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  • 1.
    Ahn, Henrik Casimir
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Holm, Jonas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Najar, Azad
    Scandinavian Real Heart AB, Vasteras, Sweden.
    Hellers, Goran
    Scandinavian Real Heart AB, Vasteras, Sweden.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    A New Total Artificial Heart Concept Allowing Replacement or Support of the Native Heart2018In: Journal of Clinical & Experimental Cardiology, E-ISSN 2155-9880, Vol. 9, no 2, article id 1000569Article in journal (Refereed)
    Abstract [en]

    A total artificial heart (TAH) is typically used to bridge the time to heart transplantation. A device designed by Robert Jarvik has been improved through the years and under the name of Syncardia™ this has been the most successful commercially available TAH so far. Since 2008 the Carmat™ heart has been under development in Europe. The Scandinavian Real Heart™ is based on a unique physiological concept where the atrio-ventricular valve plane is of utmost importance in the pumping function of the heart. It consists of two identical parts driven separately by independent motors and in this first animal study we have used one part as a left ventricular assist device. This new concept makes the device flexible as it may be used not only as a TAH but also as a separate pump for left or right ventricular assist.

  • 2.
    Chang-Chun, Chen
    et al.
    Katholieke Universiteit Leuven, Belgium.
    Masuda, Munetaka
    Katholieke Universiteit Leuven, Belgium.
    Szabó, Zoltán
    Katholieke Universiteit Leuven, Belgium.
    Szerafin, T
    Szecsi, J
    Katholieke Universiteit Leuven, Belgium.
    Van Belle, Herman
    Janssen Research Foundation, Beerse, Belgium.
    Flameng, Willem
    Katholieke Universiteit Leuven, Belgium.
    Nucleoside transport inhibition mediates lidoflazine-induced cardioprotection during intermittent aortic crossclamping1992In: Journal of Thoracic and Cardiovascular Surgery, ISSN 0022-5223, E-ISSN 1097-685X, Vol. 104, no 6, p. 1602-1609Article in journal (Refereed)
    Abstract [en]

    The effects of pretreatment with the nucleoside transport inhibitor lidoflazine on repeated ischemia-reperfusion injury induced by normothermic intermittent aortic crossclamping were studied in canine hearts. Eighteen mongrel dogs were allocated to three groups: placebo (n = 6), lidoflazine (1 mg/kg) (n = 6), and lidoflazine (1 mg/kg) plus the adenosine receptor blocker aminophylline (7 mg/kg) (n = 6). Pretreatment was performed intravenously during 15 minutes before extracorporeal circulation. All hearts were subjected to four intervals of 15 minutes of global ischemia each followed by 10 minutes of reperfusion. After weaning from extracorporeal circulation, functional recovery was followed for 1 hour. In the lidoflazine group, myocardial adenosine content (0.25 +/- 0.06 mumol/gm dry weight) was 3.5 times higher than that in the control group (0.07 +/- 0.03 mumol/gm dry weight; p < 0.05) at the end of the last aortic crossclamping. The release of adenosine from the myocardium during each reperfusion period was significantly higher than that in the control group (p < 0.05). Myocardial extraction of lactate was normalized at every reperfusion interval in the lidoflazine group but not in the control group (p < 0.05). In the lidoflazine group functional recovery was significantly better than that in the control group. Positive rate of rise of pressure, negative rate of rise of pressure, and cardiac output recovered to, respectively, 150% +/- 19%, 82% +/- 8%, and 131% +/- 15% in the lidoflazine group versus, respectively, 37% +/- 9%, 23% +/- 7%, and 29% +/- 8% in the control group (p < 0.001) at 1 hour after extracorporeal circulation. When the adenosine receptor blocker aminophylline was administered in association with lidoflazine, protection dropped significantly: positive and negative rate of rise of pressure and cardiac output were, respectively, 58% +/- 8%, 46% +/- 9%, and 67% +/- 16% at 1 hour after extracorporeal circulation (p < 0.05 versus lidoflazine alone). These results suggest that the cardioprotective effects of lidoflazine are at least in part mediated by adenosine receptor stimulation via nucleoside transport inhibition-induced accumulation of endogenous adenosine in the myocardium.

  • 3. Faragó, E.
    et al.
    Haczku, A.
    Mihóczy, L.
    Péterffy, Á.
    Szabó, Zoltán
    A perfloxacin farmakokinetikájának vizsgálata szérumban és penetrációjának mérése köpetben és tüdöszövetben: [The examination of perflozacin's pharmacokinetics in the serum and measurement of the drug penetration in the lung and bronchial secretion]1991In: Medicina Thoracalis, ISSN 0238-2571, Vol. 43, no 7, p. 284-289Article in journal (Refereed)
  • 4. Faragó, E.
    et al.
    Hermann, K.
    Obbágy, V.
    Kruzsicz, V.
    Szabó, Zoltán
    Szerafin, T.
    Az Augumentin egyes testváladék és szövetszint vizsgálata pulonológiai és sebészeti osztályon vizsgált betegeken: [The measurement of Augumentin levels in the different body secretions and tissue in pulmonological and surgical patients]1991In: Medicina Thoracalis, ISSN 0238-2571, Vol. 44, no 2, p. 56-62Article in journal (Refereed)
  • 5.
    Forsell, Claes
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Åberg, Jonas
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Preoperative Topical Hypothermia used in Prolonged Severe Lower Limb Ischemia to Avoid Ischemic Damage - The First Clinical Experience2013In: International Journal of Biomedical Science, ISSN 1550-9702, E-ISSN 1555-2810, Vol. 9, no 3, p. 181-184Article in journal (Refereed)
    Abstract [en]

    Severe lower limb ischemia TASC IIB/III with sensory and motor neurologic deficiencies leads to prolonged hospital care, amputation, and death in 20-70 % of cases. We present our first clinical experience of the use of preoperative topical hypothermia to improve muscular viability in these patients. Two hours after onset of symptoms, six 4-liter plastic bags were filled with snow and packed against the ischemic leg which was protected from frost injury by a layer of towels. After surgical revascularization four hours later muscular and neural functions in the leg were completely restored. A maximum serum myoglobin of 6500 ng/L (median 12000 ng/L in similar but untreated patients) postoperatively decreased to 1400 ng/L after 27 hours.

  • 6.
    Grams, M
    et al.
    John Hopkins University, USA.
    Sang, Yingying
    John Hopkins University, USA.
    Ballew, Shoshana
    John Hopkins University, USA.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Matsushita, Kunihiro
    John Hopkins University, USA.
    Kalantar-Zadeh, Kamyar
    UC Irvine, USA.
    Coresh, Josef
    John Hopkins University, USA.
    Kovesdy, Csaba
    Memphis VA, USA.
    Incidence of and risk factors for acute kidney injury after major surgery2014Conference paper (Refereed)
  • 7.
    Grams, Morgan E
    et al.
    Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
    Sang, Yingying
    Departments of Epidemiology, Baltimore, Maryland, USA.
    Coresh, Josef
    Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
    Ballew, Shoshana H
    Departments of Epidemiology, Baltimore, Maryland, USA.
    Matsushita, Kunihiro
    Departments of Epidemiology, Baltimore, Maryland, USA.
    Levey, Andrew S
    Departments of Epidemiology, Baltimore, Maryland, USA.
    Greene, Tom H
    5Division of Clinical Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
    Molnar, Miklos Z
    6Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Kalantar-Zadeh, Kamyar
    University of California Irvine Medical Center, Irvine, California, USA.
    Kovesdy, Csaba P
    University of Tennessee Health Science Center, Memphis, Tennessee, USA.
    Candidate Surrogate End Points for ESRD after AKI2016In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 27, no 9, p. 2851-2859Article in journal (Refereed)
    Abstract [en]

    AKI, a frequently transient condition, is not accepted by the US Food and Drug Association as an end point for drug registration trials. We assessed whether an intermediate-term change in eGFR after AKI has a sufficiently strong relationship with subsequent ESRD to serve as an alternative end point in trials of AKI prevention and/or treatment. Among 161,185 United States veterans undergoing major surgery between 2004 and 2011, we characterized in-hospital AKI by Kidney Disease Improving Global Outcomes creatinine criteria and decline in eGFR from prehospitalization to postdischarge time points and quantified associations of these values with ESRD and mortality over a median of 3.8 years. An eGFR decline of ≥30% at 30, 60, and 90 days after discharge occurred in 3.1%, 2.5%, and 2.6%, of survivors without AKI and 15.9%, 12.2%, and 11.7%, of survivors with AKI. For patients with in-hospital AKI compared with those with no AKI and stable eGFR, a 30% decline in eGFR at 30, 60, and 90 days after discharge demonstrated adjusted hazard ratios (95% confidence intervals) of ESRD of 5.60 (4.06 to 7.71), 6.42 (4.76 to 8.65), and 7.27 (5.14 to 10.27), with corresponding estimates for 40% decline in eGFR of 6.98 (5.21 to 9.35), 8.03 (6.11 to 10.56), and 10.95 (8.10 to 14.82). Risks for mortality were smaller but consistent in direction. A 30%-40% decline in eGFR after AKI could be a surrogate end point for ESRD in trials of AKI prevention and/or treatment, but additional trial evidence is needed.

