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Biomedical subjects

J Miholic

Publications and source records attributed to J Miholic.

49 records · Page 3Linked to original sources
PubMed1987

[Prognostic factors in cardia cancer].

Among 164 patients operated upon for adenocarcinoma of the cardia 102 (61%) were resected, 87 of them with curative intent. The mortality within 30 days was 20%, and the 5-year survival 15%. A total gastrectomy was performed in 36 patients, whereas a proximal partial gastrectomy was carried out in 66 cases. The median survival was 19 months after total gastrectomy, and 11 months after proximal resection (Breslow: 0.22). Only in stages N0 and N1 total gastrectomy resulted in a significantly longer (32 months) median survival than proximal resection (11 months; p = 0.03). The impact of total gastrectomy was more pronounced in the diffuse type according to Lauren, whereas lymphadenectomy was more effective in stages N0 and N1 and in Lauren's intestinal type. It is concluded that total gastrectomy should be carried out in all cases of carcinoma of the cardia.

Adenocarcinoma↗
PubMed1987

[Risk factors for morbidity and mortality in resection of cancer of the cardia].

Operations were performed on 166 patients for adenocarcinoma of the cardia, between 1970 and 1986, with resections being applied to 102 of them (6.1 per cent), including 87 curative approaches with complete removal of tumours and no macroscopic evidence of metastases. Total gastrectomy with oesophagectomy was performed on 36 patients and proximal oesophagogastrectomy on 66, in 43 of these via left thoracic incision. Regional lymph nodes were free of tumour in 29 patients (28 per cent). The other approaches to proximal resection were thoracoabdominal in eight cases, abdominal in 13, and transmediastinal in two. Leakage of oesophageal anastomosis occurred in 19 cases and was followed by septicaemia and death in 13. Overall mortality during hospitalisation amounted to 22.5 per cent, including two patients who died on the 30th postoperative day as a result of dehiscence and septicaemia. Mortality figures were 17 per cent following total gastrectomy and 19 per cent in the wake of proximal gastrectomy by thoracic incision. Mortality amounted to 48 per cent in the 23 cases on which abdominal, thoraco-abdominal, and transmediastinal operations had been performed. Multiple logistic regression was used to determine age, ECG, spread of lymph nodes, and surgical techniques as potential risk factors. Emphasis in the context of surgical techniques was laid on proximal versus total gastrectomy, incision on both sides of the diaphragm, palliative resection, and anastomotic suturing (using one-layer or two-layer techniques or mechanical staples). Tumour spread to lymph nodes and proximal resection were the only independent variables associated with dehiscence. Electrocardiogram (ECG), lymph node involvement, and palliative resection proved to be of relevance to prognostication of lethality. No statistical correlations were found to exist between lethality, on the one hand, and surgical approach, age of patient, incision on either side of the diaphragm or suturing, on the other. The conclusion was drawn that in cases of cardia carcinoma total gastrectomy does not aggravate the risk of lethality, as compared to cardia resection.

Adenocarcinoma↗
PubMed1986

Early prediction of deep sternal wound infection after heart operations by alpha-1 acid glycoprotein and C-reactive protein measurements.

Serum C-reactive protein (CRP) and alpha 1-acid glycoprotein (AAG) levels were studied in 188 patients undergoing heart operations with cardiopulmonary bypass. Mediastinitis or osteomyelitis of the sternum or both developed in 10 patients on postoperative day 4 to 13 (median, day 9). The mean CRP levels on day 2 were lower in patients with later deep sternal wound infection (9.1 +/- 1.5 mg/dl [mean +/- standard error]) compared with patients without major infections (14.0 +/- 0.8 mg/dl; p = 0.103 [univariate logistic regression]). AAG levels on day 2 reacted in a similar manner, yielding 78.2 +/- 5.5 mg/dl and 100.9 +/- 2.7 mg/dl, respectively (p = 0.0004). No correlation was found between CRP or AAG and duration of cardiopulmonary bypass, number of blood transfusions, or total protein levels on day 2. The white blood cell count (WBC) on day 2 was 13.1 +/- 1.7 X 10(3)/microliter for patients with infection and 9.7 +/- 0.3 for those without infection. Multivariate logistic regression analysis revealed that AAG, WBC, and CRP on day 2 were significant risk factors sufficiently predicting the probability of a deep sternal infection. After adjustment for these three variables, other variables (age, sex, total protein on day 2, diabetes mellitus, type of operation, duration of cardiopulmonary bypass, length of operation, repeat thoracotomy for bleeding, number of blood transfusions on the day of operation, intraaortic balloon pumping, reoperation, emergency operation, and surgeon's professional status) were not of additional significance. The goodness of fit of the statistical model was confirmed by a high correspondence between predicted and observed cases of deep sternal infection.(ABSTRACT TRUNCATED AT 250 WORDS)

C-Reactive Protein↗
PubMed1986

Antibiotic-associated pseudomembranous colitis as cause of intestinal obstruction in a five-day-old newborn.

