UNLABELLED: Pulmonary embolism (PE) is after myocardial infarction and cerebrovascular events the third most frequent cardiovascular cause of death. Simultaneously it belongs to at least often correctly diagnosed cardiovascular diseases. The AIM OF THE STUDY: The retrospective analysis of the database of inpatients with the target assess the clinical course of PE according to prevalence, mortality, average duration of stay, risk factors, used diagnostic methods and kinds of therapy. Another aim of the study was a comparison of the data among the survivors and deceased persons. Patient's set and method: between 2005 and 2010 years we had altogether 6,323 elderly patients of an average age 80.7 +/- 6.9 y. (range 65-103 y.) treated at the Department of Geriatrics. Out of this number there were 4,163 women (66%) and 2,160 men (34%). We evaluated the course of PE in 260 cases of mean age 79.8 +/- 7.2 y. (165 women and 95 men). For the verification of the diagnosis of PE we used following usual procedures (anamnesis, clinical examination, ECG, X-ray, labs etc.) also ECHO-cardiography, perfusion scan or helical CT of lungs. Eighty per cent of the deceased had an autopsy. In the set of in-patients with PE 89 died (34.2%) and 171 survived (65.8%) with anticoagulant treatment. RESULTS: Prevalence of PE was 4.1% per year among all the hospitalized elderly in-patients (> or = 65 y.). Mortality among all the admitted patients to our department was 1.4%. Its occurrence was increasing with age to 81 y. and thereafter slightly decreasing. In one third of the deceased PE was an occasional finding in autopsy without any previous clinical signs. Mortality in the non-symptomatic group with PE in autopsy was significantly higher (chi2 = 57,293; p < 0.001). We didn't find any significant gender difference in prevalence of mortality according to gender structure of the set with PE. In 14 cases PE clinically demonstrated as sudden death. We determined the age significant difference between survivors and the deceased--79.1 +/- 7.1 y. vs. 81.3 +/- 7.0 (t = 1.997; p < 0.05). Average duration of hospital stay was significantly different between both groups: the deceased 9.2 +/- 9.6 vs. 12.4 +/- 7.4 in survivors (t = 4.256, p = 0.01). Risk factors were assessed and compared between both groups: the deceased and survivors. We found the most important risk factors in the group of the deceased immobility (p < 0.001) heart failure (p < 0.005) and stroke (p < 0.01). On the contrary in the survivor group there were more frequent risk factors obesity (p < 0.025); deep venous thrombosis (p < 0.025) and tumors (p < 0.05). Previous operations and traumas in the last month did not show any significant difference between both groups. Used treatment methods were evaluated, too. In the group of those who died multi-morbidity, often frailty and geriatric giants predominated even if the anticoagulant therapy was used comparably in both groups (survivors and the deceased). CONCLUSION: We would like to emphasize the need to think permanently in elderly persons with present risk factors of the possibility of PE and also the requirement of correctly assessed diagnosis and starting therapeutic procedures as soon as possible.

• MeSH
• echokardiografie MeSH
• elektrokardiografie MeSH
• geriatrie * MeSH
• lidé MeSH
• plicní embolie diagnóza   epidemiologie   MeSH
• prevalence MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

The determination of GADA may be useful for clinical classification of diabetes mellitus (DM) in clinically unclear cases. This GADA positivity may persist in any diabetics Type 1 Diabetes Mellitus (T1D) with an onset in adulthood and Late Autoimmune Diabetes of Adults (LADA) many years after appearance of DM. The study was aimed at comparing the levels of GADA between both diabetic subsets with their clinical parameters, age of onset DM, period of insulin need, body mass index, HbA1C, fasting and postprandial C-peptide, risky HLA-DRB1* alleles, occurrence of micro- and macrovascular diabetic complications. Further analysis of GADA titers in different time consequences to the development of DM and relations to IA-2 were made. In the study, we included 130 diabetics with an onset of diabetes (T1D or LADA) 35+ y. who were hospitalized and afterwards long-term observed in the diabetological outpatient department. Out of this number there were 62 men and 68 women of the average age 65.5 +/- 14.0 y. (range 35-93 y.). 54 were assessed as the T1D patients and 76 as the LADA ones. Patients of the T1D subgroup were GADA positive 22 times and of the LADA subgroup 21 times. LADA 2 patients that were GADA negative were more obese than GADA positive LADA diabetics (p < 0.01). Also postprandial C-peptide was higher in LADA patients GADA negative (p < 0.05). Other clinical characteristics were without statistically significant differences. We found in our diabetic patients a relation between alleles HLA-DRB1*03 and particularly combination with HLA-DRB1*04 with positive GADA levels. In the GADA negative group obesity, coronary heart disease, hypertension, syndrome of diabetic foot and dyslipidaemia appeared more frequently (OR = 2.8; 3.1; 6.2 and 2.4). We found no significant differences in observed parameters--comparison GADA positivity and negativity according to the duration of DM. GADA positive were even 10 y. duration 16 times and after 20 y. even 6 times. Recent DM had positive GADA in 11 cases and 13 cases of recent DM had GADA negative. IA-2 antibodies were positive (> 1.0 U/ml) 18 times altogether and always with positive GADA, but only 7 times in recent DM. The presence of elevated GADA identifies patients unequivocally suitable for early insulin therapy. Our observations and experiences confirm that GADA can be found increased after more than 10-20 years duration of DM, although in decreasing trend.

