Biomedical subjects

P Maruna

Publications and source records attributed to P Maruna.

At least 19 recordsLinked to original sources

PubMed2006

[Prediction and monitoring of severe acute pancreatitis].

Twenty to thirty percent patients with acute pancreatitis develop severe acute pancreatitis with high mortality and morbidity rate. Markers of severity of acute pancreatitis are clinically important for the early diagnosis of complications. We reviewed the literature for markers of acute pancreatitis. On their relevance for prediction of severe pancreatitis are given. Several markers can predict severe cases of acute pancreatitis with a different positive and negative predictive value. Useful predictors of severity may include serum procalcitonin and urinary trypsinogen activation peptide at the admission, serum interleukins-6 and -8 at 24 h, and serum C-reactive protein (CRP) in 48 hours interval. The valuable marker for daily monitoring appears to be serum procalcitonin.

APACHE↗

PubMed2006

[Gynecological aspects of thyroid disorders. A review].

OBJECTIVE: The most frequent thyroid syndromes--hypothyroidism and thyrotoxicosis--are often accompanied with menstrual disturbances. The aim of this study was to summarize knowledge of physiology, pathology and clinical aspects of both thyroidal and gonadal axis interactions. SUBJECT: A review. SETTING: Department of Pathological Physiology, 1st Faculty of Medicine, Charles University, Prague. CONCLUSION: About 25% female infertility and 15% menstrual cycle disorders result from thyroid dysfunction. Particularly, the subclinical hypothyroidism has a high prevalence in the population; therefore, thyroid function must be examined in female with unclear infertility or menstrual disturbances. The next overlap of thyroid disorders and gynaecology represents iodine-131 use for differentiated thyroid carcinoma in fertile age with aspects to ovarian failure and gestational risk.

Female↗

PubMed2005

The postoperative stress response and its reflection in cytokine network and leptin plasma levels.

The objective of the present report was to clarify the postoperative stress response of some inflammatory markers, namely of proinflammatory cytokines and leptin levels during uncomplicated postoperative periods. The results were compared with the dynamics of these parameters during intraabdominal sepsis. We followed 20 patients after a planned resection of colorectal cancer in stage Ib-IV with uncomplicated healing and 13 obese men after laparoscopic non-adjustable gastric banding. These were compared to 12 patients with proven postoperative sepsis. The control group consisted of 18 healthy men. The observed parameters included serum levels of cytokines, tumor necrosis factor-alpha (TNFalpha), interleukin-1 beta (IL-1 beta), interleukin-1 receptor antagonist (IL-1 ra), IL-6, IL-8, soluble receptor of interleukin-2 (sIL-2R) and leptin. It was found that during the first 24 h after resection there was a significant increase in the serum concentration of IL-6 up to 1125+/-240 ng/l, which declined within the next 48-72 h. Serum concentration of TNFalpha was highest 18-24 h after resection (205+/-22 ng/l) and after banding (184+/-77 ng/l). IL-1 beta had a stable serum concentration without significant elevation. Serum concentration of IL-8 after resection rose to 520+/-200 ng/l after 36-48 h. Maximal cytokine levels after gastric banding were quantitatively lower (IL-6 414+/-240 ng/l, TNFalpha 184+/-77 ng/l) than after resection. We found significant elevation of plasma leptin concentration (32+/-10 ng/ml) 24 h after banding compared with preoperative values (18+/-5 ng/ml, p 0.05). Leptin levels 48 and 72 h after banding rapidly returned to the level before operation. During abdominal surgery leptin shows to be an acute phase reactant. Proinflammatory cytokines can be main regulatory factors of leptin during this period. Significant correlation between leptin and TNFalpha (similarly demonstrated by other authors in models of bacterial inflammation) indicates that TNFalpha can be the crucial regulator of leptin generation in the early postoperative period. On the basis of our results we recommend to observe IL-6 and IL-8 at 24-72 h after the surgery in patients with a high risk of early postoperative septic complications.

