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Biomedical subjects

V Treska

Publications and source records attributed to V Treska.

At least 73 records · Page 4Linked to original sources
PubMed2000

Endogenous fibrinolysis in patients with lower extremity ischemia.

To explore the relationship between disorders of endogenous fibrinolysis and thrombosis in patients with lower extremity ischemia, we measured the activity of tissue plasminogen activator (tPAac) and plasminogen activator inhibitor (PAlac) and the antigens of tissue plasminogen activator (tPAa) and inhibitor (PAla) in plasma from 420 patients treated for lower extremity ischemia. Values and ratios observed were compared with those in healthy volunteers. Additionally, values and ratios in the patients were examined with respect to the severity of ischemia and site of atherosclerotic occlusion or stenosis (pelvic compared with femoropopliteal or crural). Patients with lower extremity ischemia had higher plasma concentrations of PAla (p<0.01) and PAlac (p<0.0001) than healthy volunteers. In patients with rest pain or gangrene, the ratio of tPAac to PAlac was higher than in patients with claudication (p<0.05). The elevation of tPAac in patients with the more severe form of lower extremity ischemia is probably the feedback protective reaction on prothrombotic mechanisms of the organism suffered from severe atherosclerosis. Results did not vary according to the site of occlusion or stenosis. Our study found defects in endogenous fibrinolysis in patients with lower extremity ischemia. A defect in fibrinolysis may contribute to the development of thrombosis in native arteries and bypasses.

Adult↗
PubMed2000

Cytokines as plasma markers of abdominal aortic aneurysm.

UNLABELLED: The pathogenesis of abdominal aortic aneurysms (AAA) is a complex process in which atherosclerosis and inflammation play a leading role. Cytokines are important mediators of both processes. The aim of our study was to determine whether plasma levels of cytokines which are most involved in AAA pathogenesis can be used as endogenous markers of AAA development, and thus to facilitate the decision on surgical intervention in cases when this is clinically unclear (e.g. small AAA). In the prospective study a total of 90 patients with AAA were examined. These patients were divided into the following groups according to symptoms and AAA diameter: symptomatic AAAs, including ruptures (n=16); asymptomatic AAAs (n=74); AAAs with a diameter of up to 5 cm (n=30), AAAs of 5-8 cm (n=38), and AAAs with a diameter over 8 cm (n=22). The average age of the patients was 70.7 (56-82) years. The male to female ratio was 4:1 (71:19). A control group consisted of 30 healthy individuals of similar age and sex presentation with no manifestation of atherosclerosis. Plasma levels of cytokines were assessed in venous blood by means of radio- or enzymo-immunoassay. Statistical processing of the results was conducted with ANOVA and Wilcoxon tests with Spearman correlation, where p<0.05 was considered to be statistically significant. Plasma concentrations of cytokines were significantly higher in AAA patients than in healthy individuals. In AAA patients the tumour necrosis factor-alpha (TNF-alpha) and interleukin (IL-8) levels were low in large and in symptomatic AAAs. IL-6 levels were increased with increasing AAA diameter and symptoms. IL-8 levels (p<0.05) showed a statistically significant correlation with the diameter, and TNF-alpha (p<0.05) with the symptoms of AAA. IL-1beta, IL-2 and IL-6 did not show any significant changes with different AAA diameter or symptomatology. IN CONCLUSION: IL-8 and TNF-alpha can be used as endogenous markers of the process of AAA development, in deciding for either surgical or endovascular treatment of patients when the clinical indication is not entirely clear.

Aged↗
PubMed2000

[Manifestation of popliteal aneurysm during pulse spray thrombolysis (PST)].

We report the case of a 32-year-old woman presenting with acute extremity ischemia due to thrombosis of a previously undetected popliteal artery aneurysm. The popliteal artery aneurysm was revealed by PST which was indicated for the treatment of thrombosis of the superficial femoral artery. PST was complicated by a peripheral embolism with subsequent severe extremity ischaemia. Immediate embolectomy and reconstructive vascular surgery led to a successful result. This case illustrates the diagnostic problems of a thrombosed popliteal artery aneurysm and warns of embolic complications during PST.

Adult↗
PubMed2000

[Femorodistal vascular reconstruction at the Surgical Clinic of the Medical School Hospital in Plzen 1993-1999].

