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Biomedical subjects

T Z Lajos

Publications and source records attributed to T Z Lajos.

At least 19 recordsLinked to original sources
PubMed1992

Intramyocardial calcification in the elderly. A diagnostic and therapeutic puzzle.

A 70-year-old woman presented with anular and progressive intramyocardial calcification within a five-year period. She had become increasingly symptomatic with mitral regurgitation and coronary insufficiency during the same period. The subvalvular (mitral) calcified intramyocardial mass was found to be "grumous atherosclerosis." This was obliterated while the mitral valve was replaced with a prosthetic valve and the coronary arteries were bypassed x3. She is surviving and well four years postoperatively.

Aged↗
PubMed1990

Intracavitary melanoma of the left atrium.

A 32-year-old man was seen with shortness of breath and increasing fatigue. Echocardiography revealed an intracavitary mass occupying the entire left atrium. The lesion was resected using cardiopulmonary bypass and found to be a large malignant melanoma. This case represents the rare occasion in which antemortem diagnosis of malignant melanoma within left atrium permitted successful palliative surgical resection. The patient is alive and active 6 months after operation.

Adult↗
PubMed1990

Pulmonary resection combined with cardiac operations.

Surgical management of patients with concomitant critical cardiac disease and resectable lung lesions is controversial. During a 7-year period (1982 to 1988), 21 patients underwent combined cardiac and pulmonary operations. Patients had cardiac symptoms only; the lung lesions were found on preoperative chest roentgenograms. The pathological diagnosis was established in only 2 of the patients before operation. All underwent concurrent pulmonary resection during cardiac operations requiring extracorporeal circulation. The pulmonary operations included 17 wedge resections and four lobectomies. The final diagnoses in 8 patients with stage I non-small cell lung cancer included epidermoid carcinoma (4), adenocarcinoma (3), and bronchoalveolar carcinoma (1). Postoperatively, 1 patient required a permanent pacemaker and 1 patient died. The actuarial survival at 5 years for all patients who underwent combined procedures was 95%. The 5-year survival for the 8 patients with lung cancer was 88% compared with 100% for those with benign pulmonary pathology (p = 0.172). This experience suggests that combining pulmonary resection with cardiac operations is safe and offers a favorable prognosis to a select group of patients.

Adult↗
PubMed1990

Left thoracotomy reoperation for coronary artery disease.

Twenty patients underwent reoperative coronary artery bypass grafting (CABG) through a left thoracotomy since 1971. This was their second CABG in 16 patients, third in three patients and fourth in one patient. Surgery was performed from 1 to 16 years following the initial procedure. Demographic data showed no significant variation from patients undergoing standard reoperative CAGB in this institution. Ejection fraction varied between 30% and 73%. Cardiopulmonary bypass technic has gradually developed since 1971, using the left femoral artery and vein. For venous cannulation a 50-cm long catheter was positioned in the right atrium. Monitoring included pulmonary artery catheter with oximetry. Fibrillatory arrest of the heart was utilized with 18-33 degrees C core cooling cardioplegia. The left internal mammary artery (6) and reverse saphenous veins (44) were used for an average of 2.5 grafts per patient. The proximal anastomosis was placed on the descending thoracic aorta or the left subclavian artery. There were two early and no late deaths. Sixteen patients were restudied before discharge from the hospital with an early graft patency rate of 98% (41/42). The left thoracotomy approach may be preferable in selected cases of redo CABG. The danger of damage to the heart and patent grafts is greatly reduced.

Aged↗
PubMed1989

Evaluation of post-cardiopulmonary bypass Sonoclot signatures in patients taking nonsteroidal anti-inflammatory drugs.

Patients who take nonsteroidal anti-inflammatory drugs (NSAID) and who experience bleeding after cardiopulmonary bypass (CPB) are treated empirically with platelet transfusions because of the unavailability of rapid and accurate diagnostic clotting function tests. Therefore, a Sonoclot Analyzer (Sienco, Inc, Morrison, CO), which measures the change in the viscoelastic properties of recalcified whole blood, was used to assess platelet function in 51 patients undergoing CPB for cardiac surgery. Seventeen patients (group 1) taking NSAID were compared with 34 patients who were not taking NSAID (group 2). Blood samples were drawn for Sonoclot analysis before and after CPB. Chest tube drainage was measured for 24 hours postoperatively in both groups. Clot retraction, measured by the down slope on the Sonoclot signature, decreased significantly in group-1 patients, although values obtained for both groups were in the normal range. No difference was found between groups when Sonoclot signatures were compared, requirements for replacement of clotting factors or platelets, chest tube blood drainage, and unscheduled return to the operating room for bleeding. It is concluded that patients taking NSAID did not experience increased bleeding after cardiopulmonary bypass and that empiric platelet transfusion seemed unnecessary. In addition, the Sonoclot Analyzer seems to be a useful and sensitive instrument for rapidly assessing platelet function in the operating room.

Aspirin↗
PubMed1988

Circumferential intimal tear causing obstruction of the aortic arch: an unusual complication of aortic dissection.

A 66-year-old man was first seen because of occlusive disease of the aortic arch vessels secondary to a Type I aortic dissection. At operation, circumferential detachment of the intima was found with intussusception of this flap into the descending aorta causing obliteration of the arch vessels. There has been only one previous report of circumferential intimal intussusception complicating aortic dissection.

