Biomedical subjects

I Kantorová

Publications and source records attributed to I Kantorová.

At least 19 recordsLinked to original sources

PubMed2001

[CRASH--the first large randomized controlled study of head injuries].

CRASH (www.crash.lshtm.ac.uk) is already today the most extensive randomized controlled study of patients with head injuries which was implemented, but its completion and statistical evaluation will be possible only when it achieves the planned and necessary 20,000 enlisted patients. This calls for unselfish cooperation of physicians and nurses world-wide. In the Czech Republic so far six departments participate in the study and we would be glad if this number would increase substantially.

Adult↗

PubMed2001

Attenuation correction stress myocardial SPECT: possibility of reduction in number of rest investigation.

BACKGROUND: Attenuation-corrected (AC) imaging frequently shows normal stress myocardial perfusion while non-corrected (NC) imaging shows hypoperfusion. The aim of the work was to assess whether it is necessary to continue with resting examination in this situation. MATERIAL AND METHODS: 121 consecutive patients had positive finding at AC and/or NC sestamibi stress myocardial imaging using E.CAM Profile system and resting examination was carried out. AC stress imaging was normal while NC imaging showed hypoperfusion in 29 cases. In one case this finding was reversed. In this group of 30 patients with AC/NC stress discrepancies, resting examination has not revealed any additional information in 28 cases. RESULTS: In 2 cases NC imaging, in contrast to AC, showed stress ischaemia. In one of these 2 cases coronarography was carried out with negative result. In the other case patient refused coronarography. CONCLUSIONS: The resting examination did not bring any benefits in 29-30 cases out of 30 (96.7 to 100.0%) patients with AC/NC stress discrepancies. If the results of this study are considered accordingly, in our group approximately one fourth of the resting examinations (29 to 30 out of 121) could be saved.

Journal Article↗

PubMed1999

A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices.

BACKGROUND: Endoscopic ligation (EVL) and endoscopic sclerotherapy (EIS) are both effective in the treatment of bleeding esophageal varices, but the efficacy of the two techniques in the prophylaxis of first variceal bleeding has not been investigated. The aim of this study was to investigate the frequency of first variceal bleeding, the recurrence of varices, and survival after treatment with the two techniques, as compared to a nontreated control group. METHODS: A total of 157 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either an EIS group (n = 55), an EVL group (n = 52), or a nontreated control group (n = 50). After the eradication of esophageal varices in the EIS and in EVL groups and in all control patients, the endoscopic examination was performed at 3-month intervals. RESULTS: There were no significant differences between EIS and EVL in the eradication rate of esophageal varices (85% in the EIS group versus 81% in the EVL group). The mean number of sessions required to obtain eradication was lower in the EVL group than in the EIS group (4.8 +/- 1.8 versus 6.2 +/- 2.0; p = 0.0003), but the recurrence of esophageal varices was higher in the EVL group (31% versus 11%; p = 0.01). Total mortality was significantly lower in the EIS patients than in the controls (20% versus 38%; p = 0.04). It was also lower, but not significantly, in the EVL patients than in the controls (23% versus 38%; p = 0.10). A significant decrease in variceal bleeding was observed both in sclerotherapy cases (20%) and controls (54%; p = 0.0005) and in ligation cases and controls (29%; p = 0.01). No significant difference in bleeding episodes was observed between the sclerotherapy and ligation cases (p = 0.29). No serious complications were observed either in the EIS or EVL groups. CONCLUSIONS: EIS and EVL are similarly effective in the prevention of first variceal bleeding. The choice between EIS and EVL depends on the skill of the endoscopic unit. For highly experienced surgeons facing no complications, sclerotherapy seems to be preferable; for all others, it is technically easier to perform ligation.

Adult↗

PubMed1999

[Changes in acid-base equilibrium, ventilation parameters and immunologic reactions in thoracoscopic operations].