The authors evaluate the success of femorodistal vascular reconstructions during the past seven years, in particular their asset for patients. A total of 41 femorodistal reconstructions were implemented in 39 patients (incl. 25 diabetics--64.1%). The annual patency of reconstructions is 85.4%, the five-year patency 68.3%. In 11 (28.2%) of patients subsequently a high amputation of the extremity had to be performed. In more than one third of patients with early and late occlusion of the reconstruction it was not necessary to make an amputation and the patients with an originally critical ischaemia of the extremity suffered from brief claudications. The thirty-day mortality was 2.6% (one patient died from embolism of the pulmonary artery). Femorodistal reconstructions have at present a firm position in vascular reconstruction surgery and are usually the last hope for saving the extremity in patients with critical ischaemia of the extremity. They call, however, for exact indication and a delicate surgical procedure.

Aged↗
PubMed2000

Plasma and tissue levels of collagen types I and III markers in patients with abdominal aortic aneurysms.

BACKGROUND: To study the levels of the aminoterminal propeptide of type III(PIIINP) and carboxyterminal propeptide of type I procollagen (PICP) in plasma and in the wall of abdominal aortic aneurysms in relation to their size and symptomatology. PIIINP serves as a marker of turnover and PICP as a marker of the synthesis of the corresponding collagens. METHODS EXPERIMENTAL DESIGN: A prospective non-randomised study. SETTING: University Hospital, Plzen, Czech Republic. PATIENTS: Eighty-six patients who underwent resection of abdominal aortic aneurysms, average age 70.1 years (range 45 to 91 years), men to women ratio 5:1. The indication for resection was its symptomatology without relation to its diameter, and diameter over 5 cm in asymptomatic patients. Twenty patients (with similar age and gender distribution) scheduled for hernia repair or laparoscopic cholecystectomy were examined as a control group. MAIN OUTCOME MEASURES: The plasma and tissue PICP and PIIINP concentrations were evaluated using radioimmunoassay methods. The plasma samples were taken from the cubital vein without the use of a tourniquet. Full-thickness sections of the anterior abdominal aortic aneurysm wall at the site of the largest aneurysm diameter were taken at the time of operation. RESULTS: A significant difference between plasma PIIINP levels in patients with abdominal aortic aneurysms and the control group was observed (p<0.01). No correlation of PICP, PIIINP plasma levels with diameter and symptomatology of abdominal aortic aneurysms was found. The increase in PHIIINP tissue concentration was significant in patients with increasing diameter and positive symptomatology (p<0.01). No statistically significant correlation between plasma and tissue PICP and PIIINP concentrations was observed. CONCLUSIONS: The metabolism of type III collagen is increased in patients with abdominal aortic aneurysm, in contrast to type I collagen. The result is a degradation of collagen in the aneurysmal wall. The turnover of type III collagen increases with the enlargement of the aneurysm diameter and with the positive symptomatology. Degradation of type III collagen in the aneurysmal wall has therefore a fundamental significance for abdominal aortic aneurysm rupture. Because no correlation between plasma and tissue levels of PIIINP was found, the plasma levels of PIIINP cannot be used as the plasma markers of this process.

Aged↗
PubMed2000

[Etiopathogenesis, diagnosis and treatment of aneurysms of the abdominal aorta in the year 2000].

The author presents an account of the present status in the sphere of epidemiology, etiopathogenesis, diagnosis and treatment of an aneurysm of the abdominal aorta (AAA). Based on the experience from his own department and data in the literature he summarizes recent findings in particular on the etiopathogenesis and treatment of AAA. Research on the etiopathogenesis of AAA is focused at present mainly on inflammatory processes in the aortal wall leading to subsequent destruction of the intercellular matrix. An important part is pleayed by inflammatory cells (macrophages, T and B lymphocytes), smooth muscle cells of the media and fibroblasts. Important information molecules in the inflammatory process are cystokines. However the causal factor or factors which start the process are still unknown. Hypertension and smoking are important risk factors for the development of AAA. The contemporary rapidly developing trend of treatment of AAA are endovascular operations which have however technical limitations and so far long-term results are not known. An obvious advantage, as compared with classical surgical treatment, is the sparing operation and the short hospitalization of the patient. A certain disadvantage is the necessity of permanent follow up of the patient by duplex sonography or CT and a certain percentage of complications associated with this technique which calls for subsequent endovascular or surgical operations. It is therefore difficult to compare the economic cost of endovascular and surgical treatment. The objective of research, diagnostic and therapeutic efforts in the near future should be reduction of the incidence of AAA ruptures (40% of all AAA is manifested first by rupture) and better therapeutic results (the mortality is at present 30-70%).

