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M Brodanová

Publications and source records attributed to M Brodanová.

At least 19 recordsLinked to original sources
PubMed2003

[Cholestasis].

Cholestasis is a condition, where the bile flow into the intestine is defective. The causes may be extrahepatic (in large biliary ducts) or intrahepatic (at the level of hepatocytes or minor biliary ducts). The lack of bile in the intestine results in serious consequences, mainly malabsorption, malnutrition and skeletal changes. The compounds, which are normally excreted in the bile, accumulate and liver biliary cirrhosis ensues. Cholestatis is characterized by a typical laboratory picture, outlined in publications, which serves for differentiation of individual forms of cholestasis. There are various causes of cholestasis, listed in the survey. Extrahepatic cholestasis must be treated as early as possible (by endoscopy or surgery). The highest attention is devoted mainly to chronic intrahepatic cholestatis: primary biliary cirrhosis. It affects mainly women at middle age and is most frequently considered as an autoimmune disease. A survey of present therapeutic possibilities for cholestasis is given. Ursodeoxycholic acid became the main therapeutic drug. It must be administered as early as possible and for long period of time in all cases.

Cholestasis↗
PubMed2002

[Risk factors for transmission of hepatitis C in the the Czech population].

BACKGROUND: Recent reports from all over the world have repeatedly indicated a change in the incidence of individual risk factors for hepatitis C virus (HCV) infection transmission compared with the pattern in the late 1980s and early 1990s. In the Czech Republic, HCV is very often referred to as an addicts' disease, rare in the general population. To establish the incidence of individual risk factors for HCV infection transmission in a group of patients on follow-up at the Department of Internal Medicine I. General University Hospital in Prague 2. METHODS AND RESULTS: The group of patients included 216 individuals (127 men, 89 women) with documented HCV infection. The mean age of the patients was 40.2 years (10-81 years; SD 14.3). The risk factors were identified on the basis of evaluation of the patient's medical history, and/or their medical records if available. The presence of at least one of the following risk factors was regarded as the source of infection (the figure in brackets gives the incidence of the respective factor in the examined group in percent): blood product transmission (15%), intravenous drug injection (16%), inclusion into a regular dialysis program (12%), profession-related risk of transmission (10%), sexual contact with an infected individual (2%), surgery including dental surgery (14%), invasive examination (6%), and tattooing (1%). No risk factor for infection transmission was identified in 24% of cases. CONCLUSIONS: It has been shown a risk factor for infection transmission can be identified, through careful examination of medical history data, in the Czech population in as much as 76% of cases. An important finding is the fact the infection can be regarded as iatrogenic in as much as 57% of cases. Our data clearly show HCV infection is not exclusively a disease of intravenous drug addicts.

Adolescent↗
PubMed2002

[Importance of liver biopsy in chronic hepatitis C virus infection].

INTRODUCTION: The importance of liver biopsy and knowledge of the histological activity of liver les on in chronic hepatitis C virus (HCV) infections is widely discussed recently. There are attempts to find an alternative evaluation which will make it possible to avoid liver biopsy. The crucial question in patients with chronic HCV infection is to differentiate patients with already developed liver cirrhosis from those with chronic hepatitis. OBJECTIVES: 1. To evaluate the impact of the calculation of the discrimination score of liver cirrhosis (DSC) for prediction of liver cirrhosis in the histological assessment. 2. To assess the correlation of prediction of cirrhosis liver based on clinical signs and actual histological verification. 3. To evaluate the frequency of unexpected histological findings not correlating with the clinical picture. GROUP OF PATIENTS: The group was formed by 139 patients. In all patients during the baseline examination the patient's history data were analyzed as well as possible physical signs of liver cirrhosis. In all patients also, based on laboratory values before liver biopsy, the DSC according to Bonacini was calculated. Furthermore agreement between the histological finding of liver cirrhosis and chronic hepatitis with DSC values was assessed. RESULTS: 1. Based on calculation of DSC it is possible to predict accurately the existence of cirrhosis of the liver or chronic hepatitis only in 31% patients. In 69% patients even comprehensive evaluation of the type of DSC is not a sufficient guide for assessment of the hepatic lesion. 2. Even clinical signs of cirrhosis are not a quite reliable guide for its prediction. In 8% patients of our group the histological finding of liver cirrhosis was a surprise and in 3.5% patients cirrhosis of the liver was not confirmed despite the presence of clinical signs. 3. The frequency of other histological findings participating in the development of the hepatic lesion in chronic HCV infection was minimal. In the authors group as such only steatosis and toxic damage of hepatic tissue by alcohol were identified. These findings were, however, suspected already before biopsy. Steatosis can be however considered also a manifestation of HCV infection. CONCLUSION: The results of the trial support the view that liver biopsy is in the majority of cases irreplaceable for evaluation of the severity of the hepatic affection in chronic HCV infection.

