Dalibor Murgas | Commenius University (original) (raw)

Papers by Dalibor Murgas

International Journal of Gynecology & Obstetrics, 2012

Pediatric Surgery International, 2012

Background Traumatic diaphragmatic hernia (TDH) is very rare in the pediatric age group. Because ... more Background Traumatic diaphragmatic hernia (TDH) is very rare in the pediatric age group. Because of its rarity and its coexistence with more serious injuries, the diagnosis is often missed or delayed. Patients and methods All children with the diagnosis of TDH were retrospectively reviewed for age at diagnosis, sex, mechanism of injury, site of diaphragmatic rupture, associated injuries, injury severity score, investigations, treatment and outcome. Results Over a period of 15 years (1992-2007), we treated seven children with TDH. All were males except one. Their mean age was 7.4 years (3.75-14 years). The site of TDH was on the left in three, on the right in three and one had bilateral TDH. The mechanism of injury was blunt trauma in six and penetrating injury from a stab in one. Three had right TDH and in all three, the diagnosis of TDH was delayed. All sustained severe injuries as reflected by the ISS score (mean 38.6). The time from presentation to diagnosis was variable ranging from 3 to 240 h (mean 65.7 h). The three patients with left TDH were repaired trans-abdominally while the three with right TDH were repaired via a right thoracotomy. The patient with bilateral TDH required laparotomy and thoracotomy. All our patients survived and the hospital stay was variable ranging from 7 to 24 days (mean 17 days). Conclusions TDH is very rare in children and often associated with severe more serious injuries. These two factors contribute to the delay in diagnosis. This is specially so for right TDH. To obviate delay in diagnosis, it is important to have a high index of suspicion as well as careful interpretation of the initial and follow-up radiological investigations including CT-scan of the chest and abdomen. This is important to detect a slowly increasing TDH that may not be apparent initially.

Respiratory Physiology & Neurobiology, 2021

BACKGROUND Cardiopulmonary exercise testing (CPET) is a method used to evaluate functional impair... more BACKGROUND Cardiopulmonary exercise testing (CPET) is a method used to evaluate functional impairment of patients with various diseases. OBJECTIVE The objective was to use CPET to estimate the usability of anthropometric index (AI) in patients with pectus excavatum (PE) as a marker of functional impairment caused by chest deformity. METHODS The study included 32 paediatric patients (28 males) with PE. Patients underwent CPET using a breath-by-breath exhaled gas analysis method and continuous monitoring of cardiac parameters. RESULTS In both groups, two (overall four) patients met criteria for cardiogenic limitation (low VO2 and low O2Pulse). Mean VO2/WR was below two standard deviations (2SD) in patients with less severe PE; other observed parameters were within normal limits (Z-score ± 2 SD). The AI had no observed correlation with peak ventilation, VO2peak and peak workload. CONCLUSION The obtained CPET data do not correlate well with the severity of chest deformity expressed with AI. There were similar physical activity limitations in both examined groups of patients and they did not depend on the severity of the deformity.

Indian Journal of Surgery, 2020

Pulmonary sequestration is a rare congenital pulmonary malformation. This malformation consists o... more Pulmonary sequestration is a rare congenital pulmonary malformation. This malformation consists of dysplastic lung tissue with no connection to the tracheobronchial tree and with an anomalous systemic arterial supply. The clinical hallmarks of intralobar sequestration are recurrent pulmonary infections. Chest CT scan with contrast is actually gold standard for identifying pulmonary sequestration. CT volume-rendering technique image reconstructions can be particularly helpful in detecting anomalous arterial vessels and show the venous drainage. Surgical resection is the treatment of choice and intralobar sequestration often requires lobectomy. We present an interesting case of intralobar pulmonary sequestration with 3 aberrant arteries arising from the descending thoracic aorta in a 2-year-old boy.

