Stresová kardiomyopatie je klinický syndrom, při kterém dochází k rozvoji myokardiální dysfunkce v reakci na stres. Častým spouštěčem bývá neurologické onemocnění, nejčastěji netraumatické subarachnoidální krvácení a ischemická CMP. Rozvoj stresové kardiomyopatie může být u těchto pacientů příčinou arteriální hypotenze, arytmií nebo akutního srdečního selhání. I přes reverzibilitu onemocnění je zvláště její sekundární forma nebezpečná pro riziko rozvoje závažných komplikací. Kauzální léčba se zaměřuje na eliminaci příčiny, další terapie je symptomatická, vedená echokardiografickým nálezem. Cílem tohoto přehledového článku je shrnutí dosavadních znalostí ohledně stresové kardiomyopatie se zaměřením na recentní postupy v diagnostice a terapii a zdůraznění jejich odlišností u pacientů s neurologickým onemocněním.
Stress cardiomyopathy stands for a clinical syndrome characterized by the onset of myocardial dysfunction caused by stressful event. A common trigger is neurological disease, most commonly non-traumatic subarachnoid hemorrhage and ischemic stroke. The development of stress cardiomyopathy may cause arterial hypotension, arrhythmias, or acute heart failure in these patients. Despite the reversibility of the disease, its secondary form is particularly dangerous because of the risk of developing serious complications. Causal treatment focuses on eliminating the cause; further therapy is symptomatic, guided by echocardiographic findings. The aim of this review article is to summarize the current knowledge regarding stress cardiomyopathy focusing on up- -to-date diagnostics and treatment and highlight their differences in patients with neurological disease.
- MeSH
- akutní koronární syndrom etiologie MeSH
- cévní mozková příhoda komplikace MeSH
- lidé MeSH
- rizikové faktory MeSH
- subarachnoidální krvácení komplikace MeSH
- takotsubo kardiomyopatie * diagnóza etiologie komplikace terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BackgroundThe ischemia-reperfusion injury (IRI) is unavoidable in vascular surgery. Damage to the microcirculation and endothelial glycocalyx might set up a shock with loss of circulatory coherence and organ failure. Sulodexide may help to protect endothelial glycocalyx and alleviate the ischemia-reperfusion injury.MethodsTwenty female piglets underwent surgery with a 30-min-long suprarenal aortic clamp, followed by two hours of reperfusion. Ten piglets received sulodexide before the clamp, and 10 received normal saline. Blood and urine samples were taken at baseline and in 20-min intervals until the 120th minute to analyze the serum syndecan-1, E-selectin, and thrombomodulin. Albumin and glycosaminoglycans were examined in the urine. The kidney biopsies before and after the protocol were examined by light microscopy with hematoxylin-eosin staining. The sublingual microcirculation was recorded by side-stream dark field imaging at the time as blood and urine.ResultsBased on the 2-way ANOVA testing, there was no statistically significant difference in the parameters of sublingual microcirculation. Serum markers of endothelial cell activation and damage (E-selectin and thrombomodulin) did not show any statistically significant difference either. Syndecan-1, a marker of glycocalyx damage, showed statistically significantly higher values based on the 2-way ANOVA testing (p < 0.0001) with the highest difference in the 80th minute: 7.8 (3.9-44) ng/mL in the control group and 1.8 (0.67-2.8) ng/mL in the sulodexide group. In the urine, the albuminuria was higher in the control group, although not statistically significant. Glycosaminoglycans were statistically significantly higher in the sulodexide group based on the mixed-effect analysis due to the intervention itself. Histological analysis of the renal biopsies showed necrosis in both groups after reperfusion.ConclusionAdministering sulodexide significantly reduced the level of endothelial markers of IRI. The study results support further research into using preemptive administration of sulodexide to modulate IRI in clinical medicine.
