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J Kvasnicka

Publications and source records attributed to J Kvasnicka.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Stability of corneal optic power after photorefractive keratectomy].

Changes in the values of optical power of cornea in patients after photorefractive keratectomy (PRK) obtained by Fourier analysis of videotopographic picture of cornea were investigated. The authors compared changes of cornea surface (optical power) in patients with preoperation myopia up to 6 and more than 6 diopters. Moreover, the changes of absolute values of corneal optical power were compared with the development of refraction of the optical system as a whole. In patients with a lower degree of myopia the cornea optical power became stable up to 6 months after the operation. The cornea surface in patients with higher myopia was still changing one year after the operation. The changes of optical power of cornea in patients with a higher myopia were more marked, but the differences were not statistically significant (except for the period after cornea ablation). There was not any significant difference between the changes of objective refraction and the changes of cornea optical power. The main cause of fluctuating postoperative refraction is apparently the change of cornea surface associated with healing of cornea.

Adult↗
PubMed2002

Circulating intercellular cell adhesion molecule-1, endothelin-1 and von Willebrand factor-markers of endothelial dysfunction in uncomplicated essential hypertension: the effect of treatment with ACE inhibitors.

The aim of the study was to examine whether the circulating cell adhesion molecules, von Willebrand factor (vWf) and endothelin-1, are elevated in patients with essential hypertension with no other risk factors for atherosclerosis and thus may serve as a markers of endothelial dysfunction in uncomplicated hypertension. Furthermore, the effect of treatment with the ACE inhibitor, quinapril, on levels of endothelial dysfunction markers were studied. The levels of adhesion molecules (intercellular cell adhesion molecule-1 [ICAM-1], E-selectin, P-selectin), von Willebrand factor (vWf) and endothelin-1 were measured in patients with hypertension without any other risk factors of atherosclerosis before and after treatment with quinapril (n = 22) and in normotensive controls (n = 22). Compared with normotensive subjects, the hypertensive patients had significantly higher levels of ICAM-1 (238 vs 208 ng/ml, P = 0.02), vWf (119 vs 105 IU/dl, P < 0.05) and endothelin-1 (5.76 vs 5.14 fmol/ml, P < 0.05). Three-month treatment of hypertensive patients with quinapril led to a significant decrease in the levels of endothelin-1 (5.76 vs 5.28 fmol/ml, P < 0.01). We did not observe significant changes in the levels of adhesion molecules and vWf after ACE inhibitor treatment, although a trend toward a decrease was apparent with all these parameters. Patients with uncomplicated hypertension with no other risk factors of atherosclerosis had significantly elevated levels of ICAM-1, vWf, and endothelin-1. Our data suggest that these factors may serve as markers of endothelial damage even in uncomplicated hypertension. In hypertensive patients, treatment with the ACE inhibitor quinapril resulted in a significant decrease in endothelin-1 levels. These findings indicate a beneficial effect of ACE inhibitors on endothelial dysfunction in hypertensive patients.

Adult↗
PubMed2002

[Dysfunction of a valve prosthesis].

The authors describe the case of a haemodynamically unstable patient with dysfunction of a valvular prosthesis which was resolved by emergency surgery. In the discussion they deal with two basic causes of these dysfunctions and their possible solutions.

Female↗
PubMed2002

[The photopic ERG response in diabetes mellitus].

The authors made photopic ERG examinations according to the international standard in 82 diabetic patients. They recorded a significant reduction of amplitudes of the b wave in a group of 38 patients who at the time of the examination did not have yet any pathological changes on the fundus. Regressive analysis did not prove after laser photocoagulation in these patients, contrary to a control group and diabetic patients with simple diabetic retinopathy, any correlation between the patients age and the extent of the retinal response. Photopic electroretinograms must be included in the electrophysiological diagnostic arsenal in diabetes.

Adaptation, Ocular↗
PubMed2002

[Is mild essential hypertension without obvious organ complications and risk factors associated with increased levels of circulating markers of endothelial dysfunction? Effect of ACE inhibitor therapy].

