Biomedical subjects
M Chochola
Publications and source records attributed to M Chochola.
[Prevention of thrombembolic disease in internal medicine].
Although deep vein thrombosis is often considered to be associated with recent surgery, 50-70% of symptomatic thrombembolic events occur in nonsurgical patients. Hospitalization for acute medical illness is independently associated with about eightfold increase in relative risk for venous thrombosis. Thus correct evaluation of risks for thrombembolic disease in individual inpatient and appropriate prophylaxis offers the opportunity to improve the prognosis of acutely ill patient. The most efficient and easy way of pharmacologic prophylaxis is subcutaneous administration of low molecular weight heparin. Only in minority of patients mechanical methods of prevention are sufficient. The optimal duration of thromboprohylaxis in medical patients is unknown and we have to evaluate the changing conditions in each patient.
[Buerger's disease].
Buerger's disease (Thromboangiitis obliterans--TAO) is a nonatherosclerotic, segmental inflammatory disease that most frequently affects the small and medium-sized arteries and veins in the upper and lower extremities. There exists an extremely strong association between heavy tobacco use and TAO. The histopathology of the involved blood vessels varies according to the chronologic stage of the disease at which the tissue sample is obtained for examination. The histopathology is most likely to be diagnostic at the acute phase of the disease. Buerger's disease typically occurs in young male smokers, with the onset of symptoms before the age of 40 to 45 years. Several published series have shown an increasing prevalence of the disease in women. There is little information on the use of intra-arterial thrombolytic therapy, prostaglandin therapy, or angiogenesis. Discontinuation of tobacco use is the mainstay of treatment. Patients who successfully stop smoking almost never need amputation.
[Epidemiology of ischemic diseases of the lower extremities].
The most serious problem in angiology is peripheral arterial occlusive disease. The prevalence of this disease is 2 % in men under 50 years of age and 5 % in men over 70 years of age. Women reach the same numbers approximately 10 years later. The most serious consequence is that in many cases patients with PAOD have also coronary disease and ischemic brain disease. The most common cause of death in patients with PAOD is coronary artery disease (40-60 %); ischemic stroke develops as a cause of death in 10-20% of the patients. About 20-30% of the patients die due to noncardiac factors.
[Value of duplex ultrasound examination of the proximal part of the common carotid artery].
A significant part of patients with carotid artery stenosis is operated on without preoperative angiography, to reduce the risks and cost of such examination. Duplex ultrasound often cannot reliable visualise the proximal parts of the aortic arch vessels. We evaluated the ability of duplex ultrasound to identify those types of lesions and ascertain their prevalence. We analysed retrospectively carotid duplex scans and carotid angiography in 448 carotid arteries. 17 significant proximal lesions (3.89%) were identified on the duplex scan and confirmed by angiography. Lesions of the proximal parts of the aortic arch vessels are rare and may be reliably detected by duplex ultrasound.
[Liver abscesses with portal and mesenteric vein thrombosis in combination with late onset of appendicitis].
Pyogenic liver abscesses are caused by appendicitis in less than 10%. Also the ascending septic inflammation of portal vein (pylephlebitis) could be a serious complication of intra-abdominal infection. Although pylephlebitis is not frequent today, its' mortality and morbidity rates remain high. We describe a case of young man with fever, abdominal pain, and multiple hepatic abscesses. After the symptomatic relief due to antibiotic therapy the pain returned as a result of the development of portal and mesenteric vein thrombosis. The cause of either hepatic abscesses or thrombosis was not clear at the time of dismissal. 2 months later the patient underwent acute abdominal revision with appendectomy for acute phlegmonous and gangrenous appendicitis. Since that time he has been without any clinical symptoms.
[Renal artery embolism].
Renal artery embolism (RAE) is a rare disease. Urgent treatment is necessary, as ischaemia can cause irreversible kidney damage in 60 to 90 minutes. RAE frequently clinically manifests as a pain similar to renal colic. Source of embolus is predominantly the heart at atrial fibrillation. Laboratory findings are unspecific. Ultrasonography with color Doppler imaging is essential. Kidney perfusion is low and upper urinary tract is undilated. Renal function can be recognized by intravenous urography and at renal scintigraphy. In angiography, renal artery is closed with thromboembolus. With no delay, transcatheter clot aspiration should be performed and fibrinolytic agents (tissue plasminogen activator) should be topically administered. Continual heparinisation and later warfarinisation should follow. In spite of successful revascularisation, parameters of kidney function can almost never reach that prior the RAE and shrinkage of kidney becomes a frequent consequence. Treatment can be successful even in patients with renal occlusion lasting over 90 minutes, since occlusion is often incomplete or significant collateral blood supply exists. In conclusion, renal artery embolism must be considered in cases of flank pain in patients with certain risk actors (especially atrial fibrillation). Ultrasonography with color Doppler imaging and urgent angiography of the renal artery are necessary in these cases. Thromboembolus can be then aspirated, and kidney perfused with fibrinolytic agent.
