Lajos Szentgyorgyi - Academia.edu (original) (raw)
Papers by Lajos Szentgyorgyi
Journal of Cardiothoracic and Vascular Anesthesia
Magyar sebészet, 2008
The authors present the case of a patient with heparin induced thrombocytopaenia who needed antic... more The authors present the case of a patient with heparin induced thrombocytopaenia who needed anticoagulation during the perioperative period of a third repeat cardiac operation without transfusions. Prostacyclin pretreatment was contraindicated because of critical aortic stenosis, heparinoids could not have been used due to necessity of postoperative anticoagulation. Recombinant hirudin was applied and its effect was monitored with ekarin coagulation time. Hirudin anticoagulation was continued until the proper INR was reached in the postoperative period. There were no intra- and postoperative complications detected, and there was no need for transfusion either. On his long-term follow-up, 6.5 years after the last cardiac surgery the patients was feeling well and had no complaints. Open heart operation of a patient with heparin induced thrombocythopenia can be performed safely by total anticoagulation with lepirudin if it is conducted by ecarin clotting time.
Minerva surgery, Nov 1, 2022
BACKGROUND Surgical repair of tracheobronchial tree injuries is challenging due to the difficulti... more BACKGROUND Surgical repair of tracheobronchial tree injuries is challenging due to the difficulties associated with providing perioperative ventilatory support. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a recognised treatment modality for managing respiratory failure. Its use has expanded to include offering respiratory support for patients requiring surgery on the tracheobronchial tree. This study presents our experience with V-V ECMO support for elective and emergency surgery for acquired and iatrogenic tracheobronchial pathology. METHODS A retrospective review of our single-centre experience of surgical tracheobronchial repairs where V-V ECMO was employed between 2017 and 2020 was undertaken. Preoperative patient characteristics, intra-operative findings, details of ECMO support and postoperative outcomes were collected and analysed. RESULTS Five patients underwent surgery with V-V ECMO support during the study period. Indications for surgery included repair of iatrogenic tracheal tear (n=2), repair of iatrogenic gastro-bronchial fistula (n=1), elective tracheoplasty (n=1) and elective resection of tracheal tumour (n=1). The median duration of V-V ECMO was 17 hours (range 4-543 hours), and the median postoperative length of stay was 9 days (range 7-19 days). In-hospital and 90-day mortality were both 0% (n=0). Post-operative complications included reoperation for bleeding (n=1) and thrombotic complications (n=2). CONCLUSIONS We have shown how V-V ECMO can be safely utilised to manage patients with a range of tracheobronchial injuries with low rates of postoperative morbidity. Acceptable postoperative outcomes can be achieved for this cohort of clinically complex patients when treatment is provided with a multidisciplinary team approach in high-volume specialist centres.
BMJ Open, Jul 1, 2019
et al. Randomised controlled trial to investigate the effectiveness of thoracic epidural and para... more et al. Randomised controlled trial to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain (TOPIC): a pilot study to assess feasibility of a large multicentre trial. BMJ Open 2019;9:e023679.
PubMed, 2005
Background: Recent reports have demonstrated that cardiopulmonary bypass (CBP) utilization leads ... more Background: Recent reports have demonstrated that cardiopulmonary bypass (CBP) utilization leads to a TH2 cytokine bias in patients undergoing coronary artery bypass grafting (CABG) operation. The relation of soluble ST2 and secretion of IL-10, markers of TH2 T-cell activation, and IL-13 in relation to immunoglobulin isotope production is not known in patients undergoing On- versus Off-pump (CABG) procedure. Methods: 30 patients were prospectively included in the study (On- vs Off-pump CABG, each n = 15). Serum samples were obtained prior to, and 30 min, 60 min and 24hrs after operation. ELISA was utilized to detect sST2 and IL-10, IL-13 and immunoglobulin isotype production. Results: In both cohorts we could demonstrate a significant rise of ST2 24 hours after the CABG procedure. In the On-pump group ST2 levels (pg/ml) before the operation, at 30 and 60 minutes and after 24 hours were 115.3 +/- 25, 71.2 +/- 15, 114.1 +/- 26 and 4231.9 +/- 520, respectively. In the Off-pump group they were 200.3 +/- 109, 91.2 +/- 20, 137 +/- 29 and 4144.9 +/- 488 (both, p < 0.0001, p < 0.0001, respectively). IL-10 (pg/ml) levels rose from preoperative values of 6.2 +/- 1.6 in the On-pump group and 7.91 +/- 1.8 in the Off-pump group to 33.14 +/- 8.7 and 13.72 +/- 3 after 60 minutes (p 0.0189, p 0.0397, respectively). IL-13 levels and immunoglobulin production did not change significantly within the study period irrespective of the operation procedure used. Conclusion: In conclusion, our results demonstrate that sST2 and IL-10, markers of TH2 cytokine producing cells, are increased in CABG operation, irrespective of the procedure selected, and settles a longstanding controversy concerning the shift from Th1 to Th2 cells.