Bacterial Infections↗

PubMed2005

[Laparoscopic diagnosis and treatment of organic hyperinsulinism--our first experience].

Laparoscopic pancreatic procedures are still at the stage of evaluation with regard to their indications and the technical variation used. Laparoscopic pancreatic surgery is currently used for staging malignant pancreatic tumours, for the resection of benign pancreatic tumours and for the occasional management of inflammatory disorders of the pancreas. Insulinomas are rare tumours with incidence per year of 0.1-0.4 per 100,000. Ist Surgical clinic, IIIrd Internal clinic and Radiological clinic are cooperating since 1971. On the list of IIIrd Internal clinic are 80 patients with insulinoma. Since 1971 at Ist Surgical Clinic 66 patients have been operated. In our article are diagnostic and therapeutic problems discussed. Laparoscopic pancreatic procedures are still at an evaluation stage regard to their indications and techniques. Authors give report about first experience with successful laparoscopic enucleation of insulinoma in case 83 year old woman (Fig. 3, 4). The operative time was 90 min. Drainage is necessary. CT guided drain in cavity of seroma is shown (Fig. 5).

Humans↗

PubMed2005

[Pathophysiology of postoperative dysfunctions of the intestinal motility. A review].

The postoperative motility dysfunction (POI) is a frequent secondary complication of surgical procedures. The POI results from a number of simultaneous factors of both local and systemic nature. Activation of inhibitory neural reflexes and a mediator response to the surgical procedure are among the main ones. Neurohumoral response of the organism to painful stimuli and the effect of the opioid medication used during the perioperative period, are the modulating factors. The intraabdominal procedure with manipulation with the intestine results in activation of the mediator response, followed by increased levels of cytokines and other mediators, inhibiting the smooth intestinal musculature contractility. The extent of the traumatization of the tissue is a principal factor affecting the extent and duration of the POI.

Gastrointestinal Motility↗

PubMed2005

[The risk of malignancy after organ transplantation].

Improvements in immunosuppressive therapy during the past decade brought about improvements of the long term tolerance of organ allografts. However, the long-term immunosuppressive therapy has an important limitation, because it can increase the risk of cardivascular diseases, infections and tumors. As compared with age-matched healthy population, organ-transplant recipients have an increased incidence of tumors.

Humans↗

PubMed2005

Gonococcal infection as a cause of acute abdomen.

Gonococcal infection in the postantibiotic era continues to cause disseminated and severe disease in some patients. The differential diagnosis of pain in the lower abdomen in young women is difficult. Our case report described a 19-year-old patient who presented with acute abdomen as a result of Gonococcal infection, assessed as a local complication, pelveoperitonitis: pelvic inflammatory disease. The message of our case report is sexually transmitted infections should invariably be considered in young women and searched for accordingly.

Abdomen, Acute↗

PubMed2004

[Results of the large intestine resection in elderly patients].

The colorectal carcinoma incidence increases with age. The radical resection procedure significantly extends the survival period, when compared with other therapeutic approaches. The tissue damage may exceed the organ reserve capacity in cases of the elderly patients and may result in higher postoperative morbidity and mortality rates. The aim of this study was to compare the results and the surgical risks of the large intestine carcinoma resection procedure in elderly patients, compared to younger patients with the same diagnosis. THE PATIENT GROUP AND METHODOLOGY: The retrospective study summons up the clinical results of 3778 patients from all over the Czech Republic, who underwent primeoperations for the following diagnoses: C18--a malignant neoplasm of the large intestine, and C19--a malignant neoplasm of the rectosigmoideal junction, in 2001. The results are compared with our own patient group in the same time-period. The results were assessed according to the following age-group criteria: 21-59 yrs., 60-69 yrs. and over 70 yrs. of age. We assessed the following factors: age, diagnosis, incidence of early postoperative complications and duration of patients hospitalization. RESULTS: The patients in the 21-59 year-group and in the group over 70 years of age, had significantly different rates of early postoperative complications (12.3% vs 17.6%, p < 0.001). The rate of complications was twice as high in urgent procedures compared to planned procedures in all age groups (p < 0.001). The average hospitalization lasted 14.8 +/- 10.9 days. We discovered statistically significant differences in the duration of hospitalization among all three age groups respectively (p < 0.01). CONCLUSION: Based on our results, we believe the age itself not be an indication-limiting factor for the radical resection procedure for the large intestine carcinoma. The elderly patients benefit from its oncological radicality with acceptable rates of the postoperative complications risks. We believe even extensive surgical procedures to be feasible in cases of appropriately indicated elderly patients, and their surgical risks to be acceptable considering the expected benefits for the respective patient.

