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Biomedical subjects

P Maruna

Publications and source records attributed to P Maruna.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Percutaneous electrogastrography in the perioperative period in laparoscopic gastric banding at the First Surgical Clinic of the General Faculty Hospital in Prague].

Percutaneous electrogastrography (EGG) is a method which makes non-invasive follow-up of the myoelectric gastric activity possible. The authors present the results of assessment of the myoelectric gastric activity during the perioperative period in patients undergoing, at the First Surgical Clinic General Faculty Hospital, laparoscopic non-adjustable gastric banding. The data were recorded using a Microdigittrapper and evaluated using spectral analysis and Fourier's transformation. The authors mention also briefly conditions which must be met to ensure the study, and the physiological and pathophysiological background of the method. In 14 patients the ECG record was made 24 hours prior to surgery and then 5 hours, 24 and 48 hours after surgery on fasting and after a fluid bolus. The assembled results of the dynamics of perioperative changes on the EGG were compared with results obtained in a group of healthy volunteers. The most frequent finding during the early postoperative period was bradygastria, the return to preoperative values occurred on average 48 hours after surgery. Percutaneous electrogastrography is a non-invasive method which can provide the surgeon during the early postoperative period with information on myoelectric gastric activity.

Adult↗
PubMed2001

Serum leptin levels in septic men correlate well with C-reactive protein (CRP) and TNF-alpha but not with BMI.

Leptin, an adipocyte-derived signaling factor, is a member of the IL-6 cytokine family. However there is no direct evidence of leptin stimulation of the acute phase protein (APP) synthesis which is typical for all other IL-6-like factors. The purpose of this study was to characterize the dynamics of circulating leptin in relation to ten APPs. We used postoperative septic patients as a model of cytokine network hyperstimulation and intensive APP reaction. The prospective study was performed on 22 patients with proven postoperative intraabdominal sepsis after large abdominal surgery. Plasma levels of leptin, TNF-alpha, IL-1beta, soluble IL-2 receptor (sIL-2R), IL-6 (ELISA analysis) and ten APPs (nephelometric analysis) were estimated. We have demonstrated a statistically significant elevation of plasma leptin concentrations in the septic group compared with healthy subjects (p<0.001). The correlation of plasma leptin and BMI during postoperative sepsis was diminished. The regression coefficient was the highest for leptin and CRP (r=0.48, p<0.05), and for leptin and alpha-1-antitrypsin (r=0.46, p<0.05) in the septic group. There was significant correlation between TNF-alpha and leptin (r=0.47, p<0.05) and between IL-6 and leptin (r=0.45, p<0.05) in septic patients. No significant correlation was found between leptin and "negative" APP and between leptin and IL-1beta. Leptin has thus been shown as an acute phase reactant with a potential hematopoietic, immunomodulatory and hepatocyte stimulating activity during the infectious and non-infectious stress response. The significant correlation between leptin and CRP and leptin and alpha-1-antitrypsin indicates that leptin can participate in APP synthesis regulation during a systemic inflammatory response.

Adult↗
PubMed2001

[Differences in the dynamics of leptin and cortisol during the non-infectious stress reaction].

