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Biomedical subjects

J Marek

Publications and source records attributed to J Marek.

At least 91 records · Page 5Linked to original sources
PubMed1997

[Plication of the diaphragm--a method of surgical treatment of diaphragmatic paralysis in neonates and infants after heart surgery].

The cause of paresis of the diaphragm after cardiosurgery is damage of the phrenic nerve. The diagnosis of paresis is based on X-ray examination, sonography and electromyography of the diaphragm. Plication of the diaphragm is indicated only in those children with paresis of the diaphragm who develop during spontaneous ventilation severe respiratory insufficiency. In the Cardiocentre of the Faculty Hospital Prague-Motol between 1983 and 1996 of 5333 children operated on account of heart disease 29 children were subjected to plication of the diaphragm, incl. five where the operation was made during the neonatal stage (17%), 20 in infant age (69%) and four were older than one year (14%). By the third day after plication 9 children (38%) could be disconnected from the respirator, by the 5th day 20 children (70%) by the 7th day 22 children (75%). In neonates and infants with postoperative paresis of the diaphragm, where spontaneous ventilation cannot be induced, plication of the diaphragm is according to the authors the method of choice. It is a rapid and safe surgical operation which reduces the period of artificial ventilation and its complications.

Cardiac Surgical Procedures↗
PubMed1997

[Morphologic findings in the tracheal wall after long-term intubation and tracheostomy].

Investigation of tracheal wall in 27 patients showed flat ulcerations of mucosa majority of which was combined with marginal squamous metaplasia of superficial conspicuously proliferating epithelial layer. Squamous metaplasia of mucosal glands (sialometaplasia) was found around ulcerations in 14 cases. Fibroproductive inflammatory lesion of tracheal wall was accompanied by a serious destruction of cartilages reminding of that in relapsing chondritis. Regeneration of cartilages was found in 23 cases.

Adult↗
PubMed1997

[Psammomatous melanotic schwannoma].

Psammomatous melanotic schwannoma is a rare variant of schwannoma. The authors present histological and immunohistochemical findings in two cases of the tumor arising in the spinal nerve roots region at a 56-year-old woman and a 58-year-old man. The latter recurred locally. Microscopically the tumor was composed of polygonal epithelioid or spindle-shaped cells. Some of these cells contained melanin. Small calcifications were dispersed throughout the lesion. Ultrastructural examination of one of these cases revealed nerve sheath origin of the tumor cells and identified premelanosomes and melanosomes within the cytoplasm of neoplastic cells. Histogenesis and relationship of the tumor to Carney complex are discussed.

Female↗
PubMed1997

[Changes in levels of cell adhesion molecules, acute phase proteins, lipids and hemostasis in relation to levels of endogenous estrogens during pregnancy and after ovariectomy].

The protective effect of oestrogens is probably caused also by the active inhibition of the inflammatory reaction of the acute phase and release of inflammatory cytokines type IL-1 beta or TNF-alpha by this hormone. We formulated this hypothesis because we recorded a drop of the protein of the acute stage, orosomucoid, in relation to the rising oestrogen level during pregnancy (r = -0.511, p < 0.0001). It ensues also from the finding of a lower level of cytoadhesive molecules of sE-selectins in a group of 66 pregnant women (sE-sel.: 32.95 +/- 12.5 ng/ml) with a higher level of 17-beta estradiol (17-beta E2: 9.34 +/- 7.8 nmol/l), as compared with the sE-selectin level in a group of 14 women after ovariectomy (sE-sel.: 43.97 +/- 8.174 ng/ml, p < 0.016) who lacked oestrogen (17-beta E2 0.14 +/- 0.13 nmol/l) and in a group of pregnant women (n 19) in the first trimester with level of 17-beta E2: 1.89 +/- 0.711 nmol/l where the sE-selectin concentrations at the onset pregnancy was higher (sE-sel.: 35.59 +/- 9.5 ng/ml) than in a group of pregnant women (n 38) during the second and third trimester (sE-sel.: 30.58 +/- 13.3 ng/ml, p < 0.05) with 17-beta E2 concentration 11.96 +/- 7.18 ng/ml. The finding of lower sE-selectin levels which is a sign that the endothelium is not exposed to the action of inflammatory cytokines IL-1 or TNF may thus be associated with the active "control" of thrombophilia in pregnancy. When during pregnancy in conjunction with oestrogen levels changes in the lipid concentration were investigated a compensating mechanism could be observed. Hypercholesterolaemia and hypertriglyceridaemia in pregnant women was associated with a rise of oestrogen levels as well as of "cardioprotective" HDL-cholesterol (the HDL level was during the first trimester 1.31 +/- 0.26 nmol/l, in the second and third trimester 1.69 +/- 0.48 nmol/l, p < 0.0167).