Annals of Saudi Medicine, 2001

tracheoesophageal fistula (TEF), and radial limb dysplasia. 2 Generally, TEF may occur with or wi... more tracheoesophageal fistula (TEF), and radial limb dysplasia. 2 Generally, TEF may occur with or without esophageal atresia. In 85% of the VATER syndrome cases, TEF results from a fistulation of the distal esophagus to the trachea by an atretic proximal blind end of the esophagus. Polyhydramnion and excessive salivation are early clinical manifestations of TEF, followed by choking, coughing and cyanosis after the first feeding. These symptoms can even appear before the first feeding due to a saliva and gastric content aspiration. 3 Therefore, surgical repair of this

Journal of physiology and pharmacology : an official journal of the Polish Physiological Society, 2007

Experimental and clinical studies performed in adults revealed that gastresophageal reflux diseas... more Experimental and clinical studies performed in adults revealed that gastresophageal reflux disease (GORD) is associated with an appreciable increase in cough reflex sensitivity (CRS). The association between respiratory diseases and GORD is also present in children, but there is little evidence that GORD without aspiration of refluxate (proximal reflux) is a frequent cause of cough in children. The aim of this study was to find out whether CRS in children with GORD will be changed compared with healthy children, and if so, to determine the role of proximal vs. distal reflux in these changes. CRS and 24-h esophageal pH monitoring were performed in 20 children of whom 13 had confirmed GORD and 7 were suspected to have GORD. The control group consisted of 27 healthy children. For assessing the CRS, each subject inhaled 12 capsaicin aerosol concentrations (0.61-1250 micromol/l) at 1 min intervals. CRS was defined as the lowest capsaicin concentration that evoked minimally 2 coughs (C2)....

Indian Pediatrics, Mar 1, 2022

European Journal of Medical Genetics, 2016

Mitchell-Riley syndrome, an autosomal recessive disorder caused by mutations in the RFX6 gene, is... more Mitchell-Riley syndrome, an autosomal recessive disorder caused by mutations in the RFX6 gene, is defined as a combination of neonatal diabetes mellitus and serious congenital gastrointestinal defects. We describe Mitchell-Riley syndrome in two sisters with two novel compound heterozygous variants in the RFX6 gene: c.1154G > A, p.(Arg385Gln), and c.1316_1319delTCTA, p.(Ile439Thrfs*13). Both sisters present milder forms of the syndrome, likely due to possible residual activity of the p.Arg385Gln variant, which is localized in a dimerization domain of the RFX6 transcription factor. We propose that the prognosis is dependent on patient RFX6 genotype and possible residual activity of RFX6 transcription factor. Both sisters had atypical later onset of diabetes, at 2 years and 10 months and 2 years and 7 months, respectively. This supports the need of extending the definition of diabetes in Mitchell-Riley syndrome from neonatal to childhood onset and regular glyceamia check in patients with gastrointestinal tract malformations typical for Mitchell-Riley syndrome. The clinical course in both sisters improved significantly after surgical removal of parts of the small intestine with heterotopic gastric mucosa. We suggest that gastric mucosa heterotopy is an important actionable part of Mitchell-Riley syndrome and could have been responsible for the malabsorption, failure to thrive and severe anemia present in previously reported patients with Mitchell-Riley syndrome.