UNLABELLED: Leptin is a hormone and acute phase reactant with multiple effects during both rest and inflammatory period. Effects of leptin in acute phase response cover a modulation of hypothalamo-pituitoadrenal (HPA) axis, too. In our study we evaluate the dynamics of leptin and glucocorticoid acute changes in model situations of infectious and non-infectious inflammatory reaction. PATIENTS AND METHODS: This study was realized on a group of patients 1--after operation of carcinoma coli (16 persons), 2--after laparoscopic non-adjustable gastric banding (13 persons), and patients 3--with development of postoperative intraabdominal sepsis (22 persons). Plasma levels of leptin, ACTH, cortisol, TNF-alpha, IL-6, C reactive protein (CRP), and alpha1-antitrypsin (AAT) were measured from -7 to +3 day related to surgery or 2nd day after a day when signs of sepsis were occurred. RESULTS: All tested parameters responded to surgical trauma with elevation 12 h after operation except leptin that elevated +24 h after surgery. Maximal levels of measured parameters were found 12 h after surgery (for cortisol), 24 h after surgery (for leptin, TNF-alpha, IL-6), or 36 h after operation (for CRP and AAT). Maximal levels of cortisol after a resection of coli or maximal levels of leptin after laparoscopic gastric banding fall to septic range. Other parameters in uncomplicated postoperative period significantly differed from septic levels on p < 0.01. There wasn't found statistically significant correlation between leptin and cortisol or between leptin and ACTH in all groups. DISCUSSION AND CONCLUSION: The elevation of leptin in postoperative period and during sepsis reflects a different regulation of this protein in rest period and during systemic inflammatory response. The inhibitory effect of leptin to HPA axis during stress response was documented in vitro, however, its physiological importance is not clear, yet. Our study didn't prove a statistically significant relation between plasma cortisol and leptin. The different dynamics of leptin and cortisol after surgical trauma shows that both factors have own specific regulation.

Acute-Phase Reaction↗
PubMed2000

Physiology and genetics of procalcitonin.

Procalcitonin (PCT), a protein of 116 amino-acids with molecular weight of 13 kDa, was discovered 25 years ago as a prohormone of calcitonin produced by C-cells of the thyroid gland and intracellularly cleaved by proteolytic enzymes into the active hormone. Circulating levels of PCT in healthy subjects are below detection limit. Since 1993 when its elevated level was found in patients with bacterial infection, PCT became an important protein in the detection and differential diagnostics of inflammatory states. The production of PCT during inflammation is linked with a bacterial endotoxin and with inflammatory cytokines (TNF, IL-6). PCT detectable in the plasma during inflammation is not produced in C-cells of the thyroid. The probable site of PCT production during inflammation are the neuroendocrine cells in the lungs or intestine. There is no evidence of plasma PCT binding to cellular receptors of calcitonin, and the role of PCT in calcium and phosphate metabolism during sepsis is still not clear. Other hypothetical roles of PCT (cytokine network regulation, PCT as an endogenous non-steroid antiinflammatory drug) are being considered.

Analgesics↗
PubMed2000

[Cytokines in the diagnosis of peritoneal inflammation].

Early diagnosis of peritoneal inflammation in the initial stage with equivocal clinical manifestations is not always simple. At present there are in the literature many new laboratory indicators which to a different extent describe the inflammatory process. In the present paper the authors focused attention on the practical importance of the use of cytokines in the diagnosis of peritoneal inflammations. They compare the diagnostic impact of clinical examination as compared with assessed plasma concentrations of inflammation promoting cytokines. The authors maintain that the diagnosis of secondary peritonitis is based on the clinical examination of the patient. Elevated values of PCT or IL-6 can support this clinical conclusion. In postoperative peritonitis dynamic investigation of cytokines is important. The diagnosis of tertiary peritonitis is based on laboratory findings.

Biomarkers↗
PubMed2000

[Postoperative immunosuppression--a physiological process and source of complications. Minireview].

Postoperative immunosuppression reflects non-specific neurohumoral stress responses to surgical trauma. Surgical stress in the early stage is characterised by a dysbalance of the adrenocortical response, the index of the formation of glucocorticoids and dehydroepiandrosterone is shifted to the glucocorticoids. This non-specific hormonal response has an impact on the balance between TH1 and TH2 lymphocyte response. Inhibition of the TH1 response occurs, the clinical reflection of which is a decline of cell-mediated immunity. Postoperative immunosuppression and dysbalance of cell-mediated and humoral immunity are physiological processes, part of the neurohumoral stress response to surgical trauma. Its potential pathological consequences, although proved so far only experimentally, make it on the one hand an important factor for evaluation of the risk of postoperative complications and on the other hand a possible of object of therapeutic intervention in oncological or high risk patients.

