery, amount of transfusions and duration of mechanical ventilation. The group of patients with systemic infection and other complications required in the majority cases left ventricular support and developed multiorgan system failure that resulted in a higher rate of mortality. In conclusion, this study shows that the causes of complications and systemic infection in the early postoperative period could be due to a greater blood loss following surgery, demand for blood transfusions and duration of mechanical ventilation.

[War injuries of the thorax]. / Ratne ozljede prsnog kosa.

Chest injuries are very common in war circumstances. Chest injury is commonly associated with other injuries of intrathoracic organs and development of shock, which has to be treated immediately. Our patients with war chest injuries are presented, along with our approach to the treatment of these injuries. "The conservative treatment" is stressed, with particularly importance of proper chest drainage, as a corner stone of proper and successful therapy. Shock treatment and prevention of atelectasis does present an unavoidable procedure of this type of therapy.