The objective of the investigation was to assess whether circulating adhesion molecules, von Willebrand factor (vWf) and endothelin-1 are elevated in patients with mild uncomplicated essential hypertension without further risk factors of atherosclerosis and whether they could serve as indicators of endothelial dysfunction in this form of hypertension. Furthermore the authors investigated the effect of ACE inhibitor treatment (ACEI), quinapril, on the level of these markers of endothelial dysfunction. The level of adhesion molecules [intercellular cytoadhesion molecule-1 (ICAM-1), E-selectin, P-selectin], von Willebrand s factor (vWf) and endothelin-1 were assessed in patients with mild essential hypertension without further cardiovascular risk factors or clinical manifestations of atherosclerosis before and after quinapril treatment (n = 25) and compared with normotensive controls (n = 29). The results of the examinations provided evidence that contrary to controls the hypertensive subjects had significantly higher ICAM-1 levels (237.8 vs. 207.8 ng/ml, P = 0.02) vWf (118 vs. 106 IU/dl, p < 0.05) and endothelin-1 (5.81 vs. 5.15 fmol/ml, p < 0.05). Three-month treatment of hypertensive patients with ACEI led to a significant drop of endothelin-1 levels (5.81 vs. 5.26 fmol/ml, p = 0.01). The authors proved also an unequivocal declining trend of other cytoadhesion molecules and vWf after ACEI treatment, the changes however were not statistically significant. From the investigation it may be concluded that also patients with uncomplicated essential hypertension without other cardiovascular risk factors or clinical manifestations of atherosclerosis have significantly elevated plasma levels of ICAM-1, vWf and endothelin-1. Higher concentrations of these factors suggest endothelial dysfunction already in mild forms of essential hypertension without further risk factors or cardiovascular complications. A significant drop of endothelin-1 and declining trend of the other investigated indicators suggest that ACEI treatment can favourably influence endothelial dysfunction in hypertensive patients also independently on reduction of the BP.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

[Optic disc pits and maculopathy (electroretinography study)].

An ERG examination according to the international standard was made in 55 patients with pits in the optic nerve disc. 19 of them suffered from concurrent maculopathy. Electroretinography revealed in scotopic responses a significant reduction of amplitudes of oscillatory potentials and reduction of potentials of the b wave in standard (maximal) reactions. Even more markedly the cone reactions and flicker were reduced--responses to intermittent (30 Hz) photostimulation. The authors consider maculopathies with pits a separate nosological unit with possible hereditary transmission. ERG signalizes a more extensive alteration of retinal structures than affection of the centre, probably on the basis of the circulation. Maculopathies with pits are also characterized by the fact that the dramatic drop of amplitudes is associated with the patient's age or the duration of the disease.

Adolescent↗
PubMed2002

[Fatal complications in pre-eclampsia and eclampsia].