The case report is presented of a newborn that developed pseudomembranous colitis and intestinal obstruction after antibiotic therapy with cefoxitin and gentamicin in the first week of life. At laparotomy on the fifth day a complete obliteration of the descending colon by pseudomembranes was encountered. After resection of the diseased segment the recovery was uneventful. We believe this case is the first to be published of antibiotic-associated pseudomembranous colitis causing intestinal obstruction.

Cefoxitin↗
PubMed1985

Risk factors for severe bacterial infections after valve replacement and aortocoronary bypass operations: analysis of 246 cases by logistic regression.

Risk factors for severe bacterial infections, that is, deep sternal wound infection, pneumonia, septicemia, and prosthetic valve endocarditis, were evaluated in 246 consecutive patients undergoing valve replacement (N = 84) or aortocoronary bypass operation (N = 162). Multiple logistic regression analysis was applied to determine the ability of putative risk factors to predict infection. The risk factors considered were age, sex, diabetes mellitus, duration of cardiopulmonary bypass (CPB), duration of operation, amount of blood restored on the day of operation, repeat thoracotomy for bleeding, intraaortic balloon pumping, reoperation, emergency operation, and the professional status of the surgeon. Severe infections occurred in similar frequency after valve replacement (8/84; 9.5%) and aortocoronary bypass (11/162; 6.8%). For patients who had a bypass procedure, repeat thoracotomy was the only factor significantly associated with infection (p = 0.0004). However, the classification analysis revealed that this variable alone is too unspecific for a reliable prediction. Univariate analysis indicated that restoration of more than 2,500 ml of blood (p = 0.0001), reoperation (p = 0.0821), duration of operation (p = 0.0061), duration of CPB (p = 0.0318), and intraaortic balloon pumping (p = 0.0281) were associated with infection following valve replacement. A model with three variables emerged from the multiple logistic regression: after correction for blood restoration, reoperation, and duration of CPB, no other variable was of additional predictive value. For patients who underwent valve replacement, the model performed well in predicting complications. The classification analysis revealed a high correspondence between observed and predicted instances of infection: it correctly predicted 75% of the patients with infection and 96% of those without infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Plasma fibronectin, albumin, IgM and total protein during cardiopulmonary bypass.

Plasma concentrations of fibronectin, albumin, total protein and IgM were measured in 14 male patients undergoing aorto-coronary bypass operations. Fibronectin and IgM concentrations fell to 55% of the preoperative values 5 minutes after start of the extracorporeal circulation, and the same percentages were encountered 5 minutes after the termination of bypass. The concentrations had recovered to 75% of the preoperative values by the end of the operation. The plasma concentration of albumin was 68 +/- 9% of the preoperative value after 5 minutes of bypass, 66 +/- 7% at the end of bypass, and 83 +/- 9% of the end of operation (significantly different from fibronectin and IgM, p less than 0.05; Wilcoxon's test for paired differences). No correlation was found between the duration of extracorporeal circulation and the post-bypass concentrations of any protein (Kendall correlation). It is concluded that the fall of fibronectin concentrations during cardiopulmonary bypass can be sufficiently explained by dilution, and that a specific consumption of fibronectin does not occur. The less marked decreases of albumin and total protein were probably due to infusion of plasma-protein solution, which is poor in fibronectin and IgM.

Adult↗
PubMed1985

Experimental coronary angioplasty using a UV-Excimer laser.