In the thoracoscopic operations it is usually necessary to deflate completely the ipsilateral lung. The aim of this study was to determine changes of blood gases and alterations of immune response mediators during thoracoscopic surgery with one-lung ventilation OLV. In the study 38 patients were included undergoing thoracoscopic or video-assisted thoracic surgery. Arterial blood gases, respiratory parameters, heart rate, blood pressure were determined before one-lung ventilation, at the peak of operation and after finishing OLV. The circulatory cytokines IL-1 beta, IL-2, IL-6, IL-8, TNF-alpha, and reactive oxygen species (ROS) were measured before and after operation, 3 h, 24 h and 48 h after operation. The obtained variables were statistically evaluated. One-lung ventilation caused a significant increase of PaCO2 (from 4.69 +/- 0.67 to 5.91 +/- 0.87 kPa) which was accompanied by an adequate decrease of pH (7.455 +/- 0.033-7.368 +/- 0.037) and a number of patients developed respiratory acidosis (34%). There were no significant changes in levels of the investigated cytokines, only a mild increase of IL-6, IL-8 and TNF during first 24 h after operation was observed. The activity of ROS was highest at the end of the operation, but did not differ significantly from the start, but then decreased significantly for a period of 24 h. The authors conclude that the observed increase of carbon dioxide levels and decrease of pH had no impact on the fate of the patients. Thoracoscopic or VATS procedures were a minimal load for patients causing no significant changes of proinflammatory cytokines. The operations did not significantly elevate the activity of ROS.

Acid-Base Equilibrium↗

PubMed1999

[Does insufflation of the abdomen in laparoscopic surgery affect acid-base and ventilatory parameters?].

The cardiopulmonary and metabolic changes experienced by patients undergoing laparoscopic cholecystectomy with CO2 pneumoperitoneum are not well understood. The purpose of this study is to determine changes of basal parameters during laparoscopy and evaluate their prognostic value. One hundred patients (26 obese, 39 older than 60 years, 7 obese and older than 60) undergoing laparoscopic cholecystectomy for uncomplicated cholecystolithiasis were included in the study. Arterial blood gases, respiratory and ventilatory parameters, heart rate, blood pressure were determined before the induction of pneumoperitoneum, at the peak of operation and after exsufflation. The obtained variables were statistically evaluated. Pneumoperitoneum caused significant hypercapnia and a decrease of pH accompanied with increase of expiratory CO2 concentration, which continued after exsufflation (p < 0.001). The changes were more expressed in older and obese patients and were solely of a respiratory type. No significant changes were observed in the heart rate, blood pressure, minute ventilation, PaO2, SaO2, base excess. Although changes were highly significant, there was no impact on clinical status--all patients survived without problems. The authors conclude that observed increase of carbon dioxide levels and decrease of pH had no impact on survival of patients. Changes were caused mostly by CO2 absorption from the abdominal cavity. Laparoscopic cholecystectomy is a safe and effective procedure even in older and obese patients, especially when insufflation is as low as possible.

Acid-Base Equilibrium↗

PubMed1999

[Preventive sclerotherapy of esophageal varices with a high risk of hemorrhage: a prospective randomized controlled study].

Endoscopic sclerotherapy (ES) is known to be effective in the treatment of bleeding esophageal varices, but the efficacy in the prophylaxis of first variceal bleeding has not been clear yet. The aim of this study was to investigate the frequency of first variceal bleeding, eradication and recurrence of varices, and survival after treatment with ES compared to non-treated control group. A total of 104 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either endoscopic sclerotherapy group--SKL n = 56, or non-treated control group--KON n = 48. After eradication of esophageal varices in SKL group and in all control patients, the endoscopic examination was performed in 3 month intervals. The complete eradication of esophageal varices was achieved in 45 (83%) patients of SKL group. The mean number of sessions required to obtain eradication was 7.8 +/- 2.5. The recurrence of esophageal varices occurred in 9 (17%) patients. Total mortality was significantly lower in SKL patients as compared to controls (21.4% vs. 39.6%; p = 0.047, 95% CI 0.5-35.5). The significant decrease of variceal bleeding we observed in sclerotherapy (21%) versus controls (52%; p = 0.002, 95% CI 13-49%). Serious complications of ES were not observed. Endoscopic sclerotherapy is effective in the prevention of first variceal bleeding and in experienced hand, if the complication rate is low, is able to reduce total mortality of treated patients. The newer endoscopic method, variceal ligation, must be examined in this indication.

Adolescent↗

PubMed1998

Benefit of prophylactic endoscopic sclerotherapy of esophageal varices. A retrospective analysis.

