INTRODUCTION: Historically, gastric bypass (GB) has been the oldest procedure used in bariatric surgery. Even though technically demanding, it had been the most widely used method for decades worldwide and still holds an irreplaceable position for its pronounced and long-term metabolic effect as well as for the therapeutic effect in gastroesophageal reflux (GERD). METHOD: The authors retrospectively analyse a series of 268 cases of GB, focusing on short-term weight loss, the metabolic effect on type two diabetes (T2DM), complication and reoperation rates and the BAROS scoring system in Roux-en-Y bypass (RYGB) and in minigastric bypass with one anastomosis (MGB/OAGB), comparing both of them to more frequently used gastric plication and sleeve gastrectomy. RESULTS: Both GB, without any increase in complication and reoperation rates, lead to a higher weight loss and the best BAROS scoring in comparison to other, simpler restrictive procedures. One year after GB, resolution of T2DM is seen in most diabetes patients operated on, the number needed to treat being.

• Klíčová slova
• bariatric and metabolic surgery, diabetes mellitus, gastric bypass, surgical treatment of diabetes, type,
• MeSH
• bariatrická chirurgie * MeSH
• gastrektomie MeSH
• lidé MeSH
• morbidní obezita * chirurgie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• žaludeční bypass * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

An analysis of the experience obtained in combined cardiac valve and coronary artery surgery in 23 patients was performed. The dominant feature of their clinical symptomatology was valvular disease in the majority of patients, even though angina pectoris was present in 14 of them. In all patients, cardiac valve surgery was carried out together with coronary reconstruction in the form of a single to triple bypass. The procedure involved, in two cases, simultaneous removal of a left ventricular aneurysm and, in one patient, closure of a postinfarction lesion of the interventricular septum. One patient died in the postoperative period displaying signs of the low cardiac output syndrome. Long-term follow-up included 20 patients operated on. Improvement of a varying degree was observed in 19 patients.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• koronární bypass * MeSH
• koronární nemoc chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nemoci srdečních chlopní chirurgie   MeSH
• srdeční chlopně chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Hereditary spherocytosis is a genetically determined abnormality of red blood cells. It is the most common cause of inherited haemolysis in Europe and North America within the Caucasian population. We document a patient who underwent an aortocoronary bypass procedure on cardiopulmonary bypass. In view of the uncertain tolerance of the abnormal red cells in hereditary spherocytosis to cardiopulmonary bypass, we reviewed the patient's chart and analyzed recorded values of these parameters: free plasma haemoglobin, renal parameters, cystatin C, bilirubin, liver tests, urine samples. From the results, we can see that slight haemolysis-elevated bilirubin in the blood sample and elevated bilirubin and urobilinogen in the urine sample occurred on the first postoperative day. The levels of these parameters slowly decreased during the next postoperative days. There was no real clinical effect of this haemolysis on renal functions.

• Klíčová slova
• cardiac surgery, cardiopulmonary bypass, haemolysis, hereditary spherocytosis,
• MeSH
• ankyriny nedostatek   MeSH
• dědičná sférocytóza etiologie   terapie   MeSH
• hemolýza MeSH
• kardiopulmonální bypass škodlivé účinky   MeSH
• koronární bypass škodlivé účinky   MeSH
• lidé MeSH
• pooperační komplikace * MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• ankyriny MeSH

Bariatric surgery has been proven to be an effective method in the treatement of morbid obesity. The ideal bariatric procedure should be effective, easy to perform and safe. Sleeve gastrectomy and RYGB currently represent the most frequently used bariatric/metabolic procedures. However, they have a certain percentage of complications and post-operative morbidity and also they fail in some patients. These facts lead to the development of new surgical procedures, which also include single anastomosis sleeve ileal bypass (SASI) and single anastomosis sleeve jejunal bypass (SASJ). These procedures combines the advantages of restrictive and malabsorptive operations at the same time reducing the risk of nutrient deficiencies by maintaining passage through all the alimentary tract. The results so far are encouraging, further research and especially longer-term results are necessary.

• Klíčová slova
• SASI, SASJ, bariatric surgery, sleeve ileal bypass, sleeve jejunal bypass,
• MeSH
• anastomóza chirurgická metody   MeSH
• bariatrická chirurgie * metody   MeSH
• gastrektomie metody   MeSH
• ileum chirurgie   MeSH
• jejunum chirurgie   MeSH
• laparoskopie * MeSH
• lidé MeSH
• morbidní obezita * chirurgie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• žaludeční bypass * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Extracorporeal circulation is nowadays part of the standard technique of aortocoronary reconstruction. The authors summarize in their paper their experience with operations in 45 patients where an aortocoronary bypass was made on the beating heart without the use of extracorporeal circulation. None of the patients died. The incidence of postoperative complications was low. Rapid rehabilitation of the patients and a shorter period of hospitalization makes this method an alternative standard technique of aortocoronary reconstruction.

