Biomedical subjects

H Kubesová

Publications and source records attributed to H Kubesová.

At least 19 recordsLinked to original sources

PubMed2003

[Specific features of hematopoiesis and hemostasis in advanced age].

The ageing process affects also haematopoiesis and haemostasis and these changes can have a far reaching effect on other organ systems and their function. The authors decided therefore to present a review on involutional changes on the formation and function of blood elements and the system of blood clotting. The review is divided into description of changes in the bone marrow and explanation of hitherto known facts on the pathophysiological background of these changes. Furthermore the authors deal with changes in the peripheral blood stream and their mutual relations with administered drugs, diseases under way, reactions to external stimuli such as immunization etc. In the second part of the review the authors describe changes of haemocoagulation, emphasize the tendency of hypercoagulation and the mutual relationship of the development of atherosclerotic changes and hypercoagulation trends and their pathophysiological background. Attention is paid to thromboembolic disease and its increasing risk in elderly patients incl. the possible late manifestation of congenital defects of coagulation inhibitors. The authors mention also the influence of lifestyle and dietary factors on the coagulation activity in old age. They analyze in detail possibilities and pitfalls of prophylaxis of thromboembolic disease in elderly patients and the risks of haemorrhagic complications of different operations.

Aged↗

PubMed2001

[Pain in elderly patients and aspects of its therapy].

Treatment of pain in elderly patients can meet with diagnostic problems, namely in those with cognitive disorders, as well as with problems concerning pharmacokinetic and pharmacodynamics brought about by the advanced age. Our article presents an overview on the basic differences in the diagnostics and treatment of pain, on the therapeutic risks, and on other interrelations, which have to be considered in the therapy of elderly patients. The review is supplemented with results of our examination on the rate of analgesic treatment, spectrum of analgesics in use in the population of patients older than 75 years. About one quarter of the population use analgesics regularly, the order of most frequently prescribed analgesics is: ibuprofen 38%, diclophenac 24%, tiaprophenic acid 14%, tramadol 8%, indometacine 4%. Included were also data concerning the quality of life of patients with pain and information about the relations among patients and the curing personnel where obtained by our own inquiry. Patients concluded that pain was better tolerated at home, administration of drugs in tablets revealed to be most satisfactory, all information, namely from medial doctors, were welcome. Treatment of pain improved the quality of life in 1/3 of patients; one half of them considered it as successful. Personnel also asked for better professional information, though they had good of knowledge on the evaluation and documentation of pain and the principles of pharmacological treatment. Failure of treatment evokes in 69% of the personnel the feeling of impotency, in 41% affection of unsatisfactoriness, in 20% a tension, in 13% feeling of failing, in 18% depression and frustration. Reconciled with failure is 6% of the curing personnel.

Age Factors↗

PubMed2001

The influence of new scientific information on the treatment of elderly patients in general practice.

UNLABELLED: It has been proven that with an increasing number of diseases elderly patients are treated by an increasing number of drugs despite the fact that treatment of elderly persons should be as simple as possible. Simpler dosage of (fewer?) drugs may contribute to a good cooperation on the part of patients, as well as to a lower incidence of undesirable effects and drug interactions. Sticking to established medication schemes is another feature observed in practice, which interferes with the introduction of novelties. The aim of this study was to investigate the actual situation of medication of elderly patients treated by general practitioners in this country. Between 1996 and 1998, a random group of 1481 patients aged older than 75 was studied in cooperation with general practitioners. A detailed history was obtained and physical examination was performed, signs of depression were assessed, Barthel's test of everyday activities, and IADL (activities of daily living) and MMSE (Mini Mental State Examination) tests were applied. A unified "Protocol on Examination" was used in which three questions were concerned with medication--the kinds of drugs taken by the patient, their names and dosage, and whether any hypnotics were taken. The five most frequently prescribed groups include vasodilators (62% patients), cardiotonics (39%), analgetics (41%) and Ca-antagonists (25%). The dynamics of the prescription were remarkable--a significant decrease of the use of analgetics and cardiotonics was observed in comparison with a significant increase in the use of ACE inhibitors. The number of drugs administered is as follows: while only 1.3% patients took no drugs, 1.6% patients took more than 13 drugs. 61% patients rank among the categories taking 4-5 or 6-8 kinds of drugs. On the whole, general practitioners tend to prescribe medicaments in doses one tablet per day. CONCLUSIONS: The results suggest that, even nowadays, elderly patients are treated with a rather high number of medicaments. In contrast, the dosage of one tablet a day decreases the total number of the tablets taken. A significant influence of new scientific information was visible in the prescription habits of general practitioners. Be that as it may, in elderly patients, the simplest possible medication should continue to be aimed at.

