Vnitr̆ní lékar̆ství
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Pericardial effusion after cardiac surgery is common, but only in a small part of patients it has progressive character and cardiac tamponade occurs. Accurate diagnosis and well-timed pericardiocentesis are necessary to effective management of this life threatening complication. The study aimed at presentation of our centre outcomes of echocardiographically-guided pericardiocentesis in patients after cardiac surgery. ⋯ Pericardiocentesis was significantly more frequent after valve surgery (7.1%, p < 0.001), aortic root surgery (8.2%, p < 0.001) and surgical ablation of atrial fibrillation (6.6%, p < 0.001), i.e. in patients who had received postoperative anticoagulation therapy. Echo-guided pericardiocentesis was technically and therapeutically successful in 100% of cases and no complications were registered. The time elapsed between surgery and puncture was in range 6 to 80 days (median, 13 days). The median volume initially aspirated was 450 ml (range, 50 to 1,550 ml). Forty five patients (93.8%) had extended catheter drainage with active suction, the median duration of the drainage was 1 day (range, 1 to 6 days), the mean volume of catheter drainage was 328 ml (median, 145 ml; range, 20 to 2,950 ml). Four patients (8.3%) required repeated pericardiocenteses because of recurrence of significant pericadial effusion. Extended pericardial catheter drainage (after initial evacuation of the effusion) was associated with a significant reduction of recurrence of significant pericadial effusion and with lower probability of repeated pericardiocentesis. We can conclude, echo-guided pericardiocentesis was effective and safe method for primary treatment of postoperative pericardial effusions.
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Vnitr̆ní lékar̆ství · Dec 2007
Randomized Controlled Trial Comparative Study[The treatment of hyperglycaemia in critically ill patients: comparison of standard protocol and computer algorithm].
Hyperglycemia is commonly observed in patients hospitalized on intensive care units. It is has been demonstrated that normalization of blood glucose level using intensive insulin therapy significantly improves prognosis of these patients. The aim of our study was comparison of standard protocol of intensive insulin therapy used on cardiac surgery ICU in General University Hospital in Prague and computer algorithm MPC (Model Predictive Control). ⋯ Our results show that the use of MPC algorithm result in more effective blood glucose control in critically ill patients than standard protocol.
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Pulmonary alveolar proteinosis is a rare disease characterised by excessive accumulation of surfactant components in the alveoli and the distal airways with minimum inflammatory reaction and fibrosis of pulmonary interstitium. Three clinical forms of pulmonary alveolar proteinosis are distinguished - congenital, primary and secondary. Results of ultrastructural, biochemical and functional analyses and studies performed on genetically modified mice support the presumption that accumulation of surfactant in pulmonary alveolar proteinosis is a result of a degradation disorder and of diminished clearance of the surfactant from the alveolar space rather than of excessive synthesis of surfactant components. ⋯ In most cases, the prognosis for the disease in adult patients is good, even though there is a 10 to 15% rate of patients who develop respiratory failure. Total pulmonary lavage is considered to be the standard method of treatment. In recent years, recombinant human GM-CSF has been studied as a prospective therapy for the treatment of pulmonary alveolar proteinosis.
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Subclinical thyroids disease (STD) is recently defined term in clinical thyroidology, which includes mainly functional disorders. Basic diagnostic signs are: normal values of thyroid hormones (fT4, fT3) and elevated TSH level (subclinical hypothyroidism) or suppresed TSH level (subclinical hyperthyroidism). In a category of STD may be included subclinical autoimunne thyroiditis (elevated level of thyroid antigens antibodies and/or hypoechogenity in sonographic screen, increased volume of the thyroid without clinical symptoms and/or autoimminity) and microscopic lesions of papillary thyroid carcinoma. ⋯ Indication of treatment of STD is a matter of controversies. Recomendations of experts, varied from "no therapy, monitoring only" to "treat always". Treatment of risk groups (esp. pregnant women) is probably nowadays a most rationale recommendations since results of sofisticated prospective studies will be available.
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Vnitr̆ní lékar̆ství · Apr 2007
[Long-term experience with trerpostinil infusion treatment in patients with pulmonary arterial hypertension in the Czech Republic].
Pulmonary arterial hypertension (PAH) is a serious primary illness of the pulmonary arterioles, characterised by progressive precapillary pulmonary hypertension. The conventional therapy for this condition is so-called specific pharmacotherapy, which addresses the key mechanisms in the pathophysiology of the illness, making use of drugs from the prostanoid group, endothelin receptor antagonists and phosphodiesterase inhibitors. Treprostinil is a stable analogue of prostacyclin, which can be administered subcutaneously, intravenously or by inhalation. ⋯ Treprostinil improves symptoms and hemodynamics for PAH patients and reduces mortality.