Adult↗

PubMed2004

[The onset of physiological activity in the stomach in the postoperative period. A comparative study with a prokinetic preparation, Ganaton].

UNLABELLED: Postoperative gastroparesis decreases patient's postoperative comfort. The aim of this prospective study was to assess efficacy of the peroperatively administered prokinetic preparation Ganaton (Itopridi hydrochloridum, Abbott) on the postoperative gastroparesis. METHODOLOGY: This prospective study was conducted in the Ist Surgical Clinic of the 1st Medical Faculty in Prague in 2001-2001. The total of 64 patients took part in this study. The patients underwent either a non-adjustable bandaging of the stomach via laparoscopy for a severe obesity, or a laparoscopic cholecystectomy. In the postoperative period, a subjective status of each patient, as well as objective examinations (auscultaion, gas excretion, stool excretion) and a percutaneous electrographic record were recorded. RESULTS: The patients after both the gastric bandaging and the laparoscopic cholecystectomy, demonstrated faster restoration of the physiological stomach contractions frequency in the group with itopride, compared with the placebo group. CONCLUSION: The prokinetic preparation was well tolerated and the authors did not record any undesirable side-effects. The preparation significantly speeded up restoration of the physiological stomach contractions frequency compared with the placebo group. Based on our results, its administration is a suitable part of the prophylaxis and treatment of the postoperative gastroparesis.

Adult↗

PubMed2004

[Therapeutic approach for treatment of postoperative ileus].

The postoperative motility disorder of the gastrointestinal tract (POI) is a transient, however a frequent reaction of the gastrointestinal tract to intraabdominal procedures. The cause of the onset of the POI is multifactoral and, therefore, the treatment must also cover all known pathophysiological causes. The management of the POI includes the following basic measures: employment of the minimally invasive surgical techniques, prophylactic administration of the prokinetics, early postoperative mobilisation of the patient and early enteral nutrition.

Humans↗

PubMed2003

Severe late complication of appendicitis. Case report.

BACKGROUND: Diffuse necrotizing soft-tissue infections are severe due to their rapid progression; there is a vital need for settling proper early diagnosis. The task of the clinician is mainly in distinguishing localized infection from the diffuse process. CASE PRESENTATION: In our case report we demonstrate a 32 yr old man with a curious development of severe necrotizing infection of submucosis with gas production as a conclusion of perforation of Schloffer's tumour, which developed after appendectomy carried 20 years ago. CONCLUSIONS: In case of diffuse necrotizing soft-tissue infections only immediate surgical revision can confirm initial stages of severe forms of infection.

Abdominal Abscess↗

PubMed2002

[Changes in levels of acute phase proteins in patients with central hypercortisolism].