  • 8.
    Grams, Morgan E
    et al.
    Johns Hopkins University School of Medicine, Baltimore, MD.
    Sang, Yingying
    Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
    Coresh, Josef
    Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
    Ballew, Shoshana
    Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
    Matsushita, Kunihiro
    Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
    Molnar, Miklos Z
    Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Kalantar-Zadeh, Kamyar
    Harold Simmons Center for Chronic Disease Research & Epidemiology, University of California Irvine Medical Center, Irvine.
    Kovesdy, Csaba P
    Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN.
    Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data.2016In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 67, no 6, p. 872-880Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Few trials of acute kidney injury (AKI) prevention after surgery have been conducted, and most observational studies focus on AKI following cardiac surgery. The frequency of, risk factors for, and outcomes after AKI following other types of major surgery have not been well characterized and may present additional opportunities for trials in AKI.

    STUDY DESIGN: Observational cohort study.

    SETTING & PARTICIPANTS: 3.6 million US veterans followed up from 2004 to 2011 for the receipt of major surgery (cardiac; general; ear, nose, and throat; thoracic; vascular; urologic; and orthopedic) and postoperative outcomes.

    FACTORS: Demographics, health characteristics, and type of surgery.

    OUTCOMES: Postoperative AKI defined by the KDIGO creatinine criteria, postoperative length of stay, end-stage renal disease, and mortality.

    RESULTS: Postoperative AKI occurred in 11.8% of the 161,185 major surgery hospitalizations (stage 1, 76%; stage 2, 15%, stage 3 [without dialysis], 7%; and AKI requiring dialysis, 2%). Cardiac surgery had the highest postoperative AKI risk (relative risk [RR], 1.22; 95% CI, 1.17-1.27), followed by general (reference), thoracic (RR, 0.92; 95% CI, 0.87-0.98), orthopedic (RR, 0.70; 95% CI, 0.67-0.73), vascular (RR, 0.68; 95% CI, 0.64-0.71), urologic (RR, 0.65; 95% CI, 0.61-0.69), and ear, nose, and throat (RR, 0.32; 95% CI, 0.28-0.37) surgery. Risk factors for postoperative AKI included older age, African American race, hypertension, diabetes mellitus, and, for estimated glomerular filtration rate < 90mL/min/1.73m(2), lower estimated glomerular filtration rate. Participants with postoperative AKI had longer lengths of stay (15.8 vs 8.6 days) and higher rates of 30-day hospital readmission (21% vs 13%), 1-year end-stage renal disease (0.94% vs 0.05%), and mortality (19% vs 8%), with similar associations by type of surgery and more severe stage of AKI relating to poorer outcomes.

    LIMITATIONS: Urine output was not available to classify AKI; cohort included mostly men.

    CONCLUSIONS: AKI was common after major surgery, with similar risk factor and outcome associations across surgery type. These results can inform the design of clinical trials in postoperative AKI to the noncardiac surgery setting.

  • 9.
    Grams, Morgan
    et al.
    John Hopkins University.
    Sang, Yingying
    John Hopkins University.
    Coresh, Josef
    John Hopkins University.
    Ballew, Shoshana
    John Hopkins University.
    Matsushita, Kunihiro
    John Hopkins University.
    Greene, Tom
    University of Utah.
    Levey, Adrew S
    Tufts Medical Center.
    Molnar, Miklos Z
    University of Tennessee Health Science Center.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Decline in Estimated Glomerular Filtration Rate After Acute Kidney Injury: A Surrogate Endpoint?2015In: ASN (American Society of Nephrology), 2015, Vol. 26Conference paper (Refereed)
    Abstract [en]

    Background: Often a transient condition, acute kidney injury (AKI) is not currently accepted as an endpoint for drug registration trials by the US FDA. We sought to determine whether an intermediate-term change in eGFR after AKI has a sufficiently strong relationship with subsequent ESRD to serve as an alternative endpoint in clinical trials of AKI preventionand/or treatment.

    Methods: We evaluated 161,185 US veterans who underwent major surgery between2004-2011. Post-surgical AKI was defined by the KDIGO creatinine criteria;decline in eGFR was calculated from pre-hospitalization value to two time-points post-discharge (60-days, 90-days) and related to ESRD and mortality using Cox proportional hazards regression.

    Results: In-hospital mortality varied by AKI status, ranging from 1% for patients without AKI to 35% for those with dialysis-requiring AKI. An eGFR decline of ³30% at 60-days was relatively frequent: 2.5%, 9.7%, 17.2%, and 28.6% in those with no AKI, Stage 1 AKI, Stage 2 AKI, and Stage 3 AKI, respectively. There was a graded relationship between eGFR decline at 60-days and risk of ESRD in persons both with and without AKI (Figure). Compared to stable eGFR/no in-hospital AKI, the adjusted hazard ratio (HR) of ESRD associated with a 30% decline at 60-days after AKI was 6.42 (95% CI: 4.8-8.7). Risks for mortality associated with eGFR decline were smaller: the HR for 30% decline 60-days after in-hospital AKI was 1.59 (95% CI: 1.46-1.73). Risk relationships were similar at 90-days.

    Conclusions: A 30% decline in eGFR from pre-hospitalization baseline to 60-days or 90-days after an episode of AKI may be an acceptable surrogate endpoint in trials of AKI prevention and/or treatment.

  • 10. Hejjel, L.
    et al.
    Vaszily, M.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Peterffy, Arpad
    Östergötlands Läns Landsting, Heart Centre.
    Alternatives to heart transplantation1997In: Orvosi Hetilap, ISSN 0030-6002, Vol. 138, no 18, p. 1107-1111Article in journal (Refereed)
  • 11. Kozlovszky, B.
    et al.
    Vaszily, M.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Bánfi, C
    Szerafin, T
    Péterffy, Á
    Az aorta disszektio mai kezelési lehetöségeiröl-A tipusú acut dissectio sikerrel operált esete: [On the possibilities of aortic dissection-after a successful type-A dissection operation]1995In: Èrbetegségek (Vascular disease), Vol. 2, no 2, p. 19-26Article in journal (Refereed)
  • 12.
    Lindbergh, Tobias
    et al.
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Larsson, Marcus
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences.
    Casimir-Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Strömberg, Tomas
    Linköping University, Department of Biomedical Engineering, Biomedical Instrumentation. Linköping University, The Institute of Technology.
    Intramyocardial oxygen transport by quantitative diffuse reflectance spectroscopy in calves2010In: Journal of Biomedical Optics, ISSN 1083-3668, E-ISSN 1560-2281, Vol. 15, no 2Article in journal (Refereed)
    Abstract [en]

    Intramyocardial oxygen transport was assessed during open-chest surgery in calves by diffuse reflectance spectroscopy using a small intramuscular fiber-optic probe. The sum of hemo- and myoglobin tissue fraction and oxygen saturation, the tissue fraction and oxidation of cytochrome aa3, and the tissue fraction of methemoglobin, were estimated using a calibrated empirical light transport model. Increasing the oxygen content in the inhaled gas; 21%-50%-100%, in five calves (group A) gave an oxygen saturation of 19+/-4%, 24+/-5% and 28+/-8%, and mean tissue fractions of 1.6% (cytochrome aa3), and 1.1% (hemo- and myoglobin). Cardiac arrest in two calves gave an oxygen saturation lower than 5%. In two calves (group B) a left ventricular assistive device (LVAD pump) was implanted. Group B animals displayed similar trends in hemo- and myoglobin oxygen saturation as in group A, but at higher levels (maxima of 38% (B1) and 44% (B2)). The cytochrome aa3 oxidation level was above 96% in both group A and B calves, including the two cases involving cardiac arrest.