OBJECTIVE: Analysis of preeclampsia and eclampsia--one of the major contributor to life-threatening maternal morbidity frequently leading to maternal mortality in the Czech Republic till late 70's. Our goal was to mention major causal links in clinical courses of individual maternal death and to highlight main mistakes and faults, and to provide frequencies and basic characteristics of risk groups. DESIGN: Retrospective epidemiological study. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague. Institute for the Care of Mother and Child, Prague-Podoli; 1st Intern Department of the 1st Medical School of Charles University and General University Hospital, Prague. METHODS: Analysis of 31 cases of maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic during 1978-2000, using a database of 470 maternal deaths during the observed period. We analyzed clinical course with special attention to obstetrical surgery and clinical management. We considered timelines of life-threatening events, age of mother, parity, and place of death. RESULTS: There were 36 maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic in 1978-2000, contributing 7.7% to total maternal mortality. Group A1 was 5th most frequent cause of maternal death. We analyzed 31 cases closely related to severe preeclampsia and eclampsia. During 1978-1990 there was 1 death per 74,263 live-born babies in this category, while during 1991-2000 we observed only 1 death per 171,137 live-born babies. Clinical management was not adequate in 15 cases of death (48%) and content of care did not reflect possibilities of prevention, diagnosis and therapy. Severe preeclampsia and eclampsia was more frequent among older women and multiparae. First group (61%) is composed of women with manifest convulsions, 25% of them experienced convulsion after delivery, and only few cases had mild preeclampsia ante partum. Eclampsia with convulsions leading to coma were in 10 cases complicated with DIC, two cases in this group had premature separation of placenta. Besides classic symptoms of preeclampsia there were within this group 5 cases of multiple pregnancy, history of unstable hypertension, hepatopathy in previous pregnancy and chronic nephrosis. The second group (39%) were cases without convulsions. These cases were complicated with severe liver disorders and renal failure, and 5 cases of intra-cranial hemorrhage. Several cases had combination of symptoms. DIC was present in 6 cases. In both groups there were 5 cases with hemorrhagic skin symptoms, thrombopenia, symptoms of DIC and liver and renal failure, which would fall into HELLP syndrome according to current classification. The most of women died during the postpartum period (87%) mostly after emergency operative deliveries. The fact that no women died during pregnancy indicates the effort to perform life-saving operative delivery. Forty two percent of women were in term. Especially at the beginning of observed period we noticed tendency to prolong gestation in order to save the baby. The mortality of fetuses or newborns was 71%. Operative deliveries accounted for 71%, the majority of them were caesarean sections. More than 50% of cases were operated in coma. We indicate major mistakes and failures in organization of care, primary prevention, diagnosis, and consequent care. CONCLUSION: Positive results in area of maternal deaths in association with severe preeclampsia and eclampsia during last 10 years are due to improved diagnostic and therapeutic measures in our field, especially in neonatology, because obstetricians currently terminate pregnancies early than before while symptoms of preeclampsia get worse. We focus on early recognition of symptoms of coagulopathy in combination with symptoms of preeclampsia, especially on early detection and treatment of HELLP syndrome.

Adult↗
PubMed2002

[Acute phase reaction in severe injuries].

UNLABELLED: This study observes acute phase response in first time after injury. HYPOTHESIS: Injured patients are already in first timepiece up severe injury in worse general state developed acute phase response than control group before planed surgery. Levels of indicators acute phase response and haemostasis from venous blood samples collected in an injury day and at patients control group before planned surgery were compared. We compare findings of traumatized in admission day and of patients at 6th-7th day after planned surgery, when is the biggest handicap. Plasma levels of orosomukoid, C reactive protein, prealbumin, transferin, alpha-2-macroglobulin, PAI-1, tPA, sE-Selectin, SICAM, sP-Selectin, antithrombin III, fibrinogen, haemoglobin, time of Quick test, TT, APTT, number of leukocytes, erythrocytes and thrombocytes were determined. RESULTS: Tested group severe injured admitted in I. Surgical Department of First Medical School of Charles University and General Faculty Hospital in Prague in years 1995-1998 (n = 105) be characterized by average value ISS--19.182 +/- 3.315, PTS--28.284 +/- 2.362, AIS--6.739 +/- 0.829 and GCS--11.449 +/- 0.974 and average age 56.89 +/- 4.84 year. Average time hospitalization was 70 days. Between 7th-21st day of hospitalization 23 patients dead on multiorgan failure or sepsis. Control patient file before planned surgery (n = 50) and after planned surgery (n = 33) was comparable in age characteristics. CONCLUSIONS: Adaptation reserve of injured is already in first time-piece since injury significantly lower to patients without trauma. Starting position traumatized patients before acute surgery is comparable with state of patients at 6th-7th day after planned surgery, when culminates postoperative acute phase response.

Acute-Phase Proteins↗
PubMed2002

[Prevention of thromboembolism in surgery of fractures of the upper end of the femur].