Adult↗
PubMed1996

[Determination of ACTH in the inferior petrosal sinuses in the examination of patients with hypercortisolism].

BACKGROUND: Differential diagnosis of the etiology of ACTH-dependent hypercortisolism is very difficult in some cases. The uncertainty, whether there is a central or ectopic etiology, is also strengthened by the fact that even nuclear magnetic resonance (MR) sometimes does not prove the pituitary adenoma. A more precise differential diagnosis under these conditions has been made, over the last years, by selective determination of ACTH levels bilaterally in sinus petrosi inferiores (SPI) and by their comparison with the level in peripheral blood. The confirmation of central etiology makes a decision about neurosurgical intervention easier. This intervention, due to the present microsurgery technique, makes it possible to detect otherwise undetectable microadenoma and enables its selective excision with maintaining healthy hypophysis tissue and all its functions. METHODS AND RESULTS: In the last two years the authors indicated 11 patients (10 women, one man at the age of 17-54 years, mean age 33.5 year) with proved ACTH-dependent hypercortisolism to the determination of ACTH in SPI. Their CT or NMR examination did not prove a hypophysis tumour unequivocally. Only in one female patient the catheterization was not possible for anomalous vascular bed with aplasia of internal jugular vein on the left and hypoplasia of internal jugular vein on the right. In 8 patients the determination of the ratio of ACTH levels between SPI and periphery (7.78 +/- 1.54, mean +/- S.E.) has shown that even the basal levels indicated central etiology of hypercortisolism. This has been confirmed by the ratio of the values of ACTH after stimulation with corticotrophin releasing hormone (CRH). The diagnosis was confirmed in all patients by surgery, by histology and post-operation course. In two female patients the ratio of basal levels of ACTH, SPI/periphery did not prove useful for the diagnosis of the Cushing's disease. In the first patient the CRH stimulation was not yet performed routinely and the ratio of basal levels of ACTH, SPI/periphery gave a false negative result, as shown by the finding of adenoma of hypophysis during the operation. The operation was indicated on the basis of hormonal examinations and repeated MR with a finding of suspected microadenoma and the diagnosis was then confirmed by further clinical development. The determination of the levels of ACTH after CRH stimulation would give more precision in this case, as shown by analysis of the results of large cohorts in literature, which we perform at present as well. In the other patient the CRH stimulation test was done, changing the ratio from 1.1 to 5.7 and thus confirmed central etiology of the Cushing's syndrome. In agreement with literature this method did not contribute to lateral localization of the tumour. CONCLUSIONS: The determination of basal levels of ACTH in SPI and levels after CRH stimulation enables to differentiate between central and ectopic overproduction of ACTH in the ACTH-dependent Cushing's syndrome.

Adenoma↗
PubMed1996

Utility of routine carotid duplex screening in patients who have claudication.

PURPOSE: The recently published Asymptomatic Carotid Atherosclerosis Study (ACAS) demonstrated the benefit of performing carotid endarterectomy in selected asymptomatic patients who have > 60% carotid stenoses. It therefore becomes clinically important to identify the subgroups of patients who have a sufficiently high incidence of high-grade carotid stenosis to warrant routine carotid duplex screening. METHODS: To determine the incidence of asymptomatic carotid disease in patients who had a chief complaint of claudication, we evaluated 188 patients who had claudication and no history of cerebrovascular symptoms. After a complete history was taken and a physical examination performed, patients underwent standard lower-extremity noninvasive vascular laboratory studies and carotid duplex scanning. Carotid duplex findings were interpreted by the Strandness criteria. Associated atherosclerotic risk factors were assessed (patient age, male sex, diabetes, hypertension, smoking history, lipid levels, history of coronary artery disease, coronary or vascular surgery, and family history of cerebrovascular disease). Presence of a carotid bruit was also noted. Univariate analysis, logistic regression, and odds ratios were performed to identify subgroups of patients that had an increased incidence of significant carotid disease. RESULTS: Of the 188 patients with claudication who were screened, 8% had an internal carotid artery stenosis of 16% to 49%, 21.8% had a stenosis that exceeded 50%, and 2.7% had an occluded internal carotid artery. The presence of a carotid bruit on physical examination was predictive of a > or = 50% internal carotid artery stenosis (p = 0.027). The ankle-brachial index was highly predictive of the presence of carotid stenoses in an inverse relationship (p = 0.001). Patient age approached significance (p = 0.143). Patients older than 65 years of age who had claudication, an ankle-brachial index less than 0.7, and a carotid bruit had a 45% incidence of significant carotid disease. The atherosclerotic risk factors of male sex, diabetes, hypertension, hyperlipidemia, smoking history, coronary history, previous coronary or vascular surgical history, and family history were not predictive of the presence of a > 50% carotid stenosis. CONCLUSIONS: In patients who seek medical attention with the chief complaint of claudication and who have no cerebrovascular symptoms, there is a 24.5% incidence of a > 50% internal carotid artery stenosis or occlusion on duplex examination. Select subsets of these patients have upwards of a 45% incidence of significant asymptomatic carotid disease. All patients who seek medical attention with claudication should therefore undergo routine carotid duplex screening to detect asymptomatic high-grade stenosis.