Adjuvants, Immunologic↗
PubMed1999

[Preventing the development of secondary infections in severe acute pancreatitis].

Severe acute pancreatitis is in its first stage characterized by the syndrome of systemic inflammatory response (SIRS). The extent of activation of the mediator defense cascade of the organism depends on a hitherto unknown primary insult which cannot be influenced by therapeutic care. The cause of the development of sepsis or multiorgan failure is the supraliminal action of secondary insults (ischaemic reperfusion syndrome, hypoxia, impaired physiological function of the gut). By early and aggressive therapeutic action the effect of these adverse factors can be markedly reduced. Then also better therapeutic results in severe acute pancreatitis may be expected.

Humans↗
PubMed1999

[Use of procalcitonin in surgery].

Procalcitonin (PCT) is a new early indicator of developing systemic bacterial infection. As compared with other anti-inflammatory markers (cytokines, acute stage proteins), the attained plasma levels during extensive but uncomplicated surgery are by orders lower than maximal levels during sepsis. The authors assume that PCT will be used in surgical practice as an early indicator of developing systemic bacterial infection (in multiple injuries, after surgery) and for subsequent evaluation of the effectiveness of treatment of septic conditions.

Bacterial Infections↗
PubMed1999

[Pathophysiology of development of acute pancreatitis].

Acute pancreatitis is a severe illness with unclear prognosis and mortality rate ranging from 5 to 70%. Dynamic observation of changes in systemic inflammatory response of the body may be helpful in estimating the development of acute pancreatitis as well as giving an idea of therapeutical possibilities. It is obvious, that the intensive therapeutic intervention may reduce the influence of secondary insults (ischemic-reperfusion syndrome, hypoxia, disrupted physiological function of the bowel) on pancreatic tissue. Surgery is limited only for precisely specified indications in the latter stage of acute pancreatitis (secondary inflammation of the necrosis). In this paper we conclude some pathophysiological mechanisms involved in the development of acute pancreatitis.

Acute Disease↗
PubMed1998

[The significance of cytokines in the early diagnosis of postoperative intraabdominal sepsis].

The objective of the investigation was to evaluate the possible use of selected cytokines and cytokine receptors in the early diagnosis of postoperative intraabdominal sepsis. The investigation was focused on the dynamics of plasma levels of tumour necrotizing factor-alfa (TNFalfa), interleukin (IL)-1beta, IL-2, IL-6, IL-8, IL-10, soluble receptors IL-2 and IL-6 (sIL-2R and sIL-6R) and the receptor antagonist IL-1 (IL-1ra). The investigated parameters were tested on model operations (resection of large bowel and resection of pancreas). These two groups were compared with values recorded in patients with sepsis and with healthy subjects. Based on the assembled results the authors recommend to use for postoperative investigations the first 48 hours and to follow up the following parameters: IL-6, IL-ra or sIL-2R. During the first 48 hours these indicators differentiate sufficiently specifically incipient sepsis from an uncomplicated postoperative condition. During the subsequent period, i.e. more than 48 hours after surgery, it is useful to include in the examination pattern also some acute stage proteins (C reactive protein, alfa1-antitrypsin and haptalobin) which differentiate sepsis between the 3rd and 5th day after surgery.

Abdomen↗
PubMed1995

[Cytokine therapy].

Cytokines, mediators of intercellular communication, penetrate as a new therapeutic group in to haematology, oncology, immunology and other disciplines. Recently two main spheres of indication of wider clinical use are in the foreground: 1. treatment of leukaemias and advanced solid tumours (interferons, interleukin-2, tumour-necrosis factor and others) and 2. treatment of impaired haematopoiesis (in clinical practice in particular erythropoietin, granulocyte-macrophage and granulocyte colonies stimulating factor). Other possibilities are offered by cytokines in the treatment of viral diseases (in addition to hepatitis B and C, perspectively also AIDS), inborn immunodeficiencies, progressive systemic sclerosis and other indications. In particular in oncological diseases, contrary to original assumptions, monotherapy with cytokines will not be greatly extended and a combination of cytokines with classical treatment will be used. The limiting factor in addition to cost is the considerable toxicity of some cytokines which calls for alternative routes of administration (local, compartmental etc).

