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Biomedical subjects

P Kalmar

Publications and source records attributed to P Kalmar.

At least 55 records · Page 3Linked to original sources
PubMed1982

[Wound infection and its treatment. In thoracic and cardiovascular surgery].

Wound infections following aseptic operations are considered to be hospital infections. Among 4,166 patients operated on between 1973 and 1980 for cardiovascular diseases, there have been wound infections in 58 cases (1.4%) and associated sternal or mediastinal infection in 11 cases (0.26%). One-third of the infections were caused by staphylococci. In superficial infections therapy consisted in healing by second intention. In deep infections surgical intervention with débridement and irrigation was the method of choice.

Anti-Bacterial Agents↗
PubMed1982

Bioadhesives in cardiac and vascular surgery.

Bleeding through the pores of thoracic vascular grafts sealed with bioadhesive has been eliminated without inducing additional defects in the coagulation system. This has been true regardless of whether additional valve replacement or aorto-coronary bypass procedures were performed. The operative risk and the need for blood transfusions has been lowered significantly thus reducing the cost of these procedures. Bioadhesive has been also applied successfully in a variety of perioperative bleeding complications.

Aorta↗
PubMed1981

[Perioperative complete right bundle branch block after aorto-coronary bypass surgery (author's transl)].

In 322 patients undergoing isolated coronary artery bypass grafting, the possible factors responsible for the development of intraventricular conduction disturbances were investigated. In 18 patients (5.6%), complete right bundle branch was observed perioperatively, 2 of whom also demonstrated left anterior hemiblock. Left bundle branch block, either complete or incomplete, was not observed. Patients demonstrating perioperative complete right bundle branch block were further characterized by the finding that 14 of 18 (77.7%) had preoperative inferior wall infarction as opposed to only 34% in the remaining 304 patients. Fifteen of the 18 patients (83.3%) had prolonged aortic cross-clamp times in contrast to only 37.5% of the remaining patients. Three-vessel disease, present in 16 of the 18 (88.9%) patients, was less frequently present (56.2%) in those in whom complete right bundle branch block did not develop perioperatively. Application of the chi 2-test showed significant differences in all of the latter variables. The perioperative onset of complete right bundle branch block may be due to several factors. The results of this study indicate that the extent of scar tissue and arteriosclerotic changes as well as the ischemic time during surgery may play a decisive role. In ten of the patients, the perioperatively-incurred complete right bundle branch block was irreversible. Postoperative angiographic studies revealed no relationship between block development and graft occlusion.

Adult↗
PubMed1980

[Use of mezlocillin in open heart surgery (author's transl)].

Concentrations of mezlocillin in serum and heart tissue were studied in 29 patients undergoing open heart surgery. The antibiotic agent was administered three times as a bolus injection of 2 grams each: after induction of anaesthesia, after initiation of extracorporeal bypass (ECC) and shortly after discontinuation of ECC. Serum levels were measured in 25 patients from samples drawn 30 minutes after the bolus injection and subsequently biologic assays were carried out by the agar diffusion method. The mean initial values during the three phases of surgery were 119.2, 170.6 and 236.0 micrograms/ml, respectively; at 60 minutes the values were 61.3, 100.8 and 101.9 micrograms/ml. Calculation of the exponential curve enabled a mathematical comparison of the half-life of the substance during the pre-ECC, ECC and post-ECC periods. The most rapid elimination was found to occur prior to initiation of ECC, the slowest during ECC, while in the post-ECC period the elimination was similar to, but somewhat slower than that of, the pre-ECC period. The concentration, measured in the tissue of eleven aortic valves, averaged 35.96 (range 8.4 to 63.4) micrograms/ml. The mean concentration found in papillary muscles of the left ventricle, resected at the time of mitral valve replacement in six patients, was 31.54% (range 17.7 to 58.33) micrograms/ml. Mean tissue concentration found in five resected mitral valves was 43.77 (range 27.33 to 71.5) micrograms/ml. The findings indicate that mezlocillin, administered as described, will reach serum and tissue concentrations at all periods of open heart surgery well above those of the minimum inhibitory concentration of most clinically relevant bacteria.

Cardiac Surgical Procedures↗
PubMed1980

[Urea and ammonia metabolism as partial aspects of nitrogen metabolism after surgery using the heart-lung machine].