[Intraoperative enteroscopy--personal experience from 1995 to 2002].
Authors present their experience with the intraoperative enteroscopy method--an invasive technique of small bowel examination. It is performed under narcosis at an operating theatre (i.e. in co-operation with surgeon and anaesthesiologist). The endoscopy-performing physician becomes one of the members of the operating team. The advantage of the method is the possibility to examine of the whole small intestine and to solve immediately the pathological findings by endoscopic or surgical intervention. The examination is invasive and the correct indication is mandatory. Authors report their results of 18 intraoperative panendoscopies of small intestine.
[Basic epidemiologic indicators of venous diseases].
Venous diseases are among the major causes of morbidity and mortality in The Czech Republic. The incidence of venous diseases increases rapidly with age, especially in those older than 65 years. Among discussed entities is the most important deep venous thrombosis and its complications--pulmonary embolism and postthrombotic syndrome. We discuss epidemiology of acute and chronic venous diseases in context of risk factors and offer a short outline of currently applied therapy. Then we focus on the new perspective possibilities of treatment of venous diseases especially in acute states (including local thrombolysis), on its influence of quality of life, on the progression of diseases into chronic states and on its socioeconomic consequences.
[Interventional therapy of the inferior vena cava syndrome].
Interventional procedures are becoming increasingly popular in the treatment of impaired patency of deep venous system caused most often by extensive phlebothrombosis. Restoration of patency to affected venous segments while preserving the valvular function with a high degree of success in a relatively short period of time can be achieved by combination of endovascular methods such as catheter guided thrombolysis followed by percutaneous transluminal angioplasty and stenting. This approach enables not only the resolution of acute vascular complications but also the prevention of postthrombotic syndrome. This case report of a 52-year-old man with retroperitoneal fibrosis causing chronic compression of vena cava inferior further complicated by travelling associated bilateral ileofemoral thrombosis clearly demonstrates the wide ranging applications of the endovascular techniques.
[Thromboembolic complications in the use of oral estrogen-gestagen contraceptives].
Deep vein thrombosis is a serious complication of oral contraception. The most serious complication, pulmonary embolism, could be lethal. The relative risk of thromboembolic disease is four time higher in women using oral contraception. Both the amount of estrogen and the type of gestagen can increase the relative risk of thromboembolic disease. Oral contraceptives influence procoagulants, fibrinolytic system and inhibitors of coagulation. The choice of oral contraceptive should be very careful. It is advised to use preparations with less then 50 micrograms of ethinyl-estradiol and the type of gestagen that has minimal metabolic side effects, including minimal effect on coagulation. It is not recommended to perform screening of trombophilia before prescribing oral contraception. Family history of thrombosis is indication for more detailed investigation. However in the case of positive history of thromboembolic disease use of oral contraception is contraindicated. Oral contraception users should be informed about increased risk of deep vein trombosis, and what to do to prevent deep vein thrombosis.
[The effect of heparan sulfate on percutaneous transluminal angioplasty in the vessels supplying the lower extremities].
BACKGROUND: The condition of patients after percutaneous transluminal angioplasty is influenced among others by the subsequent development of restenoses and reocclusions. The objective of the submitted work was to assess whether oral administration of heparan sulphate can influence the development of restenoses after percutaneous transluminal angioplasty in the pelvic and femoropopliteal region. METHODS AND RESULTS: 102 patients (78 men and 24 women, age 42-86 years) were divided into four groups. Percutaneous transluminal angioplasty was performed either on account stenosis in the aortoiliac or femoropopliteal area. (The original number was 115 patients, 13 patients were eliminated: the reasons were technical failure of the intervention procedure, reocclusion, the patient was lost from records.) As antiaggregant the patients were given acetylsalicylic acid, 250 mg/day: patients included in the heparan group were given heparan sulphate (Hemovasal, Manetti and Roberts) 100 mg/day for a period of 3 - 4 months. As compared with controls, the patients treated with heparan sulphate had within the 3 - 4 month period a significantly longer claudication distance (p < 0.05), a higher Doppler index (p < 0.05) and maximal blood flow in the feet. CONCLUSIONS: Heparan sulphate administration to patients after percutaneous transluminal angioplasty on account of stenosis of the aortoiliac or femoropopliteal area improves some angiological parameters which can suggest a slighter tendency of early restenosis.