Burns, Aug 1, 2018
Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal li... more Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal life support (ECLS) and can be used as rescue therapy in patients with severe respiratory failure resulting from burns and/or smoke inhalation injury. Experience and literature on this treatment option is still very limited, consequently results are varied. We report a retrospective analysis of our experience with veno-venous (VV) ECMO in burn patients. All five patients, three male and two female (age: 28-37 years) had flame type burns and smoke inhalation injury. Their Murray scores ranged between 3.25 and 3.75, and their revised Baux scores between 62 and 102. The mean pre-ECMO conventional ventilation time was 7.4days (3-13). The mean ECMO duration was 18days (8-35). Three patients were cannulated with dual lumen, two with separate cannulae. One oxygenator had to be changed due to technical issues and two patients needed two parallel oxygenators. Four patients had renal replacement therapy. All patients needed vasoconstrictor support, antibiotics and packed red blood cells (5-62 units). Three had steroid treatment. All five patients were successfully weaned from ECMO. One patient died later from multi-organ failure in the ICU, the other four patients survived. VV-ECMO is a useful rescue intervention in patients with burns related severe respiratory failure. Patients in our institution benefit from having both burns and ECMO centres with major expertise in the field under one roof. The results from this small cohort are encouraging, although more cases are needed to draw more robust conclusions.
Background Thoracotomy is considered one of the most painful surgical procedures and can cause de... more Background Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost effectiveness in preventing chronic post-thoracotomy pain. Methods TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomized controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomized in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qua...
Journal of Cardiothoracic and Vascular Anesthesia
Journal of Cardiothoracic and Vascular Anesthesia
thorough preoxygenation with 100% oxygen for several minutes prior to each application, limiting ... more thorough preoxygenation with 100% oxygen for several minutes prior to each application, limiting the flow and the duration of the treatment bursts, and rapidly correcting the resulting hypoxemia using intermittent jet ventilation with 100% oxygen. In addition to the risk of hypoxemia, the massive gas expansion has the potential for causing barotrauma. Protection against barotrauma necessitates strict observance of unobstructed passive ventilation. This requires the use of a large (48.5) endotracheal tube when a flexible bronchoscope is used to allow for effective unobstructed passive release of the volatized liquid nitrogen. Another rare risk of the procedure is the development of unpredictable life-threatening hemodynamic instability following endobronchial LNSCT, which was thought to be due to pulmonary venous gaseous emboli into the heart, coronary arteries, and systemic circulation. 4 Effective communication between the anesthesiologist and the pulmonologist is critical for mitigating and dealing with the risks of LNSCT.
Journal of Cardiothoracic and Vascular Anesthesia, 2018
Journal of Cardiothoracic and Vascular Anesthesia, 2016
Respiratory Medicine Case Reports, 2015
A previously fit and well man developed acute respiratory failure due to environmental mould expo... more A previously fit and well man developed acute respiratory failure due to environmental mould exposure from living in damp rental accommodation. Despite aggressive intensive care management he rapidly deteriorated and required respiratory and cardiac Extracorporeal Membrane Oxygenation. We hypothesize that poor domiciliary conditions may make an underestimated contribution to community respiratory disease. These conditions may present as acute and severe illness with non-typical pathogens identified.