    In conclusion, the estimated tissue fractions and oxygenation/oxidation levels of the myocardial chromophores during respiratory and hemodynamic provocations where in agreement with previously presented results, demonstrating the potential of the method.

  • 13. Mihóczy, L.
    et al.
    Obbágy, V.
    Rusznák, C.
    Faragó, E.
    Szabó, Zoltán
    Péterffy, Á.
    Az Augumentin szerepe a nyitott szímütétek után fellépö szepszis megelözésébe: [Augumentin in the prevention of sepsis following open heart surgery]1991In: Medicina Thoracalis, ISSN 0238-2571, Vol. 44, no 7, p. 304-309Article in journal (Refereed)
  • 14.
    Peterffy, Arpad
    et al.
    Östergötlands Läns Landsting, Heart Centre.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Can mechanical valve prostheses be recommended in the tricuspid position?1996In: Journal of Heart Valve Disease, ISSN 0966-8519, E-ISSN 2053-2644, Vol. 5, no 5, p. 570-571Article in journal (Refereed)
  • 15.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Szabo, Zoltán
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Optimal dosage of insulin and glucose in glucose-insulin-potassium treatment of acute myocardial infarction remains to be established.1999In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 100, p. 106-106Article in journal (Refereed)
  • 16.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Metabolic intervention for the ischemic and post-ischemic heart1999In: Wiener Klinische Wochenschrift, ISSN 0043-5325, E-ISSN 1613-7671, Vol. 111, p. 501-511Article in journal (Refereed)
  • 17.
    Svedjeholm, Rolf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Routine SVO2mesurement after CABG surgery with a surgically introduced pulmonary artery catheter.1999In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 16, p. 450-457Article in journal (Refereed)
  • 18.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Håkansson, Erik
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Predictors of atrial fibrillation in CABG surgery1997In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 78, no 2, p. 42-42Article in journal (Refereed)
  • 19.
    Svedjeholm, Rolf
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Vánky, Farkas
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Neurological injury after surgery for ischemic heart disease: risk factors, outcome and role of metabolic interventions2001In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, ISSN 1010-7940, Vol. 19, no 5, p. 611-618Article in journal (Refereed)
    Abstract [en]

    Objectives: Neurological complication remains a feared and increasing problem in association with cardiac surgery. The aim of this study was to analyze risk factors for neurological complications in a cohort of patients in whom inotropes for weaning from cardiopulmonary bypass was gradually replaced by metabolic treatment.

    Methods: The records of 775 consecutive patients undergoing coronary artery bypass grafting (CABG) or combined CABG+valve procedures were examined. Forward stepwise multiple logistic regression analysis was used for statistical evaluation of independent risk factors.

    Results: The incidence of neurological injury was 1.8% in patients undergoing isolated CABG and 5.4% after combined CABG+valve procedures. After cross-validation multivariate analysis identified history of cerebrovascular disease, advanced age and aortic cross-clamp time as independent risk factors for postoperative cerebral complications. Chronic obstructive pulmonary disease and number of bypasses also emerged as risk factors in the primary analysis.

    Conclusions: In general, markers for advanced atherosclerosis, with history of cerebrovascular disease as the most important, emerged as predictors for neurological injury. Although it did not enter the final risk model, the results also suggest that postoperative heart failure deserves further surveillance as a potential risk factor for neurological complications. However, no evidence for untoward neurological effects associated with glutamate or glucose–insulin–potassium treatment was found.

  • 20. Svensson, Anders
    et al.
    Kovesdy, Csaba P
    Memphis VA, USA.
    Escobar Kvitting, John-Peder
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Cederholm, Ingemar
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Serum cystatin C as disgnostic marker of acute kidney injury after cardiopulmonary bypass: a word of caution2014Conference paper (Refereed)
  • 21.
    Svensson, Anders S.
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Escobar Kvitting, John-Peder
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Kovesdy, Csaba P
    University of Tennessee Health Science Center, Memphis, TN, USA.
    Cederholm, Ingemar
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Linköping University, Faculty of Medicine and Health Sciences.
    Changes in serum cystatin C, creatinine, and C-reactive protein after cardiopulmonary bypass in patients with normal preoperative kidney function.2016In: Nephrology (Carlton. Print), ISSN 1320-5358, E-ISSN 1440-1797, Vol. 21, no 6, p. 519-525Article in journal (Refereed)
    Abstract [en]

    AIM: The use of cardiopulmonary bypass (CPB) can cause changes in serum creatinine and cystatin C independent of glomerular filtration rate. We aimed to quantify the temporal changes of these biomarkers and C-reactive protein (CRP) after CPB.

    METHODS: This was a prospective study at an academic medical center between April and October 2013. We compared postoperative changes in serum creatinine and cystatin C in 38 patients with normal preoperative kidney function who underwent cardiac surgery using CPB and did not develop perioperative acute kidney injury (AKI). The effect of inflammation on intra-individual changes was examined in mixed effects regressions, using measurements of pre- and postoperative CRP.

    RESULTS: Both serum creatinine (79.9 ± 22.7 vs. 92.6 ± 21.4 µmol/L, p = 0.001) and cystatin C (1.16 ± 0.39 vs. 1.33 ± 0.37 mg/L, p = 0.012) decreased significantly in the first 8 hours postoperatively compared to preoperatively, as a result of hemodilution. Thereafter serum creatinine returned to preoperative levels, whereas serum cystatin C continued to rise and was significantly elevated at 72 hours post-CPB compared to preoperative levels (1.53 ± 0.48 vs. 1.33 ± 0.37 mg/L, p = 0.003). CRP levels increased significantly post-CPB and were significantly associated with increases in both serum creatinine and cystatin C.

    CONCLUSIONS: Serum creatinine and cystatin C appear not to be interchangeable biomarkers during and immediately after CPB. Processes unrelated to kidney function such as acute inflammation have a significant effect on post-CPB changes in these biomarkers, and may result in significant increases in serum cystatin C that could erroneously be interpreted as AKI. This article is protected by copyright. All rights reserved.

  • 22.
    Svensson, Anders S.
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Kovesdy, Csaba P.
    Division of Nephrology, University of Tennessee Health Science Center, USA.
    Escobar Kvitting, John-Peder
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Rosén, Magnus
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Cederholm, Ingemar
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Comparison of serum cystatin C and creatinine changes after cardiopulmonary bypass in patients with normal preoperative kidney function2013In: International Urology and Nephrology, ISSN 0301-1623, E-ISSN 1573-2584, Vol. 45, no 6, p. 1597-1603Article in journal (Refereed)
    Abstract [en]

    Purpose

    Serum creatinine is used ubiquitously to estimate glomerular filtration rate and to diagnose acute kidney injury after cardiac surgery. Serum cystatin C is a novel biomarker that has emerged as a possible diagnostic alternative to serum creatinine. It is unclear if the dynamic changes in serum cystatin C immediately following cardiopulmonary bypass (CPB) differ from those of serum creatinine in patients with normal preoperative kidney function.

    Methods

    We compared changes in serum levels of creatinine and cystatin C by measuring them serially in 19 patients undergoing CPB. Within-patient differences for serum creatinine and serum cystatin C were compared by repeated measures ANOVA.

    Results

    Serum creatinine and cystatin C levels showed significant correlation with each other. Both biomarkers showed a significant decrease after CPB, but their serum concentrations reverted to pre-CPB levels within 12 h. Serum levels of serum creatinine remained unchanged from baseline levels throughout 72-h post-CPB. In contrast, serum cystatin C levels rose further and became significantly higher compared to baseline within 48 h. Serum cystatin C remained significantly elevated at 48- and 72-h post-CPB.

    Conclusions

    Processes that determine the serum concentrations of serum creatinine and cystatin C in the post-CPB period affect the two biomarkers differently, suggesting that the two are not interchangeable as diagnostic markers of glomerular filtration rate. Future studies are needed to examine if these discrepancies are related to differences in their production rates, in their ability to detect small changes in glomerular filtration rate, or to a combination of these, and to determine the effect of such differences on the diagnostic and prognostic accuracy of the two biomarkers.