Activities of Daily Living↗

PubMed2000

[Cardiotoxicity of antineoplastic therapy].

Cardiotoxicity is a serious complication of anti-tumorous treatment. Cytostatics can cause a number of undesirable side-effects such as arrhythmias, angina pectoris, acute myocardial infarction, sudden death, cardiac failure. The probably most serious cardiotoxicity is chronic cardiac failure after treatment with anthracyclines. Interest in the diagnosis, monitoring and treatment of cardiotoxicity revealed new findings of cardiac complications after various cytostatics, high-dosage chemotherapy and transplantation of haematopoietic cells. Prospective paediatric studies provided evidence of the serious character of late cardiotoxicity of anthracyclines. The authors review the most frequent cardiac complications of anti-tumorous treatment. They emphasize in particular the toxicity of anthracyclines and its possible prevention.

Antineoplastic Agents↗

PubMed1999

[Warning signs preceding the development of septic shock in patients with neutropenia treated for hematologic malignancies].

BACKGROUND: 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. METHODS AND RESULTS: 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.

Adult↗

PubMed1998

Herpes simplex infection as possible etiology for febrile neutropenia and mucositis in patients treated for hematological malignancies.

Mucositis is a common complication following chemotherapy. Clinical findings similar to herpetic infection are observed in some patients. Acyclovir administered in addition to empirical, antibiotic treatment improves the course of mucositis, and can also bring down the temperature. The aim of our study was to define the etiological influence of herpetic infection on the course of febrile neutropenia in patients with mucositis. A total of 34 patients with febrile neutropenia were divided into 2 groups: 15 with typical herpetic eruption, and 19 with non-specific mucositis. Both groups received 5-10 mg/kg acyclovir every eight hours together with empiric antibiotic treatment. The effect of acyclovir was studied, and results compared in the two patient groups. Body temperatures decreased in both groups, clinical symptoms, however, disappeared more slowly in the group with non-specific mucositis. The beneficial effect of acyclovir treatment was particularly well expressed in seropositive patients. In this group of patients, herpetic infections may recur under further chemotherapy. Thus, it would be useful to administer acyclovir to them prophylactically during risk periods.

Acyclovir↗

PubMed1995

[Subcutaneous chamber systems (ports) for long-term care in cancer patients].

Maintenance of satisfactory and safe venous access in cancer patients is part of a comprehensive care of cancer patients. As the Hickman/Broviac catheter is today used an implantable port. This port is placed in a subcutaneous pocket. The catheter connected to the port leads into the central vein, usually through the subclavian vein. An application of drugs in the port is done trough the skin. In this time could be used different types of ports, one or two chambers port, low profil port, peripheral port and others. In this paper we reported our two-years experience with 33 totally implantable access systems, which has been implanted in patients with cancer in Masaryk University Hospital Brno Bohunice. In our department was most frequently used port the nonmetallic port IMPLANTOFIX (BRAUN MELSUNGEN). All ports were in place for a total of 5,582 days, in average of 169 days. A frequency of complications were 2.15 on 1,000 days. Four ports were in place for longer than 1 year. A comparison of the incidence of complications in the present study with an analysis of 23 studies reported in literature was satisfactory. Minimal maintenance care, no restriction of life activity, improving quality of life and probably less frequency of infection complications, identify it as a significant advantage for the satisfactory maintenance of venous access of oncology patients in comparison with Hickman/Broviac catheter. Both the patients and the nursing staff showed a very high degree of satisfaction with this system. In cancer patients, especially with poor venous access, and prognosis longer than 6 months can be indicated this system with the advantage for patients.