Orvosi hetilap, Jan 16, 2003
This is a case report of a 52 year-old male patient with severe calcific aortic valve stenosis, a... more This is a case report of a 52 year-old male patient with severe calcific aortic valve stenosis, associated with extended circular calcification of the ascending aorta and the aortic arch. Six months ago the patient underwent an explorative sternotomy in another institute, but the aortic valve replacement was not performed regarding the great risk of the porcelain aorta. The patient's complaints became more severe, so the authors recommended the excision both of the stenotic aortic valve and the calcified ascending aorta and replacement with a mechanical valve and vascular prosthesis. The operation was performed in deep hypothermia and total circulatory arrest with help of cardiopulmonary bypass. The calcified ascending aorta was excised without crossclamping. The vascular graft used for replacement of the ascending aorta was anastomosed to the proximal part of the aortic arch, then it was clamped and the extracorporal circulation was started again with rewarming of the patient. ...
Magyar Sebészet (Hungarian Journal of Surgery), 2008
Absztrakt A szerzők két beteg szívműtéte során fellépő tűzesetet ismertetik. Minkét esetben az op... more Absztrakt A szerzők két beteg szívműtéte során fellépő tűzesetet ismertetik. Minkét esetben az operációs terület szokásos fertőtlenítésén és izolálásán kívül a műtét folyamán 70%-os alkoholtartalmú fertőtlenítő oldattal való lemosással óhajtották a műtéti sebfertőzés veszélyét csökkenteni, illetve a megbomlott műtéti izolálást helyreállítani. Az alkoholos fertőtlenítővel való lemosás után a szinte azonnal alkalmazott diathermia az el nem párolgott alkoholt meggyújtotta. Az egyik betegnél a tűz ráterjedt a műtéti fóliára, és kb. 5%-os másodfokú és 1%-os harmadfokú égési sérülést okozott, amely plasztikai sebészi kezelést igényelt. A másik betegnél a tűz meggyújtotta a beteg szakállát, és 1%-os másodfokú égési sérülést okozott, amely a szokásos helyi sebkezelésre meggyógyult. Mindkét beteg felépült szívműtétje után az égési sérülések ellenére. Ez a két tűzsérülés az összes műtét 0,003–0,004%-a. Következtetés: A műtét alatti – szerencsére igen ritka – tűzesetek súlyos következményekkel...
Magyar Sebészet (Hungarian Journal of Surgery), 2008
Absztrakt A szerzők heparin által kiváltott thrombocytopeniában szenvedő beteg billentyűhibája mi... more Absztrakt A szerzők heparin által kiváltott thrombocytopeniában szenvedő beteg billentyűhibája miatti harmadik szívműtétjének véralvadásgátlását hirudinnal végezték. A szoros aortaszűkület miatt prostacyclin-előkezelés nem jöhetett szóba, és a műtét utáni alvadásgátlás igénye a heparinoidok alkalmazását is kizárta. Rekombináns hirudint (Refludan®/Hoechst) adagoltak és a plazmaszintet ekarin alvadási idő segítségével ellenőrizték. Műtét után újraindították a cumarin hatású véralvadásgátló kezelést, de a hirudin adását az INR kívánt szintjének beállításáig folytatták. A műtét és az ezt követő időszak szövődménymentesen zajlott le, a beteg transzfúziót nem igényelt, és 6,5 évvel a legutóbbi szívműtétje óta panaszmentes és elégedett az életminőségével. Következtetés: Heparinindukált thrombocytopeniában szenvedő beteg nyitott szívműtétjének elvégzéséhez szükséges teljes fokú véralvadásgátlás hirudinnal biztonságosan végezhető, ha azt ekarin alvadási idővel ellenőrzik és vezérlik.
Magyar sebészet, 2003
Invading the inferior vena cava and right atrium is the most serious, but fortunately not common ... more Invading the inferior vena cava and right atrium is the most serious, but fortunately not common complication of renal cell carcinoma. Radical nephrectomy with tumor-thrombus extraction is the only way to improve these patients survival. Cardiopulmonary bypass with or without deep hypothermia and total circulatory arrest might be necessary during surgery. Between 1998 and 2003 at the Department of Cardiac Surgery of University of Debrecen, 5 patients, with renal cell carcinoma extending into the right atrium, had radical nephrectomy and thrombectomy. We used cardiopulmonary bypass, in 2 patients in total circulatory arrest, in deep hypothermia. There was no operative death and neurological complications. One patient died 3 years after the operation due to cardiac failure. In average 42 months after surgery, 4 surviving patients are under regular follow up, they have a good quality of life, without recurrence. In our opinion cardiopulmonary bypass and total circulatory arrest, if nec...