Aged↗
PubMed1986

Metabolic activity of the lung during cardiopulmonary bypass.

Metabolic functions of the lung were examined in sixty patients undergoing coronary artery bypass surgery employing a method to separate right and left heart flow during surgery. Six study groups were employed to investigate the activity of normal serum electrolytes, minerals, enzymes and vasoactive prostanoids as they pass through the pulmonary vasculature. Various sample sites were employed to represent isolated segments of the vascular tree: pump (systemic) and right atrium (myocardium), aortic (bronchial flow). LDH, Ca++, phosphate and SGOT were documented to vary with passage through the pulmonary circulation while alkaline phosphatase, bilirubin, creatinine, urate, cholesterol, albumin and BUN remained essentially unchanged. Bronchial flow was calculated and directly related to temperature and pump flow with an average range of 15 ml/min +/- 6 ml/min. The stress of surgery produced elevated PGE2 in bronchial flow and urine that caused reproducible hypotension when rapidly reinfused into the patient. PGE2 production, though decreased with Indomethacin block, could be rapidly reversed with the stress of surgery.

Blood Pressure↗
PubMed1985

Hemodynamic consequences of bronchial flow during cardiopulmonary bypass.

Nine patients (seven men and two women) were studied while undergoing coronary artery bypass on cardiopulmonary bypass. Selective bronchial flow samples were obtained and analyzed for prostaglandin E2 levels, and the hemodynamic effects of this vasodilator were studied. Bronchial flow collection and measurements were performed during hypothermic cardioplegic arrest while the peripheral anastomosis was being completed, as described previously. This collected sample was reinfused abruptly to the pump circuit, but samples were also analyzed for specific radioimmunoassay antiserum for prostaglandin E2 levels. Urine levels were obtained both with and without indomethacin block. All nine patients were studied for the hemodynamic effects of rapidly reinfused bronchial flow. A 34% +/- 8.8% mean drop of blood pressure and peripheral vascular resistance were recorded (p less than 0.002). Three study groups were established: In Group I, serum prostaglandin assay was performed on six patients. Prostaglandin E2 levels showed an average of increase of 159% compared to the baseline (p less than 0.02). In Group II, urine prostaglandin was measured. Nine assays were performed on six patients. Analysis of the total urine production while on cardiopulmonary bypass showed an average increase in prostaglandin E2 of 300% (p less than 0.02). In Group III, combined serum and urine prostaglandin levels were measured in three patients before and after indomethacin block (50 mg four times a day for 48 hours before the operation). All of these patients demonstrated the same hypotensive phenomena with reinfusion of the bronchial flow. The urinary prostaglandin E2 output and serum prostaglandin E2 levels in bronchial flow were elevated. Overall, this group manifested a 50% reduction in prostaglandin E2 production over baseline values with indomethacin block (p less than 0.02) and a 300% increase in production during cardiopulmonary bypass (p less than 0.02). Our data suggest that significant amounts of prostaglandin E2 are released in the lung during the stress of cardiac operations. Rapid reinfusion of bronchial flow is responsible for hypotension during cardiopulmonary bypass. Pretreatment with indomethacin will not completely block prostaglandin E2 release in the lung during stress.

Aged↗
PubMed1979

The revival of the horseshoe graft (side-to-side saphenous-vein-to-aorta anastomosis).

The technique of the horseshoe graft, side-to-side saphenous-vein-to-aorta anastomosis, using a long saphenous vein harvested from the leg is described in this communication. The lack of valves between the ankle and the knee and the high caliber natural Y distributions make this technique attractive. Constructing a double set of vein graft provides, in particular, unlimited possibilities for the construction of six to eight grafts if this appears anatomically feasible.

Coronary Artery Bypass↗
PubMed1978

Epicardial atrial pacing.

A modification of the technique for placing a permanent epicardial electrode to the atrium is described. It results in long-term atrial pacing and low sensing thresholds. The method requires meticulous surgical technique but is reliable, safe, and free from serious or long-term complications.

Cardiac Pacing, Artificial↗
PubMed1978

Decompression of the heart with siphon drainage.

A simple technique for inducing intracavitary hypothermic cardioplegia and decompressing the left heart through the ascending aorta is presented. The technique is based on siphon drainage, which eliminates the dangers of air embolism.

Cardiac Catheterization↗
PubMed1977

Detection of creatine kinase BB isoenzyme in sera of patients undergoing aortocoronary bypass surgery.

Creatine kinase BB isoenzyme (CK-BB) was detected intraoperatively in 22 of 25 patients undergoing aortocoronary bypass surgery, both in the coronary sinus and in the mixed venous blood. In a group of 10 patients in whom selective intracavitary profound hypothermic arrest was used, CK-BB values were lower than in another group of 10 patients, in whom controlled ventricular fibrillation with moderate total body hypothermia was instituted. This latter group also had higher levels of CK-MB. Patients who developed acute myocardial infarction immediately prior to or during the surgical intervention had the highest CK-BB values. This enzyme appeared as early as 15 minutes after the institution of cardiopulmonary bypass and disappeared within 6 hours. It is considered that part of the BB isoenzyme in serum of patients undergoing heart surgery is of myocardial origin.

Adult↗