Casopís lékar̆ů c̆eských
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Casopís lékar̆ů c̆eských · Jan 2007
Review[Thrombotic complications of sepsis and their pharmacological prophylaxis].
Patients with severe sepsis are at increased risk for developing thrombembolic phenomena. This article aims to clarify the association between systemic inflammation activation and coagulation, pathogenesis of coagulation abnormalities during severe sepsis. The article reviews incidence and deep venous thrombosis risk factors among these patients and summarizes recent evidence-based guidelines for deep venous thrombosis prophylaxis.
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Casopís lékar̆ů c̆eských · Jan 2007
Review[Obesity based on mutation of genes involved in energy balance].
Within the last decade an intensive research led to an identification of several genes which are involved in a regulation of energy balance. In most cases, carriers of these gene mutations do not exhibit further characteristic phenotypic features except for a severe obesity. Obesity based on mutation of one gene product is called monogenic obesity. ⋯ Mutations of the other genes involved in energy homeostasis are very rare. Although these mutations are sporadic we assume that further research of monogenic forms of obesity might lead to our understanding of physiology and pathophysiology of regulation of the energy homeostasis and eating behaviour. Additionally, they may open new approach to the management of eating behaviour and to the treatment of obesity.
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Sepsis represents an important infectious process with systemic manifestation. The incidence of sepsis is continuously increasing. This epidemiologic trend reflects the aging population, increasing number of chronically ill patients and invasiveness of the modern medicine. ⋯ As an example is a failure of clinical study with monoclonal antibody against TNF-a. Thus, the search for new clinically effective therapeutic agents is aimed at pathogenetic mechanisms activated in longer time frame after the primary insult. Currently, out of drugs modulating the already known immunopathophysiological mechanisms of sepsis corticosteroids and activated protein C are used.
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Casopís lékar̆ů c̆eských · Jan 2007
[Surgery tracheostomies and percutaneous dilatation tracheostomies--retrospective study].
Surgical tracheostomy (ST) is replaced by percutaneous dilatation tracheostomy (PDT), namely because the second one requires less equipment and it consumes less time. PDT is indicated and performed mostly in intensive-care units. We focused on the type of technique of both methods and on the frequency of their complications. ⋯ During the last five years an increase of PDT performed to secure airways was observed. When performing ST, horizontal incision of the skin and division of the thyroid gland isthmus were used most frequently. Griggs' technique was used to perform PDT. PDT was associated with the higher rate of early complications and there was no significant difference in late complications in both groups.
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Adverse cardiac outcomes continue to be an important cause of perioperative morbidity and mortality in the non-cardiac surgery. This is related to the high prevalence of coronary artery disease in the aging surgical population. Beta-blockers were proved useful and efficacious in the treatment of perioperative myocardial ischaemia and arrhythmia. ⋯ However, one recent meta-analysis and several new studies have not confirmed the postulated beneficial effects of perioperative betablockade and gave rise to an animated controversy. Until the finalization of ongoing large trials in the next two years, the decision to start prophylactic perioperative beta-blockade remains at the discretion of the responsible physicians. This decision should be based on the patient's risk, the type of surgery and on the consideration of potential interactions and side-effects of the selected beta-blocker.