JMM Case Reports, 2015
Introduction: The Legionellaceae are fastidious Gram-negative bacteria that reside in aquatic env... more Introduction: The Legionellaceae are fastidious Gram-negative bacteria that reside in aquatic environments. They are a cause of severe community acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 70-90 % of human infection, with cases caused by some of the other 15 serogroups accounting for the rest. Most hospitals use the Legionella urinary antigen test for detection of legionellosis; however, this will only reliably detect L. pneumophila serogroup 1. Case presentation: We report two cases of severe community acquired pneumonia in patients requiring extracorporeal membrane oxygenation, referred to our adult Severe Respiratory Failure Unit. Legionella urinary antigen was negative in both cases. As clinical presentation strongly suggested Legionnaires' disease (LD), respiratory samples were sent to the reference laboratory for PCR, which confirmed L. pneumophila non-serogroup 1 in both cases. Case 1 was subsequently confirmed by culture and confirmed as L. pneumophila serogroup 5. Case 2 was culture-negative. Conclusion: Legionella is an important pathogen. Recognition of the potential for non-serogroup 1 strains to cause severe LD should prompt requests for further investigations including Legionella PCR in patients who present with suggestive symptoms when the urine antigen is negative. Reliance on the urine antigen test may result in a potentially serious under-recognition of L. pneumophila nonserogroup 1 and lead to mis-diagnoses and inappropriate antimicrobial treatment.
Endocrine …, 2012
Methods: Patients undergoing cardiothoracic surgery without any history of glucocorticoid drug us... more Methods: Patients undergoing cardiothoracic surgery without any history of glucocorticoid drug use or adrenal pathology were recruited into the study. Paired saliva and serum samples were collected pre-and post-operatively. Serum total cortisol, serum free cortisol, ...
Journal of Cardiothoracic and Vascular Anesthesia
Magyar sebészet, 2008
The authors present the case of a patient with heparin induced thrombocytopaenia who needed antic... more The authors present the case of a patient with heparin induced thrombocytopaenia who needed anticoagulation during the perioperative period of a third repeat cardiac operation without transfusions. Prostacyclin pretreatment was contraindicated because of critical aortic stenosis, heparinoids could not have been used due to necessity of postoperative anticoagulation. Recombinant hirudin was applied and its effect was monitored with ekarin coagulation time. Hirudin anticoagulation was continued until the proper INR was reached in the postoperative period. There were no intra- and postoperative complications detected, and there was no need for transfusion either. On his long-term follow-up, 6.5 years after the last cardiac surgery the patients was feeling well and had no complaints. Open heart operation of a patient with heparin induced thrombocythopenia can be performed safely by total anticoagulation with lepirudin if it is conducted by ecarin clotting time.
Minerva surgery, Nov 1, 2022
BACKGROUND Surgical repair of tracheobronchial tree injuries is challenging due to the difficulti... more BACKGROUND Surgical repair of tracheobronchial tree injuries is challenging due to the difficulties associated with providing perioperative ventilatory support. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is a recognised treatment modality for managing respiratory failure. Its use has expanded to include offering respiratory support for patients requiring surgery on the tracheobronchial tree. This study presents our experience with V-V ECMO support for elective and emergency surgery for acquired and iatrogenic tracheobronchial pathology. METHODS A retrospective review of our single-centre experience of surgical tracheobronchial repairs where V-V ECMO was employed between 2017 and 2020 was undertaken. Preoperative patient characteristics, intra-operative findings, details of ECMO support and postoperative outcomes were collected and analysed. RESULTS Five patients underwent surgery with V-V ECMO support during the study period. Indications for surgery included repair of iatrogenic tracheal tear (n=2), repair of iatrogenic gastro-bronchial fistula (n=1), elective tracheoplasty (n=1) and elective resection of tracheal tumour (n=1). The median duration of V-V ECMO was 17 hours (range 4-543 hours), and the median postoperative length of stay was 9 days (range 7-19 days). In-hospital and 90-day mortality were both 0% (n=0). Post-operative complications included reoperation for bleeding (n=1) and thrombotic complications (n=2). CONCLUSIONS We have shown how V-V ECMO can be safely utilised to manage patients with a range of tracheobronchial injuries with low rates of postoperative morbidity. Acceptable postoperative outcomes can be achieved for this cohort of clinically complex patients when treatment is provided with a multidisciplinary team approach in high-volume specialist centres.
