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Biomedical subjects

M Penka

Publications and source records attributed to M Penka.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Warning signs preceding the development of septic shock in patients with neutropenia treated for hematologic malignancies].

BACKGROUND: In patients with haematological malignities infectious complications take a very rapid course, and in particular during the period of neutropenia, they are not necessarily manifested by a clear symptomatology. Frequently they may be manifested only by an elevated temperature and general deterioration of the condition. The onset of shock then can be rapid and surprising. The objective of the work was to identify clinical and laboratory signs warning against the possible development of septic shock. METHODS AND RESULTS: The investigation comprised a total of 38 patients hospitalised due to infectious complications at the intensive care unit because of general deterioration of the condition. 18 developed septic shock (group S), the remaining 20 (group N) achieved during hospitalisation at the ICU a stabilised condition. In both groups the laboratory values and clinical condition were followed up for 2-3 days prior to deterioration of the condition. Risk factors for development of septic shock in the group of investigated patients were: unusual weakness, heart rate above 95/min. beyond the temperature peak, hypoalbuminaemia, mucositis, hypokalaemia, presence of a central venous catheter and administration of parenteral nutrition.

Adult↗
PubMed1999

[Involvement of the cardiac muscle in anemia].

Anemia is probably the most widespread syndrome associated with a very wide spectrum of pathological conditions with a different genesis. In malignities and their treatment it is one of the very serious complications the impact of which is manifested in particular in the state of the circulation. Thus anemia can cause deterioration of primary cardiac and cardiovascular complications which develop either as a result of the malignant disease or as a result of its treatment by cardiotoxic drugs. Thus risk conditions with the functional consequence of cardiovascular impairement are potentiated. This can complicate the disease or limit therapeutic possibilities. In the submitted work the authors tried to analyze the importance of anemia from the aspect of cardiovascular pathophysiology and outline results of their own observation supported by data from the literature concerned with this problem. From the observations ensues that in the group of patients studied by the authors who had careful substitution treatment with erythrocyte concentrates there were no serious drops of Hb which could be of fundamental importance from the aspect of cardiovascular damage. For this reason the cardiovascular status can be evaluated only from the aspect of primary toxicity of oncological treatment (if we omit direct damage by the disease) and it is not necessary to consider the consequences of hematological complications which must be taken into account when HB levels are lower than 70 g/l.

Anemia↗
PubMed1998

[Chemotherapy of resistant and recurrent lymphoma based on a combination of ifosfamide and etoposide. Antitumor effects, toxicity and stimulation of peripheral stem cells].

BACKGROUND: Treatment of Hodgkin's disease (HD) and non-Hodgkin lymphomas (NHL) is still unsatisfactory in patients resistant to primary therapy or those with early relapses. The objective of the trial was to test whether salvage regimens based on a combination of iphosphamide and etopozide have a sufficient anti-lymphoma effect, while the toxicity is still acceptable, and in conjunction with growth factors as satisfactory mobilizing potential for the collection of peripheral stem cells (PBSC). METHODS AND RESULTS: A group of 40 patients with relapsing and/or primary therapy resisting lymphomas (14 NHL, 26 HD) were treated by life saving or stimulating chemotherapy VIM (etopozide, iphosphamide, methotrexate) and MINE (iphosphamide mitoxanthrone, etopozide; mostly NHL). If the response to these regimes was inadequate, to some patients in addition mini (dexa) regimes were administered, BEAM and DHAP resp., with the objective to achieve maximum reduction of the tumourous mass before high-dosage treatment with the support of autologous PBSC. The authors administered 119 cycles of salvage chemotherapy (51 VIM, 46 MINE, 22 mini-dexa-BEAM and DHAP). The toxicity of chemotherapy and the therapeutic response were evaluated according to WHO criteria. The toxicity of VIM and MINE, with the exception for mobilization of desirable transient leukopenia, was not serious. During stimulation of PBSC on average three leukophereses were made and on average 9.9. 10(6) CD34+ cells/kg body weight of the patient were obtained and 53.2. 10(4) CFU-GM/kg (VIM), and 13.5. 10(6) CD34+ cells/kg 53.4. 10(4) CFU-GM/kg (MINE) resp. A total of 64% (MINE) and 61% (VIM) therapeutic responses were obtained, 14% (MINE) and 26% (VIM) complete remissions and 50% (MINE) and 35% (VIM) partial remissions. CONCLUSIONS: Life saving regimes, VIM and MINE, have a good antilymphoma activity, low toxicity and in combination with growth factors (filgrastim) they ensure a good collection of PBSC. As compared with other regimens, in particular for stimulation, VIM and MINE appear to be better.

