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Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 217 records · Page 12Linked to original sources
PubMed1993

[Paraplegia, a catastrophic complication of interventions on the infrarenal aorta].

Damage to the spinal cord in course of the treatment of diseases of the infrarenal aorta is a rare but calamitous complication. The reported incidence is about 0.2%. The neurological loss is usually complete flaccid paraplegia with high mortality and rare full or partial recovery. Between 1980 and 1991, 1070 reconstructive procedures of the infrarenal aorta were performed: 821 due to aneurysm (316 elective procedures [mortality 1.6%] and 505 emergency procedures [mortality 24.5%]) and 249 due to aorto-iliac occlusive disease. Damage to the spinal cord occurred in 2 patients (2/1070, 0.19%). One patient had incomplete paraparesis following repair of an unruptured abdominal aortic aneurysm with gradual return of all neurological symptoms to normal. The second patient developed complete paraplegia following repair of a ruptured infrarenal aneurysm. There war no recovery of the symptoms. The patient died from septicaemia 4 months later.

Aged↗
PubMed1993

[Results of surgical revascularization of the kidney].

There are many different etiologies of renal artery disease (atherosclerosis, aneurysm, dissection, arteriovenous fistula, embolism, fibromuscular dysplasia) and also a lot of different therapies (conservative treatment, percutaneous transluminal angioplasty [PTA], endarterectomy, bypass grafting, patch plasty, nephrectomy). Recently conservative treatment and PTA have significantly improved. Patients who are referred to surgery today are of older age with severe and often bilateral disease of the renal arteries. Additional manifestations of general atherosclerosis like coronary artery disease, aortic aneurysm, peripheral occlusive vessel disease and cerebral vascular insufficiency are often present as well. The main goal of all forms of treatment is the preservation of general renal function. With our retrospective study the results after surgical revascularisation of kidneys are evaluated over a short period of time. Only graft revascularisations are included in the study and we were mainly interested in renal function and blood pressure.

Aged↗
PubMed1993

[Differential diagnosis of ischemia of the lower extremities in young adults].

Lower-extremity arterial occlusive disease in individuals younger than 50 years is rare. We report on 4 young adults with lower limb ischemia, each of them with a different cause. According to literature premature atherosclerosis is the most common cause and is followed by thromboangiitis obliterans, coagulation abnormalities and popliteal artery entrapment syndrome. We suggest a diagnostic concept which could help to avoid undue delay.

Adult↗
PubMed1993

Endocarditis in intravenous drug addicts and HIV infected patients: possibilities and limitations of surgical treatment.

The incidence of infective endocarditis in drug addicts is increasing with the spread of intravenous drug abuse. The tricuspid valve is involved most commonly, followed by the mitral. We evaluated 22 patients prospectively with a mean age of 23 years, presenting with addiction-associated endocarditis and referred to our institution during a three-year period. The tricuspid valve was involved in 13 instances, the mitral in four, mitral plus tricuspid valves in five patients and the aortic valve in one. Staphylococcus aureus was the most frequent infective organism (15 cases), followed by streptococci (4 cases), corynebacteria (2 cases) and one case with a mixed infection. Six patients were HIV positive and 17 had evidence of chronic viral hepatitis. Ten patients (three of them HIV positive) were treated surgically. Resection of the tricuspid valve with (one case) or without replacement (four cases), resection of vegetations and tricuspid repair (two cases), mitral valve replacement (2 cases) and aortic valve replacement (one case) were performed. Operative mortality (< 30 days) was high (2/10, 20%); one patient died from cerebral hemorrhage and another from multi-organ failure. Another three patients died after a mean follow up of 10 months. In 12 patients, surgery was not attempted because of still existing intravenous drug abuse or renal and liver failure. Five of these patients died after a mean follow up of 13 months, two from septicemia, two from AIDS-related complications and one from drug overdose. The prognosis of drug-associated endocarditis treated with antibiotics is generally good.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Long-term results of tissue development and cell differentiation on Dacron prostheses seeded with microvascular cells in dogs.