Adult↗
PubMed2001

[Diabetes mellitus and the liver].

Liver diseases are frequently associated with disorders of the carbohydrate metabolism--impaired glucose tolerance, hyperinsulinaemia, insulin resistance. Impaired glucose tolerance is due in particular to impaired glucose uptake in the splanchnic area and periphery. Glucose production by the liver is normal, similarly as insulin secretion. Its reduced clearance leads to hyperinsulinaemia with subsequent down regulation of insulin receptors and the development of insulin resistance. In diabetic subjects hepatomegaly is frequent, most frequently associated with steatosis of the liver. It correlates with the degree of obesity rather than the type of hepatic lesion. It is reversible for a long time and develops into cirrhosis only when combined with other factors, in particular alcoholism or infection with hepatotropic viruses. Cirrhosis of the liver is also more frequent in diabetic subjects. Treatment with antidiabetics is discussed, attention is drawn to new types of biguanides, which may have some advantages. Cholelithiasis is in diabetic subjects three times more frequent and leads more frequently to serious, in particular inflamatory, complications with an adverse course. Therefore cholecystectomy should be contemplated. According to contemporary views it seems that diabetic hepoatopathy proper does not exist. The authors draws practical conclusions for the everyday work of physicians.

Diabetes Complications↗
PubMed2000

[Diagnosis and treatment of hepatic cysts].

Hepatic cysts are at the present time of widespread use of abdominal ultrasonography a frequent finding. The authors summarize contemporary diagnostic possibilities of liver cysts and submit variants of the therapeutic procedure in case of symptomatic liver cysts. They present their own experience with the treatment of hepatic cysts by the evaluation method combined with administration of 96% ethanol into the cyst. They compare this therapeutic procedure with the method of simple evaluation of the contents of the cyst. The method of evaluation of hepatic cysts under ultrasonographic control with subsequent administration of 96% alcohol appears to be more successful from the aspect of the long-term effect, manifested by the disappearance of clinical symptoms and non-refilling of the cyst.

Cysts↗
PubMed1997

[Ursodeoxycholic acid in the treatment of primary biliary cirrhosis].

BACKGROUND: Pharmacotherapy of primary biliary cirrhosis (PBC) was not resolved unequivocally so far. During the last decade bile acids are used more widely. The objective of the submitted paper was to investigate under conditions of an open perspective study the influence of long-term administration of ursodeoxycholic acid on the clinical course and selected laboratory indicators. METHODS AND RESULTS: Ursodeoxycholic acid (Ursosan cps PRO.MED.CS) was administered to patients with PBC for a period of three years, 10-12 mg/kg/day. The investigation was completed by 13 women with a confirmed diagnosis of PBC which met clinical, laboratory and morphological criteria. During treatment marked improvement of itching was recorded, a significant drop of serum bilirubin, ALP and ALT. Changes of serum albumin levels were recorded only after three years treatment. The prothrombin time and galactose elimination capacity did not change significantly. Immunoglobulins M remained elevated and antimitochondrial antibodies were detected throughout treatment. The prognosis of the disease was evaluated by means of the Mayo score, the values of which declined significantly during the investigation. No serious side-effects were observed during treatment. CONCLUSIONS: Clinical evaluation proved beyond doubt a favourable effect of ursodeoxycholic acid on clinical and laboratory findings in PBC. Treatment should be started as soon as possible. Long-term continual administration is preferable.

