Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Jan 2002
[Chronic myeloid leukemia as a model for modern noncytostatic therapy of malignant diseases. From Virchow to STI 571].
Chronic myelogenous leukemia (CML) has been described in the middle of the 19th century. It took further 100 years to the time of the discovery of the first cytotoxic drugs. Ph1 chromosome, the cytogenetic hallmark of CML, has been described in 1960, however, the majority of important discoveries on the molecular level has been done in the 1980s' and later. ⋯ It must be emphasized, however, that STI 571 has been clinically tested only since 1998. Moreover, from the mechanisms of action it is clear, that STI 571 influences the secondary, not the primary cause of the CML. Nevertheless, it is without any doubts that the development of new anti-cancer drugs will be done on this non-cytotoxic principle.
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Vnitr̆ní lékar̆ství · Dec 2001
Review[Extravascular lung water in acute respiratory distress syndrome: pathophysiology, monitoring and therapeutic possibilities].
Excessive amount of extravascular lung water (EVLW) resulting from increased permeability of alveolo-capillary membrane is a pathophysiological hallmark of acute respiratory distress syndrome (ARDS). Increased EVLW produces hypoxemia by interference with gas exchange. ⋯ The presented paper briefly reviews the mechanisms involved in lung edema formation and describes current options to measure EVLW. In addition, it discusses clinical implications of EVLW measurement in intensive care setting with particular focus on transpulmonary indicator dilution technique.
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Vnitr̆ní lékar̆ství · Nov 2001
Review[Prevention of septic conditions in adult patients with functional hyposplenism and after splenectomy].
Splenectomy and functional hyposplenism predispose the patient to serious life threatening infections. The most frequent pathogenic organism which causes serious infections in splenectomized adults or hyposplenic patients is Streptococcus pneumoniae. In the etiology of these conditions however also a number of other bacterial and non-bacterial microorganisms may be involved. The risk of serious infections and deaths may be markedly reduced by simple preventive measures, education of the patient, vaccination and antibiotic prophylaxis.
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Vnitr̆ní lékar̆ství · Sep 2001
Clinical Trial[Non-cytostatic treatment of malignancies. Anti-CD20 monoclonal antibody (Rituximab, Mabthera) in the treatment of non-Hodgkin's lymphoma].
Some types of non-Hodgkin lymphomas cannot be treated by contemporary preparations. After repeated relapses and chemotherapy moreover damage of bone marrow occurs and further intense cytostatic treatment is not possible. Monoclonal antibodies against structures on tumour cells are an interesting alternative of cytostatic treatment. ⋯ Favourable therapeutic results were recorded in patients with follicular lymphoma (70% of the therapeutic responses), small lymphocyte lymphomas (64% of therapeutic responses) and in patients with a relapse after autologous transplantations (80% of therapeutic responses). Anti CD20 monoclonal antibody is a new effective alternative of cytostatic treatment. Its position in the therapeutic strategy in patients with non-Hodgkin lymphoma awaits elaboration.
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Weaning from mechanical ventilation is not complicated in the majority of patients, in some, however, this process is very complicated and lengthy. These patients are described as difficult to wean. A suitable weaning strategy and properly timed extubation or decannulation is important not only from the aspect of the patient's health status but also with regard to costs of care. ⋯ Promising seems the use of non-invasive ventilation but this was not proved unequivocally so far. The use of weaning protocols reduces the weaning period from mechanical ventilation. The authors summarize most recent findings on the weaning problem incl. the most frequently used ventilation regimes and prognostic indicators of successful weaning.