BACKGROUND: Acute phase protein reaction depends on complex interaction of proinflammatory cytokines and hormones, especially glucocorticoids. Glucocorticoids are essential factors for hepatocellular microenvironment and proteosynthesis during both rest and inflammatory period. Cushing's disease represents a model of glucocorticoid hyperstimulation of acute phase protein synthesis without interleukin-6 and other cytokine influence. METHODS AND RESULTS: 20 patients (age of 38 +/- 11, 11 males, 9 females) with a diagnosis of central hypercorticolism were examined. Plasma levels of 11 acute phase proteins were estimated. These results were compared with plasma ACTH, interleukin-6, and U-cortisol concentrations and correlated to the control group (healthy volunteers, age 30 +/- 5, 13 males, 7 females). Plasma levels of albumin and prealbumin in patients with Cusing's disease were significantly lower. We proved significant elevation of alpha 1-acid glycoprotein, haemopexin, and fibrinogen compared with healthy subjects. The positive correlation of alpha 1-acid glycoprotein and U-cortisol (r = 0.51, p < 0.01), haemopexin and U-cortisol (r = 0.47, p < 0.05) respectively was found. CONCLUSIONS: The interaction between glucocorticoids and proinflammatory cytokines in acute phase protein synthesis depends on permissive effects of corticoids on cytokine signal transduction in hepatocytes. However, our results document that corticoida themselves significantly stimulate acute phase protein synthesis, and this stimulation differs from inflammatory pattern of hepatic proteosynthesis.

Acute-Phase Proteins↗

PubMed2002

[Percutaneous electrogastrography in the perioperative period in laparoscopic and classical cholecystectomy and in laparoscopic nonadjustable gastric banding].

Percutaneous electrogastrography (EGG) is a non-invasive measuring method of gastric myoelectrical activity. We measured myoelectrical activity patients after laparoscopic cholecystectomy (16 patients), after laparotomic cholecystectomy (9 patients) and after gastric bandage (14 patients). We used a Microdigitrapper (Medtronic) and data were analysed with a spectral analysis and Fournier's transformation. We measured 24 hours and 5 hours before operation procedure and 24 and 48 hours after operation. After operative procedure we compared results with healthy voluntaries. Bradygastria was found in most frequent cases in early postoperative period. Physiologic conditions were renewed in laparoscopic operative procedure in first day, after laparotomic operation in second day after operation.

Adult↗

PubMed2002

[Cytokines and soluble cytokine receptors in the perioperative period].

UNLABELLED: The common basis of systemic inflammatory response to surgical trauma is the activation of cytokine cascade, accompanied by the release of soluble cytokine receptors. The main cytokine axis stimulates the release of acute phase proteins (APP) form liver, modulates metabolic pathways and hormonal responses. The aim of this study was to assess characteristic changes in levels of pro- and anti-inflammatory cytokines in early post-op stages after a major intraabdominal surgery and to compare the results with dynamic changes in APP levels. The results will form a basis of evaluation of diagnostic value of certain cytokines and APP in post-operative complications. SUBJECTS AND METHODS: Subjects fell into three categories: 1--patients after colonic resection for colorectal carcinoma I. and II. grade (N = 20), 2--patients after hemipancreatoduodenectomia (N = 17) and 3--control group of 18 healthy subjects. The levels of following parameters were measured between from one day before to three days after surgery: tumour necrosis factor-alpha, interleukin (IL)-1 beta, IL-1ra, IL-2, IL-6, IL-8, IL-10, soluble IL-2 receptors, C reactive protein (CRP) and alpha1-antitrypsin (AAT). RESULTS: Measured parameters exhibited different dynamic changes in reaction to surgical trauma, according to their roles in immune reaction. Main pro-inflammatory cytokines culminated within 24 hours from the onset of surgery, marked elevations were noted in IL-1ra and the soluble IL-2 receptor. Both measured APP were rising until he 72nd hour post surgery, and their rise was markedly delayed compared to cytokines. The extent of immune reaction as measured by the amplitude of changes in both types of surgery was similar in most measured parameters, apart from marked difference in IL-2R. We also noted significant correlation of plasma levels of IL-6 and IL-1ra. CONCLUSIONS: Surgical trauma as any other significant painful stimulus activates the pro-inflammatory cytokine axis with secondary response of APP. The release or pro-inflammatory cytokines, i.e. TNF-alpha, IL-1, IL-6 and IL-8 is synchronized with the release of antagonistic mediators (i.e. IL-1ra, IL-10, IL-2 and IL-6 soluble receptors), who precede the acceleration of APP production and thus modulate its extent. The evaluation of relationships between pro- and anti-inflammatory factors with regard to prognosis is confounded by unclear interpretation of their changes. The maximum effect of cytokines takes place at local autocrine and paracrine level and systemic levels do not reflect this. This is how we explain minimal changes in plasma levels of IL-1 beta and IL-2, despite their key role as initiators of cytokine cascade. In order to increase their diagnostic value the use a series of measurements is advocated in combination with other clinical and laboratory parameters of inflammation, such as the levels of acute phase proteins.