The role of intravascular stents in preventing peripheral embolization during pulse-spray thrombolysis.
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[Significance of hetero-collateral circulation in patients with chronic occlusion of the superficial femoral artery].
The authors examined a total of 11 lower extremities in 10 patients with chronic occlusion of the superficial femoral artery (mean length of occlusion 17.2 cm) in order to compare the participation of the heterocollateral and homocollateral circulation in the maintenance of the ankle pressures assessed by the Doppler principle. Before percutaneous transluminal recanalization of the chronic occlusion of the superficial femoral artery the authors induced by means of a balloon catheter short-term occlusion of the deep femoral artery in its central portion, closely after its insertion (complete block of the heterocollateral circulation) and in the periphery of this artery (partial block of the collateral circulation). During both types of balloon occlusion the authors assessed the ankle pressures and compared them with control values, assessed before occlusion. The authors found that in their patients the heterocollateral circulation, as compared with the homocollateral one, participated substantially more in the value of the ankle pressure at rest. The importance of the heterocollateral circulation increased with the length of chronic occlusion of the superficial femoral artery. In some patients the homocollateral circulation did not participate at all in the maintenance of the ankle pressure. A drop of the ankle pressure in patients with chronic occlusion of the superficial femoral artery is also more marked in acute occlusion of the deep femoral artery in its central portion, as compared with acute occlusion in the periphery.
A thrombus in the right pulmonary artery and its follow-up using transoesophageal echocardiography.
Using transoesophageal echocardiography, the authors documented development of a right pulmonary artery thrombus in a patient with pulmonary hypertension due to chronic obstructive lung disease. This case confirms the potential of transoesophageal echocardiography in diagnosing pulmonary artery diseases.
Percutaneous transluminal angioplasty of the deep femoral artery.
Percutaneous transluminal angioplasty (PTA) of the deep femoral artery (DFA) was performed in 21 patients with chronically occluded superficial femoral artery (SFA) and a significant DFA lesion as documented by arteriography. The authors failed to pass the guidewire through the occlusion in two patients. The results do not include another patient who, while the PTA was technically successful, had to have a limb amputated because of skin lesion infection. The remaining 18 patients showed a significant increase in the ankle-arm pressure index, prolongation of the claudication interval and reported subjective improvement immediately after PTA; plethysmography performed in 14 patients revealed a significant increase in maximum foot blood flow. While the claudication intervals were found to have further significantly prolonged 6-12 months following PTA, the ankle-arm pressure index remained unchanged. There were no serious complications during and after the PTA procedure. In patients with both superficial and deep femoral artery involvement, where SFA PTA is not suitable or feasible, PTA of the DFA seems to be the method of choice. Considering its probable clinical benefits, it is appropriate to attempt it even in cases where the chances of technical success are low.
[Arrhythmia as a major manifestation of Lyme borreliosis].
The submitted case-history is focused on one of the leading manifestations of cardiac affection in Lyme borreliosis. The authors recapitulate and analyze the patient's complaints, her electrocardiographic and other findings and confront them with data from the literature on this "new" nosological unit.
[Initial experience with modification of dosage of anti-arrhythmic agents using telephone transmission of the electrocardiogram].
Despite the doubtless advances in the knowledge of cardiac electrophysiology, the mechanism of action of antiarrhythmia and the considerable clinical experience with these drugs, treatment of arrhythmia remains on a trial error basis. The authors tried to use the system serving the transmission of one lead electrocardiograms by telephone as a means of checking and correcting antiarrhythmia treatment. It is a method which despite its unpretentious character and reliability is used on a very limited scale. As compared with other contemporary means of the control of the effect of antiarrhythmia treatment, i.e. above all Holter's method or investigation of plasma levels of antiarrhythmia drugs, it is less time consuming and cheaper. The preliminary results of the authors, based on initial experience, are encouraging.