Aged↗
PubMed1996

Congenital absence of aortic and pulmonary valve in a fetus with severe heart failure.

A case of congenital absence of both aortic and pulmonary valves with severe heart failure detected prenatally by cross-sectional and pulsed and colour Doppler echocardiography is reported in small for gestational age male fetus in 17th week of gestation. Additional double outlet right ventricle, hypoplastic left ventricle, and ventricular septal defect, as well as multiple extracardiac anomalies, were found by prenatal echocardiographic investigation and confirmed by necropsy examination. Retrograde diastolic Doppler waveforms retrieved from pulmonary artery, aorta, and umbilical arteries revealed massive insufficiency throughout both the great arteries, which eliminated diastolic placental perfusion, documented by absent anterograde diastolic flow in the umbilical vein. These prenatal echocardiographic findings may contribute to an understanding of the mechanism of rapid and progressive heart failure and growth retardation in the fetus. Severe cardiac failure may explain why congenital aplasia of both the aortic and the pulmonary valves has not been described postnatally, and only two fetal cases revealed by necropsy have been published.

Adult↗
PubMed1996

[Tissue plasminogen activator in treatment of fibrinous membranes after cataract surgery].

UNLABELLED: The aim of our study is estimation of the efficacy of recombinant tissue plasminogen activator for the treatment of fibrinous membranes following cataract extraction. PATIENTS AND METHODS: The fibrinous membranes were formed, despite conventional antiinflammatory therapy, in 17 eyes after ECCE with IOL and in 3 eyes after ECCE without IOL. We injected the solution of recombinant tissue plasminogen activator-Actilyse (Boehringer Ingelheim) into the anterior chamber of 20 eyes after cataract surgery. Simultaneously, topical corticosteroid and cycloplegic therapy was continued. Routine follow-up included slit lamp examination, ophthalmoscopy and intraocular pressure measurement. RESULTS: Injection of the solution of tissue plasminogen activator into anterior chamber of 20 eyes resulted in complete dissolution of the fibrinous membranes in 18 eyes within 1 day. In 7 eyes, within a few days after injection, fibrinous membrane recurred. In four of this cases durable effect of fibrin dissolution was obtained after multiple tPA injections. Finally, expectable stable result was obtained in 15 of 20 eyes. CONCLUSIONS: Results of our study confirm high efficacy of recombinant tissue plasminogen activator in the treatment of fibrinous membranes after cataract surgery. Short term follow-up and small number of cases motivates further continuation of observation.

Aged↗
PubMed1995

[Initial experience of an endocrinologist with the treatment of hypophyseal adenomas with the Leksell gamma knife].

BACKGROUND: Surgery of pituitary adenomas is not quite satisfactory so far and in some patients it is associated with a high risk. Conventional radiotherapy is only partly successful. Only few hospitals have experience with treatment of pituitary adenomas with Leksell's gamma knife. The objective of the presented paper is to give an account of the authors' own results of treatment of pituitary adenomas by irradiation with Leksell's gamma knife. METHODS AND RESULTS: The treated group comprised 13 patients (6 women, 7 men, 25-72 years old, median 44 years) with a pituitary adenoma. Hormonally active acromegaly was recorded in 9 patients, a prolactinoma in one female patient, afunctional adenoma in 3 patients. Twelve patients had been operated already previously, 3 of them twice. For visualization of the pituitary magnetic resonance (NMR) was used on a Magnetom apparatus 1.5 Tesla, Siemens Co. before surgery and one year after surgery. As hormonal indicators the following were examined: growth hormone (GH) profile in the course of the day and during the thyroliberin test (TRH), insulin-like growth factor I (IGF I), the prolactin level, the thyrotropin level (TSH) during the thyrotropin releasing hormone test (TRH) test the thyroxine level (T4) and the triiodothyronine level (T3), the plasma concentration of adrenocorticotropin (ACTH), the cortisol level, plasma testosterone level and 17-beta estradiol level. Complete recovery was achieved only in one female patient with acromegaly 18 months after irradiation, and in one patient with a prolactinoma a partial decline of hormone levels was recorded without detectable changes in the size of the adenoma. Only one female patient developed hypopituitarism. No other complications were recorded. CONCLUSIONS: Stereotactic irradiation with Leksell's gamma knife is valuable for treatment of pituitary adenomas and it is well tolerated therapy. Its effect is manifested only after several months. Complications in the sense of hypopituitarism may occur.