• MeSH
• koronární bypass * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mimotělní oběh * MeSH
• pooperační komplikace MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The left internal thoracic artery (LITA) is used routinely for coronary bypass surgery. A simple technique for assessing, prior to harvesting, the length of LITA required for an individual bypass of the left anterior descending artery (LAD) is described.

• MeSH
• hojení ran MeSH
• koronární bypass * MeSH
• koronární stenóza patologie   chirurgie   MeSH
• lidé MeSH
• mamární tepny chirurgie   MeSH
• odběr tkání a orgánů metody   MeSH
• perikard chirurgie   MeSH
• sternum chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The purpose of this study was to determine the cost implications of the Coronary Artery Bypass Graft Off or On Pump Revascularization Study (CORONARY) at 1 year. METHODS: Country-specific healthcare costs were obtained from public databases or local experts from each country in the CORONARY trial. Purchasing power parities were applied to these costs of consumed healthcare resources. Analyses of subgroups included in the CORONARY clinical trial were also conducted. Costs are reported in US dollars. RESULTS: After 1 year, the total cost per patient in the off-pump coronary artery bypass graft surgery (CABG) arm was $9,650 ($9,216 to $10,285) compared with $9,583 ($9,239 to $9,988) for the on-pump CABG arm; that resulted in a nonsignificant increase of $68 (-$575 to $710). Similar findings were noted for various subgroups. There were also no differences due to late conversions. CONCLUSIONS: The CORONARY trial demonstrated that off-pump CABG was clinically as safe and effective as on-pump CABG with no difference in costs. Thus, the decision as to which method to choose is free from costs considerations and should be based on patient preference and surgeon expertise (Coronary Artery Bypass Graft [CABG] Off or On Pump Revascularization Study [CORONARY]; clinicaltrials.gov NCT00463294).

• MeSH
• analýza nákladů a výnosů MeSH
• časové faktory MeSH
• koronární bypass bez mimotělního oběhu ekonomika   MeSH
• koronární bypass ekonomika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náklady na zdravotní péči MeSH
• nemoci koronárních tepen ekonomika   chirurgie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

OBJECTIVE: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia (TEA) as for general anesthesia. However, compared with general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption and may result in lactic acidosis when standard blood flow rates were used. The aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. METHODS: Forty-five patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=15), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor the adequacy of standard blood flow rates, arterial lactate, acid base parameters, and central venous and jugular bulb saturation were measured at six time points (before, during, and after the surgery) in all groups. Blood flow rates were adjusted when needed. RESULTS: No lactic acidosis has developed in any group (p=NS). TEA as compared with TEA-GA and GA groups had lower central venous (67±4%, 75±11%, and 72±13%, respectively, p<0.05) and jugular bulb oxygen saturations during cardiopulmonary bypass (60±7%, 68±9%, and 75±12%, respectively, p<0.05) during the post-cardiopulmonary bypass period. The TEA group as compared with the TEA-GA and GA groups also had mild hypercapnic respiratory acidosis (56±10, 42±8, and 37±4 mmHg, respectively, p<0.05) and mild decrease of arterial oxygen saturation (93±4%, 97±2%, and 96±1%, respectively, p<0.05) at the end of surgery without any clinical consequences. Thus, no additional blood flow rates adjustments in any study group and no ventilatory support in TEA group were required. CONCLUSIONS: Under careful monitoring, the use of standard blood flow rates is adequate for patients undergoing awake on-pump normothermic cardiac surgery.

• MeSH
• acidóza laktátová etiologie   prevence a kontrola   MeSH
• aortální chlopeň chirurgie   MeSH
• arterie MeSH
• celková anestezie * MeSH
• chirurgická náhrada chlopně MeSH
• epidurální anestezie * MeSH
• hemoglobiny metabolismus   MeSH
• kardiopulmonální bypass metody   MeSH
• koncentrace vodíkových iontů MeSH
• koronární bypass metody   MeSH
• krevní glukóza metabolismus   MeSH
• kyslík aplikace a dávkování   krev   MeSH
• laktáty metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• oxid uhličitý krev   MeSH
• parciální tlak MeSH
• peroperační komplikace etiologie   prevence a kontrola   MeSH
• rychlost toku krve fyziologie   MeSH
• senioři MeSH
• spotřeba kyslíku MeSH
• studie případů a kontrol MeSH
• vědomí * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH
• Názvy látek
• hemoglobiny MeSH
• krevní glukóza MeSH
• kyslík MeSH
• laktáty MeSH
• oxid uhličitý MeSH

