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Biomedical subjects

A Laczkovics

Publications and source records attributed to A Laczkovics.

At least 109 records · Page 6Linked to original sources
PubMed1981

[The operated ASDI (author's transl)].

The postoperative course of 37 children with atrial septal defect primum type with or without a cleft in the septal mitral or tricuspid valve, is traced. The mortality rate, the number of postoperative rhythmic disorders and the success of functional restitution of the mitral valve are emphasized. The number of patients between 1962-1979 was 37. The age was between 3 years and 5 month and 14 years and 9 month. As a parameter of success or failure of the operation the pre- and postoperative symptoms, the ECG and PCG, the X-ray of the chest and the postoperative echocardiogram were considered.

Adolescent↗
PubMed1979

[Surgery of the mitral valve (author's transl)].

A report is given on the results of different forms of mitral valve operations in 866 patients. Closed mitral valvulotomy was performed in 519 patients and mitral valve replacement in 291 cases. Open mitral valve anuloplasty was performed as reconstructive surgical procedure in 15 patients. The overall mortality was 10.4%. Follow-up of the surviving patients showed that the long-term results of mitral valve replacement are significantly worse than those of mitral valve reconstruction.

Austria↗
PubMed1979

[Left ventricular aneurysm in an eight-year-old girl (author's transl)].

A female patient with a heart murmur typical for mitral insufficiency that was first heard, when she was 17 months old, is reported. In the ECG flattened T-waves in the left praecordial leads are seen. Because of a typical x-ray seven years later the diagnosis of leftventricular aneurysm was suspected, guaranteed by angiocardiography and because of repeated supraventricular tachycardias the congenital aneurysm was operated. A differentiation between congenital diverticulum and congenital aneurysm is established, the clinical symptoms of this malformation and the therapeutic consequences are discussed.

Angiocardiography↗
PubMed1978

[Exit block: a postoperative complication of pacemaker implantation (author's transl)].

Exit block occurs in 7% of cases following implantation of a pacemaker for the first time and appears to be a serious and unpredictable occurrence which cannot be prevented by the selection of a particular technique or type of electrode of pacemaker. Therapeutic measures in patients who are not dependent on a pacemaker consist primarily of exchanging the intracardial lead. In all patients, as well as in those cases with recurrence of exit block, a pulse width-adjustable pulse generator should be implanted without resorting to other methods of questionable efficacy. The implantation of such a pulse generator was successful in all our cases.

Cardiac Pacing, Artificial↗
PubMed1978

[Sudden cardiac death in patients with pacemakers].

The risk of sudden death in our material, is 13.6% of all deaths. 2. In 5 patients (1.6%) death was caused by failure of the pacemaker (PM), or the electrode. 3. Patients with an asynchronous PM have no higher risk for sudden death, than patients with demand PM. 4. In 9 of 44 patients, a dysfunction of the PM or electrode, can not be excluded. Thus, it must be strictly advised in all patients with an implanted PM, that an autopsy and control of the explanted PM and electrode should be performed. 5. Patients who have a higher risk for sudden death (total AV-Block, Adams-Stokes-Attacks) should be kept hospitalized at least 4 weeks after implantation, controlled more frequently than others, and should be labelled as high risk patients in their PM passport. 6. Control of the resistance in the patients circuit can detect impending failure of the electrode and prevent life threatening complications.

Death, Sudden↗
PubMed1977

[Unusual course and site of metastases of a granulosa cell tumour (author's transl)].

The case is reported of a patient in whom a granulosa cell tumour of the right ovary was removed at the age of 47 years. 14 years later the same type of tumour was found in the left ovary, together with an adenocarcinoma of the body of the uterus. 5 years after removal of these neoplasms splenectomy was carried out on account of splenic metastases. The unusual course taken by the disease and site of metastatic involvement are discussed, as well as the therapeutic management.

Adenocarcinoma↗
PubMed1977

[Thyroid function following thyroidectomy determined by the TRH-induced release of thyrotropin (author's transl)].

The response of hTSH to TRH (400 mug i.v.) was studied in 45 patients who underwent thyroid surgery for various reasons. Euthyroid values of T4 and ETI were observed in all but one patient. An increased response of hTSH to TRH (as compared with 15 control subjects) was observed in 12 out of 30 patients operated upon for non-toxic goitre, in one out of nine operated upon for toxic goitre and in three out of six patients who underwent thyroidectomy for thyroid carcinoma or proliferating adenoma of the thyroid. The necessity of specific replacement therapy in those individuals with increased release of hTSH upon TRH administration is discussed.

Adult↗
PubMed1976

[Punctate cytology of benign and malignant changes in the thyroid gland (author's transl)].