Morbidity and mortality after hip fractures is often a result of deep vein thrombosis and pulmonary embolism. Therefore, prophylaxis for venous thrombosis is recommended in patients undergoing osteosynthesis of upper end of lower extremity or arthroplasty of the hip. Study compared efficacy of UFH and LMWH in prevention of thromboembolic disease. The most important part of the study is the prospective trial, which describe group of 81 patients, undergoing operation for hip fracture. These patients suffered fracture of the neck of femur (35) or intertrochanteric fracture (46). For prevention of DVT was used UFH or LMWH. The evaluation was exercised by laboratory tests, Doppler test and by phlebography in cases, where was suspicion of phlebothrombosis. All patients were controlled for two months after operation. Died eleven patients; in every case was PE or cause of death or main complication. Nine of dead was operated for pertrochanteric fracture, another two for fracture of the neck. Prevention drug was UFH in nine dead patients; eight of them suffered pertrochanteric fracture. The most often death sated in fourth and fifth weeks after operation. It means, that the risk of PE continue for a several weeks. It appears, that the prevention use of UFH is not sufficient.

Aged↗
PubMed2002

[Metabolic changes caused by artificial ischemia in knee arthroscopy].

The most important complication of arthroscopy of the knee is DVT. We studied 53 patients who undergoing arthroscopy with artificial ischemia of lower limb. We examined some biochemics and haematological dates, for example lactate, APTT, INR, PAI-1 etc. In our collection we did not find any case of thromboembolic disease. It seems, that arthroscopy operation with artificial ischemia of lower limb do not increase the risks of DVT. We means, that especially in cases with longer tourniquet time (more than 30 min) is better, when we give some type of Heparin (best is LMWH) as prevention of DVT, because in laboratory results we found significant increase of PAI-1. It is possible, that it can be caused by the rising thrombus.

Adolescent↗
PubMed2002

[Disseminated intravascular coagulation syndrome and protein C].

Disseminated intravascular coagulation (DIC) is characterized by systemic activation of the haemostasis. In many instances the release of inflammatory cytokines and tissue factor trigger the system in septic or traumatic conditions. Initially, the increased activation of haemostasis can be compensated by natural inhibitor systems. As release of the triggers persists, inhibitors (e.g. antithrombin and protein C) will be consumed leading to intravascular clotting. In this process many coagulation factors, most notably fibrinogen and platelets are consumed too, resulting in a failure of haemostasis system and in a diffuse bleeding (decompensated DIC). Fresh frozen plasma, blood transfusion, and fibrinogen concentrate correct the bleeding, if needed, in the case of traumatic (obstetric) DIC. Arrest of the activated haemostasis by heparin and natural anticoagulants (antithrombin or/and protein C) is recommended, mainly in septic conditions with systemic inflammatory reactions. A case of stercoral sepsis usefully treated by recombinant human activated protein C is reported.

Disseminated Intravascular Coagulation↗
PubMed2002

[Increased sP-selectin and other cardiovascular risk factors: fibrinogen, tissue plasminogen activator (t-PA Ag) and acute phase proteins after kidney transplantation].

BACKGROUND: Our study was designed to monitor the presence of the "coronary artery disease (CAD) risk factors" after kidney transplantation. METHODS: 26 kidneys transplant recipients with well-functioning (creatinine clearance > 0.8 mL/s) renal allografts receiving cyclosporine A (CsA) as the basic component of immunosuppressive therapy and 60 healthy age-matched controls were included into the study. As "CAD risk factors" were determined the levels of fibrinogen, acute phase proteins orosomucoid and C-reactive protein, t-PA Ag, PAI-1 Ag and soluble adhesion molecules E-selectin, P-selectin and ICAM-1 in the peripheral blood serum or plasma. RESULTS: Renal transplant recipients showed higher BMI (p < 0.001) and levels of fibrinogen (p < 0.001), t-PA Ag (p = 0.007) and PAI-1 Ag (p < 0.001), acute phase protein orosomucoid (p < 0.001) and higher level of soluble P-selectin (p = 0.038). The levels of sICAM-1 and sE-selectin did not differ statistically significantly from those in controls. CONCLUSION: Our study has demonstrated renal graft recipients with good kidney function already show significantly raised levels of "CAD risk factors" fibrinogen, acute phase reactant orosomucoid, t-PA Ag, PAI-1 Ag and sP-selectin.