Adolescent↗
PubMed1998

Herpes simplex infection as possible etiology for febrile neutropenia and mucositis in patients treated for hematological malignancies.

Mucositis is a common complication following chemotherapy. Clinical findings similar to herpetic infection are observed in some patients. Acyclovir administered in addition to empirical, antibiotic treatment improves the course of mucositis, and can also bring down the temperature. The aim of our study was to define the etiological influence of herpetic infection on the course of febrile neutropenia in patients with mucositis. A total of 34 patients with febrile neutropenia were divided into 2 groups: 15 with typical herpetic eruption, and 19 with non-specific mucositis. Both groups received 5-10 mg/kg acyclovir every eight hours together with empiric antibiotic treatment. The effect of acyclovir was studied, and results compared in the two patient groups. Body temperatures decreased in both groups, clinical symptoms, however, disappeared more slowly in the group with non-specific mucositis. The beneficial effect of acyclovir treatment was particularly well expressed in seropositive patients. In this group of patients, herpetic infections may recur under further chemotherapy. Thus, it would be useful to administer acyclovir to them prophylactically during risk periods.

Acyclovir↗
PubMed1997

[A new purine analog in the treatment of hematologic malignancy. I. Fludarabine].

New purine analogues, fludarabine, 2-chlorodeoxyadenosine and 2-deoxycoformycin are remarkably active in generally incurable malignant lymphoproliferative disorders. The first part of the review summarises pharmacological properties, the mechanism of action, toxicity and clinical use of fludarabine. Major clinical experience with fludarabine has been obtained in patients with chronic lymphocytic leukaemia (CLL). In the studies in pretreated patients with CLL, the overall response rate was over 50%. In previously untreated patients with CLL response rate of 75-80% was recorded with a high ratio of complete responses. Fludarabine was found to be active agent in indolent lymphoma in phase I/II. Approximately 60% of patients with follicular lymphoma respond to fludarabine monotherapy. Combination of fludarabine with cytosine arabinoside (ara-C) is now successfully used in the treatment of acute myelogenous leukaemia (AML) and myelodysplastic syndrome (MDS). Other potential areas of use for fludarabine include hairy-cell leukaemia, Waldenström's macroglobulinaemia and mycosis fungoides. Myelosupression, especially leuko and lymphopenia is the major dose-limiting adverse effect of fludarabine. A long term reduction in CD4+ T cell count may be associated with an increased incidence of opportunistic infections. Other adverse effects such as nausea and vomiting or neurotoxicity are of mild to moderate severity when the recommended dosage is used.

Antineoplastic Agents↗
PubMed1997

[Activation of blood coagulation in oncology patients].

Thromboembolic complications are a very important part of neoplastic diseases. In these complications specific processes participate which are the result of the action of substances produced by the tumour or they are formed as a consequences of the reaction to the neoplastic disease, its complications or treatment. A special role in this respect is played by the tissue factor and cancer procoagulant which are very important procoagulant proteins. Post-mortem evaluation reveals thromboembolic manifestations in as many as 50% of all oncological patients. Considerable attention is paid to the prevention of thromboembolic episodes or their progression and patterns for their prevention and treatment were elaborated. One of these provisions is the use of anti-thrombotic drugs, their introduction being motivated by an attempt to check coagulation and eliminate its tendency towards hypercoagulation. In this respect the importance of heparin is beyond doubt, i.e. of non-fractionated as well as low-molecular heparin.