80 thyroid gland aspirates obtained post-operatively were compared with 69 clinically punctured cases. The results suggest that the vast majority of cytological misdiagnoses are caused by a faulty withdrawal technique. As a contribution to the differential diagnosis of "follicular neoplasia" an attempt was made to introduce the diameter of the nucelus obtained morphometrically as a parameter of malignancy. In aspirates of highly differentiated follicular carcinomas a significantly higher percentage of thyrocytes with larger nuclear diameters are found than in benign nodular changes in the thyroid gland.

Adenocarcinoma↗
PubMed1976

[Surgical complications in pacemaker operations and their management].

A review is presented of the range of surgical complications encountered in 120 out of 749 patients (16%) receiving a pacemaker implantation over the period October 1974 to September 1975. These complications can be subdivided into those involving interruption or disturbance of the conduction of the pacemaker impulse and those associated with impaired wound-healing. The aetiology, the diagnosis and the surgical management are discussed.

Arrhythmias, Cardiac↗
PubMed1976

[Clinical experiences with cardioplegic injection in open heart surgery (author's transl)].

Two groups of 50 patients each who had undergone valve replacement with extracorporeal circulation, were examined. In the first group surgery had been performed only under coronary ischemia, whereas in the second group cardiac arrest was induced pharmacologically. IC CLUMP OCCURE MORE OFTEN. Also the amount of necessary defibrillation at occurrence of ventricular fibrillation was significantly lower. Besides it was extraordinary that after the cardiopulmonary bypass the consumption of positive inotropic drugs (Catecholamine) fsults injection-cardioplegia with its simple handling seemed evidently superior to coronary ischemia. But it remains to be seen, if injection-cardioplegia is equal to coronary perfusion.

Cardiac Surgical Procedures↗
PubMedDate not supplied

The electrophysiology of cardiac allograft rejection: independent effects of rejection and perioperative ischemia on the sinus node recovery phenomenon after cardiac transplantation.

We characterized the effect of cardiac allograft rejection on the sinus node (SN) recovery response from overdrive suppression. A total of 54 corresponding data sets (SN recovery time [SNRT]/endomyocardial biopsy [EMB]) was available in 24 transplant recipients with normal SNRT. Data were pooled in the rejection vs the no-rejection group (n = 16 vs n = 38, respectively). During cardiac rejection (defined as a 7-day period starting 3 days prior to and lasting until 3 days after the EMB) the SNRT curves were moderately, but significantly shifted towards higher values (F = 13.4, p = .0003). All changes occurred within accepted normal limits for the SNRT. Multivariate analysis indicated independent effects of donor heart ischemic time (p = .0005) on SNRT in addition to that of rejection. After accounting for that influence of ischemic time respective F values regarding the influence of rejection on the SNRT excursions were 10.8 (ischemic time < 100 min, p = .0014) and 4.36 (ischemic time > or = 100 min, p = .039). This study shows that cardiac allograft rejection significantly delays the SN recovery response from overdrive suppression. These changes, however, are subtle and, hence, are an unlikely explanation for the often grossly abnormal postoperative SN function.

Adolescent↗
PubMedDate not supplied

Decreasing use of donated blood and reduction of bleeding after orthotopic heart transplantation by use of aprotinin.

Twenty patients undergoing orthotopic heart transplantation were randomized preoperatively to receive either the serine proteinase inhibitor aprotinin in a low dose (560 mg; n = 10) or a placebo (control group, n = 10) at the time of transplantation. Blood loss 24 and 48 hours after transplantation was significantly lower in the group treated with aprotinin (i.e., 510 ml vs 820 ml, p less than 0.01, and 690 ml vs 1000 ml, p less than 0.03, respectively. Accordingly, the aprotinin group required significantly less transfused blood in the first 48 postoperative hours 0 to 250 ml versus 0 to 1000 ml (p less than 0.04). Seventy percent of the patients treated with aprotinin underwent transplantation without the need of nonautologous blood, compared with only 30% in the control group.

Aprotinin↗
PubMedDate not supplied

Quality of life after orthotopic heart transplantation.

During the last decade heart transplantation has become the chosen method to treat terminally ill patients suffering from severe cardiac illness. It was the aim of our study to retrospectively survey life quality of donor organ recipients who underwent heart transplantation during the first years of transplantation at our center (1984 through 1987). Thirty-five patients were asked to evaluate their postoperative improvement or deterioration and their satisfaction with the level reached on visual scales. Life quality was defined in nine areas: physical, emotional, mental, vocational, and sexual status, financial situation, leisure activities, partnership, and overall life quality. The following results were obtained: (1) our former patients informed us about a distinct improvement in almost all dimensions (except financial situation). We found an absolute increase in life quality after heart transplantation. (2) Although improvement was ranked best for physical status, there was also a high amelioration in psychosocial fields. (3) A significant difference was seen between changes in condition and satisfaction in the financial situation (z = 2.3) and in partnership (z = 2.9), in which the latter was ranked higher. (4) The date of transplantation (less/more than 2 years ago) had no influence on the evaluation of postoperative life quality.

