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Biomedical subjects

K Kubát

Publications and source records attributed to K Kubát.

At least 19 recordsLinked to original sources
PubMed1999

[Etiopathogenesis of type 2 diabetes mellitus].

In the genesis and development of type 2 diabetes in the great majority of subjects the contemporary lifestyle characterized by inadequate physical activity and an excessive energy intake is of basic importance. The majority of abnormalities and defects revealed by laboratory tests is probably secondary and caused by the above mentioned factors. Contemporary views of the etiopathogenesis of the disease are demotivating for patients: if the cause of their disease were an inborn disorder at the level of transmission of a signal on membranes then probably nothing else can be done than to take prescribed drugs. If the mistake involves the lifestyle, the latter can be changed and the disease avoided. Any medicamentous treatment is associated with the risk of undesirable effects--the complication of hyperinsulinism in treatment with sulphonyl urea derivatives and insulin or lactate acidosis after treatment with biguanides. This risk is not influenced by early prevention: dietary restraint and adequate physical exercise. Diabetes type 2 and 1--despite the common sign of hyperglycaemia--are characterized by a fundamental difference: (not influenced by treatment) DM type 1 is characterized by enhanced catabolic processes, starvation at the cellular level. Type 2 is characterized by enhanced anabolic processes, excessive amounts of nutrients in cells. The authors submit recommendations which respect the secondary character of deviations for the development of DM 2 which can be detected by laboratory methods: The following are the basic etiopathogenetic mechanism for the development of DM 2: 1. Chronic excessive intake and inadequate output of energy a) increased nutrient supply to the liver with secondary increase of gluconeogenesis in the liver, b) chronic increased supply of glucose to peripheral tissues, in particular muscles and adipose tissue, inadequate physical exercise, with secondary restriction of nutrient supplies to these tissues. 2. Secondary affection of insulin secretion in the islets of Langerhans in the pancreas.

Diabetes Mellitus, Type 2↗
PubMed1999

[The paradox of insulin resistance].

Insulin resistance (IR) is a phenomenon which associates several serious "diseases of civilization" within the framework of Reaven's metabolic syndrome. In the submitted paper the authors describe the so-called "paradox of insulin resistance"--a paradoxical finding of inadequate insulin action under laboratory induced conditions while under "common" conditions the finding is reversed. Diabetes mellitus type 2 (with obesity) is characterized by excessive filling of cells by energetically rich substances. A low energy output, inadequate physical activity in these subjects leads to the development of regulatory mechanisms, which restrict further nutrient (glucose) uptake from blood into cells. During subsequent stages of the disease the excessive glucose uptake by adipose tissue cells and muscle is ensured by the high concentration gradient, hyperglycaemia and hyperinsulinaemia. Induction of "comparable" conditions in clamp studies leads to paradoxical results. During relative hypoglycaemia and hypoinsulinaemia (as compared with normal conditions) the tissues of the diabetic patient, due to regulatory mechanisms, take up a smaller amount of glucose than tissues of non-diabetic subjects (although under normal conditions the glucose uptake is higher). This phenomenon is called "Paradox of insulin resistance". In a major proportion of patients IR can be induced by mere maintenance of hyperinsulinaemia, it can be minimalized by reducing the nutrient intake and by increasing physical exertion. Differentiation of patients where IR is a secondary, regulatory phenomenon is one of the basic tasks of the physician. Only patients who suffer from primary disorders of insulin function, primary IR and true insulin deficiency should be treated by administration of hyperinsulinaemia inducing drugs. It is questionable how suitable it is to administer these drugs to patients who suffer from a life-style disorder and are threatened by complications associated with hyperinsulinism.

Diabetes Mellitus↗
PubMed1997

[Combined disorders of the acid-base equilibrium. Clinical comments].

The submitted paper contains comments on the evaluation of combined disorders of the acid-base balance. Some different definitions of the acid-base balance are given as well as their importance for the evaluation of combined conditions. The author discusses parallel and opposite deviations which develop inside and outside the cell, disorders associated with the mere accumulation of some ions and disorders associated with an impaired energy balance. On several examples clinical manifestations of impaired acid-base balance are illustrated where the laboratory finding may be atypical.

Acid-Base Imbalance↗
PubMed1996

[Basic indicators characterizing the acid-base equilibrium and its disorders].