PURPOSE: The purpose of this study was to investigate in vivo the long-term development, differentiation, and proliferation of the subendothelial tissue on Dacron prostheses seeded with microvascular cells (MVC). METHODS: Autologous MVC from omental adipose tissue were seeded on 4 mm Dacron prostheses and the prostheses interposed in the carotid arteries of mongrel dogs for 5, 13, and 26 weeks. RESULTS: Light and electron microscopic evaluation of patent seeded prostheses demonstrated an almost complete monolayer of endothelial cells and well-organized subendothelial tissue, whereas patent control prostheses were mainly covered by red and white thrombi, which were partially replaced by organized tissue with increased implantation time. The measurements of the thickness of the luminal cell layer in seeded and control grafts showed no statistically significant increase between 5 and 26 weeks of implantation. The subendothelial tissue of seeded prostheses demonstrated a time-dependent maturation of highly synthesizing myofibroblasts embedded in a collagen matrix to cells with features of smooth muscle cells located in a collagen-elastin matrix. In control grafts examined after 26 weeks the spontaneous endothelialization was accompanied by a delayed or incomplete maturation of subendothelial tissue. CONCLUSIONS: Our study indicates that MVC seeded onto Dacron prostheses are able to generate a vascular wall that does not continue to proliferate after prolonged implantation and that increasingly resembles the wall of a normal artery in cell differentiation and intercellular matrix.

Animals↗
PubMed1993

Transcaval liver resection with hepatoatrial anastomosis for treatment of patients with the Budd-Chiari syndrome. Late results.

Between 1980 and 1990 transcaval liver resection with hepatoatrial anastomosis was performed in 17 patients with the Budd-Chiari syndrome. There were two early deaths (early mortality 11.7%). Hepatic function returned to normal and hepatosplenomegaly disappeared in all but two patients with preexisting cirrhosis. All survivors regained normal working capacity after the operation. During an average follow-up of 6 years (7 months to 11 years) there were three late deaths due to progression of the underlying disease. The actuarial 1-, 5-, and 10-year survivals were 82%, 76%, and 57%, respectively. Hepatoatrial anastomosis represents an optimal treatment for patients with the Budd-Chiari syndrome and obstruction of major hepatic veins. Patients with compression of the inferior vena cava, very common in this disease, were treated by simultaneous transcaval stenting. The late results are very satisfactory, with excellent quality of life. With adequate hepatic function, results of hepatoatrial anastomosis are superior to those of liver transplantation, which represents the only alternative for patients with the advanced form of the Budd-Chiari syndrome.

Adult↗
PubMed1993

[Effect of aortic clamping on heart function in elective operation of the abdominal aorta: immediate effects of coronary revascularization].

Infrarenal aortic cross-clamping required during surgical treatment of abdominal aortic aneurysm is generally well tolerated but can be occasionally associated with severe cardiac and haemodynamic disturbances, particularly in patients suffering from coronary artery disease. We compared the haemodynamic changes and the ECG-records before and shortly after infrarenal aortic clamping in three groups of 20 patients (group I: without coronary artery disease, group II: with overt coronary disease without indication for prior myocardial revascularization, and group III: patients undergoing combined procedure: coronary artery bypass immediately prior to aortic repair, during the same anesthesia). There was no significant difference in demographical characteristics between the three groups. Aortic cross-clamping lead to an increase in systemic arterial pressure in all patients. Group I demonstrated a decrease in pulmonary artery pressure, pulmonary capillary wedge pressure and central venous pressure, whereas patients of group II demonstrated an increase of each value when the aorta was clamped. 11 patients of this group developed either arrhythmia and/or ischemia during aortic cross-clamping. Haemodynamic and cardiac effects of aortic clamping seen in patients who had received coronary bypass immediately prior to aortic repair (group III) were surprisingly similar to those of patients without coronary disease, probably owing to systematic application of 2 vasodilators. Tolerance to infrarenal aortic cross-clamping differs in patients with and without coronary artery disease. Development of myocardial ischemia may be predicted by an increase in wedge pressure after clamping. Afterload reduction was the best treatment of ischemia occurring when the aorta was clamped.

Aged↗
PubMed1993

In situ repair of mycotic aneurysm of the ascending aorta.