Adenoma↗
PubMed1995

Beneficial influence of Vero cells on in vitro maturation and fertilization of bovine oocytes.

The aim of this study was to examine the effects of Vero cells and other somatic cells on in vitro maturation of bovine oocytes. Both denuded oocytes and oocytes with intact cumuli (COCs) were cultured on monolayer of Vero cells, cumulus cells and granulosa cells. The effect of gonadotropins was investigated after the addition of gonadotropins to the culture medium. The evaluation using analysis of variance revealed that removal of cumulus cells generally reduced the percentage of oocytes completing their maturation in vitro and that this effect could not be overcome by the addition of gonadotropins to the culture medium. However, in individual experiments, when oocytes were co-cultured with different monolayers of somatic cells, Vero cells were able significantly support the maturation of denuded oocytes, and their beneficial effect was further enhanced by the addition of gonadotropins (76 vs 80.9%). We did not observe a similar effect after the co-culture of oocytes with a monolayer of cumulus cells (65.3 and 53%, respectively). Granulosa cell monolayer delayed maturation in the both COCs and denuded oocytes (10.5 and 16.5%, respectively). In vitro fertilization was successful in most of the experimental groups. However, when denuded oocytes were cultured without any somatic cell support, they did not decondense the penetrated sperm head after in vitro fertilization. This study demonstrates that 1) Vero cells beneficially affect the in vitro maturation of bovine oocytes; 2) cumulus cells in the form of monolayer lose their beneficial influence on in vitro maturation of bovine oocytes; and 3) granulosa cells and FSH and LH alone (without somatic cells) do not show positive effects on in vitro maturation of bovine oocytes.

Journal Article↗
PubMed1995

Seven-year experience of noninvasive preoperative diagnostics in children with congenital heart defects: comprehensive analysis of 2,788 consecutive patients.

The spectrum of patients operated on without preoperative catheterization and angiography, the accuracy of echocardiographic diagnosis and its impact on the results of surgical treatment were prospectively assessed in 2,788 children consecutively operated for congenital heart defects (CHD) between 1986 and 1992. The overall percentage of surgery based solely on noninvasive preoperative examination increased from 63% in 1986 to 81% in 1990 and decreased to 72% in 1992. There were no differences in the preoperative diagnostic approach between groups of newborn, infants and children. A high percentage of patients with patent ductus arteriosus (96.5%), atrial septal defect (94%), incomplete atrioventricular septal defect (88.6%), ventricular septal defect (86.3%), coarctation of the aorta (80.2%) and total anomalous pulmonary venous connection (79.3%) was referred for surgery without prior invasive examination, while a lower percentage was found in univentricular heart (48.4%), pulmonary atresia (34.6%) and double outlet right ventricle (27.7%). More patients with pulmonary and tricuspid atresia were catheterized before complete repair compared to those who underwent palliative surgery (p < 0.01 and p < 0.0001, respectively). The echocardiographic diagnosis was correct in 96% of patients. Two patients of those with incomplete preoperative diagnosis died early postoperatively, both with missed apical ventricular septal defect. One with tetralogy of Fallot died after reoperation, the other with persistent truncus arteriosus due to sepsis. When the echocardiographic findings are in full agreement with the clinical status, physical examination, ECG and chest X-ray, we recommend cardiac surgery without prior catheterization in many patients with CHD.

Adolescent↗
PubMed1995

[Tactics and technique of primary correction of aortic arch interruption using a median sternotomy].

Primary correction of an interrupted aortic arch was performed in seven neonates aged 2 to 26 days. The operation was performed from median sternotomy with extracorporeal circulation using hypothermic arrest of the circulation for reconstruction of the aortic arch. In all neonates it proved possible to make a direct anastomosis of the ascendent and descendent aorta. At the same time in six children a defect of the ventricular septum was closed, in two the common arterial trunk was corrected, in one resection of subaortic stenosis was performed and in another child correction of the aortopulmonary window. After the operation three neonates died from sepsis and multiorgan failure. At present four patients are alive who, 10 to 20 months after operation, are in a good condition. All have a non-restrictive anastomosis of the aorta. Primary correction of an interrupted aortic arch and associated defects is preferred by the authors to two-stage surgery.