BMJ Open, Jul 1, 2019
et al. Randomised controlled trial to investigate the effectiveness of thoracic epidural and para... more et al. Randomised controlled trial to investigate the effectiveness of thoracic epidural and paravertebral blockade in reducing chronic post-thoracotomy pain (TOPIC): a pilot study to assess feasibility of a large multicentre trial. BMJ Open 2019;9:e023679.
PubMed, 2005
Background: Recent reports have demonstrated that cardiopulmonary bypass (CBP) utilization leads ... more Background: Recent reports have demonstrated that cardiopulmonary bypass (CBP) utilization leads to a TH2 cytokine bias in patients undergoing coronary artery bypass grafting (CABG) operation. The relation of soluble ST2 and secretion of IL-10, markers of TH2 T-cell activation, and IL-13 in relation to immunoglobulin isotope production is not known in patients undergoing On- versus Off-pump (CABG) procedure. Methods: 30 patients were prospectively included in the study (On- vs Off-pump CABG, each n = 15). Serum samples were obtained prior to, and 30 min, 60 min and 24hrs after operation. ELISA was utilized to detect sST2 and IL-10, IL-13 and immunoglobulin isotype production. Results: In both cohorts we could demonstrate a significant rise of ST2 24 hours after the CABG procedure. In the On-pump group ST2 levels (pg/ml) before the operation, at 30 and 60 minutes and after 24 hours were 115.3 +/- 25, 71.2 +/- 15, 114.1 +/- 26 and 4231.9 +/- 520, respectively. In the Off-pump group they were 200.3 +/- 109, 91.2 +/- 20, 137 +/- 29 and 4144.9 +/- 488 (both, p < 0.0001, p < 0.0001, respectively). IL-10 (pg/ml) levels rose from preoperative values of 6.2 +/- 1.6 in the On-pump group and 7.91 +/- 1.8 in the Off-pump group to 33.14 +/- 8.7 and 13.72 +/- 3 after 60 minutes (p 0.0189, p 0.0397, respectively). IL-13 levels and immunoglobulin production did not change significantly within the study period irrespective of the operation procedure used. Conclusion: In conclusion, our results demonstrate that sST2 and IL-10, markers of TH2 cytokine producing cells, are increased in CABG operation, irrespective of the procedure selected, and settles a longstanding controversy concerning the shift from Th1 to Th2 cells.
Burns, Aug 1, 2018
Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal li... more Extracorporeal membrane oxygenation (ECMO) is one of the most frequent forms of extracorporeal life support (ECLS) and can be used as rescue therapy in patients with severe respiratory failure resulting from burns and/or smoke inhalation injury. Experience and literature on this treatment option is still very limited, consequently results are varied. We report a retrospective analysis of our experience with veno-venous (VV) ECMO in burn patients. All five patients, three male and two female (age: 28-37 years) had flame type burns and smoke inhalation injury. Their Murray scores ranged between 3.25 and 3.75, and their revised Baux scores between 62 and 102. The mean pre-ECMO conventional ventilation time was 7.4days (3-13). The mean ECMO duration was 18days (8-35). Three patients were cannulated with dual lumen, two with separate cannulae. One oxygenator had to be changed due to technical issues and two patients needed two parallel oxygenators. Four patients had renal replacement therapy. All patients needed vasoconstrictor support, antibiotics and packed red blood cells (5-62 units). Three had steroid treatment. All five patients were successfully weaned from ECMO. One patient died later from multi-organ failure in the ICU, the other four patients survived. VV-ECMO is a useful rescue intervention in patients with burns related severe respiratory failure. Patients in our institution benefit from having both burns and ECMO centres with major expertise in the field under one roof. The results from this small cohort are encouraging, although more cases are needed to draw more robust conclusions.
Background Thoracotomy is considered one of the most painful surgical procedures and can cause de... more Background Thoracotomy is considered one of the most painful surgical procedures and can cause debilitating chronic post-surgical pain lasting months or years postoperatively. Aggressive management of acute pain resulting from thoracotomy may reduce the likelihood of developing chronic pain. This trial compares the two most commonly used modes of acute analgesia provision at the time of thoracotomy (thoracic epidural blockade (TEB) and paravertebral blockade (PVB)) in terms of their clinical and cost effectiveness in preventing chronic post-thoracotomy pain. Methods TOPIC 2 is a multi-centre, open-label, parallel group, superiority, randomized controlled trial, with an internal pilot investigating the use of TEB and PVB in 1026 adult (≥ 18 years old) patients undergoing thoracotomy in up to 20 thoracic centres throughout the UK. Patients (N = 1026) will be randomized in a 1:1 ratio to receive either TEB or PVB. During the first year, the trial will include an integrated QuinteT (Qua...