Adult↗
PubMedDate not supplied

Domino transplantation of heart-lung and heart: an approach to overcome the scarcity of donor organs.

The scarcity of donor organs remains the main restricting factor for heart, heart-lung, and lung transplantation. Recently new techniques for separate harvesting of the heart and the lungs from one donor for two recipients have been developed. These techniques enable the optimal use of available grafts. Another approach to this problem is combined heart-lung transplantation for patients with end-stage lung disease but still adequate heart performance, and the subsequent transplantation of the recipient's heart into a second patient with end-stage heart disease. The main advantages of this procedure are its technical simplicity compared with double lung transplantation; the preservation of aortobronchial collaterals, resulting in improved blood supply to the trachea; and the possibility of transplanting a conditioned right heart well adapted to chronically elevated pulmonary pressure. We recently have performed this procedure with good clinical results and suggest it as the method of choice whenever two well-matched recipients are available.

Adolescent↗
PubMedDate not supplied

Neopterin as a new marker to detect acute rejection after heart transplantation.

Neopterin is excreted at high levels in the course of activation of the immunologic system during allograft rejection or viral infection. This pteridine therefore may be considered as a specific indicator of T cell-mediated immunity. With radioimmunoassay we analyzed both serum and urine levels of neopterin in 43 patients after orthotopic heart transplantation. These data were correlated to the histologic finding at routine endomyocardial biopsies (EMB). In case of rejection (that is, grades I to II or more in EMB) serum levels of neopterin increased about 156% +/- 94% within 1 week before EMB, whereas urine levels increased about 215% +/- 137%. The most marked increase was seen 2.8 days before the corresponding EMB. The predictive value theory was used to elaborate the reliability of the correlation between an increase of neopterin levels and the occurrence of an acute rejection episode. With regard to serum levels, sensitivity and specificity were 0.872 and 0.815, respectively. The positive predictive value was 0.41 and the negative predictive value was 0.977. We found similar results in urine levels.

Acute Disease↗
PubMedDate not supplied

Impacts of low-dose steroids and prophylactic monoclonal versus polyclonal antibodies on acute rejection in cyclosporine- and azathioprine-immunosuppressed cardiac allografts.

The ideal combination of immunosuppressants after heart transplantation that safely prevents graft rejection and maintains a low rate of infections and toxic side effects is still a topic of discussion. Between March 1984 and March 1988, 76 patients underwent orthotopic heart transplantation. Sixty-five patients received either double-drug (cyclosporine + azathioprine) or triple-drug (cyclosporine + azathioprine + steroids) maintenance therapy. In addition all patients with double-drug protocol (group 1, n = 13) and the majority with triple-drug protocol (group 2, n = 39) received prophylactic antithymocyte globulin (ATG); 13 patients with triple-drug protocol (group 3) received prophylactic monoclonal antibody (murine antihuman mature T cell [OKT3]). Recipients with perioperative or intraoperative deaths, maintenance protocol without cyclosporine, or previous total artificial heart bridge were excluded from the study. Cyclosporine was given in low doses according to a trough whole blood high-performance liquid chromatography target level of 200 to 400 ng/ml in the first month, 150 to 250 ng/ml from the second to sixth month, and 100 to 150 ng/ml after the sixth month. Azathioprine dose was adjusted to a leukocyte count of approximately 4,000 cells/mm3. In patients with triple-drug protocol, prednisolone (0.2 mg/kg/day) was added. The mean follow-up (group 1, 12.75 months; group 2, 12.84 months) was comparable between the groups who received ATG perioperatively. The mean follow-up for group 3 was 3.46 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMedDate not supplied

Noninvasive assessment of acute rejection after orthotopic heart transplantation: value of changes in cardiac volume and cardiothoracic ratio.

Since 1984, 47 orthotopic heart transplantations (HTX) were carried out in 45 patients. In 29 long-term survivors cardiac volume as well as cardiothoracic ratio were measured during their routine follow-up. These two parameters of cardiac size were evaluated from posterior-anterior (pa) and lateral chest x-rays by using conventional technics. Changes of these parameters were correlated to the histological grading of endomyocardial biopsies (EMB). Increases of cardiac volume of more than 10 percent or 100 ml compared with the last measurement and simultaneous increases of cardiothoracic ratio of more than 2 percent were assumed to represent rejection equivalents. Sensitivity and specificity were 0.759 and 0.969, respectively. Predictive values of a positive or negative test for the presence or absence of disease came to 0.815 and 0.957.

Cardiac Volume↗