22 patients undergoing open heart surgery for mitral valve dysfunction using extracorporeal circulation were studied pre- and postoperatively. Our study revealed a hypercatabolic situation with increased excretion of total nitrogen, urea and less significant excretion of ammonia on the day of surgery and during the 1-4th postoperative days. The portion of urea in percent of the total nitrogen excretion rose up to 95%. Ammonia excretion, however, did not exceed 4% during the whole period of investigation (7 days preoperatively, the day of surgery and 13 days postoperatively). Obviously the combined enteral and parenteral nutrition containing an average of 59.5 g protein, 207.0 g carbohydrate and 47.8 g fat per day which gave a total caloric intake of 1,536 kcal/day was not sufficient to compensate for the postoperative catabolism, but excessive situations could be avoided. The values of urea and nitrogen excretion in relation to the nitrogen intake indicate that a sudden shift of enteral and parenteral nutrition is associated with a considerable loss of body nitrogen. Therefore we suggest simultaneous enteral and parenteral nutrition which should be shifted only gradually over a period of 10-12 days to complete enteral nutrition for the postoperative treatment of patients undergoing open heart surgery with the use of extracorporeal circulation.

Adult↗
PubMed1979

Hemofiltration during extracorporeal circulation (ECC).

In cardiac surgery hemofiltration can be used: 1. to balance fluids during ECC, especially in long-term perfusion; 2. to carry out open heart procedures in patients with terminal renal insufficiency; 3. to treat acute hyperkalemia. The model of the 12.5 by 4.5 cm DIAFILTER TM and the model of operation are described. The compounds of the ultrafiltrate (UF) are identical with that of plasma water. Particles with a molecular weight of less than 50,000 can pass freely across the filtration membrane. The filtration capacity is 100 cc/min UF (Q blood: 300 cc/min, pressure across the membrane 600 mm Hg and hematokrit (Hkt) 25%). The technical details of operation are explained. Its general use as well as its simplicity is demonstrated in 10 patients.

Adult↗
PubMed1979

Clinical application of cardioplegia in aortic cross-clamping periods longer than 150 minutes.

Out of more than 1000 patients operated upon by means of cardioplegia in profound myocardial hypothermia (15 degrees - 20 degrees C) aortic crossclamping time exceeded 150 min in 26 cases. The average clamping time in this group of patients was 169 +/- 22 min (150 to 227 min). The average duration of the cardioplegic coronary perfusion was 35 +/- 21 min (14 to 99 min). The following procedures were performed. Aneurysmectomy of the ascending thoracic aorta combined with valve replacement (n = 7); valve replacement combined with aorto-coronary bypass procedures (n = 9); multiple valve replacement (n = 3); multiple coronary grafting (n = 6) and one complicated reoperation. Three patients (11.5%) died, none intraoperatively and none as the result of a heart failure connected with the operation.

Adenosine Triphosphate↗
PubMed1978

[Replacement of the thoracic aorta by sealed dacron prostheses (author's transl)].

Dacron prostheses for replacement of the thoracic aorta were sealed with bioadhesive following the Viennese method. Native human fibrinogen was brought to coagulation by adding thrombin. Factor XIII was also added in order to accelerate polymerisation and to reinforce fibrin formation in the presence of thrombin and CaCl2, thus producing a stable thrombus. In order to avoid local fibrinolysis a fast but short-acting as well as a slow but longer-acting antifibrinolytic agent was added. This method was applied in twenty patients. The prostheses remained completely impermeable to blood after resuming circulation in spite of full heparinization. No post-operative haemorrhages from the prostheses were observed.

Aorta, Thoracic↗
PubMed1978

[Behavior of ldh and its isoenzymes after cardiac surgery (author's transl)].

The degree of intraoperative myocardial injury was determined in two groups undergoing different methods of myocardial protection by observing the LDH and its isoenzymes up to the 11th postoperative day. Both groups consisted of patients who underwent mitral- and aortic-valve replacement. In the first group myocardial protection consisted of Kirsch cardioplegia (2) combined with conventional coronary perfusion in cases of aortic-valve replacement. In the second group the same initial cardioplegic procedure was followed by the noncorpuscular, hypothermic and aerobic coronary perfusion by Bleese and Döring (1). No difference was noted among the mitral valve patients. During the 11 days postoperative period, the aortic valve patients in the first group demonstrated a significantly higher LDH activity than the mitral-valve cases whereas LDH activity of aortic-valve patients in the second group resembled that of the mitral valve cases. Since the length of extracorporal circulation and ischemia did not vary significantly, the LDH behavior in the aortic-valve cases of the first group may be explained by the inferiority of the myocardial protection method used. In comparison with the other methods conventional coronary perfusion resulted in more myocardial injury.