Journal of Cardiothoracic and Vascular Anesthesia
Journal of Cardiothoracic and Vascular Anesthesia
thorough preoxygenation with 100% oxygen for several minutes prior to each application, limiting ... more thorough preoxygenation with 100% oxygen for several minutes prior to each application, limiting the flow and the duration of the treatment bursts, and rapidly correcting the resulting hypoxemia using intermittent jet ventilation with 100% oxygen. In addition to the risk of hypoxemia, the massive gas expansion has the potential for causing barotrauma. Protection against barotrauma necessitates strict observance of unobstructed passive ventilation. This requires the use of a large (48.5) endotracheal tube when a flexible bronchoscope is used to allow for effective unobstructed passive release of the volatized liquid nitrogen. Another rare risk of the procedure is the development of unpredictable life-threatening hemodynamic instability following endobronchial LNSCT, which was thought to be due to pulmonary venous gaseous emboli into the heart, coronary arteries, and systemic circulation. 4 Effective communication between the anesthesiologist and the pulmonologist is critical for mitigating and dealing with the risks of LNSCT.
Journal of Cardiothoracic and Vascular Anesthesia, 2018
Journal of Cardiothoracic and Vascular Anesthesia, 2016
Respiratory Medicine Case Reports, 2015
A previously fit and well man developed acute respiratory failure due to environmental mould expo... more A previously fit and well man developed acute respiratory failure due to environmental mould exposure from living in damp rental accommodation. Despite aggressive intensive care management he rapidly deteriorated and required respiratory and cardiac Extracorporeal Membrane Oxygenation. We hypothesize that poor domiciliary conditions may make an underestimated contribution to community respiratory disease. These conditions may present as acute and severe illness with non-typical pathogens identified.
Orvosi hetilap, Jan 16, 2003
This is a case report of a 52 year-old male patient with severe calcific aortic valve stenosis, a... more This is a case report of a 52 year-old male patient with severe calcific aortic valve stenosis, associated with extended circular calcification of the ascending aorta and the aortic arch. Six months ago the patient underwent an explorative sternotomy in another institute, but the aortic valve replacement was not performed regarding the great risk of the porcelain aorta. The patient's complaints became more severe, so the authors recommended the excision both of the stenotic aortic valve and the calcified ascending aorta and replacement with a mechanical valve and vascular prosthesis. The operation was performed in deep hypothermia and total circulatory arrest with help of cardiopulmonary bypass. The calcified ascending aorta was excised without crossclamping. The vascular graft used for replacement of the ascending aorta was anastomosed to the proximal part of the aortic arch, then it was clamped and the extracorporal circulation was started again with rewarming of the patient. ...
Magyar Sebészet (Hungarian Journal of Surgery), 2008
Absztrakt A szerzők két beteg szívműtéte során fellépő tűzesetet ismertetik. Minkét esetben az op... more Absztrakt A szerzők két beteg szívműtéte során fellépő tűzesetet ismertetik. Minkét esetben az operációs terület szokásos fertőtlenítésén és izolálásán kívül a műtét folyamán 70%-os alkoholtartalmú fertőtlenítő oldattal való lemosással óhajtották a műtéti sebfertőzés veszélyét csökkenteni, illetve a megbomlott műtéti izolálást helyreállítani. Az alkoholos fertőtlenítővel való lemosás után a szinte azonnal alkalmazott diathermia az el nem párolgott alkoholt meggyújtotta. Az egyik betegnél a tűz ráterjedt a műtéti fóliára, és kb. 5%-os másodfokú és 1%-os harmadfokú égési sérülést okozott, amely plasztikai sebészi kezelést igényelt. A másik betegnél a tűz meggyújtotta a beteg szakállát, és 1%-os másodfokú égési sérülést okozott, amely a szokásos helyi sebkezelésre meggyógyult. Mindkét beteg felépült szívműtétje után az égési sérülések ellenére. Ez a két tűzsérülés az összes műtét 0,003–0,004%-a. Következtetés: A műtét alatti – szerencsére igen ritka – tűzesetek súlyos következményekkel...
