Casopís lékar̆ů c̆eských
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Acute respiratory distress syndrome (ARDS) is the general term used for severe acute respiratory failure of diverse aetiology. It is associated with a high morbidity, mortality (50-70%), and financial costs. Regardless of aetiology, the basic pathogenesis of ARDS is a systemic inflammatory response leading to a diffuse inflammatory process that involves both lungs, thus causing diffuse alveolar and endothelial damage with increased pulmonary capillary permeability and excessive extravascular lung water accumulation. ⋯ Therapeutic goals include resolution of underlying conditions, maintenance of acceptable gas exchange and tissue oxygenation and prevention of iatrogenic lung injury. Many new specific therapeutic strategies have been developed, however, most of them require further scientific evaluation. The paper reviews definition, basic pathogenesis and pathophysiology of ARDS and discusses current concepts of therapeutic possibilities of ARDS.
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Casopís lékar̆ů c̆eských · Mar 1999
[Warning signs preceding the development of septic shock in patients with neutropenia treated for hematologic malignancies].
In patients with haematological malignities infectious complications take a very rapid course, and in particular during the period of neutropenia, they are not necessarily manifested by a clear symptomatology. Frequently they may be manifested only by an elevated temperature and general deterioration of the condition. The onset of shock then can be rapid and surprising. The objective of the work was to identify clinical and laboratory signs warning against the possible development of septic shock. ⋯ The investigation comprised a total of 38 patients hospitalised due to infectious complications at the intensive care unit because of general deterioration of the condition. 18 developed septic shock (group S), the remaining 20 (group N) achieved during hospitalisation at the ICU a stabilised condition. In both groups the laboratory values and clinical condition were followed up for 2-3 days prior to deterioration of the condition. Risk factors for development of septic shock in the group of investigated patients were: unusual weakness, heart rate above 95/min. beyond the temperature peak, hypoalbuminaemia, mucositis, hypokalaemia, presence of a central venous catheter and administration of parenteral nutrition.
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Casopís lékar̆ů c̆eských · Sep 1998
[Interferon alpha--the drug of choice for patients with chronic myeloid leukemia].
The conventional, or standard, treatment of chronic myeloid leukaemia (CML) with hydroxyurea and busulfan has no marked influence on its course or duration. Interferon (IFN) alpha administration has, on the other hand, been shown to induce not only a haematological but also cytogenetic response, i.e. partial or complete bone marrow repopulation by Ph-negative cells. This has triggered studies comparing IFN and conventional chemotherapy. The present work had the purpose to gain experience with IFN alpha treatment and compare the results with hydroxyurea and busulfan treatment, in the chronic phase of CML. ⋯ The results obtained confirm the value and efficacy of IFN-alpha treatment in CML patients, especially if it is started early and the dose is effective. Regular cytogenetic monitoring is necessary. Longer follow-up of the patients will be necessary for evaluation of the IFN effect on the length of their survival.
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Cancer of the prostate is an heterogenic, "epidemic" world-wide tumor, which represents the most common form of solid cancer in adult males, excluding nonmelanoma skin cancer. Prostate cancer now surpasses the incidence of lung cancer and becomes the second leading cause of male cancer death in the industrialized West countries. The incidence and mortality of prostate cancer are increasing to alarming rates (in the USA carcinoma prostate was projected to be responsible for 14% of all male cancer deaths in 1996). ⋯ This fact may more a reflection of earlier diagnosis rather than improvements in treatment. Five-year prostate cancer survival has improved for every stages of disease in the last decenium. Thanks to the screening programmes performed in many countries, urologists are faced with an increasing incidence of clinical less advanced prostate cancer and this trend is likely to continue. (ABSTRACT TRUNCATED)
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Casopís lékar̆ů c̆eských · Jan 1998
[Reoperation in congenital heart defects after primary surgery in the neonatal period and infancy].
Reoperations in cardiac surgery of congenital heart defects represent not only the difficult technical problem but also a prognostic one. They are demanding reconstructive procedures with broad spectrum of hazards and are definitely cumulating the operative risk. ⋯ Staged procedures are the major source of reoperations. Their volume does not change much and it is difficult to influence it because still a large number of complex heart defects are operated every year. On the contrary the residual or recurrent defects as well as a number of further complications can be influenced by preventive measures during primary operation.