Cytokines↗
PubMed1995

The effect of protoporphyrinogen oxidase inhibitors on microsomal and mitochondrial cytochromes.

Neurological dysfunction is a characteristic feature of acute porphyrias, unexplained until now. One of the possible explanations is a deficiency of heme in the central nervous system, caused by a block in porphyrin biosynthesis. To test this possibility, the content of brain mitochondrial cytochrome a3 was determined after intracerebroventricular administration of the protoporphyrinogen oxidase-inhibiting herbicide fomesafen. It was established in in vitro experiments that fomesafen is a potent inhibitor of brain mitochondrial protoporphyrinogen oxidase (PROTOOX). Addition of 10(-6) M fomesafen to incubation mixture decreased PROTOOX from 1.02 nmol/mg/h (controls) to 0.42 nmol/mg/h. 10(-5)M of fomesafen decreased this activity to 0.27 nmol/mg/h. In in vivo experiments, 5 microleters of fomesafen solution containing 0.2 M fomesafen/l was administered to male rats by intracerebroventricular injection. The content of brain mitochondrial cytochrome a3 was determined 72 hours later. A slight decrease of the a3 content was observed (control rats 0.25 nmol/mg protein, treated rats 0.22 nmol/mg). Brain cytochrome P450 activities were below detection limits in both control and treated groups. In a separate experiment, male ICR mice were fed 1000 ppm of the protoporphyrinogen oxidaseinhibiting herbicide oxadiazon in the diet for 10 days. Liver microsomal cytochrome P450 content was decreased and liver porphyrins increased. An increase of porphyrin content was also observed in the testes of oxadiazon-fed mice, but testicular cytochrome a3 content was unchanged. The results indicate that, contrary to liver microsomal cytochromes P450, the mitochondrial cytochromes are not susceptible to changes in heme biosynthesis.

Animals↗
PubMed1995

[Acute phase proteins].

Various plasma protein patterns following inflammation and metabolic stress were described since diagnostic value of ESR was established. This reactive dysproteinemia is now recognized to reflect the shift in hepatic proteosynthesis after the immunoendocrinological activation. Four main groups of mediators are necessary for expression of hepatic positive and negative acute phase proteins (APPs): first and second "wave' of proinflammatory cytokines, further glucocorticoids and growth factors including insulin. Actual data showing details of the immunological and endocrinological regulation of stress hepatocyte proteosynthesis are summarized and our own results are presented. We evaluated the diagnostic use of APPs in some defined clinical situations (neutropenic period after bone marrow transplantation, postoperative complications) and correlated APPs with the plasma levels of the circulating interleukin-6 and cortisol. In another study, APPs, plasma and urinary TNF, interleukin-6, interleukin-8 and adhesive molecules ICAM-1, VCAM-1 were found to be significantly different in various glomerulopathies. Finally, our experimental data indicate the nitric oxide participation in oestradiol regulation of coeruloplasmin synthesis in rat.

Acute-Phase Proteins↗
PubMed1994

[Evaluation of laparoscopic and laparotomy cholecystectomy by comparing the dynamics of acute phase proteins].

The authors investigated in two groups of surgical patients subjected to laparoscopic (n = 10) and laparotomic (n = 10) cholecystectomy changes in the levels of nine acute stage proteins. The objective was to evaluate the extent of surgical stress of the two surgical procedures with regard to changes of serum levels of albumin, transfirrin, prealbumin, alpha 1-antitrypsin, alpha 1-acid glycoprotein, alpha 2-macroglobulin, haptoglobin, ceruloplasmin and C-reactive protein. Before operation no significant differences (p < 0.05) were found between the investigated indicators. Changes of acute stage proteins up to the third day following surgery indicate a lower surgical trauma and more favourable course during the early postoperative period in patients operated by the laparoscopic route.

