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M Kvapil

Publications and source records attributed to M Kvapil.

49 records · Page 3Linked to original sources
PubMed1996

[Short-term hospitalization for patient education--effect on metabolic compensation in type I diabetics].

The objective of the work was to evaluate the effect of short-term hospitalization on metabolic compensation in type 1 diabetics with an intensified insulin regime who are admitted to hospital with the main purpose to participate in an intense educational and therapeutic programme. Twenty patients were examined, mean age 26.3 +/- 6.5 years, mean duration of diabetes 13.2 +/- 8.0 years, who participated in a 5-day educational therapeutic programme which takes place in the authors' department. The level of metabolic compensation was evaluated at the onset and at the end of the hospitalization by means of fructosamine (F), mean blood sugar level, Michaelis index, MAGE (mean amplitude glycaemic excursion), the M value, MDD. During hospitalization in the whole evaluated group an average 6% drop of F was recorded. In the sub-group of patients with a baseline F > 2.6 mmol/l a statistically significant decline occurred from 2.91 +/- 0.14 mmol/l to 2.44 +/- 0.31 mmol/l (p < 0.05). The changes of different indexes calculated from the whole group did not reach statistical significance. In the sub-group with a poorer compensation (F > 2.6 mmol/l), however, the mean blood sugar level declined from 13.48 +/- 2.45 mmol/l to 9.17 +/- 2.05 mmol/l (p < 0.05) and the M value improved from 141.4 +/- 56.6 to 60.5 +/- 40.7 (p < 0.05). The MAGE index deterioration significantly during hospitalization only in the sub-group with a baseline F < 2.6 mmol/l from 2.70 +/- 1.11 to 3.65 +/- 1.28 (p < 0.05). The results indicate that in patients with type 1 diabetes mellitus short-term hospitalization with an educational therapeutic programme need not be associated with a deteriorated metabolic compensation. In those whose compensation is unsatisfactory marked improvement is recorded.

Adult↗
PubMed1996

[Cystic fibrosis--a serious disease affecting the nutritional status and energy requirements in adult patients].

At the Department for TB and Respiratory Diseases of the Faculty Hospital in Prague Motol at present half the patients with cystic fibrosis who in the Czech Republic reached adult age are being followed-up. The objective of the present work was to evaluate the nutritional profile of these adult patients with cystic fibrosis. The authors examined 15 patients, mean age 22.9 +/- 3.2 years. The examination included assessment of height, body weight, skinfold thickness above the triceps, brachii, the energy output transferrin, blood gases. Functional examination of the lungs was made by the method of the flow-volume curve. The body mass index (BMI) was 18.04 +/- 4.17, albumin 32.75 +/- 4.57. The resting energy expenditure was 112.1 +/- 20.8% of the basal energy output calculated according to the Harris-Benedict formula. The mean value of pO2 was 8,081 +/- 1,145 kPa, pCO2 5,841 +/- 1,197 kPa. The results indicate malnutrition of the examined patients: in general the findings can be considered as a sign of severe protein-energy malnutrition. The baseline study confirmed the assumption of a high prevalence of nutritional disorders in adult patients with cystic fibrosis. The next essential step must be to ensure comprehensive and individualized nutritional intervention.

Adult↗
PubMed1993

[Basic indicators of energy metabolism in patients with rheumatoid arthritis evaluated by indirect calorimetry].

The objective of the investigation was to examine basic parameters of the energy metabolism (energy expenditure at rest (REE), the respiratory quotient (RQ) and evaluate their relationship with age, basic parameters of the activity of the disease, serum positivity, basal therapy and corticoid therapy in patients with rheumatoid arthritis. The investigation comprised 26 patients with rheumatoid arthritis selected at random, incl. 12 serum positive ones. The mean age af the patients was 62.2 +/- 11.0 years, BMI 26.65 +/- 4.35, the mean duration of the disease was 11.8 +/- 9.9 years (range 1-36 years). A total of 12 patients had basal therapy, 12 patients took glucocorticoids regularly. The examination comprised a record of the case-history, clinical examination (Thompson's articular index), REE was evaluated by indirect calorimetry. The assessed REE value was compared with the expected value calculated according to Harris-Benedict's empirical formula (BMR) and expressed in per cent of the calculated value (REE%). The respiratory quotient (RQ) was calculated from the assessed CO2 and O2 consumption. The authors found a close correlation between REE and REE% (r = 0.606, p < 0.01) but no correlation between BMR and REE% (r = 0.115). The above parameters did not differ in serum positive and serum negative patients with RA treated with corticoids and those without corticotherapy, only in patients with basal therapy there are statistically significantly higher REE values (6456.7 +/- 790.5 kJ/24 h vs. 5396.4 +/- 826.7 kJ/24 h, p < 0.01) and REE% (110.6% +/- 99.2%, p < 0.05), as compared with subjects without basal therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis, Rheumatoid↗
PubMed1993

[Thrombosis of the inferior vena cava--an unusual cause of a chronic septic condition in a female patient with type 1 diabetes mellitus].