BACKGROUND: The therapeutic schedule in bleeding esophageal varices is today established: emergency endoscopy with sclerotherapy or ligation combined with somatostatin and decreasing portal pressure drug followed by repetitive sclerotherapy or ligation. But the approach to varices that do not bleed is not clear. METHODS: The authors submit the results of a 6-year sclerotherapeutic program. Since January 1989 they have treated 421 patients with varices and have together performed 4,115 endoscopic sclerotherapeutic procedures. Among the 421 patients 95 were treated during acute bleeding and 254 were treated after first bleeding; in 72 patients prophylactic sclerotherapy (PSG) was performed. RESULTS: The procedure was indicated, when grade III or IV varices or high-risk signs and/or hepatic venous pressure gradient (HVPG) > 15 in grade II varices were observed. Prophylactic therapy (not-treated group-NTG) refused next 31 selected patients. The mean follow-up time was 32 months in the PS group and 28 months in NTG (n.s.). Fifteen PSG patients died (21%), while the mortality among the NTG patients (13 = 42% patients) was significantly higher (P < 0.02). CONCLUSIONS: We recommend prophylactic sclerotherapy with 1% polidocanol in patients with advanced varices in liver cirrhosis of varied etiology. We emphasize the need to perform these procedures in a department with adequate experience, where at least 100-200 sclerotherapies per year are performed.

Endoscopy, Digestive System↗

PubMed1997

[Transjugular intrahepatic portosystemic shunt in the treatment of complications in portal hypertension].

Transjugular intrahepatic portosystemic shunt (TIPS) is a side-to-side portocaval shunt for threatening complications of portal hypertension. The purpose of this study was to evaluate in first 33 patients indicated for TIPS insertion in our institution the efficacy, complications, and mortality. Indication was failure of sclerotherapy or ligation in control either of acute (n = 4) or repetitive (n = 25) variceal bleeding and refractory ascites (n = 4). The technical success rate was with 70% (21/30) lower than expected, but the complication rate was also very low. There were no fatal complications, only one subcapsular liver hematome, and in one patient repetitive punction of biliary tract. The 30-days mortality was 10% (2/21) and rebleeding was 15% (3/20), caused always by thrombosis of the shunt. TIPS seems to be a promising therapeutic procedure after failed endoscopic therapy of esophageal varices without the mortality and morbidity of an open surgical procedure. Recent indications for TIPS are acute variceal hemorrhage refractory to endoscopic treatment and recurrent variceal bleeding despite sclerotherapy or band ligation. Promising seems to be TIPS insertion in the treatment of refractory ascites.

Adolescent↗

PubMed1997

[Recurrent source of bleeding in patients with esophageal varices].

During last 7 years were in Endoscopic Centre of Brno Traumatologic Hospital treated 824 patients (624 male, 200 female) with esophageal varices, indicated to endoscopic sclerotherapy, ligation, or tissue adhesive injection. For one or more episodes of bleeding were treated 659 patients and resting 165 received therapy prophylactically. Recurrent acute bleeding from upper GIT occurred from 1 January 1990 to 30 April 1997 in 212 of them. In patients with previously proved esophageal varices were investigated for repetitive acute bleeding in this period 212 of them. In 157 (74%) patients endoscopy confirmed expected repetitive bleeding from esophageal varices, but in 55 (26%) was found bleeding from other source of upper gastrointestinal tract. The bleeding from gastroduodenal ulcers in 18 (8%) patients, in 22 (10%) from apths, Mallory-Weiss syndrome was source of bleeding in 8 (4%) patients, and hemorrhagic gastropathy in 7 (3%) was found. The authors draw attention to the fact that, in their big group patients with esophageal varices, duplicity of source of bleeding occurred in 1/4 patients. They concluded, that in patients with previously proved esophageal varices in necessary to perform in case of recurrent bleeding emergency of urgent endoscopy not only of esophagus, but even of whole upper GIT. Therapeutic mistake can happen in 1/4 of patients, if repetitive bleeding from varices would be expected and automatically treated by balloon tube. The patients could be damaged by delay in the treatment of bleeding from other source.

Acute Disease↗

PubMed1996

[Stress ulcers in patients with polytrauma].

Authors treat in their institution yearly 100-120 patients with polytrauma. In the Endoscopic Centre of the hospital approx. 20 gastroduodenal ulcers are diagnosed yearly in patients with supposed stress etiology. Authors analyze the pathophysiology of origin of stress ulcer, clinical symptoms and acute diagnostics. They evaluate results of early surgical treatment. Authors place the great importance on explicit treatment methods for prevention of stress ulcer origin.

Humans↗

PubMed1996

[Thoracoscopic major pulmonary resection--pro and con].