  • 23.
    Szabó, Zoltan
    et al.
    Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Andersson, Rolf
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences.
    Arnqvist, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Intraoperative muscle and fat metabolism in diabetic patients during coronary artery bypass grafting surgery: a parallel microdialysis and organ balance study2009In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 103, no 2, p. 166-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Surgical trauma causes stress and inflammatory reactions with elevated serum free fatty acids (FFA) and glucose levels characteristic of intraoperative insulin resistance. Our aim was to compare microdialysis findings with those using the classical organ balance technique and to test the clinical feasibility of microdialysis during cardiac surgery. METHODS: Nine diabetic and nine non-diabetic patients, undergoing routine coronary artery bypass grafting surgery, were studied using both microdialysis and the organ balance technique in the brachio-radial muscle of the forearm, and microdialysis in the pre-pectoral fat tissue. Glucose, lactate, and glycerol were measured in arterial and venous plasma and in the microdialysate before administration of heparin, at the release of the aortic cross-clamp, and before transfer to the intensive care unit. RESULTS: Glucose release from the diabetic muscle at the last sampling time was detected. This was confirmed by a negative glucose A-I (arterial-interstitial difference) in the muscle. No differences were observed regarding lipolysis in the fat tissue in terms of A-I of glycerol. Intergroup differences were detected at the first sampling time, where arterial plasma glucose and plasma insulin levels were higher and muscle interstitial glucose lower in the diabetic patients. Plasma insulin was higher in the diabetic patients even at the final measurement time. CONCLUSIONS: In terms of lipolysis in the fat tissue and glucose transport in the muscle, the non-diabetic patients were metabolically 'diabetics' during surgery. Despite strict blood glucose control, disturbances in glucose homeostasis in the diabetic muscle persist. Microdialysis was easy to use during cardiac surgery.

  • 24.
    Szabó, Zoltan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sjökvist, Stefan
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology.
    Gustavsson, Torbjörn
    Carleberg, Per
    Uppsäll, Magnus
    Wren, Joakim
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Smedby, Örjan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Intraoperativ visualisering av myokardiell perfusion i realtidmeaugmented reality temperatur monitorering-en experimentellstudie2013Conference paper (Other academic)
  • 25.
    Szabó, Zoltán
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    A simple method to pass a pulmonary artery flotation catheter rapidly into the pulmonary artery anaesthetized patients2003In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 90, no 6, p. 794-796Article in journal (Refereed)
    Abstract [en]

    Background. In some patients passage of a pulmonary artery flotation catheter (PAFC) into the pulmonary artery may be difficult and time consuming and the prolonged manipulation can cause ventricular arrhythmias. A simple clinical method used during general anaesthesia is presented to allow rapid passage of a PAFC into the pulmonary artery. Methods. The operating table is positioned head up and slightly right side down to position the pulmonary valve at the highest level possible. When the balloon catheter is in the right ventricular outflow tract (indicated by premature ventricular contractions) the ventilator is paused in inspiration and the balloon catheter simultaneously passed into the pulmonary artery. Results. The manoeuvre shortens the time necessary to pass the catheter into the pulmonary artery and may reduce ventricular arrhythmias. Over 5 yr, 105 PAFCs were inserted with this method without major complications. Conclusion. This method may reduce the risk of ventricular arrhythmias, and could be particularly useful in high-risk critically ill patients.

  • 26.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Diabetes and Coronary Surgery: Metabolic and clinical studies on diabetic patients after coronary surgery with special reference to cardiac metabolism and high-dose GIK2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction An increasing proportion of the patients undergoing cardiac surgery have diabetes mellitus, in particular type II diabetes. In spite of this, diabetic patients have received limited attention in this setting. Although diabetes is a metabolic disease cardiac metabolism in association with surgery has previously not been explored in diabetics. This investigation was carried out to describe the metabolic state of the heart in diabetics after cardiac surgery and to study if it is accessible to metabolic intervention with high-dose GIK. Also, the potential hazards associated with such a regime in clinical practice were evaluated. Furthermore, a comparison of the outcome in diabetic and nondiabetic patients after coronary surgery was done.

    Methods Myocardial metabolism and how it was influenced by high-dose GIK was assessed with coronary sinus catheter technique in a prospective randomized study on 20 type II diabetic patients undergoing CABG (paper I, II). Safety issues concerning high-dose GIK were assessed in two retrospective studies. The potential role of metabolic interventions for neurological injury was assessed in a cohort of 775 consecutive patients undergoing CABG or combined CABG + valve surgery, in whom metabolic interventions gradually replaced traditional treatment for postoperative heart failure (paper III). A detailed analysis of blood glucose and electrolyte control was done in all cases (n=89) receiving high-dose GIK during one year (paper IV). The hemodynamic impact of highdose GIK was assessed with standard postoperative monitoring including Swan-Ganz catheters (paper II, IV). Outcome and prognosis after CABG in diabetic patients (n=540) were compared with nondiabetics (n=2239) with the aid of the institutional database comprising all isolated CABG procedures from 1995-1999 (paper V).

    Results The metabolism of the diabetic heart after CABG was characterized by predominant uptake of FFA and restricted uptake of carbohydrate substrates. A high extraction rate of beta-hydroxybutyric acid and glutamate was also found. Alanine was released from the heart (paper I). High-dose GIK induced a shift towards uptake of carbohydrates, in particular lactate, at the expense of FFA and betahydroxybutyric acid (paper II). A substantial systemic glucose uptake was found during high-dose GIK treatment but the uptake tended to be lower and blood glucose higher if adrenergic drugs were used or/and if the patient was a diabetic (paper IV). High-dose GIK was associated with beneficial effects on cardiac output both in the prospective and retrospective analyses (paper II, IV). No evidence for untoward neurological effects associated with GIK treatment was found. History of cerebrovascular disease was the most important risk factor for postoperative cerebral complications and in general markers for advanced atherosclerotic disease were found to be of importance (paper III). High-dose GIK in clinical practice was associated with acceptable blood glucose and electrolyte control and no serious adverse events were recorded (paper IV). Patients with diabetes undergoing CABG had an acceptable short-term mortality that did not differ significantly from non-diabetic patients. However, diabetic patients had a higher early postoperative morbidity particularly with regard to stroke, renal- and infectious complications. Also, long-term survival was markedly reduced in diabetic patients, particularly in insulin treated patients (paper V).

    Comments FFA were the main source of energy for the heart in type II diabetics after CABG whereas the uptake of carbohydrates was restricted. The high extraction rates of beta-hydroxybutyric acid and glutamate may represent an adaptation to the unfavorable metabolic situation of the post-ischemic diabetic heart. High-dose GIK can be used in type II diabetic patients after cardiac surgery to promote carbohydrate uptake at the expense of FFA and beta-hydroxybutyric acid. The magnitude of this shift was sufficient to account for the entire myocardial oxygen consumption assuming that the substrates extracted were oxidized. This could have implications for the treatment of the diabetic heart in association with surgery and ischemia. Provided careful monitoring high-dose GIK can be safely used in clinical practice and this treatment deserves further evaluation in the treatment of postoperative heart failure. High-dose GIK also provides a means for strict blood glucose control and as substantial amounts of glucose can be infused even in critically ill patients, it may prove useful for nutrition in critical care. Several of the risk factors for neurological injury identified constitute markers for advanced atherosclerotic disease, thus, also providing an explanation for the increased risk of neurological injury in diabetics after cardiac surgery. Short-term mortality was acceptable in diabetics after CABG. However, further efforts are warranted to address postoperative morbidity and late outcome. This represents a challenge as diabetic patients are accounting for an increasing proportion of the patients undergoing CABG.

    List of papers
    1. Myocardial uptake and release of substrates in type II diabetics undergoing coronary surgery
    Open this publication in new window or tab >>Myocardial uptake and release of substrates in type II diabetics undergoing coronary surgery
    2001 (English)In: Scandinavian cardiovascular journal : SCJ, ISSN 1401-7431, Vol. 35, no 3, p. 207-211Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Knowledge about myocardial metabolism in diabetic patients is limited, and even more so in association with myocardial ischaemia and cardiac surgery. This study investigates myocardial substrate utilization in type II diabetic patients after elective coronary artery bypass graft surgery (CABG).

    DESIGN: Myocardial substrate utilization in 10 type II diabetic patients was assessed during the first hours after elective CABG with the coronary sinus catheter technique.