Adult↗

PubMed2002

[Procalcitonin in the diagnosis of postoperative complications].

UNLABELLED: The dynamic changes in levels of procalcitonin (PCT), as well as other cytokines and acute phase proteins (APP) in post-operative stages reflect the systemic immune response, integrating perioperative infectious and non-infectious stimuli. This study evaluates PCT in context of 16 other inflammatory parameters in patients with different types of infectious post-operative complications. It analyses the specificity and sensitivity of PCT, cytokines and APP and their relationships during systemic inflammatory response. SUBJECTS AND METHODS: The study involved the following groups of patients: those with confirmed bacterial sepsis, fulfilling the SIRS criteria (N = 28), those with limited infectious site at the wound (N = 16), those with post-operative pneumonia (N = 15) and a control group of N = 25. In 24-hour interval we assessed plasma levels of: PCT, TNF-alpha, IL-1 beta, IL-1ra, IL-6, IL-8, sIL-2R and a spectrum of APP. RESULTS: PCT in patients with wound infection (1.4 +/- 0.31 ng/ml) and in those with pneumonia (0.7 +/- 0.30 ng/ml) does not rise above levels expected in uncomplicated post-op course (1.7 +/- 0.04 ng/ml), but it differs significantly in comparison to healthy controls (0.2 +/- 0.07 ng/ml). Initial levels of PCT as well as their maximum levels were significantly different in septic patients compared to other groups (p < 0.001). According to specificity and sensitivity tests PCT is the most significant marker for diagnosis of sepsis as opposed to uncomplicated post-operative course (AUC 0.91, CI 0.82-1.0). CONCLUSION: Individual inflammatory parameters vary in sensitivity and specificity to causative stimulus. PCT when compared to major cytokines and APP reacts sensitively mainly to systemic stimuli accompanying bacterial infection, notably endotoxin. It is characterized by markedly lower sensitivity to non-bacterial stimuli (trauma of surgery) or localized bacterial inflammations. It is this behaviour that makes it a useful diagnostic tool in post-op courses. Unlike other parameters, PCT allows with sufficient sensitivity and specificity single-test diagnosis of initial sepsis.

Biomarkers↗

PubMed2001

Leptin as an acute phase reactant after non-adjustable laparoscopic gastric banding.

BACKGROUND: Leptin is a hormone that regulates food intake; its concentrations are elevated in the majority of obese individuals. During inflammation, plasma leptin is usually increased and may contribute to the anorexia and cachexia of infection. The purpose of this study was to characterize the dynamics of circulating leptin in the early postoperative period in relation to the acute phase response in extremely obese patients undergoing laparoscopic non-adjustable gastric banding (LNAGB). We compared plasma leptin changes with 4 proinflammatory cytokines and BMI. METHODS: The prospective study was performed on 18 patients with 3rd degree obesity. Plasma concentration of leptin, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1, soluble IL-2 receptor (sIL-2R), and IL-6 were estimated before operation and 24, 48, and 72 h after NALGB. RESULTS: We demonstrate statistically significant elevation of plasma leptin concentration (32.2 +/- 10.2 micrograms/l) 24 h after operation compared with preoperative status (18.4 +/- 5.2 micrograms/l, p < 0.05). There was diminished correlation of plasma leptin and BMI in this period. Leptin levels +48 and +72 h after banding quickly returned to preoperative levels. The regression coefficient was the highest for leptin and TNF-alpha 24 h after surgery (r = 0.40, p < 0.05), and for leptin and IL-6 24 h after surgery (r = 0.29, p < 0.05). There was no significant correlation between leptin and IL-1 and between leptin and sIL-2R respectively. CONCLUSIONS: During the non-infectious stress response (as with abdominal surgery), leptin shows itself as an acute phase reactant. Proinflammatory cytokines can be the main regulatory factors of leptin in this period. Significant correlation between leptin and TNF-alpha (similarly demonstrated by other authors in models of bacterial inflammation) indicates that TNF-alpha can be a crucial regulator of leptin generation in the early postoperative period.