Adult↗
PubMed1997

Intestinal excretion of unconjugated bilirubin in man and rats with inherited unconjugated hyperbilirubinemia.

Patients with Crigler-Najjar syndrome and Gunn rats cannot form bilirubin glucuronides owing to a lack of bilirubin UDP-glucuronosyltransferase activity. Because increased serum and tissue bilirubin levels remain constant, an alternative excretory route has to substitute for this deficiency. Gunn rats excrete in bile only 2-13% of the bilirubins eliminated in Wistar rats. In contrast, the biliary excretion rate of urobilinogen in Gunn and Wistar rats is comparable. The sum of bilirubins and urobilinogen excreted in the bile of Gunn rats amounts to 10-30% of pigments excreted in Wistar rats. Despite this low biliary excretion, the intestinal content and fecal excretion of bile pigments in Gunn and Wistar rats were similar. These data support an extrabiliary entrance of unconjugated bilirubin into the intestine. Additional proof for this was found in that the intestinal lumen of Gunn rats still contains a high amount of bilirubins and urobilinogen after 3 d of external biliary drainage. A similar procedure in Wistar rats resulted in the complete disappearance of bile pigments from the intestine. The direct transmural transport of bilirubin from blood to all parts of the intestinal lumen was demonstrated by injecting 14C-bilirubin i.v. into Gunn rats with isolated parts of small and large intestine. In Crigler-Najjar and Gilbert's syndrome patients, the biliary excretion of bile pigments has previously been shown to be strongly reduced. Their stools, however, contained approximately the same amount of bile pigments as in normal subjects. Although only traces of unconjugated bilirubin were detected in the stool of normal persons (4 +/- 3% of total bile pigments), higher amounts were found in patients with Crigler-Najjar disease (20 +/- 12&). These results suggest a direct intestinal permeation of unconjugated bilirubin in severe unconjugated hyperbilirubinemia both in man and rats.

Animals↗
PubMed1997

[Etiology and epidemiology of hepatocellular carcinoma].

Hepatocellular carcinoma (HCC) is a highly malignant tumour with a poor prognosis. Its incidence is rising. The estimate incidence worldwide is 1 million cases. Most frequently it develops in livers already affected by cirrhotic transformation. How cirrhosis predisposes for the development of HCC is not clear. It is probably associated with the increased DNA synthesis in regeneration nodules. In micronodular transformation (most frequently alcoholic) the incidence is less frequent than in the macronodular from (mostly posthepatitic). The relationship of HCC and viral hepatitis is beyond doubt-this applies in particular to hepatitis B and C. Chronic alcoholism must not be either. There the risk of development of HCC is four times higher than non-alcoholics. Toxins can be also important for the development of HCC (in particular aflatoxins, chlorinated hydrocarbons, pesticides). As to drugs, in particular anabolics and contraceptives are suspected. Smoking is also a risk factor. HCC is encountered also more frequently in some liver diseases caused by metabolic disorders. It is probable than the development of HCC is a multifactorial process with a marked component of liver transformation.

Carcinoma, Hepatocellular↗
PubMed1996

[Diet in liver diseases].