Blood Coagulation↗
PubMed1995

[Treatment of adult acute lymphatic leukemia with polychemotherapy supported by the leukocyte growth factor G-CSF].

The treatment results in 13 patients with acute lymphatic leukemia are reported. All patients were treated according to the Hoelzer protocol. Granulocyte colony-stimulating factor (G-CSF) was administered till the onset of neutropenia and was continued as long as the leukocyte number increased above 3 x 10(9)/l. In phase I of Hoelzer's protocol G-CSF was administered on the average for 12 days, in phase II for 15 days. The chemotherapy of phase I was administered in scheduled time to 11 patients. In phase II the average delay against the scheduled time was 14 days. Reductions of dose were made only in 2 person. After finishing phase II 9 patients were in complete remission. Three patients died during therapy, one patient with small response died one month after completing phase II therapy. We believe that the administration of G-CSF only at the onset of leukopenia also abbreviate its duration as if the application were started immediately with the chemotherapy.

Adolescent↗
PubMed1995

[Subcutaneous chamber systems (ports) for long-term care in cancer patients].

Maintenance of satisfactory and safe venous access in cancer patients is part of a comprehensive care of cancer patients. As the Hickman/Broviac catheter is today used an implantable port. This port is placed in a subcutaneous pocket. The catheter connected to the port leads into the central vein, usually through the subclavian vein. An application of drugs in the port is done trough the skin. In this time could be used different types of ports, one or two chambers port, low profil port, peripheral port and others. In this paper we reported our two-years experience with 33 totally implantable access systems, which has been implanted in patients with cancer in Masaryk University Hospital Brno Bohunice. In our department was most frequently used port the nonmetallic port IMPLANTOFIX (BRAUN MELSUNGEN). All ports were in place for a total of 5,582 days, in average of 169 days. A frequency of complications were 2.15 on 1,000 days. Four ports were in place for longer than 1 year. A comparison of the incidence of complications in the present study with an analysis of 23 studies reported in literature was satisfactory. Minimal maintenance care, no restriction of life activity, improving quality of life and probably less frequency of infection complications, identify it as a significant advantage for the satisfactory maintenance of venous access of oncology patients in comparison with Hickman/Broviac catheter. Both the patients and the nursing staff showed a very high degree of satisfaction with this system. In cancer patients, especially with poor venous access, and prognosis longer than 6 months can be indicated this system with the advantage for patients.

Adolescent↗
PubMed1995

[Sulodexide in the treatment of venous thrombosis].

Contemporary views on the treatment of thromboembolic disease comprise the possibility to use preparations with an antithrombotic effect in indications, where it is not necessary to administer anticoagulants or thrombolytic drugs or combined treatment. Sulodexide can due to its effects, easy administration (in particular the oral form) and unpretentious monitoring be used where so far only more pretentious therapeutic procedures could be applied. Our initial experience in fourteen patients with deep venous thrombosis seems to be very encouraging.

Adult↗
PubMed1994

[Late and slow diagnosis of acute promyelocytic leukemias--the main cause of early death].

Acute hypergranular promyelocytic leukemia (AML M3) belongs to malignant diseases leading very rapidly to death. Immediate treatment based on early diagnosis may cure one third of patients. The typical finding in peripheral blood of patients is pancytopenia with or without atypical promyelocytes. In published studies only 15-25% patients exhibit leukocyte counts above 10 x 10(9)/l. Five of our ten patients studied had leukocyte count above 10 x 10(9)/l. The difference might be in connection with late and slow diagnosis of AML M3. AML is not taken into consideration during medical examination even if the disease occurs in medical family. Thus we describe clinical signs of AML M3 that could be divided into three main groups: bleeding, infections and anemia. In patients with bleeding or anemia or with infections repeating within a short period or with an infection and concurrent signs of bleeding or anemia the complete blood cell count should be examined immediately. If blood cell count abnormalities are found the patient should be sent immediately to hematology unit for further examination and treatment. Early diagnosis enables to start "differentiation therapy" with all-trans retinoic acid that could be administered as monotherapy only in patients with leukocytes below 5 x 10(9)/l. Early diagnosis of AML M3 might ameliorate the fate of patients, since four of our five patients referred to us with elevated leukocyte counts expired in the first five days.