    RESULTS: No significant myocardial uptake of carbohydrates was observed. Free fatty acids were extracted throughout the study period but uptake was not related to arterial levels. As arterial levels of beta-hydroxybutyric acid tended to increase a significant myocardial uptake emerged. The average extraction rate of beta-hydroxybutyric acid was 31% with a peak of 42%. A comparable extraction rate of glutamate was also found whereas alanine was released from the heart.

    CONCLUSION: Free fatty acids were the main source of energy for the heart whereas uptake of carbohydrates was restricted. The high extraction rates of beta-hydroxybutyric acid and glutamate suggest an adaptive role for these substrates during this unfavourable metabolic state for the post-ischaemic diabetic heart.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13693 (URN)10.1080/140174301750305108 (DOI)
    Available from: 2001-10-11 Created: 2001-10-11 Last updated: 2009-08-21
    2. Effects of high-dose glucose–insulin–potassium on myocardial metabolism after coronary surgery in patients with Type II diabetes
    Open this publication in new window or tab >>Effects of high-dose glucose–insulin–potassium on myocardial metabolism after coronary surgery in patients with Type II diabetes
    Show others...
    2001 (English)In: Clinical Science, ISSN 0143-5221, Vol. 101, no 1, p. 37-43Article in journal (Refereed) Published
    Abstract [en]

    The effects of glucose–insulin–potassium (GIK) on cardiac metabolism have been studied previously in non-diabetic patients after cardiac surgery. Although patients with diabetes mellitus can be expected to benefit most from such treatment, the impact of GIK in diabetic patients undergoing cardiac surgery remains unexplored. Therefore the present study investigates the effects of high-dose GIK on myocardial substrate utilization after coronary surgery in patients with Type II diabetes. A total of 20 patients with Type II diabetes undergoing elective coronary surgery were randomly allocated to either post-operative high-dose GIK or standard post-operative care, including insulin infusion if necessary to keep blood glucose below 10 mmol/l. Myocardial substrate utilization was studied using the coronary sinus catheter technique. Haemodynamic state was assessed with the aid of Swan–Ganz catheters. High-dose GIK caused a shift towards carbohydrate utilization, with significant lactate uptake throughout the study period and significant uptake of glucose after 4 h. Arterial levels of non-esterified fatty acids and b-hydroxybutyric acid decreased, and after 1 h no significant uptake of these substrates was found. Increases in the cardiac index and stroke volume index were found in patients treated with high-dose GIK. A decrease in systemic vascular resistance was found both in the control group and in the high-dose GIK group. We conclude that high-dose GIK can be used in diabetic patients after cardiac surgery to promote carbohydrate uptake at the expense of non-esterified fatty acids and b-hydroxybutyric acid. This could have implications for treatment of the diabetic heart in association with surgery and ischaemia.

    Keywords
    coronary surgery, diabetes, glucose, b-hydroxybutyric acid, insulin, lactate, myocardial metabolism, non-esterified fatty acids, potassium
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13694 (URN)10.1042/CS20010005 (DOI)
    Available from: 2001-10-11 Created: 2001-10-11 Last updated: 2009-08-21
    3. Neurological injury after surgery for ischemic heart disease: risk factors, outcome and role of metabolic interventions
    Open this publication in new window or tab >>Neurological injury after surgery for ischemic heart disease: risk factors, outcome and role of metabolic interventions
    2001 (English)In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, ISSN 1010-7940, Vol. 19, no 5, p. 611-618Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Neurological complication remains a feared and increasing problem in association with cardiac surgery. The aim of this study was to analyze risk factors for neurological complications in a cohort of patients in whom inotropes for weaning from cardiopulmonary bypass was gradually replaced by metabolic treatment.

    Methods: The records of 775 consecutive patients undergoing coronary artery bypass grafting (CABG) or combined CABG+valve procedures were examined. Forward stepwise multiple logistic regression analysis was used for statistical evaluation of independent risk factors.

    Results: The incidence of neurological injury was 1.8% in patients undergoing isolated CABG and 5.4% after combined CABG+valve procedures. After cross-validation multivariate analysis identified history of cerebrovascular disease, advanced age and aortic cross-clamp time as independent risk factors for postoperative cerebral complications. Chronic obstructive pulmonary disease and number of bypasses also emerged as risk factors in the primary analysis.

    Conclusions: In general, markers for advanced atherosclerosis, with history of cerebrovascular disease as the most important, emerged as predictors for neurological injury. Although it did not enter the final risk model, the results also suggest that postoperative heart failure deserves further surveillance as a potential risk factor for neurological complications. However, no evidence for untoward neurological effects associated with glutamate or glucose–insulin–potassium treatment was found.

    Keywords
    Neurological injury, Atherosclerosis, Cerebrovascular disease, Postoperative complications, Glutamate, Glucose, Cardiac surgery
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13695 (URN)10.1016/S1010-7940(01)00664-9 (DOI)
    Available from: 2001-10-11 Created: 2001-10-11 Last updated: 2009-08-21
    4. High-dose glucose-insulin-potassium after cardiac surgery: a retrospective analysis of clinical safety issues
    Open this publication in new window or tab >>High-dose glucose-insulin-potassium after cardiac surgery: a retrospective analysis of clinical safety issues
    2003 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 47, no 4, p. 383-390Article in journal (Refereed) Published
    Abstract [en]

    Background: Metabolic treatment with insulin or glucose-insulin-potassium (GIK) has received attention in association with myocardial infarction, cardiac surgery and critical care. As a result of insulin resistance during neuroendocrine stress, doses of insulin up to 1 IU kg−1 b.w.*h are required to achieve maximal metabolic effects after cardiac surgery. The clinical experience with regard to safety issues of such a high-dose GIK regime in critically ill patients after cardiac surgery is reported.

    Methods: Retrospective, observational study involving all patients treated with high-dose GIK after cardiac surgery during one year in a cardiovascular center at a University Hospital.

    Results: Eighty-nine patients out of 854 adult patients undergoing cardiac surgery were treated with high-dose GIK. Mean age was 69 ± 1 years, Higgins score 5.3 ± 0.3. Preoperatively 31.4% had left ventricular function EF≤0.35 and 32.5% had sustained a myocardial infarct during surgery. Mortality was 5.6% and the average ICU stay was 3.7 ± 0.5 days. The main indication for GIK was intraoperative heart failure (69.7%). The average glucose infusion rate during the first 6 h was 4.22 ± 0.15 and 4.91 ± 0.14 mg kg−1 b.w.*min, respectively, in diabetic and non-diabetic patients (P = 0.023). Blood glucose and s-potassium control was acceptable.

    Conclusions: The high-dose GIK regime allowed substantial amounts of glucose to be infused both in diabetic and critically ill patients with maintenance of acceptable blood glucose control. Provided careful monitoring, this regime can be safely used in clinical practice and deserves further evaluation for treatment of critically ill patients following cardiac surgery.

    Keywords
    Cardiac surgery, glucose, insulin, metabolic support, myocardial infarction, postoperative heart failure, potassium, safety
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13696 (URN)10.1034/j.1399-6576.2003.00082.x (DOI)
    Available from: 2001-10-11 Created: 2001-10-11 Last updated: 2009-08-21
    5. Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting
    Open this publication in new window or tab >>Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting
    2002 (English)In: The Annals of Thoracic Surgery, ISSN 0003-4975, Vol. 74, no 3, p. 712-719Article in journal (Refereed) Published
    Abstract [en]

    Background: An increasing proportion of patients undergoing coronary artery bypass grafting (CABG) are diabetics. Patient characteristics, early postoperative outcome, and midterm survival in diabetic patients after CABG were investigated.

    Methods: A total of 2779 consecutive patients undergoing isolated CABG during 1995 to 1999 were studied, 19.4% of whom had diabetes mellitus. Demographic and peri-procedural data were registered prospectively in a computerized institutional database.

    Results: The diabetic group was younger and included a higher proportion of women, and patients with hypertension, triple-vessel disease, and unstable angina. They required a higher number of bypasses, and longer cross-clamp and cardiopulmonary bypass times. Intensive care unit and hospital stays were prolonged and the need for inotropic agents, hemotransfusions, and dialysis was higher in the diabetic group. Renal failure, stroke (4.3% versus 1.7%), mediastinitis, and wound infections were more frequently encountered. Thirty-day mortality was 2.6% versus 1.6% (p = 0.15). Cumulative 5-year survival was 84.4% versus 91.3% (p < 0.001).

    Conclusions: Short-term mortality was acceptable in diabetic patients after CABG but they had increased postoperative morbidity in comparison with nondiabetic patients, particularly with regard to renal function, cerebral complications, and infections. Midterm survival was impaired in diabetic patients mainly because of a less favorable outcome in patients treated with insulin.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13697 (URN)10.1016/S0003-4975(02)03778-5 (DOI)
    Available from: 2001-10-11 Created: 2001-10-11 Last updated: 2009-11-01
  • 27.
    Szabó, Zoltán
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Intraoperative insulin resistance during coronary surgery in diabetic and non-diabetic patients - parallel microdialysis and organ balance technique studying skeletal muscle and fat tissue (preliminary results)2007In: 17th Annual Meeting of the Scandinavian Society for Research in CardioThoracic Surgery,2007, 2007Conference paper (Other academic)
    Abstract [en]

         

  • 28. Szabó, Zoltán
    Kamrafibrilláció kezelése elektromágneses impulzussal állatkíséletben: [The experimental treatment of ventricular fibrillation by electromagnetic impulse]1991In: Aneszeziológia és Intenziv Terápia, Vol. 21, no 2, p. 81-84Article in journal (Refereed)
  • 29.
    Szabó, Zoltán
    Debrecen, Hungary.
    Köszöntjük a 70 éves Péterffy Árpád professzort: [Congratulations to the 70 year old Professor Arpad Peterffy]2008In: Magyar Sebeszet, ISSN 0025-0295, Vol. 61, no Suppl. 1, p. 10-11Article in journal (Refereed)
  • 30.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Letter: New forceps for videolaryngoscopic intubation2015In: Anaesthesia, ISSN 0003-2409, E-ISSN 1365-2044, Vol. 70, no 8, p. 1004-1005Article in journal (Other academic)
    Abstract [en]

    n/a

  • 31.
    Szabó, Zoltán
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vinklad tång för intubering2014Patent (Other (popular science, discussion, etc.))
  • 32.
    Szabó, Zoltán
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Andersson, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Pharmacology.
    Arnqvist, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Insulin resistance during coronary surgery in diabetic and non-diabetic patients-parallel microdialysis and organ balance technique studying skeletal muscle (preliminary results)2007In: Diabetologia(ISSN 0012-186X), vol 50, 2007, Vol. 50, p. 275-276Conference paper (Refereed)
  • 33.
    Szabó, Zoltán
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Andersson, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Pharmacology.
    Arnqvist, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Insulin resistance during coronary surgery in diabetic and non-diabetic patients-parallel microdialysis and organ balance technique studying skeletal muscle (preliminary results)2007In: European Association for the Study of Diabetes EASD,2007, 2007Conference paper (Refereed)
    Abstract [en]

        

  • 34.
    Szabó, Zoltán
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Arnqvist, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Division of cell biology. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Intraoperative insulin resistance during coronary surgery in diabetic and non-diabetic patients- preliminary results2007In: EASD: Diabetes Cardiovascular Disease Study Group Meeting,2007, 2007Conference paper (Other academic)
  • 35.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Arnqvist, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Håkanson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Jorfeldt, Lennart
    Department of Thoracic Physiology, Karolinska Hospital, Stockholm, Sweden.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Effects of high-dose glucose–insulin–potassium on myocardial metabolism after coronary surgery in patients with Type II diabetes2001In: Clinical Science, ISSN 0143-5221, Vol. 101, no 1, p. 37-43Article in journal (Refereed)
    Abstract [en]

    The effects of glucose–insulin–potassium (GIK) on cardiac metabolism have been studied previously in non-diabetic patients after cardiac surgery. Although patients with diabetes mellitus can be expected to benefit most from such treatment, the impact of GIK in diabetic patients undergoing cardiac surgery remains unexplored. Therefore the present study investigates the effects of high-dose GIK on myocardial substrate utilization after coronary surgery in patients with Type II diabetes. A total of 20 patients with Type II diabetes undergoing elective coronary surgery were randomly allocated to either post-operative high-dose GIK or standard post-operative care, including insulin infusion if necessary to keep blood glucose below 10 mmol/l. Myocardial substrate utilization was studied using the coronary sinus catheter technique. Haemodynamic state was assessed with the aid of Swan–Ganz catheters. High-dose GIK caused a shift towards carbohydrate utilization, with significant lactate uptake throughout the study period and significant uptake of glucose after 4 h. Arterial levels of non-esterified fatty acids and b-hydroxybutyric acid decreased, and after 1 h no significant uptake of these substrates was found. Increases in the cardiac index and stroke volume index were found in patients treated with high-dose GIK. A decrease in systemic vascular resistance was found both in the control group and in the high-dose GIK group. We conclude that high-dose GIK can be used in diabetic patients after cardiac surgery to promote carbohydrate uptake at the expense of non-esterified fatty acids and b-hydroxybutyric acid. This could have implications for treatment of the diabetic heart in association with surgery and ischaemia.

  • 36.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiothoracic Anaesthesia and Intensive care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Cardiothoracic Anaesthesia and Intensive care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sjökvist, Stefan
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology. Thermirage AB, Linköping, Sweden.
    Gustafsson, Torbjörn
    Thermirage AB, Linköping.
    Carleberg, Per
    Thermirage AB, Linköping.
    Uppsäll, Magnus
    Thermirage AB, Linköping.
    Wren, Joakim
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology.
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Smedby, Örjan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping.
    Real-time intraoperative visualization of myocardial circulation using augmented reality terperature display2013In: The International Journal of Cardiovascular Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 29, no 2, p. 521-528Article in journal (Refereed)
    Abstract [en]

    For direct visualization of myocardial ischemia during cardiac surgery, we tested the feasibility of presenting infrared (IR) tissue temperature maps in situ during surgery. A new augmented reality (AR) system, consisting of an IR camera and an integrated projector having identical optical axes, was used, with a high resolution IR camera as control. The hearts of five pigs were exposed and an elastic band placed around the middle of the left anterior descending coronary artery to induce ischemia. A proximally placed ultrasound Doppler probe confirmed reduction of flow. Two periods of complete ischemia and reperfusion were studied in each heart. There was a significant decrease in IR-measured temperature distal to the occlusion, with subsequent return to baseline temperatures after reperfusion (baseline 36.9 ± 0.60 (mean ± SD) versus ischemia 34.1 ± 1.66 versus reperfusion 37.4 ± 0.48; p < 0.001), with no differences occurring in the non-occluded area. The AR presentation was clear and dynamic without delay, visualizing the temperature changes produced by manipulation of the coronary blood flow, and showed concentrically arranged penumbra zones during ischemia. Surface myocardial temperature changes could be assessed quantitatively and visualized in situ during ischemia and subsequent reperfusion. This method shows potential as a rapid and simple way of following myocardial perfusion during cardiac surgery. The dynamics in the penumbra zone could potentially be used for visualizing the effect of therapy on intraoperative ischemia during cardiac surgery.

  • 37.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Forssell, Claes
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Åberg, Jonas
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Preoperative kylbehandling av nedre extremitet vid långvarig kritisk ischemi, ett sätt att minska ischemirelaterade skodor - en första kliniska erfarenhet2013In: Thoraxmötet Linköping 2013, 2013, p. 10-17Conference paper (Refereed)
  • 38.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Harangi, Márta
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Ljungman, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Theodorsson, Annette
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Davidsson, Bo
    Linköping University, Department of Behavioural Sciences and Learning.
    How students perceive problem-based learning (PBL) group tutorials at a Swedish Medical College2015In: Med Ed Publish, ISSN 2312-7996, Vol. 6, no 17Article in journal (Refereed)
    Abstract [en]

    Introduction: student perception of problem-based learning (PBL) group tutorials was investigated at a Swedish University Medical College 27 years after the introduction of PBL into the curriculum.

    Methods: a survey questionnaire comprising 43 questions answered on a Likert-type scale, together with one open question was used. The questionnaire was distributed to all 821 students taking part in the Linköping University medical program at the beginning of the Spring Term 2013. The results were subjected to explorative factor analysis, descriptive statistics and ANOVA. Responses to the open question where analyzed qualitatively by categorization.

    Results: 84 per cent of the 821 students completed the survey. Four factors describing student perception were identified: 1) PBL as a method of learning; 2) the tutor’s role; 3) PBL, stress and feelings of insecurity; and 4) traditional teaching methods within the PBL curriculum. The Cronbach´s alpha value was 0,788 overall. Two hundred and seventy-six students answered the open question declaring that they would appreciate more precise aims and objectives, smaller tutorial groups, and more formal lectures.

    Conclusions: the results of this study on PBL group tutorials, as seen from the student’s perspective, stress the importance of tutorial quality, tutor competence, tutorial group size and the quality and aims of the curriculum. Too much emphasis on the teacher’s research merits against the educational ones, and the inability to adapt to the needs and wishes of new generations of students seems a probable cause for the erosion of PBL.

  • 39.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Harangi, Márta
    Linköping, Sweden.
    Nylander, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Theodorsson, Annette
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Davidson, Bo
    Linköping University, Department of Behavioural Sciences and Learning, Education and Sociology. Linköping University, Faculty of Arts and Sciences.
    Problem-based learning (PBL): tutor perception of group work and learning2014In: MedEdPublish, ISSN 2312-7996, Vol. 3, no 46, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper reports a survey on how PBL is perceived by tutors. A questionnaire including 45 questions answered on a Likert-type scale, and an open question was constructed. The aim was to identify factors that tutors believe promote or impede student learning. All faculty tutors (116) teaching five different student semester cohorts at our medical college during the Spring Term of 2013 were included. Seventy-four tutors responded (64%). Methods:Descriptive statistics, explorative factor analysis.Results:Factor analysis identified five factors which explained 52 % of the variation. These factors were: PBL as a pedagogic method; tutoring problem analysis in the group; barriers to student learning; the tutor ́s role in the group; and the relationship betweentheory and practice. The model as a whole showed high reliability (Chrombach ́s alpha = 0,81). When responding to the open question, the tutors suggested organizational changes, improvement in tutor competence, clear goals in the curriculum, and smaller tutorial groups/miscellaneous. Conclusions:The tutors’ approach adhered to classical PBL methodology, and they considered it to be a good instrument for student learning. The tutorial group was seen as promoting learning. Problems related to group dynamics and tutor competence were considered a hindrance to learning.

  • 40.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkanson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Jorfeldt, Lennart
    Department of Thoracic Physiology, Karolinska Hospital, Stockholm, Sweden.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Myocardial uptake and release of substrates in type II diabetics undergoing coronary surgery2001In: Scandinavian cardiovascular journal : SCJ, ISSN 1401-7431, Vol. 35, no 3, p. 207-211Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Knowledge about myocardial metabolism in diabetic patients is limited, and even more so in association with myocardial ischaemia and cardiac surgery. This study investigates myocardial substrate utilization in type II diabetic patients after elective coronary artery bypass graft surgery (CABG).

    DESIGN: Myocardial substrate utilization in 10 type II diabetic patients was assessed during the first hours after elective CABG with the coronary sinus catheter technique.

    RESULTS: No significant myocardial uptake of carbohydrates was observed. Free fatty acids were extracted throughout the study period but uptake was not related to arterial levels. As arterial levels of beta-hydroxybutyric acid tended to increase a significant myocardial uptake emerged. The average extraction rate of beta-hydroxybutyric acid was 31% with a peak of 42%. A comparable extraction rate of glutamate was also found whereas alanine was released from the heart.

    CONCLUSION: Free fatty acids were the main source of energy for the heart whereas uptake of carbohydrates was restricted. The high extraction rates of beta-hydroxybutyric acid and glutamate suggest an adaptive role for these substrates during this unfavourable metabolic state for the post-ischaemic diabetic heart.

  • 41.
    Szabó, Zoltán
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Outcome and long-term survival in diabetic patients after coronary surgery. Abstract 17th Annual meeting EACTA, 2002 June 12-15, Dublin, Ireland2002In: EACTA Abstracts 2002,2002, 2002Conference paper (Refereed)
  • 42.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Maros, T.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    High-dose glucose-insulin-potassium after cardiac surgery: a retrospective analysis of clinical safety issues2003In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, Vol. 47, no 4, p. 383-390Article in journal (Refereed)
    Abstract [en]

    Background: Metabolic treatment with insulin or glucose-insulin-potassium (GIK) has received attention in association with myocardial infarction, cardiac surgery and critical care. As a result of insulin resistance during neuroendocrine stress, doses of insulin up to 1 IU kg−1 b.w.*h are required to achieve maximal metabolic effects after cardiac surgery. The clinical experience with regard to safety issues of such a high-dose GIK regime in critically ill patients after cardiac surgery is reported.

    Methods: Retrospective, observational study involving all patients treated with high-dose GIK after cardiac surgery during one year in a cardiovascular center at a University Hospital.

    Results: Eighty-nine patients out of 854 adult patients undergoing cardiac surgery were treated with high-dose GIK. Mean age was 69 ± 1 years, Higgins score 5.3 ± 0.3. Preoperatively 31.4% had left ventricular function EF≤0.35 and 32.5% had sustained a myocardial infarct during surgery. Mortality was 5.6% and the average ICU stay was 3.7 ± 0.5 days. The main indication for GIK was intraoperative heart failure (69.7%). The average glucose infusion rate during the first 6 h was 4.22 ± 0.15 and 4.91 ± 0.14 mg kg−1 b.w.*min, respectively, in diabetic and non-diabetic patients (P = 0.023). Blood glucose and s-potassium control was acceptable.

    Conclusions: The high-dose GIK regime allowed substantial amounts of glucose to be infused both in diabetic and critically ill patients with maintenance of acceptable blood glucose control. Provided careful monitoring, this regime can be safely used in clinical practice and deserves further evaluation for treatment of critically ill patients following cardiac surgery.

  • 43.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Håkansson, Erik
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Early postoperative outcome and medium-term survival in 540 diabetic and 2239 nondiabetic patients undergoing coronary artery bypass grafting2002In: The Annals of Thoracic Surgery, ISSN 0003-4975, Vol. 74, no 3, p. 712-719Article in journal (Refereed)
    Abstract [en]

    Background: An increasing proportion of patients undergoing coronary artery bypass grafting (CABG) are diabetics. Patient characteristics, early postoperative outcome, and midterm survival in diabetic patients after CABG were investigated.

    Methods: A total of 2779 consecutive patients undergoing isolated CABG during 1995 to 1999 were studied, 19.4% of whom had diabetes mellitus. Demographic and peri-procedural data were registered prospectively in a computerized institutional database.

    Results: The diabetic group was younger and included a higher proportion of women, and patients with hypertension, triple-vessel disease, and unstable angina. They required a higher number of bypasses, and longer cross-clamp and cardiopulmonary bypass times. Intensive care unit and hospital stays were prolonged and the need for inotropic agents, hemotransfusions, and dialysis was higher in the diabetic group. Renal failure, stroke (4.3% versus 1.7%), mediastinitis, and wound infections were more frequently encountered. Thirty-day mortality was 2.6% versus 1.6% (p = 0.15). Cumulative 5-year survival was 84.4% versus 91.3% (p < 0.001).

    Conclusions: Short-term mortality was acceptable in diabetic patients after CABG but they had increased postoperative morbidity in comparison with nondiabetic patients, particularly with regard to renal function, cerebral complications, and infections. Midterm survival was impaired in diabetic patients mainly because of a less favorable outcome in patients treated with insulin.