Aorta, Thoracic↗
PubMed1995

[Evaluation of changes in cells of conjunctival epithelium in dry eye syndrome by impression cytology].

48 eyes of 24 patients with dry eye syndrome and 22 eyes of 11 normal subjects (control group) were examined with the technique of impression cytology. The aim of this paper was to describe changes in the cells conjunctival epithelium in dry eyes and to evaluate relationships between cytological alternations and the clinical severity of the disease. For clinical evaluation we performed medical history, slit lamp examination, rose bengal staining, break-up time, Shirmer I test. In the specimens from dry eyes we observed morphological changes of the epithelial cells, different nuclear alterations, decrease of the goblet cells density. The degree of cytological changes was related to severity of dry eye syndrome. The impression cytology is a noninvasive, simple method, providing valuable information for diagnosis and therapeutic control of dry eye disorders.

Adult↗
PubMed1995

[Anatomic correction of transposition of the great arteries in the neonatal period].

In Cardiocentrum of the University Hospital in Prague-Motol in 1988-1994 anatomical correction of transposition of the great arteries (arterial switch) was performed in 47 neonates aged 4 to 20 days. The aorta and pulmonary artery were transferred into the appropriate ventricle concurrently with reimplantation of the coronary arteries. The surgical technique was modified with regard to the anatomy of the coronary arteries and the presence of associated cardiac defects. Eleven of the 47 neonates (23%) died during the early postoperative period, one patient died two months after operation. Of the last 20 operated neonates only two died (10%) and both had an abnormal insertion of the coronary arteries. Thirty-five children are followed up for 2-45 months following anatomical correction. All are in a very good clinical condition without serious residual findings. The authors describe the protocol of the diagnostic and therapeutic procedure in transposition of the great arteries. They consider anatomical arterial correction in the neonatal period as the method of choice for this disease. The optimal age for anatomical correction in isolated transposition is between the 7th and 14th day and in transpositions with a major defect of the ventricular septum at the age of one month. The surgical results are steadily improving with accumulating experience. The medium-term results of anatomical correction of transposition of the great arteries are very favourable.

Cardiac Surgical Procedures↗
PubMed1995

Somatometric and hormonal effects of dexfenfluramine.

The effect of dexfenfluramine, the new serotoninergic appetite suppressor, was tested in 20 women. The drug was administered 3 months, 15 mg twice a day. A selected reduction of carbohydrate and of fat intake was observed. The body weight decreased mainly due to fat loss in the abdominal region. An important decrease of blood lipids was recorded, while insulinemia and OGTT remained unchanged. Serum alkaline phosphatase increased and ALT decreased. Other liver tests did not change. During the treatment the level of cortisol, TSH, T3 and 17-ketosteroids were not affected. T4 decreased and GH increased. These metabolic and hormonal effects were discussed. The treatment with dexfenfluramine was well tolerated and was found to have several favourable effects.

Appetite Depressants↗
PubMed1995

[Clinical neuroendocrinology].

An overview of research in clinical neuroendocrinology at the 3 Dept. of Internal Medicine, Charles University in Prague is reported. The research was focused on diagnosis and therapy of pituitary adenomas and on pathophysiology of some pituitary hormones. The follow up of changes in patients with acromegaly may be used as a model for possible side-effects of growth hormone therapy or doping. In acromegaly not only growth hormone serum levels but also IGF and its binding protein 3(IGF BP-3) is used when evaluating the activity of the disease. In therapy first experience was obtained with radiosurgery using Leksell gamma knife. Thirteen year experience in using a dopaminergic agonist terguride (of Czech origin) in treatment of prolactinomas was completed. Terguride represents the treatment of first choice in patients with prolactinomas of each size, giant prolactinomas inclusively. In patients with central Cushing's disease microsurgical selective removal of pituitary adenoma is preferred. When not possible, the treatment with Leksell gamma knife is indicated with the condition of normalization of cortisol secretion with medicamentous therapy until the full effects of radiosurgery are present. Growth hormone and prolactin were proved to be immunologicaly active hormones, the effect of growth hormone being mediated by somatomedins. Somatomedins seem to be ubiquitous growth factors. Their presence was demonstrated even in eggs.

Acromegaly↗