The author describes and evaluates basic parameters used for evaluation of the acid-base balance: pH, pCO2, BE, BBS, (Na + K)/Cl, (AG) and RA. He compares the theories of two basic schools, the Copenhagen and Boston school and synthesizes the different views of various authors. A combination of modern theories permits to evaluate simple and combined disorders of the acid-base balance, disorders which can potentiate each other but also mask their effect. The author mentions also the importance of oxygen parameters and of other substances essential for obtaining energy, the importance of assessment of the patient's clinical condition, the necessity of retrospective evaluation based on the trend of changes of the acid-base balance in the course of time. In the article mathematical logical terminology of acid-base balance disorders is used, the attached figures and calculations facilitate the understanding of this pretentious problem.

Acid-Base Equilibrium↗
PubMed1995

[Determination of serum lactic acid and the acid-base equilibrium in carbon monoxide poisoning].

The authors present a description of severe accidental carbon monoxide poisoning. They stress the significance of the examination of lactic acid level at this poisoning. In case described the level of carbonyl haemoglobin could not be determined because of device trouble. Patient AA (16-year-old) was admitted in relatively very good condition, without clinical signs of severer affection. Considering the facts that gas-poisoning (over 24 hrs) was found through anamnesis, and simultaneous admission of patient's greatgrandmother in critical condition, the patient AA was treated also with oxygen of high concentration, monitored, kept in absolute rest. High lactate level (18.9 mmol/l) and the evidence of metabolic acidosis (pH 7.16, pO2 8.65, pCO2 2.06, sBE -22.1) made to suspect of severe poisoning. Despite intensive oxygenotherapy it came to severe left-side cardial failure associated with pulmonal edema, anuria, shock after 4 hours, managed successfully within 4 hours. Lactate level correlated very well with condition severity. Septum hypokinesis was demonstrated cardiografically and it disappeared within 6 days. However, symetric inversion of T wave in many leads (I, II, aVF, V 2-6) persisted for 24 days. The authors assume that routine examination of acid base balance and lactate level in addition to the determination of carbonyl haemoglobin level is very important for the consideration of the severity of carbon monoxide poisoning. Lactataemia determination is probably even more significant for the assumption of oxygen deficit and therefore for the total prognosis of the patient.

Accidents, Home↗
PubMed1995

[Lactate acidosis: a rare or common disease?].

The authors present a survey of 50 documented cases of metabolic lactic acidosis (MLAC) recorded in the course of 5 years. To this study cases of severe hyperlactataemia (determined minimum lactate level of concentration 4 mmol/l) have been included. The sample consists of patients hospitalized at the Department of Internal Medicine Litomĕrice (hinterland of about 110,000 inhabitants). Liver involvement in 5 cases, cardiogenous shock in 6 cases, sepsis in 2 cases were the cause of lactic acidosis. The administration of biguanids (Adebit, Silubin R, Diformin) seems to be the probable cause in 21 cases, other cases were triggered by rarer causes. Dehydratation (16), vomiting (9), diarrhoea (11) dominate often in the clinical picture. The patients were admitted to the hospital often unconscious, with diagnose of vasculo-cerebral incidence, transitory ischaemic incidence... Quit rarely the typical Kussmaul's respiratory (only 9 cases) was recorded. Hyperlactatemia was usually associated with decrease of blood pH (theta = 7.12, pH less than 7.35 was recorded in 49 cases, pH less than 6.8 in 5 cases) and with decrease of BE value (= Ccoase, theta = -15.3 mmol/l). When the hypochloremia and/or hypocapnia was simultaneously more severe, only in these cases the value of pH was within physiological limits or even increased (10). The conclusions show that MLAC is not a rare disorder, however, its occurrence is depended rather on the clinician's capacity to diagnose this disorder and to indicate lactate examination. Usual signs of acidosis (Kussmaul's respiratory, decrease of pH, decrease of BE) can be missing in many cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis, Lactic↗
PubMed1986

In vitro estimation of acoustic parameters of the liver and correlations with histology.

Freshly excised human liver specimens (77) were investigated echographically and histologically. The echography was concerned with the acoustic parameters: speed of sound, impedance, several attenuation parameters, and the texture parameters: reflectivity and the signal to noise ratio. It was found that the speed and impedance, the attenuation parameters, and the texture parameters did not correlate with each other. The major correlation between histologic parameters was found for the focal collagen content to the parenchymal content (r = -0.72). The most important correlations of the acoustic parameters to the histologic ones were: attenuation slope to the focal collagen content (r = +0.63) and the reflectivity to the water content (r = -0.55). The most significantly separating acoustic parameters in the comparison of normal livers from focal tumours were found to be the speed, the attenuation slope, the reflectivity, and the signal to noise ratio. A Fisher discriminant analysis revealed a specificity of 91% and a sensitivity of 83% of the separation of tumours from normals when the speed of sound and two parameters of the frequency dependence of the attenuation were considered.

Biopsy↗