The liver is the metabolic centre of all nutrients. Liver disease can thus interfere with the metabolism of the whole organism, it can have a negative impact on the nutritional status and frequently lead to marked malnutrition. On the other hand, attempts to influence liver disease by dietetic provisions have an old tradition while actual evidence of a marked benefit of these prescriptions is lacking. Therefore we witness at present rather regression from strict dietetic provisions, and individual diets are favoured where frequently the main criterium is the tolerance of the recommended diet and suitable technology. The author submits a brief review of the main metabolic changes in the course of liver diseases which contributes to the understanding of reasons for the recommended dietetic provisions. Attention is drawn to pitfalls which may depretiate therapeutic efforts. The author differentiates the procedure in acute and chronic liver diseases. In cirrhosis special restrictions during decompensation are stressed, as then quite different dietetic provisions are needed. Details are given for encephalopathy and conditions of fluid retention with ascites.

Humans↗
PubMed1996

[Treatment of chronic viral hepatitis B with interferon alfa. Experience of the last 3 years].

BACKGROUND: interferon alpha is nowadays the drug of choice in the treatment of chronic viral hepatitis. The objective of the present work was to assess the effectiveness of interferon alpha in the treatment of chronic active hepatitis B in our population and to test whether the known "prognostic factors" of successful treatment are applicable in our patients. METHODS AND RESULTS: In 1991-1994 a total of 25 patients were treated (15 men, 10 women, mean age 46.1 years, range 18-69 years) suffering from chronic active hepatitis B (HBsAg and HBeAG positive) with interferon alpha 2b (Intron A, Schering-Plough International ). Seroconversion to anti-HBe and the drop of serum aminotransferase activity was achieved in 15 patients (60%). Only in one patient within one year after termination of treatment a relapse developed. In the group of successfully treated patients the activity of serum aminotransferases before treatment was significantly higher. The mean duration of the disease was surprisingly longer than in the group where treatment failed (106 vs. 62 months), but this difference was not statistically significant. Only in two successfully treated patients during the second and third month of treatment acute exacerbation of the inflammation occurred and manifestations of hepatic insufficiency with subsequent slow improvement developed. In the remainder the activities of serum aminotransferases declined slowly to normal values.

Adolescent↗
PubMed1996

[The first case of Crigler-Najjar syndrome in the Czech Republic].

BACKGROUND: Crigler-Najjar syndrome is a rare disease due to a congenital deficiency of bilirubin UDP glucuronosyl transferase in the liver tissue. It is characterised by high levels of unconjugated bilirubin in plasma through the whole life. The aim of the study was to confirm the clinical diagnosis of the first Crigler-Najjar syndrome case in our country. METHODS AND RESULTS: 34 years old Gypsy women was admitted to our GI clinic for clinical examination before scheduled cholecystectomy. The high plasmatic level of unconjugated bilirubin was found and therefore the diagnosis of Crigler-Najjar syndrome was anticipated. The diagnosis was based on the chromatographic analysis of biliary bile pigments. The amount of diconjugates was considerable decreased. In addition, the molecular analysis of DNA isolated from peripheral blood leukocyte was performed to confirm our conclusions. Our patients was found to be homozygous for a nucleotide shift in the unique exon of bilirubin UDP glucuronosyl transferase 1, substituting guanine into an adenine at position 211.

Adult↗
PubMed1996

[Portal hypertension--introduction to the problem].

Portal hypertension is a condition with a permanently raised pressure in the portal area. The most frequent cause is restricted blood flow through some part of the circulation. Depending on the site of obstruction, we classify portal hypertension into prohepatic, hepatic and posthepatic. In adult age the most frequent form is the hepatic one associated with cirrhosis of the liver, in childhood prehepatic hypertension associated with thrombosis of the porta. The significance of portal hypertension is due in particular to its sequelaes. Among the most serious ones is the development of a collateral circulation with subsequent gastroesophageal varicosities. The latter involve the risk of rupture and massive haemorrhage into the gastrointestinal tract. The patient develops posthaemorrhagic shock. The author mentions the most important metabolic and cellular changes caused by shock. The importance of complications is emphasised. Haemorrhage is frequently followed by hepatic failure, which even nowadays is usually fatal. The author mentions also the risks of hypersplenism and emphasizes their participation in haemorrhage. In the introduction the author points out why wo much attention should be paid so portal hypertension and procedures influencing it.