Comparison of 1085 patients having coronary bypass surgery without cardioplegia from Jan. 1970 to Aug. 8, 1977 with 1060 patients operated upon with cardioplegia from Aug. 9, 1977 to Dec. 31, 1980 suggests that improved myocardial protection afforded by cardioplegia combined with profound topical hypothermia has its principal impact in those patients requiring urgent or emergency operations by reducing the probability of intraoperative left ventricular failure after coronary bypass. The need for postoperative balloon pumping and the risk of intraoperative death were significantly lower in patients operated upon with hypothermia + cardioplegia myocardial protection. In patients who survived 30 days after operation there was no significant improvement in long-term survival, incidence of myocardial infarction, or recurrence of angina pectoris in the cardioplegia group despite a greater average number of grafts per patient and a smaller number of ungrafted but obstructed coronary arteries.

• MeSH
• balónková angioplastika MeSH
• dospělí MeSH
• hemodynamika MeSH
• koronární bypass * MeSH
• koronární nemoc diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• radiografie MeSH
• senioři MeSH
• srdeční katetrizace MeSH
• terapeutická hypotermie MeSH
• vyvolaná zástava srdce * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: The internal mammary artery (IMA) ranks among excellent, widely used conduits for surgical coronary revascularization. Its harvesting and its using may cause other surgical and technical problems and complications and increase postoperative bleeding from wound surface after the IMA harvesting with significantly greater incidence of blood transfusion. The aim of this study was to get to know how much it increases postoperative bleeding losses and if the local application of aprotinin (to the wound surface after the IMA harvesting and into the pericardial cavity) can reduce them and thus decrease the number of blood transfusions. METHODS: In this study there are compared groups of patients (n = 275) operated at the University Department of Cardiac Surgery in Hradec Králové on account of ischemic heart disease. In the first part of this study results of operations of 200 patients were comprised retrospectively. Group A1 comprised 50 patients where for revascularization of the myocardium venous grafts were used. Group B1 comprised 50 patients where also the internal mammary artery was used. Group C1 was formed by 50 patients where after preparation of the IMA aprotinin (100,000 KIU) was administered locally to the wound surface after the IMA harvesting. Group D1 was formed by 50 patients where aprotinin (500,000 KIU) was administered locally to the wound surface and poured into the pericardial cavity before closure of the median sternotomy. The postoperative blood losses and the number of the administered blood transfusions were compared between these groups. RESULTS: The authors provided evidence that the using of the IMA increases significantly the postoperative blood losses (in group A1 675 ml +/- 352.9, in group B1 1232 ml +/- 336.5) and increases the number of required transfusions (in group A1 2.44 +/- 1.7, in group B1 3.45 +/- 1.0). By local aprotinin application to the wound surface after the IMA harvesting the blood losses and the number of administered transfusions were reduced in group C1 (896 ml (231.9, 2.74 +/- 0.8). In group D1 (local aprotinin application to the wound surface and into the pericardial cavity) the blood losses and the number of transfusions were increasingly reduced than in group C1 (797 ml +/- 280.5, 1.74 +/- 1.3). In the second, prospective randomised part of this study 3 groups of patients were compared. Group A2 comprised 25 patients where venous grafts for revascularization of myocardium were used. Group B2 was formed by 25 patients where also the IMA was used. Group D2 comprised 25 patients where aprotinin (500,000 u.) was administered locally to the wound surface after the IMA harvesting and poured into the pericardial cavity before closure of sternotomy. The postoperative blood losses and the number of administered blood transfusions were again compared between these groups. The total postoperative blood losses were 778 ml +/- 304.2 in group A2, 1072 ml +/- 391.8 in group B2 and 754 ml +/- 197.9 in group D2. There were compared blood losses after 6, 12 and 24 hours, too. There were the statistically significant differences among these groups during the whole postoperative period. The number of blood transfusions were 2.8 +/- 2.3 in group A2 and 2.04 +/- 1.1 in group B2. The use of aprotinin decreased this number in group D2, 1.44 +/- 1.1. CONCLUSIONS: The authors provided evidence that the harvesting and the using of the internal mammary artery for myocardial revascularization increases significantly the postoperative bleeding and increases the number of required transfusions. By local application of aprotinin the author reduced the blood losses and need of transfusions.

• MeSH
• aplikace lokální MeSH
• aprotinin aplikace a dávkování   MeSH
• hemostatika aplikace a dávkování   MeSH
• koronární bypass * MeSH
• krvácení při operaci prevence a kontrola   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mamární tepny chirurgie   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• aprotinin MeSH
• hemostatika MeSH