Gábor Bíró

Fetuin-A serum levels in patients with aortic aneurysms of Marfan syndrome and atherosclerosis.

Eur J Clin Invest 2011; 41 (2): 176–182

Ezüst-acetáttal bevont Dacron grafttal végzett rekonstrukciós érmutétek középtávú eredményei

BACKGROUND Prosthetic graft infection or the need for reconstructive arterial surgery in septic condition is a challenging situation in vascular surgery. Recent introduction of silver coated polyester graft has meant a new therapeutic option in selecting the type of graft for revascularization. In this study we analyzed the short and midterm outcome of using silver coated grafts in aortic and lower extremity arterial reconstructions (mortality, graft occlusion, graft infection, amputation). MATERIALS AND METHODS In a single center retrospective study we implanted 42 silver coated Dacron grafts (InterGard Silver Dacron prosthesis). The indication of silver graft implantation was graft infection in 17, aorto-duodenal fistula in 7, septic condition caused by gangrene in 16 cases and in 2 cases infection was not established. RESULTS Forty silver grafts were implanted in 40 patients with diagnosed infection. The mean age was 62 years (35-81 years), 70% were men. Long term follow-up data were available in 29 patients; the mean follow-up time was 36.76 months. Early (within 30 days of surgery) death occurred in 3 and late death in 11 cases (8 and 38%). Early graft occlusion was noticed in 8 and late occlusion in 2 cases (20 and 7%). Reinfection was diagnosed in 7% of the cases in the early and the midterm period as well. Eight amputations were indicated in the early postoperative period (5 major and 3 minor) and 28% of the patients required major amputation during the follow-up. CONCLUSIONS Silver coated Dacron graft means a valuable therapeutic option with good rate of infection control in the treatment of graft infection and septic condition in the lack of autologous graft material in this high risk population.

A simple surgical method for removing a large floating thrombus from the ascending aorta

We report the successful surgical removal of a large floating thrombus from the ascending aorta causing systemic embolization. It was diagnosed by transesophageal echocardiography (TEE), CT scan, aortography and Cardiovascular Magnetic Resonance Imaging (CMR). The free-floating, highly embolic source 2 cm distal to the left coronary sinus was removed from the ascending aorta using a simple surgical technique. Isolated cerebral perfusion with circulatory arrest on normothermia provided a simple and safe access to the thrombus attached to a ruptured atherosclerotic plaque. The patient was discharged on the 7 th postoperative day after an uneventful recovery.

Establishment and functioning of the Vascular Registry in Hungary

Randomized controlled trials provide the best evidence in clinical trials; however, they do have limitations. In order to evaluate the effectiveness of treatments, population based registries may also yield useful information about the actual practice and they may enable users to carry out a dynamic follow-up. To evaluate the outcome of vascular procedures, the Vascular Registry in Hungary has been established in 2002. This article presents the establishment and functioning of the Vascular Registry and provides information about scientific results obtained during the past years. The Vascular Registry is an internet based database with on-line input. The backup server is provided by the National Institute for Quality and Organizational Development in Healthcare and Medicines. The database collects data in three different fields: interventions for carotid artery, aneurysm (any type) and lower extremity vascular diseases. Twenty five vascular surgical units record interventions in the registry, which corresponds to two thirds of the whole activity. Since joining the Vascunet Group of the European Society for Vascular Surgery, the registry has contributed to several publications based on evaluation of a large common dataset in different fields of vascular surgery. A validation process has been recently performed which confirmed the internal and external validity of the database. The authors conclude that despite unsolved problems related to financing issues, the Vascular Registry has proved to be a useful tool during the past years. In order to take advantage of the registry to its fullest, measures should be taken to achieve a more complete data recording, increase publication activity on the national dataset, improve the flow of information during operation and develop a system of regular feedback.

[Surgical treatment of acute type-B aortic dissection associated with cocaine use].

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.

B típusú aortadissectio sebészi kezelése kokaint használó beteg esetében@@@Surgical treatment of acute type B aortic dissection associated with use of cocaine

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.