Aortic Aneurysm, Abdominal↗
PubMed2000

[A kidney harvesting technic from a non-heart beating donor].

The authors describe the technique of collection of kidneys from NHBD. They present their own protocol elaborated in Plzen for collection of kidneys from NHBD. For collection they use a special double-balloon catheter inserted into the aorta to ensure that the perfusion fluid will penetrate into visceral branches of the aorta. For the flow of the perfusion fluid a urinary catheter is used inserted via the femoral vein into the vena cava inferior. Immediately after the beginning of perfusion laparotomy is performed with immediate cooling of the kidney with ice. The authors give an account of their own experience and discuss further technical possibilities as regards collection of kidneys from NHBD.

Cadaver↗
PubMed2000

[Donors with non-beating hearts--a new possibility in expanding the kidney donor program].

In the Czech Republic in recent years a steady decline of renal transplantations was recorded due to shortage of organ donors. The authors present initial experience with the collection of organs from dead non heart beating donors (NHBD). In the course of less than two years this programme was introduced within the framework of a clinical experiment (grant IGA MofH CR ND/4781-3) at the Surgical Clinic, Faculty Hospital in Plzen. A total of 20 kidneys were collected from NHBD and another 12 kidneys were not collected, most frequently because of difficulties in communication and organization. The donors were grouped according to the Maastricht classification. The mean age of donors was 43.3 years, the mean period of warm ischaemia was 22 minutes and the serum creatinine level was 145 mumol/l. Of 20 collected kidneys a normal histological appearance was recorded in 14, the remainder had different degrees of damage due to inadequate rinsing. Based on hitherto assembled experience the authors emphasize perfect team collaboration in collection from NHBD and a precise technique of collection. The next stage of the clinical study will be the preparation proper for clinical transplantation of kidneys from NHBD.

Adult↗
PubMed1999

[Type I and III procollagen in patients with abdominal aorta aneurysms].

BACKGROUND: Collagen and elastin are the basic building stones of the aortal wall. During the process of development of an aneurysm of the abdominal aorta (AAA) degradation and remodelling of elastin and collagen in the intercellular matrix of its wall occurs. The two main types of collagen in the aorta are collagens type I and III. During type I collagen synthesis the carboxyterminal propeptide of procollagen (PICP) is released and during synthesis and degradation of collagen type III the aminoterminal propeptide collagen III (PIIINP). The objective of the present work was to assess to what extent the two factors can be used to follow up metabolic processes in the AAA wal and in plasma in relation to the extent and symptomatology of AAA. METHODS AND RESULTS: Samples of venous blood and the AAA wall were examined using radioimmunoanalytical methods. PIIINP levels in venous blood were significantly higher (wall p < 0.01) in patients with AAA (n = 78) as compared with the control group (n = 15). The authors did not reveal a statistically significant difference between the levels of the two factors in the blood of patients with AAA of different extent and symptomatology. The PIIINP concentration in the AAA wal correlated significantly with its extent and symptomatology (wall p < 0.01). CONCLUSIONS: Evidence was provided of an enhanced metabolism of collagen type III in the AAA wal with predominant degradation in growing and symptomatic AAA. For complete evaluation of the importance of PICP and PIIINP plasma levels it will be necessary to follow up their dynamics in subjects with growing, small (< 5 cm) AAA.

Aged↗
PubMed1999

Plasma endothelin levels in patients with abdominal aortic aneurysms.

OBJECTIVES: endothelin 1,2 plays a significant role in the process of atherogenesis and vascular wall injury. The aim of this study was to assess whether plasma endothelin 1,2 levels were elevated in patients with large or symptomatic abdominal aortic aneurysms (AAAs). DESIGN: a prospective open study. MATERIALS AND METHODS: plasma endothelin 1,2 levels were measured in 65 consecutive patients with infrarenal aortic aneurysms and compared with the levels in 44 healthy volunteer controls. The data for abdominal aneurysm patients was analysed in four subgroups: (i) small aneurysms (<5 cm), (ii) large aneurysms (>/=5 cm), (iii) asymptomatic aneurysms and (iv) symptomatic aneurysms. Comparisons were made between endothelin 1,2 levels in aneurysm patients and controls and between the different aneurysm subgroups. RESULTS: a highly significant difference (p<0.0001) was found between aneurysm patients and controls. Patients with large aneurysms had significantly higher levels than patients with small aneurysms (p<0.01). There was no statistical difference in endothelin 1,2 levels between symptomatic and asymptomatic patients; however, the highest levels were found in large, symptomatic aneurysms and the lowest in small, asymptomatic aneurysms. CONCLUSIONS: plasma endothelin 1,2 is an endogenous marker of aneurysm diameter. Further studies are required to determine whether it relates to the rate of growth of aneurysms.