Acute-Phase Proteins↗
PubMed2002

[The signal-averaged ECG in long-term monitoring of patients with fulminant myocarditis].

A case of a 24 year-old patient with fulminant myocarditis is described. The lymphocytic myocarditis was proved by endocardial biopsy. The patient had been followed for 15 months clinically, by transthoracic ultrasound and by the signal averaged ECG. The clinical and ultrasound parameters of the left ventricular systolic dysfunction subsided within 6 months, STT changes on the routine 12-lead ECG within 2 months. On the signal-averaged ECG, changes were observed in both the time and in the frequency domain. When the results of the initial examination (6 weeks after the beginning of the disease) were compared with the examination at the 7th month of the disease there was a prolongation of the QRS duration (from 95 ms to 104 ms), prolongation of the duration of the filtered ECG below 40 microV (from 21.5 to 36.2 microV) and the decrease of the total sum of the potential in the terminal part of the QRS. Most apparent was the decrease in the total sum of the high-frequency components (filter 70-250 Hz) of the QRS (RMSt: from 53.3 microV to 37.9 microV at the same noise level). In contrast to the changes in the time domain parameters there was no tendency in improvement of the RMSt. In patients with myocarditis the signal averaged ECG may prove to be a suitable tool for the long-term follow-up of the subclinical structural abnormalities of the left ventricular wall.

Adult↗
PubMed2001

[Changes in microcirculation and selected laboratory parameters in the early stages of diabetic microangiopathy].

BACKGROUND: Early stages of diabetic microangiopathy are accompanied with dysfunction, manifested by changes of some biochemical parameters. Parallel changes were observed in microcirculation. The aim of this study was to compare microcirculation in the skin of a forearm evaluated by laser Doppler with selected laboratory markers of endothelial dysfunction in Type 1 diabetes mellitus without microangiopathy or with incipient microangiopathy. METHODS AND RESULTS: Group of 43 Type 1 diabetic patients was examined in this study. 20 of them had no signs of microangiopathy and in 23 patients a simple diabetic retinopathy (background retinopathy) was diagnosed. Control group consisted of 25 healthy persons of comparable age, sex, and body mass index. All persons involved in this study were examined by laser Doppler and by biochemical examination and the results were compared. In comparison with control group, in diabetic patients the arm occlusion significantly lowered the increase of perfusion (29 +/- 12 vs. 41 +/- 18 perfusion units (PU) p < 0.01). Similarly the perfusion velocity increase was significantly lower in diabetic patients than in healthy controls (p < 0.01). Also the velocity of the perfusion increase after the warming up was lower in the diabetic than in non-diabetic persons (p < 0.01). Such changes of perfusion or those of velocity of perfusion increase were significantly lower in diabetic patients with microangiopathy than in those without this complication. Perfusion increases after both stimuli highly correlated (r = 0.86, p < 0.001). In diabetic patients with microangiopathy significantly higher N-acetyl-beta-glucosaminidase (NAG) activities in serum and E-selection or ICAM-1 concentrations were found as compared with patients without microangiopathy, whereas plasma concentrations of tissue plasminogen activator (tPA) or inhibitor (PAI-1) were comparable with those in the control group. NAG activity inversely correlated with velocity of the perfusion increase after both the occlusion (r = -0.41, p < 0.01) and the warming (r = -0.38, p < 0.05). Similar relationship was found between tPA or E-selectin and the velocity of the perfusion increase after the occlusion (r = -0.48, p < 0.01). CONCLUSIONS: Our results confirm that biochemical parameters and microcirculation are impaired in the early stage of microangiopathy in Type 1 diabetic patients. Detailed analysis showed that both types of examination offer slightly different information on the vascular status. A long prospective study in diabetic patients without incipient vascular changes will be necessary to evaluate if biochemical or microcirculatory changes can bring an earlier information on the developing angiopathy.

