Lipidomic characterization of omega-3 polyunsaturated fatty acids in phosphatidylcholine and phosphatidylethanolamine species of egg yolk lipid derived from hens fed flaxseed oil and marine algal biomass.

Membrane phospholipids, including phosphatidylcholine (PC) and phosphatidylethanolamine (PE), consist of distinct fatty acids occupying the sn-1 and sn-2 positions, reflecting the highly regulated nature of lipid biosynthesis. However, little is known about the influence of dietary lipids on the positional nature of fatty acids in tissues, including the enrichment of omega-3 polyunsaturated fatty acid (PUFA) in chicken egg yolk phospholipids. This study was undertaken to characterize the PC and PE species in egg lipids derived from Lohmann hens (n=10/treatment) randomly allocated to either a control (no supplementation), a flaxseed oil (FO) or a marine algal oil (MA) diet. Each of the FO or MA diets supplied three levels of total omega-3 PUFA (0.20, 0.40 and 0.60% of diet) that were provided for 6 weeks. A combination of multiplexed mass spectrometry (MS) experiments are used to determine total, isobaric, and position molecules for PC and PE in egg yolk. The distribution of phospholipids in the yolk was predominantly PC over PE (~72 vs. 23%, respectively) across treatments. The longer chain PUFA existed in the sn-2 position in the PC and PE. Although docosahexaenoic acid (22:6) formed isomers with fatty acids 16:0, 18:0 and 18:1; it was preferentially enriched in the egg in combination with 16:0 with both the FO and MA-fed groups in both lipid pools. All 22:6-containing isomers were enriched by ~2-fold more (P < 0.0001) with MA than FO, however, all isomers exhibited a plateau with the FO-fed group. In addition, the MS analyses of PCs revealed several isobaric species containing eicosapentaenoic acid (EPA, 20:5), however, in the PE, EPA formed only one isomer (i.e. in combination with 16:0). These results may assist to elucidate potential aspects regulating the limited enrichment of omega-3 PUFA, particularly EPA and docosahexaenoic acid (22:6) in chicken eggs.

[Aortic valve sparing operations and reconstruction--from anatomy to the long-term results]. / Záchovné operate a plastiky aortální chlopne--od anatomie chlopne az k dlouhodobým výsledkum.

The implantation of an artificial heart valve (a mechanical valve or a xenograft valve) involves the risk of serious and life-threatening complications for the patient, such as hemorrhagic complications, thromboembolic complications, the risk of endocarditis, the risk of premature degeneration of the xenograft valve, etc. Preserving the patient's own aortic valve eliminates or at least significantly reduces the above complications. On the other hand, it brings about the disadvantage of a technically more demanding surgery and the possible risk of reoperation due to failure of the spared aortic valve. The authors present a comprehensive and up-to-date view ofthe issue of aortic valve sparing surgeries and plastic corrections, beginning with the basics of aortic root anatomy and ending with the indications and principles of cardiosurgical techniques, and long-term results.

Cardiac amyloidosis in the cardiosurgical operating room--a rare but fatal trap.

Coronary artery bypass grafting resulted in a fatal outcome in two patients with unsuspected cardiac amyloidosis. Despite preoperative symptoms of myocardial ischemia, each case represented a different pathophysiological combination of cardiac amyloidosis and coronary artery disease. Pitfalls preventing correct diagnosis and possible patterns of treatment are discussed.

Complete proteinogram of cerebrospinal fluid and its contribution to the diagnostics of inflammatory and autoimmune diseases of the central nervous system.

Complete evaluation of cerebrospinal fluid proteinogram represents a routine request of the clinician in the analysis of CSF in the Czech Republic. It comprises the measurement of concentrations of acute phase proteins (CRP, orosomucoid, haptoglobin, transferrin, prealbumin), immunoglobulins (IgG, IgA, IgM), compressive markers (albumin, fibrinogen), markers of CNS tissue destruction (apolipoproteins A-I, A-II, Apo B), complement components (C3, C4), alpha-1-microglobulin, beta-2-microglobulin, and proteinase inhibitors (alpha-1-antitrypsin, antithrombin III). Therefore, 19 CSF proteins of precisely verified clinical relevance are routine parameters for the assessment of the functional state of the blood-CSF barrier, presence of the intrathecal synthesis of immunoglobulins, inflammatory changes and verification of CNS tissue destruction. Evidence of these clinically relevant and independent parameters enabled the detection of the presence of autoimmune and neuroinfective diseases of CNS, even in clinical cases where the basic CSF parameters do not express relevant changes, or they are of a bordering or non-specific character. Clinically typical and the most significant abnormalities in the CSF proteinogram represent themselves a new access to a contemporary CSF analysis. Despite the fact that assessment of CSF proteins and their analysis is quite a difficult field in laboratory medicine, it is now routinely requested and routinely performed in the Czech Republic.