Aged↗
PubMed1999

[Ethical problems in organ transplantation].

Organ transplantation is an accepted therapeutic method with good results, but it is connected with many not only medical but also ethical problems. One of the most important problems is the donor programme. In cadaverous donors the main ethical and legal question is the decision who can issue the consent with organ retrieval; in living donors it is the problem of motivation and financial compensation. Allocation of organs with low compatibility or from non-ideal donors, and the recipient's consent in these cases may involve difficult decisions.

Ethics, Medical↗
PubMed1999

[Small aneurysms of the abdominal aorta].

As "small" an aneurysm of the abdominal aorta is defined, the diameter of which is < 5 cm in the maximal anteroposterior or transverse diameter. The authors investigated the development of a small aneurysm of the abdominal aorta in a group of 55 patients for a period of 30 months. They evaluated also the influence of the main risk factors and firmness of the thrombus on the growth rate of the aneurysm. A statistically highly significant factor for the growth of the aneurysm was untreated hypertension (p < 0.0001). Other factors (age, smoking, diabetes, ischaemic heart disease) were not significant for the development of the aneurysm. The firmness of the thrombus correlated with its size but was not directly related to the rate of enlargement of the aneurysm. Based on their own experience and reports in the literature the authors assume that elective surgery or endovascular treatment is indicated in patients where the growth of a small aneurysm exceeds 0.5 cm in six months and also patients where the aneurysm has reached the size of 5 cm during regular check-up examinations. Untreated or inadequately treated hypertonic patients with an aneurysm 4-5 cm in diameter should be indicated for surgery sooner. The question remains whether to indicate for early surgery patients with an unchanging diameter of an aneurysm who are in a good general condition without serious risks. Elective surgery is indicated in these aneurysms in view of the low incidence of ruptures only in departments where the surgical mortality is substantially lower than 5%.

Aged↗
PubMed1998

Gastric lipoma presenting as upper gastrointestinal obstruction.

A 61-year-old man presented with an upper gastrointestinal obstruction caused by a submucosal gastric lipoma in the prepyloric area. The diagnosis was made coincidentally during his admission for another disease. Gastric resection was performed because of a large lipoma combined with florid gastric ulcers. The frequency of gastric lipoma, its differential diagnosis, means of diagnosis, and treatment are discussed.

Diagnosis, Differential↗
PubMed1998

[Cytokine metabolism in aneurysms of the abdominal aorta].

The main cytokines which participate in the etiopathogenesis of aneurysms of the abdominal aorta (AAA) are: tumour necrotizing factor (TNF), interleukins 1b, 2, 6 and 8 (IL 1b, 2, 6, 8), platelet growth factor (PDGF) and endothelin 1, 2 (ET 1, 2). The objective of the presented work was to assess whether plasma levels of these cytokines can be used as endogenous markers of the size and symptomatology of AAA and also to what extent they correlated with hypertension which is a serious risk factor of AAA. During the three-year period (1995-1997) 86 patients with AAA were examined. The control group (n = 30) was formed by patients admitted for planned cholecystectomy. Plasma levels of all investigated cytokines with the exception of IL 8 in AAA differed markedly from the levels in the control group (p < 0.05-p < 0.0001). Changes in levels of IL8 and ET 1, 2 were significant in relation to the size of AAA (p < 0.05 and p < 0.01 resp.). The IL8 levels together with TNF in hypertonic patients correlated with the size of the AAA (p < 0.05 and p < 0.01 resp.), in normotonic subjects with the levels of IL 1b and IL2 (p < 0.05). The TNF levels were significant in symptomatic AAA (p < 0.05). The rising or declining levels of some plasma cytokines can serve as plasma markers of the growth and symptomatology of AAA.

Adult↗