Acute-Phase Reaction↗

PubMed2001

[Dynamics of leptin plasma levels after abdominal surgical procedures].

UNLABELLED: In addition to its basic role as regulator of the amount of body fat and food intake leptin plays a part also as an acute phase reactant. A rise of the leptin level during this period may be associated with anorexia and cachexia in relation to general inflammatory manifestations. The objective of the present study was to characterize the dynamics of the leptin concentration in patients after intraabdominal surgery. PATIENTS AND METHODS: The prospective study was implemented in a group of 16 men subjected to planned surgery--resection of colorectal carcinoma. The plasma leptin concentration (RIA), TNF alpha, IL-beta. IL-6, sIL-2R (ELISA), CRP, alpha-1-antitrypsin, alpha-1-acid glycoprotein and ceruloplasmin (nephelometry) were assessed before surgery and then +24, +48 and +72 hours after the beginning of the operation and compared with concentrations in healthy subjects. RESULTS: Plasma leptin concentrations culminate +24 hours after surgery and in this stage they do not correlate with the BMI. Within 48 hours the concentration reaches rapidly normal levels. TNF alpha, IL-6 and sIL-2R reach maximal levels 24-48 hours after the onset of surgery with a subsequent slow decline. All acute phase proteins (APP) have prolonged dynamics with an elevation within +72 hours. A significant correlation was proved between the leptin concentration and TNF alpha 24 hours after surgery (r = 0.43, p < 0.05) and between leptin and IL-6 24 hours after surgery (r = 0.32, p < 0.05). CONCLUSION: The dynamics of the plasma leptin concentration during the postoperative period differ from the typical development of early indicators of the systemic inflammatory response--cytokines as well as from the dynamics of APP. Leptin elevation during this period may contribute to anorexia of patients after major surgery. However, rapid normalization of the level within 48 hours after surgery indicates however that leptin is involved also in other, so far unspecified factors with an anorectic action.

Abdomen↗

PubMed2001

[Leptin--a new acute phase reactant].

Leptin, 16 kDa protein and the product of the Ob gene was discovered six years ago and characterized as a fat cell hormone which maintains via specific receptors in the hypothalamus by a feedback mechanism the energy balance and body weight. Research conducted during the last three years detected further properties of this protein which include it, in addition to its basic role in mammalian metabolism, also among acute phase reactants. Leptin is as to its structure, pattern of the receptor and the postreceptor transduction mechanism close to the group of cytokines of interleukin 6, in particular the granulocytic colony stimulating factor. During infectious and non-infectious inflammatory reactions leptin synthesis is stimulated by a combination of inflammation promoting cytokines. The mechanism of induction is not known so far but the majority of investigations proves an indirect stimulating effect of the tumour necrosis factor and interleukin 1, depending on non-specified cytokines of the second stage. Investigations of cell lines and animal experiments provided evidence of some local and systemic effects of leptin which may play a physiological part in the acute phase reaction. Leptin mediates at least partly the anorectic effect of the tumour necrosis factor and interleukin 1 during inflammation. Synergically with bacterial antigens it activates macrophages, enhances their phagocytic capacity and stimulates secretion of pro- and anti-inflammatory factors from macrophages. Leptin stimulates neovascularization, it has a stimulating effect on precursors of white blood cells and potentiates the effect of erythropoietin on red blood cells. It is obviously an essential factor for T-lymphocyte proliferation and development. The authors discuss also the role of leptin in the modulation of the hypothalamo-pituito-adrenal stress axis. Leptin is a factor of the inflammatory mediator network, probably essential for an adequate course of the inflammatory defence reaction.

Acute-Phase Proteins↗