[Surgical treatment of lung cancer]. / Chirurgická lécba plicní rakoviny.

The surgical treatment of lung cancer has got a long tradition at our department. The aim of this work is to evaluate the group of 3,727 patients from the years 1948-1995. The special analysis has been performed of the group of 1,456 patients from the years 1974-1995 undergoing lung resection. Evaluating our operation policy a strong trend from pneumonectomy to less extensive operations can be found. The introduction of bronchoplastic operations and modern diagnostic methods has substantially improved the possibility of surgical treatment. The utilization of TNM system enabled to compare the different groups of patients according to the unified classification. The long term survival was directly related to the stage and histological type of disease. The five years period survived 32% of patients in whom the lung resection was performed during the period 1974-1995. The operative hospital mortality has been substantially reduced to 2%. Even though it is our duty to provide the surgical treatment to all the patients if the resection is still possible the best results are to be expected in patients in the first stage of disease. Therefore the early diagnosis followed by adequately sized resection without delay offers the best chance for the patients long term survival.

[Penetrating injuries of the heart and great vessels]. / Pronikající poranení srdce a velkých cév.

Between January 1975 and June 2000 565 patients with thoracic injuries were treated at our institution. 116 of them had penetrating thoracic traumas and 42 injuries of the heart and great vessels. Study includes two groups of patients: hemodynamic stable and hemodynamic unstable ones. Different algorithms of management, techniques, treatment and prognosis are described. In the group of hemodynamic unstable patients the emergency surgical treatment had to be performed sometimes even without the benefit of any radiological imaging method. Mortality rate of patients having reached the hospital equated 23.8%. The surgical treatment results were better in the past decade because of improvement in prehospital care and higher quality of emergency medical system. The possibility of fast transportation allowed a higher percentage of critically injured patients to reach the hospital alive.

Morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery.

BACKGROUND AND AIM: Due to the constantly improving results of surgical revascularization for coronary heart disease even the elderly patients are offered more frequently this type of treatment. Since older age is a harbinger of reduced vital capacity and increased morbidity the results of coronary artery bypass grafting (CABG) in elderly as well as long-term benefit deserve a careful examination. MATERIALS AND METHODS: 1475 isolated CABG procedures performed between 1995 and 1997 in a university hospital cardiac surgery unit, divided in group I (age below 70, n = 1324) and group II (age 70 and over, n = 151). A retrospective analysis of pre-operative, peri-operative and post-operative data. RESULTS: Significant differences (lower BMI and BSA, advanced NYHA and CCS stage, higher prevalence of diabetes, renal dysfunction and extracardial atherosclerotic lesions) were found in elderly. CABG was performed in both groups with no differences in technique of procedure (only slightly longer duration of CPB in group II). However, there was markedly higher mortality (2.3 vs. 7.3%, p < 0.005), incidence of NearMiss+ (18.4 vs. 36.4%, p < 0.005) and post-operative morbidity (34.6 vs. 56.3%, p < 0.005) in the older group, which was also expressed in a longer ICU stay and postoperative hospitalization. CONCLUSION: Coronary revascularization can be performed in elderly with higher but still acceptable risk. Higher mortality and associated morbidity is caused by higher preoperative prevalence of known risk factors as well as generally reduced vital capacity. Surgical procedure should not be denied to elderly population because of the age alone but a careful evaluation of an individual patient is required.

Axillary-coronary artery bypass reconstruction as an alternative in coronary artery reoperations.

BACKGROUND AND AIMS: The increasing incidence of reoperations in coronary surgery associated with higher perioperative risks is a challenge for refinement of the surgical methods. The aim of the work is to prove the feasibility and satisfactory intermediate results of minimally invasive axillary-coronary artery bypass reconstruction in redo coronary surgery in case the left internal mammary artery had already been harvested. MATERIAL AND METHODS: Three patients (six months, two and six years after primary coronary artery bypass grafting) admitted for redo coronary surgery because of a recurrence of angina and proven malfunction of the left internal mammary artery-left anterior descending coronary artery anastomosis. An axillary-coronary venous graft was performed via left anterior small thoracotomy (LAST) on a beating heart in all three cases. RESULTS: Excellent patency of the graft was noted on control angiography within 9 days after the procedure together with good clinical improvement in midterm follow-up. CONCLUSION: Minimally invasive axillary-coronary artery bypass via LAST access in redo coronary surgery is a good alternative in cases where the left internal mammary artery cannot be used.