Adolescent↗

PubMed1993

[The effect of selective decontamination on malignant hematologic diseases treated with aggressive chemotherapy].

The authors analyzed the course of 100 cycles of chemotherapy administered on account of haematological oncological disease: 66 cycles with administration of selective decontamination and 34 without its administration. Based on an analysis of the gut flora they provided evidence of the necessity of concurrent administration of originally separately administered antibiotics and of the necessity to replace nystatin by amphotericin B. They found a significant reduction of the incidence of infectious complications, the number of days with a body temperature above 38 and reduced consumption of antibiotics. The authors found a different composition of the agents causing infectious complications--a reduction of the ratio of Gram-negative agents and an increase of Gram-positive agents and fungi and also in increased percentage of fever of unknown origin. By analysis of the sensitivity of the detected microbes to antibiotics the authors assessed changes in the resistance caused by administration of selective decontamination and assessed the order of assumed effectiveness of the tested antibiotics.

Adult↗

PubMed1993

[Blood component replacement in bone marrow aplasia in patients after aggressive chemotherapy for malignant hematologic diseases].

Aggressive chemotherapy of malignant haematological diseases causes long-term aplasia of bone marrow and it is necessary to supplement blood elements repeatedly. When procuring blood derivates frequently dramatic situations develop. In an attempt to prevent alloimmunization of the patient by careful selection of the donor the time interval between indication and administration of the transfusion is prolonged. The objective of the present work was to attempt an estimate, as regards time and amount, for transfusion of blood derivates. The authors analyzed 100 cycles of aggressive chemotherapy with regard to changes of the haemogram. The group was divided arbitrarily with regard to the initial value of different components of the haemogram and for these portions of the group a time schedule of check-up examinations of the haemogram and of the assumed time of indication of transfusion of blood derivates was elaborated. In patients with an initial values of red blood cells above 3.5 x 10(12)/l the first transfusion is usually needed on the 8th day after the beginning of chemotherapy, in patients with a values lower than 3.0 x 10(12)/l after the initial supplementation a further drop may be expected already on the 4th day. Indication of replacement of thrombocytes can be expected in patients with an initial thrombocyte value above 120 x 10(9)/l cca on the 8th day, in patients with an initial thrombocyte value of 30 x 10(9)/l after initial replacement indication of another transfusion can be anticipated already on the 4th day after the beginning of chemotherapy.

Adult↗

PubMed1993

[Early empiric antibiotic therapy of infectious complications in patients with neutropenia].

Aggressive chemotherapy used at present for the treatment of malignant haematological diseases leads to prolonged aplasia of the bone marrow with the possible development of fulminant infectious complications. Treatment of these complications must be started immediately when they are detected, i.e. as a rule without knowing the bacteriological finding at the time. The objective of the present work was to assess by analysis of 376 positive bacteriological findings from hospitalized patients with neutropenia and 141 findings of immunocompromised patients in their homes a combination of antibiotics for empirical treatment of infectious complications which developed during hospitalization or treatment at home.

Adult↗

PubMed1987

Guanfacine in the treatment of hypertensives with a pronounced response to exercise and diabetes mellitus.

The authors assessed the antihypertensive effect of guanfacine (Estulic Sandoz) in 28 stage II hypertensive patients with a pronounced pressure response to the isometric test. Over a period of 4.3 months on the average, they managed to normalise both resting and exercise blood pressure in 89% of subjects. In another study, the authors administered guanfacine to 30 I- and II- type diabetics with essential, primarily stage I, hypertension. Over an average of 6 months, blood pressure normalised in 81% and, when using a guanfacine-saluretic combination, in additional 11%, that is, in a total of 92% of patients. It has been demonstrated that guanfacine has no adverse metabolic action. By contrast, the level of compensation of diabetes mellitus improved allowing 50% of patients to decrease their doses of oral antidiabetic drugs and insulin as well. The authors believe that, in diabetics with hypertension, guanfacine can be rightly regarded as the drug of first choice since it is effective in single-drug therapy and can be used with advantage in patients with whatever complication of diabetes mellitus.

Antihypertensive Agents↗

PubMed1986