The first reports of thoracoscopic video-assisted procedures are from 1993. The main reason for this new techniques was that they allow the performance of standard thoracic surgical procedures in a less invasive ways. The operation trauma is minimalised that could be a cause not only of postoperative pain but often also of chronic future problems. The other advantages are the shortened hospitalisation time and earlier end of disablement. On the other hand there are many objective arguments against here. Firstly, the operative technique is not standardised and thoracoscopic lobectomy and pneumonectomy are performed by many modified methods. No regular randomised studies are available that could confirm the positive contribution of thoracoscopy in these cases. It is possible to perform classic thoracotomy by very careful way saving muscles and contemporary observing the requirement of safe operation and to attain the maximally possible result. Resuming information from written and verbal reports in last 3 years we have necessary the impression that the main reason for thoracoscopic reactions was to demonstrate the technical feasibility of this operation which is entirely insufficient reason for acceptance of this technique. Authors suggest that thoracoscopy is in experienced hands and adequately equipped workplaces an accurate and safe method for the diagnosis and in some cases also for therapy of hemodynamic stabile patients with thoracic trauma.

Endoscopy↗

PubMed1996

[Trauma and emergency thoracoscopy].

Authors present their first experience with urgent videothoracoscopy in polytraumatism and in isolated thoracic trauma patients. During the prospective study in 1993-1995 thoracoscopically was treated 41 (18%) from 229 multiple trauma patients including thorax trauma, hospitalised in our Institute. Thoracoscopy underwent 62 (4%) from 1452 patients with simple thoracic trauma. Thoracoscopy has been indicated above all for continued bleeding into peritoneal cavity, for suspected diafragmatic injury and for the diagnosis and treatment of posttraumatic complications. Authors suggest that thoracoscopy is in experienced hands and adequatelly equipped workplaces an accurate and safe method for the diagnosis and in some cases also for therapy of hemodynamic stabile patients with thoracic trauma.

Adult↗

PubMed1995

[Cytokine levels in patients with multiple injuries].

BACKGROUND: The role of cytokines in trauma still has not been satisfactorily elucidated. Multiorgan failure (MOF) development should be also under the direction of cytokines, endotoxin, and other mediators. METHODS AND RESULTS: Therefore we prospectively studied 88 patients with multiple trauma admitted to Traumatological Hospital Brno from June 1, 1992 to May 31, 1993. Extent of the trauma was determined by Injury Severity Score (ISS), Revised Trauma Score (RTS), and TRISS methodology with probability of survival. In study patients was investigated concentrations of interleukin 1, 2, 6, and tumor necrosis factor (TNF). Of above mentioned cytokines were elevated only IL-6 levels at admission and significant correlation with ISS was found (r = 0.32; p < 0.01). MOF developed in 23 patients (12 of them died), but it was not possible to predict the MOF development nor surviving according to admission levels of cytokines. A significant difference was observed in IL-6 levels of MOF patients one day before death (439 +/- 111 ng/l) in comparison with MOF patients, who survived (132 +/- 88 ng/l, p < 0.001). None of 12 MOF patients with IL-6 concentrations above 400 ng/l survived. CONCLUSIONS: We conclude that IL-6, less TNF, seems to play an important role in organism response to multiple trauma, and later elevation in these cytokines levels, especially IL-6 level, in MOF patients mean poor prognosis. We had found a significant correlation between initial IL-6 level and ISS. Other cytokines did not show changes during the study.

Adolescent↗

PubMed1994

Dynamics of interleukin 1, 2, and 6 and tumor necrosis factor alpha in multiple trauma patients.

The involvement of cytokines in trauma still has not been satisfactorily elucidated. The development of multiorgan failure, the very serious complication of multiple trauma with high mortality, should also be controlled by cytokines, endotoxin, and other mediators. We therefore prospectively studied 42 consecutive patients with multiple trauma admitted from June to December 1992 to the Research Institute for Traumatology and Surgery in Brno. Study patients were characterized by Injury Severity Score (ISS), Revised Trauma Score, and TRISS methodology. In all patients, tumor necrosis factor alpha (TNF-alpha) and interleukin (IL) 1, 2, and 6 levels were investigated. Of the cytokines, only IL-6 levels were elevated at admission and significant correlation with ISS was observed (r = 0.735; p < 0.001). Multiple organ failure (MOF) developed in 14 patients (seven died) and it was not possible to predict this MOF development nor survival by initial cytokine levels. A significant difference was observed when IL-6 concentrations one day before death (423 +/- 105 pg/mL) were compared with the highest concentrations in MOF survivors (112 +/- 71 pg/mL; p < 0.001). This difference was found also for TNF (528 +/- 314 pg/mL vs. 216 +/- 165 pg/mL; p < 0.05). None of six MOF patients with IL-6 > 400 pg/mL survived. In conclusion, the IL-6 and TNF-alpha levels seem to play a significant role in multiple trauma and their late elevation in patients with MOF conveyed a poor prognosis. A significant correlation between initial IL-6 levels and ISS was observed. Other cytokines did not show dynamic changes during the study.