Surgical treatment of acute type B aortic dissection associated with use of cocaine

UNLABELLED Cocaine abuse is on a rise in Hungary as well. It is known that cocaine users have a higher risk developing cardiovascular complications, for example aortic dissection. Almost all patients in Hungary suffering from type B aortic dissection are referred to our department for treatment. AIM We introduce the case of a regular cocaine user, who suffered an acute type B aortic dissection and was treated surgically. To our best knowledge this is the first similar case in our country to be published. METHOD Case presentation. RESULTS We performed a successful operation: acute thoracoabdominal aortic refenestration, no complication was detected. The patient is doing well three months after the procedure, returned to his regular activities, he is normotensively receiving medical treatment, and he gave up cocaine. CONCLUSIONS Thoracoabdominal aortic refenestration can save the life of patients presenting with acute type B dissection. Good long-term result depends on adequate hypertension control and cocaine abstinence. As the frequency of cocaine abuse increases in Hungary, similar cases may be more often encountered.A kokainfogyasztas gyakorisaga Magyarorszagon is novekszik. E drog hasznalata fokozott kockazatot jelent sziv- es errendszeri betegsegek kialakulasa, peldaul aortadissectio szempontjabol. Klinikankon zajlik hazankban a B tipusu aortadissectios betegek dontő tobbsegenek ellatasa. Celkitűzes: Egy rendszeresen kokaint hasznalo, akut B tipusu aortadissectiot elszenvedett beteg műteti kezeleset mutatjuk be esetismertetesunkben, amely tudomasunk szerint az első hasonlo eset hazankban. Modszer: Esetleiras. Eredmenyek: Egy 35 eves ferfi erős, mellkasi-hati-derektaji fajdalmak miatt előszor a gerincsebeszeti osztalyhoz fordult, majd kiugroan magas vernyomasertekek miatt belgyogyaszati osztalyra helyeztek at. A B tipusu aortadissectio diagnozisat CT-angiographia igazolta, a beteg ersebeszeti centrumba kerult, ahol sikeres műtetet, thoracoabdominalis aortarefenesztraciot vegeztunk. A beteg 3 honappal a műtet utan jol van, antihipertenziv szerek szedese mellett mindennapi feladatait ellatja, szovődmenyt nem eszleltunk, a kokainrol leszokott. Kovetkeztetesek: Az akut B tipusu dissectio sebeszi ellatasa megmentheti a beteg eletet. A hosszu tavu eredmenyes kezelesben a hipertonia kontrollja mellett a kokainrol tortenő leszokas alapvető jelentősegű. Hasonlo esetek előfordulasara a kokainfogyasztas novekedese eseten hazankban is szamithatunk.

Egyszerű sebészi módszer az aorta ascendensben elhelyezkedő nagy, lebegő thrombus eltávolítására@@@A simple surgical method for removing a large floating thrombus from the ascending aorta

We report the successful surgical removal of a large floating thrombus from the ascending aorta causing systemic embolization. It was diagnosed by transesophageal echocardiography (TEE), CT scan, aortography and Cardiovascular Magnetic Resonance Imaging (CMR). The free-floating, highly embolic source 2 cm distal to the left coronary sinus was removed from the ascending aorta using a simple surgical technique. Isolated cerebral perfusion with circulatory arrest on normothermia provided a simple and safe access to the thrombus attached to a ruptured atherosclerotic plaque. The patient was discharged on the 7 th postoperative day after an uneventful recovery.

Egyszerû sebészi módszer az aorta ascendensben elhelyezkedô nagy, lebegô thrombus eltávolítására

We report the successful surgical removal of a large floating thrombus from the ascending aorta causing systemic embolization. It was diagnosed by transesophageal echocardiography (TEE), CT scan, aortography and Cardiovascular Magnetic Resonance Imaging (CMR). The free-floating, highly embolic source 2 cm distal to the left coronary sinus was removed from the ascending aorta using a simple surgical technique. Isolated cerebral perfusion with circulatory arrest on normothermia provided a simple and safe access to the thrombus attached to a ruptured atherosclerotic plaque. The patient was discharged on the 7 th postoperative day after an uneventful recovery.