Videosurgery and Other Miniinvasive Techniques, 2011

Tracheal agenesis is an extremely rare, typically fatal congenital anomaly characterised by typic... more Tracheal agenesis is an extremely rare, typically fatal congenital anomaly characterised by typical clinical manifestation, failed endotracheal intubation and difficult emergency management. The prognosis and possibility of surgical correction rest on early diagnosis, anatomy, birth weight, and associated anomalies. Tracheal agenesis causes considerable resuscitation difficulties immediately after birth, as tracheal intubation is impossible. Although emergency management, by either bag and mask ventilation or oesophageal intubation, provides some pulmonary gas exchange through tracheo-oesophageal connection, they are associated with overdistension of the stomach and the risk of stomach perforation. We have performed selective intubation of the distal trachea in a child with tracheal agenesis through the tracheo-oesophageal connection with the help of a fibroendoscope. A standard guide wire was passed through the working port of the flexible endoscope and under direct vision was directed through the tracheooesophageal connection into the distal trachea. At this point, the endoscope was removed, leaving the guide wire in place. The endotracheal tube size 2 Fr was passed over the guide wire into the distal trachea. The infant showed dramatic improvement and maintained good saturations on mechanical ventilation. The infant was taken for a computed tomography (CT) scan, which showed Floyd's type II tracheal agenesis, the oesophagus connecting with the distal trachea before it bifurcates. The endotracheal tube was seen ending in the carina. Transoesophageal intubation of the short distal segment of the trachea through the tracheo-oesophageal connection might offer a new perspective for short-term securing of the airway in a child with tracheal agenesis and should be considered in any child with suspected tracheal agenesis to buy the time while evaluating the exact anatomy of the anomaly and the possibility of tracheal reconstruction in selected cases.

Ceskoslovenská pediatrie, 2002

Measurement of the oesophageal pressure is a method that facilitates understanding of the etiopat... more Measurement of the oesophageal pressure is a method that facilitates understanding of the etiopathogenesis of the gastroesophageal reflux (GER) in children. The authors analysed measurements of the oesophageal pressure in40 children, divided into two groups according to the results of 24 hours pH metry. Ineffective motility of the oesophagus has been found more frequently in children with GER compared to those with normal pH metry (in proximal oesophagus p < 0.01; in distal oesophagus p < 0.001). The authors also found, that 96% of children with GER had more than 30% uncoordinated contractions, which is significantly different from children without GER (p < 0.01). Body weight and proportion of peristaltic contractions were significantly associated both in the proximal (p < 0.001) and distal (p < 0.001) oesophagus in children without GER, while in children with GER no association was found. The authors conclude that non-specific disorders of oesophageal motility signif...

OBJECTIVES After birth, the newborn intestinal circulation undergoes physiological changes. The p... more OBJECTIVES After birth, the newborn intestinal circulation undergoes physiological changes. The purpose of this work was to characterize the changes in mesenteric blood flow velocity occuring during the first three days of life in healthy term infants. METHODS 30 healthy term newborns were studied repeatedly at the age of 2, 24 and 70 hours. Blood flow velocity in superior mesenteric artery (SMA) was measured by Doppler ultrasound, peak systolic velocity (PSV), end-diastolic velocity (EDV) and time-averaged mean velocity (TAV) were recorded at each time point. Resistance index (RI) and pulsatility index (PI) were calculated. RESULTS SMA EDV increased from 2 h [-5.2+/-6.8 cm/s (mean +/- SD)] to 24 h (12.9+/-3.8 cm/s, p<0.001) with further insignificant increase to 70 h (14.9+/-4.7 cm/s). At 2 h of age the mean EDV was negative in 23 of 30 cases (76.7%). PSV did not change between 2 h (58.0+/-21.8 cm/s) and 24 h (58.5+/-15.0 cm/s) but it increased to 70 h (79.6+/-17.7 cm/s). TAV sh...

International Journal of Environmental Research and Public Health

The global pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory... more The global pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is having a tremendous impact on the global economy, health care systems and the lives of almost all people in the world. The Central European country of Slovakia reached one of the highest daily mortality rates per 100,000 inhabitants in the first 3 months of 2021, despite implementing strong prophylactic measures, lockdowns and repeated nationwide antigen testing. The present study reports a comparison of the performance of the Standard Q COVID-19 antigen test (SD Biosensor) with three commercial RT-qPCR kits (vDetect COVID-19-MultiplexDX, gb SARS-CoV-2 Multiplex-GENERI BIOTECH Ltd. and Genvinset COVID-19 [E]-BDR Diagnostics) in the detection of infected individuals among employees of the Martin University Hospital in Slovakia. Health care providers, such as doctors and nurses, are classified as “critical infrastructure”, and there is no doubt about...

Pediatric Radiology, 2004