Between 1969 and 1990 six patients (aged 14 to 64 years, mean 43 years) underwent in situ reconstruction for mycotic aneurysm of the ascending aorta. The primary source of infection was endocarditis in three patients (subacute bacterial endocarditis [n = one patient], sepsis with acute endocarditis [n = one patient]), sepsis with sternal osteomyelitis in one, sepsis with purulent pericarditis in one, and generalized febrile illness in one. In five of six patients the treatment consisted of the excision of changed tissue combined with a composite graft (n = one patient), a xenopericardial patch repair (n = one patient), a Dacron graft repair and aortic valve replacement (n = one patient), a Dacron graft repair alone (n = one patient), and a lateral suture combined with double valve replacement (n = one patient). In one patient with perforation of the mycotic aneurysm into the pulmonary artery, the place of rupture was oversewn without excision of the aortic or pulmonary artery tissue. Two patients with local pericardial inflammation were reoperated on during the hospital stay; one of them because of recurrent mycotic aneurysm of the ascending aorta at the other location and the other because of infection of the suture line after the Dacron patch repair. Antibiotic therapy was intravenously administered for 2 to 12 weeks postoperatively and continued orally for 4 to 8 weeks. The mean observation time was 6 years (range 4 months to 16 years). There was no late graft infection, except the chronic infection of the suture line in one patient who died suddenly 4 months after the operation. There was no early death, and there were three late deaths (chronic myocardial failure, one patient, chronic renal failure, one patient, sudden death, one patient). We concluded that in situ reconstruction for mycotic aneurysm of the ascending aorta combined with prolonged antibiotic therapy is an appropriate procedure with satisfactory early and good long-term results.

Adolescent↗
PubMed1992

[Immediate and long-term results of carotid endarterectomy: the Zurich experience].

Extracardial carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. The records of 485 patients who underwent carotid endarterectomy between 1978 and 1991 were reviewed, with special attention to both cardiac and neurological complications. 432 patients had symptomatic carotid disease whereas 53 were asymptomatic but presented with significant carotid stenosis or a large ulceration at doppler-duplex examination and/or angiography. These examinations showed the following lesions in symptomatic patients: unilateral stenosis > 75% (331; 68.5%), ulceration (41; 8.5%), bilateral stenosis (61; 12.5%) and unilateral stenosis with contralateral occlusion (51; 10.5%). Intraluminal shunt was used in nearly all patients whereas special management of cerebral metabolism (intraoperative electroencephalogram, somatosensory evoked potentials) were used in high-risk patients only. Overall early mortality was 1.8%. Three patients died from the sequelae of a neurologic injury, whereas six patients died from myocardial infarction or intractable arrhythmia. Mortality decreased from 2.4% between 1978 and 1984 to 0.8% between 1985 and 1991. At 6 and 8 years, actuarial survival rates of 88.1% and 76.1% and stroke-free survival rates of 86% and 81.5% were observed. Late mortality was essentially due to ischemic cardiac complications (38.5% of the actuarial late mortality at 8 years). Review of the literature shows that carotid endarterectomy is the treatment of choice for symptomatic high-grade extracranial carotid stenosis in patients who are not high-risk candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Congenital cleft of the anterior tricuspid leaflet with severe tricuspid regurgitation in adults.

OBJECTIVES AND BACKGROUND: Severe primary tricuspid regurgitation in the adult is a rare finding. This study describes the diagnostic findings and the treatment of an isolated congenital cleft of the anterior leaflet of the tricuspid valve as the morphologic substrate for severe tricuspid regurgitation. METHODS: The clinical, echocardiographic findings and the follow-up findings of five patients (all male, 20 to 56 years old) with this disorder are described. Four of the five patients underwent cardiac surgery that confirmed the diagnosis. RESULTS: In three of five patients, exertional fatigue was the limiting symptom (New York Heart Association functional classes II and III). The clinical findings included a holosystolic murmur and supraventricular arrhythmias in all patients. Cardiac catheterization, performed in four patients, yielded the incorrect diagnosis of Ebstein's anomaly in three. In one patient the cleft was associated with an atrial septal defect of the secundum type. In four of five patients successful reconstruction of the tricuspid valve with a DeVega annuloplasty was performed. One patient had a partial excision of the right atrium, and one had a closure of a coexisting atrial septal defect. One patient refused operation. CONCLUSIONS: Tricuspid valve anomalies can be accurately identified by Doppler echocardiography. Surgical repair is the treatment of choice in patients with severe tricuspid regurgitation due to a congenital cleft of the anterior leaflet of the tricuspid valve.

Adult↗
PubMed1992

Implications of pulsatile stretch on growth of saphenous vein and mammary artery smooth muscle.