Adult↗

PubMed1994

[Serum levels of cytokines as a measure of response to stress after various types of elective gallbladder surgery].

The authors investigated the cytokine levels in patients after laparoscopic cholecystectomy (LCHE), conventional open cholecystectomy (OCHE) and complicated open cholecystectomy (KOMPL) in order to assess whether there is a relationship between cytokine levels and the general reaction of the organism, the type and extent of the operation. They did not find an increase of IL-1 or IL-2 levels in any of the patient groups. The IL-6 concentration was slightly raised only in three patients of the OCHE group three hours after surgery and this rise persisted for 24 hours. In the KOMPL group there was a more marked rise of IL-6 in 9 patients within 3 hours after surgery, persisting in 6 patients for 24 hours and in 2 patients for 48 hours. The TNF values were similar; in group OCHE they were slightly elevated in 2 patients 24 hours after operation. In the KOMPL group these values were elevated in 5 patients for 3 hours after surgery and this increase persisted in 2 for 24 hours after surgery. Based on the investigation of cytokine levels, which is a recent indicator for evaluating the reaction of the organism to stress, conclude that laparoscopic cholecystectomy is a minimal stress for the patient and is associated with a zero defence reaction of the organism, if evaluated according to serum cytokine concentrations.

Adult↗

PubMed1994

[Hemopurification methods in the surgical unit].

The authors submit their initial experience with the activities of the hemodialyzation centre at a surgical department. They present an analysis of 79 patients where some hemopurifying procedures or their combinations were applied. These methods make it possible to perform more safely extensive surgery, they improve the care of patients with multiple injuries and extend therapeutic possibilities in acute pancreatitis and hyperbilirubinaemia when they cannot be treated by other methods. From the range of hemopurifying methods they consider the following most suitable for a surgical department: classical acute haemodialysis, hemodiafiltration, haemoperfusion and continuous arteriovenous dialysis.

Acute Kidney Injury↗

PubMed1994

[Is it possible to predict a decrease in portal pressure after administration of ACE inhibitors?].

We have previously shown that angiotensin converting enzyme inhibitor enalapril causes a potent decrease in portal pressure gradient, but only in about one half of patients with portal hypertension and an episode of bleeding esophageal varices in patient's history. Twenty-one consecutive patients after first episode of bleeding from esophageal varices were enrolled in the trial. Patients were treated by sclerotherapy in combination with enalapril. The level of ACE in patients with portal hypertension (10.4, SD 4.5) was significantly higher than in normal population (4.5, SD 1.3 mu kat/l-1) [p < 0.001]. After 3 months treatment decreased ACE to normal or subnormal levels in all 21 patients (2.9, SD 1.5 mu kat.l-1) [p < 0.001], but simultaneously measured hepatic venous pressure gradient decreased more than 3 mm Hg only in 11 (52%). No correlation between changes of portal pressure gradient and changes of ACE concentrations were found. We conclude that patients with portal hypertension have significantly higher serum ACE level with a large decrease after enalapril, but it is not possible to predict the effect of enalapril on portal pressure by estimation of ACE level in serum in individual patient.

Adolescent↗

PubMed1993

[Another source of hemorrhage--risks for patients with esophageal varices].

The authors treated during the past three years 312 patients with oesophageal varices after the first haemorrhage. All patients were treated by endoscopic sclerotization of oesophageal varices and drugs which reduce the excessive portal pressure. After a minimum of two sclerotherapeutic sessions, following control of acute haemorrhage, the authors observed a relapse of haemorrhage from the upper gastrointestinal tract in 38 patients. In 20 of them the relapse of haemorrhage was again from oesophageal varices, but in 18 patients it was of different origin and would not be affected by classical treatment with a Sengstaken tube. The authors draw attention to the necessity of emergency endoscopy in these patients and to the fact that possible postponement of rational treatment, e.g. in duodenal ulcers insertion of a tube, may threaten the patient's life.

Adolescent↗