The authors describe the accidental detection of a clinically not very marked thrombosis of the vena cava inferior in a 29-year-old female diabetic which was the cause of permanent bacteriaemia and the source of embolization of the lungs. The patient was delivered of an infant six years previously by Caesarean section, subsequently complicated by a paranephritic abscess on the right which called for surgical treatment. Since then the patient suffered from frequent dermal infections and was dyspnoic. Because of deterioration of polyneuropathic complaints of the lower extremities resulting from diabetes the patient was admitted to the authors' clinic. Sonographic examination of the abdominal cavity aroused urgent suspicion of a thrombus in the vena cava inferior, as confirmed by subsequent cavography and computed tomography. The patient was treated for prolonged periods with anticoagulants and antibiotics. During the subsequent check-up examination after four months marked diminution of the thrombus was recorded and improvement of the patient's general condition.

Adult↗
PubMed1993

Insulin resistance and compensatory insulin secretion in middle-aged persons with hypertriglyceridemia.

Insulin secretion and insulin sensitivity were measured in hypertriglyceridemic patients using the frequently sampled intravenous glucose tolerance test. Three groups of men who were matched for age and body mass index were studied: eight healthy control subjects (C), seven patients with mild hypertriglyceridemia and normal glucose tolerance (TG), and seven with well-controlled type 2 diabetes with hypertriglyceridemia (TG-DM). The first-phase insulin response was increased by 116% in the TG group and decreased by 59% in the TG-DM group. The second phase of insulin secretion was increased in both TG groups (TG by 310% and TG-DM by 250%). The mean insulin sensitivity index (SI) was reduced by 50% in the TG group and by 60% in the TG-DM group. Glucose effectiveness (SG) was reduced by 30% in the TG-DM group compared with the control subjects.

Adult↗
PubMed1993

[Insulin secretion and sensitivity in middle-aged men in the initial stages of type II diabetes mellitus (evaluated by the "minimal model" method].

The objective of the work was to test the minimal model method based on computer evaluation of parameters (blood sugar level, insulin blood level) obtained during the intravenous glucose tolerance test with frequent collection of samples, when examining the insulin glucose homeostasis in patients in the initial stage of type II diabetes. The authors examined a control group of 8 healthy men, mean age 43.6 years, BMI 24.7 and a group of 7 men with type II diabetes, mean age 46.7 years, BMI 31.37. Indexes (phi 1 and phi 2--the first and second stage of insulin secretion, SG-glucose efficiency, SI-insulin sensitivity) were obtained by evaluation of the results, using a programme for a personal computer PC AT. In men of the control group the authors recorded the following values: phi 1 5.80 +/- 1.26 microU/ml x min/mg/dl, phi 2 6.43 +/- 5.15 microU/ml x min-2/mg/dl, SG 0.016 +/- 0.010 min-2. Diabetic patients were divided with a regard to the first stage of insulin secretion into two groups: the first one (n = 4) comprises those where the first stage is minimal (phi 1 = 0.80 +/- 0.68 microU/ml x min/mg/dl, phi 2 = 33.41 +/- 19.06 microU/ml x min-2/mg/dl, in the second group are those (n = 3) where the first stage of insulin secretion is maintained phi (1 12.23 +/- 5.51 microU/ml x min-2/mg/dl, phi 2 7.77 +/- 4.98 microU/ml x min-2/mg/dl). The second stage of insulin secretion in subjects of the first group is, as compared with controls, significantly higher (p < 0.05).

Adult↗
PubMed1993

[Ultrasonography of the kidneys for the detection of incipient diabetic nephropathy].

At the First Medical Clinic of the Faculty Hospital in Prague 5 Motol a group of 15 men and 14 women treated on account of type I diabetes for a mean period of 12.8 +/- 5.8 years was examined. Their mean age was 26.3 +/- 5.8 years and their BMI 23.91 +/- 2.82. The control group was formed by 18 healthy subjects (10 men and 8 women) mean age 23.8 +/- 8.9 years, BMI 22.44 +/- 2.48. All subjects were subjected to a detailed ultrasonographic examination and, assessment of microalbuminuria. From the assembled sonomorphometric data the volume of the right kidney was related to the BMI and thus the renal volume index (RVI) was obtained. In the group of diabetic subjects a statistically significant correlation was found between RVI and microalbuminuria (r = 0.574, p < 0.01). In the group of patients with RVI higher than 7.44 a close correlation was found between microalbuminuria and RVI (r = 0.993, p < 0.05). In the group of patients with a duration of diabetes under 5 years no correlation between the investigated parameters and the RVI was found, nor a mutual correlation of parameters. In patients with diabetes persisting for 5-20 years correlation was found between microalbuminuria and RVI (r = 0.686, p < 0.01). In the group of patients with diabetes for more than 20 years there was no correlation between RVI and other indicators.