• MeSH
• alely MeSH
• autoprotilátky krev   MeSH
• C-peptid krev   MeSH
• diabetes mellitus 1. typu krev   genetika   imunologie   MeSH
• dospělí MeSH
• glutamát dekarboxyláza imunologie   MeSH
• HLA-DR antigeny genetika   MeSH
• HLA-DRB1 řetězec MeSH
• index tělesné hmotnosti MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tyrosinfosfatasy receptorového typu, třída 8 imunologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Type 1 Diabetes Mellitus (T1D) with an onset in adulthood and Late Autoimmune Diabetes of Adults (LADA) are connected with autoimmune insulitis (associated with islet cell autoantibodies) and the specific high-risk HLA class II genotype. The study was aimed at analyzing time and clinical characteristics of the diabetics with an onset of the disease after 35 y. (T1D and LADA). Main target of the study was to assess possible role of the old age onset and compare it with diabetics with the onset in the middle age (incl. analyzing HLA-DRB1 genotype). In the study, we included 103 diabetics with an onset of autoimmune diabetes at 35+ y. who were hospitalized and afterwards long-term observed in the diabetological outpatient department. 46 men and 57 women of the average age 65.7 +/- 13.8 y. (range 35-93 y.) were out of this number. 41 were assessed as the T1D patients and 61 as the LADA ones. As a control group we used 99 healthy individuals. Patients of the T1D subgroup developed diabetes in the age of 50.8 +/- 15.1 y. and of the LADA subgroup in the age of 52.6 +/- 12.8 y. Its duration in the time of this study was 10.7 +/- 11.6 y.; respectively 5.3 +/- 7.1 y. Fasting and postprandial C-peptide levels were statistically higher (p < 0.01) in the LADA subgroup vs. T1D. Obesity 1st and 2nd grade were present together only in 12.6%. BMI was not statistically significantly different between both groups. We found in our diabetic patients the predisposition alleles HLA-DRB1*03, HLA-DRB1*04 and particularly their combination. The occurrence of these HLA alleles is significantly higher in T1D patients in comparison to control groups (p = 0.01, OR = 4.0). In our study, the occurrence of the susceptible HLA-DRB1*03 and HLA-DRB1*04 alleles in T1D patients is higher than in LADA. The presence of these alleles identifies patients of high risk and requirement of insulin therapy. Since risk alleles are similarly present in middle and old age, environmental factors probably play similar role in these onsets of autoimmune diabetes.

• MeSH
• alely MeSH
• C-peptid krev   MeSH
• diabetes mellitus 1. typu diagnóza   farmakoterapie   epidemiologie   genetika   MeSH
• dospělí MeSH
• frekvence genu MeSH
• genetická predispozice k nemoci MeSH
• genotyp MeSH
• glykovaný hemoglobin analýza   MeSH
• HLA-DR antigeny genetika   MeSH
• HLA-DRB1 řetězec MeSH
• hypoglykemika aplikace a dávkování   terapeutické užití   MeSH
• inzulin aplikace a dávkování   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• polymerázová řetězová reakce MeSH
• prediktivní hodnota testů MeSH
• riziko MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• stárnutí genetika   MeSH
• studie případů a kontrol MeSH
• věk při počátku nemoci MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH