Casopís lékar̆ů c̆eských
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Hemodynamic support during the circulatory failure with vasodilation, most frequently during the septic shock, is based on volume recovery and administration of inotropic drugs. If such therapy is not sufficient, vasoconstriction drugs are subsequently or parallel added to maintain the perfusion pressure. As a standard therapy, norepinephrine or other catecholamines with alpha-adrenergic effect are used in rising doses. ⋯ In shock states with the deficit of endogenous vasopressin, which are resistant to high doses of catecholamines, administration of vasopressin analogues represents a new perspective therapy. The treatment should be studied from the point of morbidity and mortality. A careful approach has to be used in septic patients with pre-existing obliterative vassal disease.
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Casopís lékar̆ů c̆eských · Jan 2004
Review[Examination of exhaled breath condensate in patients with asthma and chronic obstructive pulmonary diseases].
Considerable interest of specialists all over the world has focused on the measurement of the markers of inflammation and oxidative stress in the exhaled breath condensate in patients with asthma or chronic obstructive pulmonary diseases recently. Use of exhaled condensate is based on the hypothesis that aerosol particles exhaled in human breath reflect the composition of the bronchoalveolar extracellular lining fluid. The standard collection of the material requires condensation of exhaled air and the samples have to be kept in biologically inert containers. ⋯ The examination of exhaled breath condensate is absolutely non-invasive method, which can be repeated as often as needed and it is extremely well tolerated both by children and seniors. Markers in the condensate enable detection and quantification of the inflammation process, the disease monitoring, and assessment of the response to the treatment. The breath condensate diagnostics is a new progressive method and in the patients with asthma and chronic obstructive pulmonary disease it can bring complementary information to the very sensitive method of determination of exhaled nitric oxide.
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With growing number and seriousness of traffic accidents and with improving quality of the rescue system, an increasing number of patients with blunt chest injury and injury of intracardiac organs arrive at the hospital facilities. Heart and thoracic aorta can be wounded simultaneously and by similar mechanisms. ⋯ Blunt injury may affect any part of the heart and thoracic aorta, most frequently the right ventricle and aortic isthmus. While diagnosis and treatment of serious injury of the heart seems unequivocal, there is no agreement about the appropriate duration and intensity of monitoring, the use of echocardiography and about the assessment of myocardial markers in stable patients with blunt chest injury.
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Multimorbidity frequently develops in old age and it is usually accompanied with pharmacotherapy of elderly patients. The growing number of seniors and comparatively low attention given to this reality among the medical community makes the problem highly significant for the practical medicine. ⋯ Moreover, some foods, beverages or preservatives can influence the pharmacological effect. Due to multimorbidity in the senescence, such problems can be linked to large geriatric syndromes (instability with downfalls, immobility, decubitus, incontinency, intellectual and sensory defects of vision and hearing).
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Casopís lékar̆ů c̆eských · Jan 2004
Historical Article[Medical and philosophical discussion of human nature].