Thoracic electrical bioimpedance versus thermodilution in patients post open-heart surgery.

Thoracic electrical bioimpedance cardiography is a non-invasive, continuous and low-cost method of estimation of cardiac output and other haemodynamic parameters. Though subject to continuous technological refinement controversial opinions exist on its validity in subsets of critically ill patients, patients with heart disease or after cardiac surgery. A comparison study between thermodilution (TD) and bioimpedance (TEB) was performed in 28 patients undergoing elective cardiac surgery (CABG, aortic or mitral valve replacement or combined procedures). 128 pairs of cardiac index estimates at specific time points during 20 hours at the postoperative ICU were evaluated. A poor correlation (r = 0.26, p < 0.05, bias -0.07 l.min-1.m2, precision + 1.1 l.min-1.m-2, 95% limits of agreement -2.27-2.13 l.min-1.m-2) between TD and TEB cannot support the routine use of TEB monitoring in early postoperative period after open-heart surgery. Possible reasons of lack of agreement in this population are discussed. Further studies with technically improved bioimpedance cardiographs will be needed.

[Coronary revascularization in diffuse atherosclerosis of the anterior descending coronary artery]. / Chirurgické moznosti revaskularizace srdce pri difuzním aterosklerotickém postizení prední mezikomorové vetve (RIVA).

The authors present surgical possibilities of treatment of diffuse atherosclerotic changes of the left anterior descending coronary artery. In such serious disease they choose the procedure of endarterectomy performed from long arteriotomy under direct eye control followed by reconstruction by long bypass anastomosis. Endarterectomy of the left anterior descending artery was performed in 32 patients during the period between 1988-1996. This represents 1.38% of patients operated for ischemic heart disease during that period (32/2324). Two patients died in consequence with the operation (6.25%), also there was one myocardial infarction as a perioperative complication (3.1%). Endarterectomy of the diffusely diseased left anterior descending coronary artery can, when carefully indicated and using proper technique, contribute to complete revascularization in patients with end-stage coronary artery disease.

Hemothorax--a complication of subclavian vein cannulation.

Massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but very serious complication. Usually laceration of the venous wall is the cause. In patients where conservative treatment, i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy, etc. is ineffective, surgery has to be performed. Bleeding can be surgically managed either from posterolateral thoracotomy or direct subclavian vessel revision is possible after partial resection of the clavicle. Brachiocephalic vein bleeding can be approached and managed through median sternotomy. We present a case report of 22-year old man with hemothorax after subclavian vein cannulation. In our patient only complex surgical procedure enabled proper management of bleeding complication.

[Double serious complication of the surgical treatment of a female patient with scoliosis (case report).]. / Dvojitá závazná komplikace pri operacním osetrení nemocné se skoliózou.

The authors present the case-history of a female patient who developed during operation of a thoracolumbal scoliotic curve haemorrhagic shock with circulatory arrest due to massive haemorrhage from the spongiosa. After more than six weeks after admission to hospital she developed tense hameothorax from the injured diaphragm caused by the edge of the osteomotized rib of the concavity. The condition was treated by leftesided posterolateral thoracotomy. The authors draw attention to some special features associated with treatment of deformities of the spine. Key words: cardiac arrest, late haemothorax.

Contribution to technique of endarterectomy of the right coronary artery.

We present our technique of performing endarterectomy of coronary arteries by means of injecting cardioplegic solution into the plane of dissection of the endarterium. This simple and gentle technique in combination with manual endarterectomy helps in separation of the core far into the periphery of the diseased vessel and thus helps to perform revascularization in patients with diffuse atherosclerotic changes. During the last 6 years (1991-1996) endarterectomy in coronary revascularization was used in 116 cases (it was 5.7 % (116/2031) of all myocardial revascularization procedures). On right coronary artery endarterectomy was used in 82 patients. Mortality rate in our group of patients was 4.88 % (4/82) and perioperative myocardial infarction developed in 4.88 % (4/82). According to our own experience with this technique of endarterectomy on right coronary artery we are convinced that in desperate patients with diffuse coronary artery disease our method can bring better and wider application of surgical treatment.

[The significance of mediastinoscopy in the diagnosis and treatment of diseases of the lungs and mediastinum]. / Význam mediastinoskopie v diagnostice a lécbe onemocnení plic a mediastina.

A total of 299 patients is presented in them the mediastinoscopy has been performed from 1970 up to 1987. The indications and examination technique are also reported. Its significance is evaluated in recognizing the individual groups of diseases of lung and mediastinum. Comparing this method with other techniques, its advantages are referred to as for its precision a good tolerance by patients. The relatively small rate of complications is stated which represented 1.33 per cent in total proposed.