Humans↗
PubMed1995

[Chronic hepatitis--diagnosis and differential diagnosis].

Since the first classification of chronic hepatitis (CHH) more than 25 years have elapsed. Since then conditions for assessment of the etiology, pathogenesis and therapy of the disease have improved. These findings must be applied in the contemporary diagnosis of CHH. The first task is to assess the correct etiology of the disease because it is decisive for treatment, development and prognosis of the disease. The most important cause of CHH is viral hepatitis. Hepatitis B and C are frequently occurring diseases and may develop into CHH and cirrhosis of the liver. New therapeutic procedures, using interferons, can prevent this. Idiopathic autoimmune hepatitis is a serious form where interferon therapy is contraindicated, while the condition usually responds very well to treatment with corticoids and immunosuppressive substances. It is important to take into consideration also possible liver damage by drugs and the fact that the clinical picture is associated with a certain stage of metabolically conditioned changes, in particular Wilson's disease. It is important to examine carefully the histological finding and laboratory results, as it is possible to evaluate from them the severity of the disease. We should also attempt to evaluate these changes quantitatively.

Chronic Disease↗
PubMed1995

[Modern therapy of ascites in liver cirrhosis].

The most frequent cause of ascites in the Czech Republic is cirrhosis of the liver. Treatment of ascites in cirrhotic patients must be very careful as the use of strong diuretics is associated with some adverse complications. The latter are reviewed. The basic therapeutic provision is restriction of water and salt intake. Aldosterone antagonists are diuretics of first choice. A commonly used diuretic is also furosemide and thiazides. The author outlines the algorithm of treatment of ascites, in particular from the aspect of the general practitioner.

Ascites↗
PubMed1994

[Prognostic significance of ascites in patients with liver cirrhosis].

The author evaluates the prognostic importance of ascites in 100 patients with cirrhosis of the liver. The patients were followed up on a log-term basis in a hepatology clinic and the diagnosis was confirmed morphologically. Ascites developed at a time when marked objective and laboratory signs of chronic liver disease were present. Ascites was diagnosed by physical examination and verified by ultrasonography. It was treated by contemporary procedures. Survival of cirrhotic patients with ascites was unfavorable--50% survived one year, 38% two years, 17% three years, 15% four years and only 9% five years. Ascites is thus still a very adverse prognostic indicator for patients with cirrhosis.

Ascites↗
PubMed1994

[Modern therapy of ascites in liver cirrhosis].

Ascites is a common sign of decompensated cirrhosis of the liver. In order to improve the patient's quality of life, it is essential to treat him systematically. The authors present an algorithm of therapeutic procedures. The basis is major rest, restricted water and sodium intake. First choice diuretics are aldosterone blockers. The basic diuretic is furosemide. The authors mention also the most important complications of treatment with diuretics. They evaluate contemporary views on paracentesis and therapy by return of ascites into the circulation. Ascites refractory to treatment is an indication for transplantation of the liver.

Ascites↗
PubMed1993

[Diagnosis and therapy of cholestasis].

The submitted paper is a contribution to the problem of cholestasis from the aspect of contemporary knowledge recorded in the literature as well as the author's experience assembled in a hepatological department. The author expands on individual steps of the diagnostic procedure--is it a case of cholestasis? What type of cholestasis? The most frequent causes of intrahepatic cholestasis are discussed. The main point is a summary of therapeutic possibilities, in particular in chronic forms of cholestasis. The author emphasizes that dietary provisions are always essential, a as well as treatment of itching, malabsorption and prevention of the development of osseous changes. Drugs which are considered specific therapy are mentioned and their effect and side-effects are briefly evaluated. It appears that ursodeoxycholic acid is most promising. In the terminal stage under local conditions treatment is symptomatic in future we may be able to ensure liver transplantations which are indicated in chronic cholestasis.

Cholestasis↗