Acute-Phase Proteins↗
PubMed1994

Methylene blue inhibition of oestradiol-induced increase of ceruloplasmin serum levels in rats.

The administration of oestrogens increases the hepatic synthesis and plasma level of ceruloplasmin both in man and laboratory animals. Methylene blue, an oxidizing agent and inhibitor of soluble guanylate cyclase, is widely used to block the effects of endothelium-derived relaxing factor (nitric oxide). We describe the inhibitory effect of methylene blue on the increase of ceruloplasmin plasma level in rats during oestradiol treatment.

Animals↗
PubMed1993

[Early diagnosis of septic complications in the postoperative period by determination of acute phase proteins].

The authors submit the results of the follow-up of the dynamics of 10 acute stage plasma proteins (up to the 7th day) in two surgical model situations: 1. planned operation of colorectal carcinoma by an intraabdominal approach and 2. operation of extensive varicosities of the lower extremities. As reference groups 3. healthy subjects (blood donors) were used and 4. patients with developed postoperative sepsis. Based on the results, the authors provide evidence of the asset of some selected indicators they assessed such as transferrin, prealbumin, alpha-1 acid glycoprotein (orosomucoid) and C reactive protein, for the early diagnosis of postoperative septic complications.

Acute-Phase Proteins↗
PubMedDate not supplied

Ghrelin and leptin elevation in postoperative intra-abdominal sepsis.

BACKGROUND: Both ghrelin and leptin are important signals in the regulation of food intake and energy balance. Leptin concentrations are elevated in the majority of obese individuals, and its levels usually correlate with adiposity and body mass index. Ghrelin as a new growth hormone (GH)-releasing peptide was discovered in 1999. Ghrelin stimulates food intake and exhibits gastroprotective properties. Many other regulatory effects of both ghrelin and leptin involving cardiovascular, gastrointestinal, renal, and endocrine systems were revealed. New experimental studies show both hormones as new acute phase reactants in animal models of inflammatory reaction. The aim of this study was to characterize the levels of circulating ghrelin and leptin in relation to systemic inflammatory response. We used a postoperative bacterial sepsis after large abdominal surgery as a model of cytokine network hyperstimulation. PATIENTS AND METHODS: The prospective study was performed on 25 surgical patients with proven postoperative intra-abdominal sepsis after large abdominal surgery. Plasma levels of ghrelin (RIA), leptin, TNF-alpha, IL-1beta, sIL-2R, IL-6 (ELISA analysis), CRP and alpha1-antitrypsin (nephelometric analysis) were analyzed. RESULTS: Authors demonstrate statistically significant elevation of plasma ghrelin (492.3+/-70.6 ng/l) and leptin (31.6+/-12.2 microg/l) compared with the control group (336.5+/-46,1, p<0.01 for ghrelin, 3.5+/-1.2 microg/l, p<0.001 for leptin). The regression coefficient was the highest for ghrelin and IL-6 (r=0,44, p<0.05), and for ghrelin and TNF (r=0.43, p<0.05) in the sepsis group. In regard to leptin, the regression coefficient was the highest for IL-6 and leptin (r=0.53, p<0.05) and for leptin and CRP (r=0.51, p<0.05). There was no significant correlation between ghrelin and IL-1beta, ghrelin and sIL-2R, and leptin and IL-1beta. CONCLUSIONS: During postoperative intra-abdominal sepsis, both ghrelin and leptin plasma levels are elevated and positively correlate with both inflammatory cytokines (TNF-alpha, IL-6) and main APP member (CRP). It supports experimental finding that TNF-alpha and IL-6 can be important regulatory factors of their synthesis. This hormonal reaction is not specific to sepsis--the significant increase of both ghrelin and leptin occurs during an uncomplicated postoperative response, although in a lesser extent than was shown in sepsis.

Abdomen↗