Adult↗
PubMed1993

[Modelling the kinetics of C-peptide and hepatic extraction of insulin (in type 2 diabetics and non-diabetics with hypertriacylglycerolemia)].

Increased glucose release from the liver which is responsible to a considerable extent for fasting hyperglycaemia in type 2 diabetics is associated with hepatic insulin resistance. Assessment of insulin extraction in the liver can therefore be useful in investigations of all pathophysiological conditions with deviations of glucose tolerance, or in the course of insulin secretion. The control group was formed by 8 healthy men, mean age 43.6 +/- 5.9 years, mean BMI 24.7 +/- 2.8. The authors examined also a group of 7 men with diabetes mellitus type II, mean age 46.7 +/- 5.9 years, BMI 31.4 +/- 8.9 and 6 men with hypertriacylglycerolaemia, mean age 44.2 +/- 3.1 years and mean BMI 26.2 +/- 1.4. All were examined by the intravenous glucose tolerance test with frequent blood sampling. In every sample the blood sugar level, insulin level and C-peptide level were assessed. The data were evaluated and the "hepatic insulin extraction index" was thus obtained. The "hepatic insulin extraction index" was significantly lower in type 2 diabetics throughout the experimental period (0-180 min.) as well as during individual intervals evaluated (0-20 min. and 20-180 min.). In subjects with hypertriacylglycerolaemia this index was lower only during the 0-20 min. interval. Changes of the "hepatic insulin extraction index" in patients with hypertriacylglycerolaemia do not reach the intensity recorded in diabetics and may thus indicate a milder grade of hepatic insulin resistance.

Adult↗
PubMed1993

[Energy expenditure at rest in patients with active rheumatoid arthritis and malnutrition].

Malnutrition is found significantly more often in patients with rheumatoid arthritis than in the normal population. One of the contributing causes may be the elevated energy expenditure at rest found in the stage of increased activity of the disease. The aim of the present work was to evaluate the association between the activity of the disease, the presence of signs of malnutrition and the energy expenditure at rest. In 26 patients with rheumatoid arthritis stage I-IV, mean age 62.2 +/- 11.0 years the basic parameters describing the activity of the disease were assessed (sedimentation rate, C-reactive protein (CRP), the articular index according to Thompson) and the nutritional status (body mass index, total serum protein and albumin, the skinfold above the triceps, the circumference of the muscles of the arm). In all patients indirect calorimetry at rest on fasting was applied. The assessed value of the energy expenditure at rest (REE) was expressed as % BMR calculated according to the formula of Harris-Benedict. In the group of patients with a higher activity of the disease (CRP positive, n = 14) REE was significantly higher as compared with the other patients (109.4 +/- 13.3% vs. 98.7 +/- 9.3%, p < 0.05). In patients who suffered from obvious depletion of visceral protein (albumin less than 30 milligrams, n = 5) REE was significantly higher than in the remainder (117.8 +/- 13.8% vs. 101.3 +/- 10.4%, p < 0.05). In the whole group there was a less close, though statistically significant correlation between CRP and REE (correlation coefficient 0.463, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[A minimal model of insulin and glucose kinetics].

The minimal model of insulin and blood sugar kinetics is a method the basis of which are two mathematical models describing the dynamic changes of plasma glucose and insulin concentration along with the beta-cell response to the rise of the blood sugar level during the intravenous glucose tolerance test with frequent collection of samples. By means of computer processing the following indices are evaluated: SI--insulin sensitivity, SG--efficacy of glucose, phi 1 and phi 2 describing the sensitivity of beta-cells for glucose. According to present knowledge it is a simple method with a satisfactory reproducibility and validity of assembled results, which is safe for the examined subject and unpretentious as regards apparatus. It makes it possible to evaluate the glucose and insulin relationship in their mutual dynamic relationship and to create specific modifications as well as the follow-up of other indicators.

Blood Glucose↗
PubMedDate not supplied

The association between left ventricle diastolic dysfunction and endothelial dysfunction and the results of stress myocardial SPECT in asymptomatic patients with type 2 diabetes.

Diabetes mellitus is associated with a poor cardiovascular prognosis. Stress myocardial single-photon emission computed tomography (SPECT) reliably detects coronary ischaemia in asymptomatic patients. Our study aimed to evaluate the association between systolic and diastolic left ventricular function, left ventricular hypertrophy, endothelial function and the results of stress myocardial SPECT in 126 patients with type 2 diabetic patients with no cardiovascular symptoms. Thirty-three patients (26%) had abnormal SPECT results, 33 patients (26%) had intermediate (equivocal) results, and 60 patients (48%) had normal results. We found a significant association between an abnormal SPECT result, left ventricular diastolic dysfunction and impaired post-ischaemic dilatation of the brachial artery. No association was found between the SPECT result and systolic function and left ventricular hypertrophy, however. An abnormal SPECT result was significantly associated with left ventricular diastolic dysfunction and the deterioration of post-ischaemic dilatation of the brachial artery in asymptomatic patients with type 2 diabetes.

Aged↗