  • 44.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Håkansson, Erik
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Svedjeholm, Rolf
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Influence of postoperative activated clotting time (ACT) on re-operations for bleeding after cardiac surgery1997In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 78, p. 36-Article in journal (Refereed)
  • 45.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Katkits, Kristofer
    Östergötlands Läns Landsting.
    Gabro, George
    Östergötlands Läns Landsting.
    Andersson, Rolf
    Linköping University, Department of Medicine and Health Sciences, Pharmacology . Linköping University, Faculty of Health Sciences.
    The Contractility of Isolated Rat Atrial Tissue during Hypoxia is Better Preserved in a High- or Zero-glucose Environment than in a Normal Glucose Environment2009In: International Journal of Biomedical Sciences, ISSN 1306-1216, Vol. 5, no 1, p. 12-16Article in journal (Refereed)
    Abstract [en]

    Aim: Hyperglycemia is known to be associated with an increase in mortality in myocardial infarction and intensive care patients despite the fact that glucose metabolism plays a central role in myocardial protection. We studied the effect of different glucose levels (22 Mm L-1; 5.5 mM L-1; and 0 mM L-1) on the contractile reserve of isolated rat atrial myocardium during and after hypoxia.Methods: We observed the contraction ofisolated rat atrium strips caused by electrical-field stimulation in a modified Krebs-Henseleit Buffer (KHB) organ bath oxygenated with 95% O2 + 5% CO2 at 37°C. We applied two periods of hypoxia and two periods of reoxygenation. Three glucose concentrations were used in the buffer to study the effect of glucose (high- n=6; normal- n=7; and zero-glucose n=6). The effect of isoproterenol 1 µM L-1 was tested during the second ischemic period.Results: The main finding was that both a zero-glucose (27.8 ± 5.9 vs. 14.7 ± 3 % of baseline tension) and a high-glucose environment (38.5 ± 14 vs. 14.7 ± 3 % of baseline tension) had a positive effect in terms of better contractility than the normal-glucose buffer during both the first (p=0.00062) and the second ischemic period (31.2 ± 5.9 % zero-glucose vs 14.7 ± 4.2 normal-glucose vs. 35.3 ± 15.9% high-glucose p=0.0038).Conclusion: Both zero-glucose and high-glucose environments resulted in a better contractile reserve in isolated rat atrial myocardium during hypoxia than in a normal one. The exact clinical relevance of this observation is, at present, unclear.

  • 46.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Sjökvist, Stefan
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology.
    Gustafsson, Torbjörn
    Thermirage AB, Linköping, Sweden.
    Uppsäll, Magnus
    Thermirage AB, Linköping, Sweden.
    Wren, Joakim
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, The Institute of Technology.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, The Institute of Technology. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ahn, Henrik
    Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Smedby, Örjan
    Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Real-time intraoperative visualization of myocardial circulation by augmented reality temperature display2010In: Minimally invasive therapy and allied technologies, Informa Healthcare, 2010, p. 61-61Conference paper (Other academic)
    Abstract [en]

    Background:  Intraoperative  ischemia   during   coronary   surgery   may   have   severe   consequences   for the patient and may also pose a difficult diagnostic problem  to the  surgeon.  There  is no  clinically used direct  method  to evaluate  the  effect on  the  circulation of various therapeutic maneuvers  to the heart. Augmented (mixed)  reality using projection  of color- coded  infra-red  (IR)  images onto  the imaged  tissues in real  time  may  give an  intuitive  representation of the tissue surface temperature and thus,  information about   myocardial   perfusion   on  the  surface  of  the organ itself.

    Purpose:  To demonstrate in animal experiments the feasibility of presenting  IR tissue temperature images  reflecting  myocardial  perfusion into  the  surgical  field  with  augmented reality.

    Method: We  have  constructed a  system  consisting of an IR camera  and  a projector  integrated in such a way that  they  have  identical  optical  axes,  solving the  geometrical  correspondence problem  in an easy way. In 5 pigs (weight = 57.5 ± 7 kg), the thorax was opened    by   median    sternotomy.   After   exposing the  heart,  an  elastic  vessel loop  was placed  around the  middle  of  the  left  descending  coronary  artery. A  2  mm   ultrasound  probe   was  inserted   distally around the LAD for flow velocity measurements. Subsequent ischemia-reperfusion periods  were induced using a fixed protocol. 

    Results:  The  time course of  an   occlusion   was  clearly  seen   in  quantitative curves  as well as in  color-coded temperature  maps on the surface of the heart.  The  difference in surface temperature between the three areas more or less affected  by  the  ischemia   was  also  clearly  demon- strated.  During  ischemia,  the surface of the myocardium  showed  concentrically  arranged  zones  of different temperatures (IR penumbra) potentially cor- responding to different  degrees  of severity of ischemia. 

    Conclusion: Surface  temperature changes  due to ischemia can be assessed quantitatively and visualized  in situ during occlusion of a coronary  artery and   subsequent  reperfusion of  the myocardium. This method shows potential  as  a  fast  and  simple way of  following  myocardial  perfusion  during surgery. The  change  of the  extension  of the  penumbra zone  is a potential monitoring device  for the  thera- pies used  in the salvage or prevention of ischemia  in experimental or clinical cardiac surgery and may introduce new practices in monitoring  duringcardiac  and vascular anesthesia.

  • 47.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center.
    Träff, Stefan
    Östergötlands Läns Landsting, Heart and Medicine Center.
    Hermansson, Ulf
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center.
    Tamas, Eva
    Östergötlands Läns Landsting, Heart and Medicine Center.
    Maros, Tamás
    University of Debrecen, Hungary.
    Szentkiralyi, István
    University of Debrecen, Hungary.
    Kiegészítő klinikai módszer a nyitott szívműtéteknél fellépő légembolisatio csökkentésére: [A complementary clinical method to minimize air embolism during open-heart surgery]2008In: Magyar Sebeszet, ISSN 0025-0295, Vol. 61, p. 57-59Article in journal (Refereed)
    Abstract [en]

    Air from the left heart is ejected even up to several hours after cardiopulmonary bypass (CPB) despite the use of CO 2 . The following method is complementary in addition to surgical de-airing in order to further reduce the chance of air embolism, especially from the pulmonary veins. After re-expanding the lungs with standard bag inflation, the ventilation is restarted in consultation with the surgeon. The ventilator is set to the respiratory minute volume used before the CPB but at a respiratory frequency of 10/minutes whereas the regularly beating heart is filled from the heart lung machine. Transoesophageal echocardiography (TEE) reliably controls the effect.

  • 48.
    Szabó, Zoltán
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Vaszily, M.
    Szerafin, T.
    Herman, K.
    Hollós, L.
    Bodnar, F.
    Herreros, J.
    Peterffy, Á.
    A dinamikus kardiomioplasztika natkózisának és hemodinamikájának néhány kérdése: [Some of the quesions related to the anesthesia and hemodynamics during dynamic cardio-myoplasty]1997In: Anszteziológia és Intenziv Terápia, Vol. 27, no 3, p. 141-144Article in journal (Refereed)
  • 49.
    Szecsi, J
    et al.
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    Batonyi, E
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    Redai, I
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    Szabó, Zoltán
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    Herman, K
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    Liptay, P
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    Medgyessy, I
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    Peterffy, A
    Sebészeti Klinika, Debreceni Orvostudományi Egyetem.
    [Effect of acute aprotinin (Gordox) therapy on hemostasis in heart surgery patients, with special reference to hyperfibrinolysis]: [Article in Hungarian]1990In: Orvosi Hetilap, ISSN 0030-6002, Vol. 131, no 51, p. 2809-2814Article in journal (Refereed)
    Abstract [en]

    Authors have studied the effect of Gordox-therapy on haemostasis after open heart surgery in a prospective clinical trial. Thirty seven patients (pts) undergoing cardiac surgery due to their valve disease were randomly assigned either to control-group (20 pts) or to Gordox-group (17 pts). The patients in the Gordox group were given Gordox according the following scheme: 2 M IU within 20 min. after induction of anaesthesia followed by 0.5 M IU/hour infusion until the end of the operation. One M IU also was given into the oxygenator before starting the extracorporeal circulation. The postoperative chest tube drainage was less in Gordox-group (534 +/- 260 ml vs. 987 +/- 583 ml, p less than 0.005), and donor blood and fresh frozen plasma requirement was also lower in this group (534 +/- 633 ml vs. 935 +/- 718 ml p less than 0.05; 70 +/- 153 ml vs. 211 +/- 245 ml p less than 0.05, respectively). There was no significant difference between the two groups concerning the postoperative activated partial thromboplastin time, prothrombin time, thrombin time values. The authors could document significantly higher fibrinogen concentration and significantly lower fibrinolytic activity postoperatively in the Gordox-group (p less than 0.05). Gordox therapy has advantageous effect on haemostasis after open heart surgery which can be documented both by clinical and laboratory examination.

  • 50. Szerafin, T.
    et al.
    Nagy, Z.
    Horvath, G.
    Szabó, Zoltán
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre.
    Péterffy, Á.
    Szívmütétet követö mediastinitis kezelése izom- és csepleszlebeny felhasználásával: [Treatment of medisatinitis following cardiac surgery by means of muscular and omental flap]1995In: Magyar Sebeszet, ISSN 0025-0295, Vol. 48, p. 250-254Article in journal (Refereed)
12 1 - 50 of 54
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