Aortic Valve↗
PubMed1978

[Some psychological predictors for psychosis after open heart surgery (author's transl)].

In a study of postoperative psychosis after open heart surgery three psychopathological syndromes were identified which had different psychological predictors. Predictors of postoperative emotional disturbances are family problems and the lack of plans for the future, whereas patients with postoperative disorientations seem to have difficulties in their jobs and therefore feel distressed preoperatively. Predictors of the paranoid syndrome after the operation are: a high degree of fear in awaiting the operation and little confidence in the doctors. The social surroundings of these patients are often unstable and although they have no precise plans for the future they object to start working again after operation.

Adaptation, Psychological↗
PubMed1976

[Hospital infection during postoperative intensive care (author's transl)].

Since 1970 all postoperative bacteriological findings recorded in surgical patients have been analyzed and compared with the postoperative course. There are also regular checks of bacterial invasion in the operating suites and in the intensive care units. By such means as systems of double lock for personnel and equipment, regular surface disinfection, frequent hand disinfection, cleaning of the respirators with antiseptics, etc., the authors have been able to reduce the incidence of hospital infection very drastically. These measures also almost eliminated cross-infections in patients on long-term ventilation and complications with long-term indwelling catheters.

Asepsis↗
PubMed1976

[Long-term cardiac arrest by cardioplegic coronary perfusion (author's transl)].

UNLABELLED: The Mg++ aspartate-procaine-cardioplegia has been proven in animal experiments as well as from 1970 til 1975 in more than 1000 open-heart-procedures by a myocardial temperature of 32 degrees C and aortic crossclamping time up to 40 minutes superior to all other known procedures of cardiac preservations. To guarantee a safe myocardial protection of the arrested heart for a remarkable longer period of total ischemia, we further developed the cardioplegic technique in the animal lab, and use it now clinically. PRINCIPLE: The arrest is induced by cardioplegia (Mg++ aspartate-procaine), than the arrested heart is cooled down to 15-20 degrees C by cardioplegic coronary perfusion maintaining the oxidative metabolism. The perfusion is stopped. The begin of ischemia is still under normal ATP-levels and continuous cardioplegia. TECHNIQUE: 1. Crossclamping of the aorta; 2. cardioplegic induced cardiac arrest by Mg++ aspartate-procaine (Kirsch); 3. Surface cooling of the heart; 4. Coronary perfusion by hypothermic cardioplegic solution (8-10 min, flow 80-120 ml/min, perfusion pressure maximal 30 mmHg). Perfusate: O2-saturated, erythrocyte free, 6% hydroxyethyl starch solution added 2 mM Mg++ aspartate, 4 mM procaine, 50 mM Na+, 5 mM K+, 0,5 mM Ca++, 25 mM HCO3-, 10 mM glucose, 200 mM mannitol, 250 mg/l 6-methylprednisolone. RESULTS: 84 patients (29 ACVB; 55 valve replacements); crossclamping time: 71 min (SD 22); total time of ischemia: 57 min (SD 18; max 96, min. 27 min); reperfusion time restoring normal excitation-contraction of the heart: 3 min (SD 2); weaning off bypass: 23 min (SD 14). Hemodynamic 12 h postop.: SO2 venous 76% (SD 6). No sympathicomimetics were used. Only 30% of myocardial ATP is splitted after 120 min of cardiac arrest. Electron microscopic findings show only small, reversible alterations of fine structure.

Adenosine Triphosphate↗
PubMed1975

[Diagnosis, frequency and importance of the "low-output-syndrome" in the postoperative period after mitral valve replacement (author's transl)].

From 1970 until 1975 single mitral valve replacement was carried out in 162 patients using Björk-Shiley disc prostheses. The surgical mortality (within 30 days postoperatively) was 9.3% (n=15). Out of these 15 patients 9 died due to myogenic cardiac insufficiency. 21 patients with "Low-output-Syndrome" due to myogenic insufficiency however survived. The improvement of intraoperative myocardial protection since 1972 (using hypothermia and cardioplegic induced cardiac arrest) reduced the frequency of myogenic cardiac insufficiency to 1%. Unrelated to the above mentioned we saw in 18.5% of all patients after ECC-procedures a temporary "Low-output-Syndrome" after the 3rd postoperative day due to pericardial effusion.

Cardiac Output↗