Internal mammary artery (IMA) coronary bypass grafts have a higher patency than saphenous vein (SV) grafts. Intimal hyperplasia and occlusion of venous grafts result from smooth muscle proliferation. Mechanical factors, such as pulsatile stretch, are potential mediators of this process. Smooth muscle cells from IMA and SV were cultured on deformable membranes and exposed to pulsatile stretch (60 cycles/min). This stimulus increased 3H-thymidine incorporation into venous (a two-fold increase) but not arterial smooth muscle cells after 24 h. Smooth muscle cell numbers from SV, but not IMA, were increased (p less than 0.05) after 6 days of stretch. Thus, pulsatile stretch stimulates smooth muscle cell proliferation in SV, but not IMA, and may contribute to venous bypass graft disease.

Cell Division↗
PubMed1992

[Main coronary artery stenosis: a continuous challenge].

The pre- and postoperative course in 118 patients (104 males, mean age 62 +/- 8.1, 14 females, 60 +/- 10.7 years) who underwent coronary artery bypass surgery for significant left main coronary artery disease was studied to analyze the current management and risk factors of this lesion. Of these patients 32% (38/118) remained in hospital care from the date of diagnosis (coronary angiography) until the operation. The mean interval between diagnosis and operation was 39 days (range 0-166). Twelve patients (10%) had urgent procedures (< or = 48 hours after angiography), 25 (21%) accelerated (< or = 2 weeks), 52 (44%) anticipated (< or = 2 months) and 30 (25%) elective procedures (> 2 months). There was a significant negative correlation (p < 0.001) between the grade of stenosis and the time interval from diagnosis to operation. The operation technique did not differ from the usual procedure except for the less frequent use of the internal mammary artery as arterial conduit. Patients with stable angina received an internal mammary artery graft in 65% (80/118) as compared to 26% (6/23) of the patients with unstable angina. This differs significantly from the overall rate of 95% of the patients undergoing coronary artery bypass surgery at our institution. The rate of perioperative myocardial infarction was 18% (21/118). There was no significant relation between infarction and angina class, severity of the stenosis and the use of internal mammary artery as bypass graft. The hospital mortality was 4.2% (5/118) and thus was not different from the overall mortality of (2.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Pericardectomy and acute infectious pericarditis].

Between 1980 and 1990 12 patients (5 male, 7 female) were operated on for acute infectious pericarditis at a mean age of 42 years. The infections were 6 bacterial (purulent 4, abscess 2), 4 tuberculous, 1 viral and 1 Candida. Pericarditis resulted from contiguous spread of infection from bilateral pneumonia in 3 patients, from subphrenic abscess in 2 and followed bacteremia in 1. Clinical signs were: tamponade/shock in 9, elevated jugular venous pressure in 11, edema in 6, hepatomegaly in 6, ascites in 1, and pericardial friction rub in 3. A preoperative pericardiocentesis in 9 patients allowed only 4 positive microbiological diagnoses and was an insufficient drainage in all cases. The preoperative mean NYHA class was 3.3. The pericardectomy was total in 9 patients and partial in 3. Total mortality was 1/12 patients (8%) with one late death due to recurrent tuberculous pericarditis. No patient with purulent pericarditis died. Another recurrence occurred 6 months after acute viral pericarditis. Atrial fibrillation in one patient was the only postoperative complication. After a mean follow-up period of 48.5 months no cardiac constriction had occurred in 11 surviving patients Actuarial survival after pericardectomy is 100% after 1 month and remains 91% after 5 years. The mean NYHA class has significantly improved to 1.2 (p less than 0.05) at the end of the follow-up. We conclude that pericardectomy combined with a specific antimicrobial therapy is a safe treatment for acute infectious and especially purulent pericarditis with low mortality and excellent longterm results. Early pericardectomy allows rapid decompression of the heart, removal of intrapericardial adhesions and infected tissue and prevents late constriction.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Implantation of antibiotic-releasing carriers and in situ reconstruction for treatment of mycotic aneurysm.

Four patients with mycotic aneurysm of the extracranial carotid artery, the innominate artery, the ascending aorta, and the infrarenal aorta were treated with local implantation of antibiotic-releasing carriers after resection of the aneurysm, excision of all infected tissue, and in situ reconstruction by prosthetic graft replacement in two patients and patch plasty in two patients. The patient with a mycotic aneurysm of the ascending aorta was operated on again 1 month after the first operation because of a second mycotic aneurysm located on the aortic arch. No early or late signs of recurrent infection were seen on clinical and laboratory postoperative follow-up done between 9 and 16 months or on duplex scan or computed tomography done at these times. Implantation of antibiotic-releasing carriers after débridement of all infected tissue and in situ reconstruction for treatment of mycotic aneurysm was performed successfully in four patients with this life-threatening condition.

Aged↗