Adult↗
PubMed1994

[Increased bone density in patients with multiple myeloma treated with clodronate].

The indication of bisphosphonates in hypercalcemia is fully accepted, the long term therapy with bisphosphonates is still controversial. The aim of our study was to evaluate the influence of clodronate on the bone density of myeloma patients. Twenty patients were included in the study. Clodronate is administered in the total dose of 3,000 mg, which is delivered in 4-6 hour infusions, 600 mg/day, once in tree 3 months. The effect of clodronate on bone density is evaluated by CT-densitometry in a period of 6 months. At the beginning of May 1994, 15 patients had completed at least two estimations of bone density. The amount of hydroxyapatite in these six months increased in 9 patients, in one of them there was no change and in 4 of them decreasing bone density was detected. The mean bone density before the administration of clodronate was -2.6 SD (standard deviation of European standard of bone density for age and sex). After 6 months of therapy the bone density increased to -2.3 SD. The mean amount of hydroxyapatite in spongiosa was raised from the mean value 32.71 mg/ml before clodronate administration to 38.91 mg/ml after the 6 month treatment period. The mean increase in calciumhydroxyapatite in trabecular bone mass was 6.2 mg. Clodronate contributed to the amelioration of bone pain in the majority of patients, but this effect is difficult to evaluate because of other treatment modalities administered concomitantly. The tolerance of clodronate was good. No impairments of renal function or other adverse effects were observed. Only in 2 patients the decrease in calcium concentration caused slight tetania. Therefore close monitoring of the calcium level is recommended and in the case of its decrease below the physiological level peroral substitution of calcium was started.

Bone Density↗
PubMed1992

Protein C and hypertension.

Protein C antigen and amidolytic activity were assayed in 38 patients with essential hypertension at the first stage of disease. As compared to 20 normal healthy blood donors no abnormality was found.

Adult↗
PubMed1991

[Disseminated intravascular coagulation and sepsis].

The authors give an account on the relations between disseminated intravascular coagulation, sepsis and multiorgan failure. Disseminated intravascular coagulation is defined as an acquired disorder of blood clotting with an increased turnover of thrombocytes, fibrinogen and coagulation factors. The authors discuss aetiopathogenetic aspects, possibilities of laboratory diagnosis, anticoagulation and substitution therapy and prophylaxis of disseminated intravascular coagulation in septicaemia. They emphasize comprehensive treatment of septicaemias where haematological monitoring and therapy must form an integral part. In an extensive series of septic multiorgan failures the authors detected failures apparent on laboratory examination in 41% of the patients.

Disseminated Intravascular Coagulation↗
PubMed1991

[Hemophilia].

Haemophilia is one of the longest known diseases. Despite its relatively low prevalence it remains a serious medical and social problem. The authors tried to summarize in the submitted review contemporary knowledge of this hereditary disease.

Diagnosis, Differential↗
PubMed1990

[Thrombocytopenia and thrombocytopathy in neonates and infants].

The authors analyze seven cases of thrombocytopenia and three cases of thrombocytopathies in neonates and infants who were hospitalized within a short period of time at the First Paediatric Clinic in Brno. The results support the view that thrombocytopenia and thrombocytopathies in neonates and infants are fairly frequent. Because they are not manifested by clinical symptoms, their frequency escapes attention.

Blood Platelet Disorders↗
PubMed1988

Clinical significance of protein C.

The coagulation inhibitors are important components of control mechanisms which ensure the haemocoagulation equilibrium. One of them is protein C, whose level was followed in patients with DIC. and IM. In DIC. cases a significant decrease was noted with regard to the MI groups and healthy donors. EID and ELISA methods were used for testing. The patients exhibiting the protein C defect require a corresponding treatment which should suppress the thromboembolic complications.

Adult↗