Magyar Sebészet (Hungarian Journal of Surgery), 2008
Absztrakt A szerzők heparin által kiváltott thrombocytopeniában szenvedő beteg billentyűhibája mi... more Absztrakt A szerzők heparin által kiváltott thrombocytopeniában szenvedő beteg billentyűhibája miatti harmadik szívműtétjének véralvadásgátlását hirudinnal végezték. A szoros aortaszűkület miatt prostacyclin-előkezelés nem jöhetett szóba, és a műtét utáni alvadásgátlás igénye a heparinoidok alkalmazását is kizárta. Rekombináns hirudint (Refludan®/Hoechst) adagoltak és a plazmaszintet ekarin alvadási idő segítségével ellenőrizték. Műtét után újraindították a cumarin hatású véralvadásgátló kezelést, de a hirudin adását az INR kívánt szintjének beállításáig folytatták. A műtét és az ezt követő időszak szövődménymentesen zajlott le, a beteg transzfúziót nem igényelt, és 6,5 évvel a legutóbbi szívműtétje óta panaszmentes és elégedett az életminőségével. Következtetés: Heparinindukált thrombocytopeniában szenvedő beteg nyitott szívműtétjének elvégzéséhez szükséges teljes fokú véralvadásgátlás hirudinnal biztonságosan végezhető, ha azt ekarin alvadási idővel ellenőrzik és vezérlik.
Magyar sebészet, 2003
Invading the inferior vena cava and right atrium is the most serious, but fortunately not common ... more Invading the inferior vena cava and right atrium is the most serious, but fortunately not common complication of renal cell carcinoma. Radical nephrectomy with tumor-thrombus extraction is the only way to improve these patients survival. Cardiopulmonary bypass with or without deep hypothermia and total circulatory arrest might be necessary during surgery. Between 1998 and 2003 at the Department of Cardiac Surgery of University of Debrecen, 5 patients, with renal cell carcinoma extending into the right atrium, had radical nephrectomy and thrombectomy. We used cardiopulmonary bypass, in 2 patients in total circulatory arrest, in deep hypothermia. There was no operative death and neurological complications. One patient died 3 years after the operation due to cardiac failure. In average 42 months after surgery, 4 surviving patients are under regular follow up, they have a good quality of life, without recurrence. In our opinion cardiopulmonary bypass and total circulatory arrest, if nec...
JMM Case Reports, 2015
Introduction: The Legionellaceae are fastidious Gram-negative bacteria that reside in aquatic env... more Introduction: The Legionellaceae are fastidious Gram-negative bacteria that reside in aquatic environments. They are a cause of severe community acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 70-90 % of human infection, with cases caused by some of the other 15 serogroups accounting for the rest. Most hospitals use the Legionella urinary antigen test for detection of legionellosis; however, this will only reliably detect L. pneumophila serogroup 1. Case presentation: We report two cases of severe community acquired pneumonia in patients requiring extracorporeal membrane oxygenation, referred to our adult Severe Respiratory Failure Unit. Legionella urinary antigen was negative in both cases. As clinical presentation strongly suggested Legionnaires' disease (LD), respiratory samples were sent to the reference laboratory for PCR, which confirmed L. pneumophila non-serogroup 1 in both cases. Case 1 was subsequently confirmed by culture and confirmed as L. pneumophila serogroup 5. Case 2 was culture-negative. Conclusion: Legionella is an important pathogen. Recognition of the potential for non-serogroup 1 strains to cause severe LD should prompt requests for further investigations including Legionella PCR in patients who present with suggestive symptoms when the urine antigen is negative. Reliance on the urine antigen test may result in a potentially serious under-recognition of L. pneumophila nonserogroup 1 and lead to mis-diagnoses and inappropriate antimicrobial treatment.
Endocrine …, 2012
Methods: Patients undergoing cardiothoracic surgery without any history of glucocorticoid drug us... more Methods: Patients undergoing cardiothoracic surgery without any history of glucocorticoid drug use or adrenal pathology were recruited into the study. Paired saliva and serum samples were collected pre-and post-operatively. Serum total cortisol, serum free cortisol, ...