Acetylglucosaminidase↗
PubMed2001

Changes in markers of anemia and iron metabolism and how they are influenced by antianemics in postpartum period.

BACKGROUND: The object of this study was to examine the occurrence of iron deficiency anemia in women after spontaneous delivery, changes in clinical and laboratory indicators of anemia in postpartum period and their possible control by administration of peroral antianemics. METHODS: Ninety pregnant women at 35th to 39th week of gestation were randomly divided into three groups and extensively examined in a laboratory. After delivery, the mothers were examined four times at monthly intervals until the end of the third postpartum month. At the same time, they were examined for their subjective feeling of health, with some focus on typical anemic symptoms. Women in the first group were treated with 80 mg of elemental iron a day for the first two months after childbirth. Women in the second group were treated with 80 mg of elemental iron+0.35 mg of folic acid a day for the same period of time. Women in the control group did not use any medication. McNamara test was used to evaluate the portion of anemic and sideropenic women and for comparison between individual groups. RESULTS: Findings of the study have shown a faster adjustment of laboratory and clinical indicators of postpartum anemia in women treated with iron. We did not observe the only, sovereign marker of iron deficiency (sideropenic) anemia in the early postpartum period. CONCLUSIONS: We recommend flat administration of iron to all women after spontaneous delivery. Postpartum substitution with iron should last at least three months because of long-lasting sideropenia. Adding folic acid to iron does not have any significant impact during the postpartum period.

Adult↗
PubMed2001

[The scotopic electroretinogram and age].

1. Electroretinographic examination according to recommendations of the International Society for Clinical Electrophysiology of Vision (ISCEV) was implemented in 115 healthy subjects of different age groups. 2. No significant difference was recorded in the results of men and women. 3. The amplitudes of all investigated retinal responses decline in a linear fashion with age and their peak latencies are prolonged. The mentioned changes are statistically significant even if changes of 0.5 to 0.8% per year are involved.

Adaptation, Ocular↗
PubMed2001

[The acute phase reaction in laparoscopic and open surgery of inguinal hernias].

The acute phase response to tissue injury is art of the wound healing process after surgery. The aim of study was to determine levels of acute phase proteins and levels of thrombocytes in patients with laparoscopic surgery (intraabdominal preperitoneal repair) and in patients with open surgery (tension free repair). Exclusion criteria in both groups of patients: malignity, diabetes mellitus, obesity (BMI > 30), infection, hypoproteinemia, hepatic or renal insufficiency and hypertension. Type of anaesthesia: general. Perioperative preventive antithrombotic medication: LMWH 5 days after surgery. The observed parameters were estimated before, one hour, 2nd and 7th days after surgery. Statistical test: ANOVA, statistical by significant difference p < 0.05. The results of the study demonstrate an increase of acute phase proteins CRP, OROSO and Fb in both groups of patients in comparison to their levels before surgery. In this respect we did not find a difference between the two types of operation. In patients with laparoscopic surgery the observed peak of FBG increase (+69%) was on the 2nd day after surgery followed by a slight drop of values in comparison to the results of open surgery patients with a FBG increase on the 2nd day (+42%) and with continuation on the 7th (%) postoperative day. The peak of CRP values was on the 2nd day in both groups. OROSO values increased even on the 7th day. The same situation occurred with Plt levels (p < 0.05). We suggested, that laparoscopic and open surgery of inguinal hernia repair are both followed by an acute phase response related to the tissue injury and this response perists even 1 week after surgery. But the recovery time of some parameters of the acute phase response (e.g. orosomucoid and fibrinogen levels) to the basical preoperative state is longer in patients with open type of surgery. We do not confirm differences in the degree of risk of postoperative thrombophilia in both types of surgery and suggest, that the prevention of thromboembolic complications is indicated in both types of surgery.

Acute-Phase Proteins↗