Both conventional Argon- and NdYAG-lasers in continuous wave or pulsed application and far ultraviolet laser radiation are able to cause a loss of substance of biologic tissue. The thermic and ablative effects of NdYAG-lasers and UV-Excimer lasers at the wavelengths of 193 nm (ArF) and 248 mm (KrF) on inconspicuous and atherosclerotic human and animal coronary vessels were compared by histologic and, in some cases, by scanning electron microscopic examinations. Whereas common lasers generally produce thermal injuries of the surroundings, pulsed far ultra-violet radiation is characterized by a lack of thermic damage. The UV-radiation in vitro cleaned precise defects of substance, and assessable tissue-removing effects were found. These results were influenced by the wavelength used. In general, the removing effect was good in normal and atherosclerotic tissue, whereas massive calcification was very resistant. Excimer lasers seem to be preferable for ablation of atherosclerotic tissue, but still there is a great number of technical problems to be solved until use in the clinical setting can be justified.

Journal Article↗
PubMed1984

[Perioperative cefamandole prevention in aortocoronary bypass operations: the course of serum levels in extracorporeal circulation].

Antibiotic prophylaxis with 2 g Cefamandole at induction of anaesthesia was performed in 12 male patients undergoing aortocoronary bypass surgery. Caused by hemodilution, there was a marked decrease of serum concentration at the beginning of extracorporeal circulation, from 110.96 +/- 40.29 mcg/ml to 70.89 +/- 34.65 mcg/ml within 10 min. During extracorporeal circulation, elimination was as fast as before and after perfusion. 240 min after application, mean serum concentrations of 16.80 +/- 9.32 mcg/ml were measured. Failure of antibiotic prophylaxis in operations exceeding 4 h might be due to unadaequate antibiotic concentrations, beyond the minimal inhibitory concentration for the pathogens, reported to cause infections after cardiac operations.

Adult↗
PubMed1984

Fever, leucocytosis and infection after open heart surgery. A log-linear regression analysis of 115 cases.

A prospective investigation was undertaken in adults to assess the specificity and sensitivity of fever (greater than 38 degrees C) and leucocytosis (greater than 10 000/microliters) for the diagnosis of infection after operations with cardiopulmonary bypass. A log-linear model analysis of a multiway frequency table was used for statistical evaluation. The model parameters were separately evaluated for 2 periods: the early one until the 6th day, the late period from the 7th postoperative day until discharge. Seven out of 115 patients suffered infections during their hospital stay: Bacteremia occurred in 3, pneumonia in 2, and deep sternal wound infection in 2 patients, and a superficial wound infection in one. No significant interactions between fever, leucocytosis and/or infection were found in the first period, except an inverse relation between fever and elevated WBC (p = 0.0197). After the 6th postoperative day the model parameters did show significant interactions, fever and leucocytosis being more frequent in infected patients. However, the specificity was low: only 15% of the patients with fever or elevated WBC had an infection. The risk of in-hospital infection was significantly higher after a long duration of cardiopulmonary bypass (p = 0.009), and after transfusion of more than 2500 ml of blood on the day of operation (p = 0.001).

Adolescent↗
PubMed1983

[A cosmetically advantageous approach to median sternotomy].

A horizontal submammary skin incision was chosen as approach route to median sternotomy in 36 patients undergoing cardiac operations. The low complication rate in conjunction with a cosmetically acceptable result makes this procedure the method of choice for selected patients. The potentially higher risk of infection should not be overlooked when planning the operation.

Adolescent↗
PubMed1982

[The chronically altered appendix in children. Cooperative work of the Austrian Society for Pediatric Surgery].

In this multicentric study the anamnestic data and parents questionaires of 2-29 children were evaluated, whose appendix vermiformis at the time of operation showed no signs of inflammation. 31,1% macroscopically showed cicatrisation or fasciation, in 13,7% other enteral or gynaecological (1%) findings were present. In 1194 of the cases of patho-histological examination of the appendix had been made of which 36.4% were negative, 37.7% showed cicatrisation, 15,0% oxyuriasis and 10,4% coproliths. In the discussion of the significance of the chronically altered non-inflamed appendix we compared patients with and without macroscopical or microscopical alterations. We came to the conclusion that the probability-index as to sex, duration of symptoms, complexity of symptoms, incidence of postoperative well-being, proved the chronically altered appendix not to be an illness per se, but the result of spontaneously arrested inflammation. Since the rate of children admitted with a perforated appendix is high (15-20%) in comparison with the rate of complications after removal of non-inflamed appendices (2,9%), we believe that according to the diagnostical problems the principle can be maintained: in dubio pro operatione.

Adolescent↗