- MeSH
- E-selektin krev MeSH
- glykokalyx MeSH
- glykosaminoglykany * farmakologie terapeutické užití MeSH
- ledviny patologie krevní zásobení MeSH
- mikrocirkulace účinky léků MeSH
- modely nemocí na zvířatech MeSH
- prasata MeSH
- reperfuzní poškození * prevence a kontrola MeSH
- syndekan-1 krev MeSH
- trombomodulin krev MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BackgroundSulodexide is a glycosaminoglycan-based drug prescribed to patients with angiopathy. We performed a pilot study to investigate whether sulodexide positively modulates the endothelial glycocalyx (EG) layer and the microcirculation in a porcine model of EG enzymatic damage. The EG is a sugar-based endothelial lining that is involved in the physiology of the capillary wall and the pathogenesis of many diseases.MethodsEG damage was induced in eight piglets by hyaluronidase III and heparanase I given intravenously. Four animals received sulodexide 600 IU intravenously before the enzymes and four animals after the enzymes were administered. Four animals constituted a control group. Sublingual microcirculation by side-stream dark field imaging and plasmatic concentration of syndecan-1 by ELISA were measured at baseline, 20 min after intervention, and at the 40th, and 60th minute onwards. The statistics were performed with a one-way ANOVA test with Turkey's correction for multiple comparisons testing. Timepoint comparison was performed by Student t-test or Mann-Whitney test.ResultsAt baseline, there were no statistically significant differences between the animal groups. After the intervention, the levels of syndecan-1 were significantly lower in the control group. While there were no differences between the two intervention groups. The sublingual microcirculation analysis showed that the DeBacker score was significantly higher in the control group. At 60 min, there was also a statistically significant difference in DeBacker score between the groups (8.1 ± 1.6 mm-1 in the group with enzymes given first and 11 ± 0.92 mm-1 in the group with sulodexide given first, p = 0.03). The analysis of the proportion of perused vessels did not show any statistically significant differences.ConclusionThe results of the study demonstrated a working model of EG damage but no specific action of sulodexide on EG modulation. In the sublingual microcirculation analysis, the sulodexide reduced the fall in absolute tissue perfusion in 60 min.
- MeSH
- cévní endotel * účinky léků MeSH
- glykokalyx * účinky léků metabolismus MeSH
- glykosaminoglykany * farmakologie MeSH
- hyaluronoglukosaminidasa MeSH
- mikrocirkulace účinky léků MeSH
- modely nemocí na zvířatech MeSH
- pilotní projekty MeSH
- prasata MeSH
- syndekan-1 krev MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The cannulation of the internal jugular vein (IJV) is a frequent procedure in critically ill patients. According to the guidelines, real-time ultrasound navigation is recommended. Traditional techniques pose several disadvantages, such as suboptimal needle visualization. Therefore, this non-inferiority trial aimed to describe the novel approach and compare the novel lateral in-plane short-axis approach for IJV access with the conventional short-axis out-of-plane approach. OBJECTIVES: The primary objective of the trial was to prove that the first attempt success rate in the novel technique is non-inferior to the conventional technique. The secondary objectives were to demonstrate that the complication rate and the functional duration of the catheter in the novel technique are not inferior to those in the conventional technique. METHODS: Patients eligible for IJV cannulation were randomly assigned to either the novel technique (Group A) or the conventional one (Group B). The procedure duration, success rate and the number of attempts required were documented. The functionality of the catheter and complications were monitored from insertion until the catheter removal. Standard descriptive statistical methods were employed for the analysis. RESULTS: A total of 200 subjects were equally divided between Group A and Group B. For the primary outcome, there was no significant difference in first attempt success rate (Group A: 79, Group B: 77, p = 0.434). Secondary outcomes, including complications and catheter functional time, did not differ significantly between the groups. However, the novel technique demonstrated a significantly faster procedure time (Group A: 315 s, Group B: 330 s, p = 0.016). Notably, the novel approach was linked with significantly larger IJV diameter measured during the procedure (Group A: 18.2 mm, Group B: 12.1 mm, p < 0.001). CONCLUSION: The novel lateral in-plane short-axis approach for IJV cannulation is a non-inferior alternative with a lower incidence of posterior vessel wall puncture compared to the conventional approach.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The process of kidney transplantation remains the optimal treatment for end-stage renal disease, offering improved quality of life and increased survival rates compared to long-term dialysis. However, despite advances in surgical techniques, immunosuppression regimens, and post-operative care, there are still significant challenges in predicting the organ's status and long-term outcomes of transplantation. Among the many factors that influence graft survival, the quality of the donated organ plays a fundamental role. There is an ongoing need for accurate and reliable biomarkers. Syndecan-1 is found in the endothelial glycocalyx and shed at a higher rate into the blood during systemic pathological conditions. The aim of this study is to evaluate the potential of serum syndecan-1 levels as a biomarker for assessing donor kidney quality and to investigate its correlation with donor characteristics and short-term outcomes in kidney recipients. MATERIAL AND METHODS: We investigated serum syndecan-1 levels in 80 deceased donors and correlated them with donor characteristics and short-term outcomes (defined as delayed graft function - defined as the need for dialysis within the first week post-transplantation and renal function at 3 months post-transplantation - assessed using serum creatinine levels) in 104 corresponding kidney recipients. This single-center retrospective observational cohort study was conducted from April to December 2021. RESULTS: The donor pool consisted of 65% males with a median age of 53 years. Of these, 45 donors (56%) were classified as extended criteria donors. Higher syndecan-1 levels correlated with the last creatinine levels before organ procurement (R = 0.32, p = 0.01) and were marginally higher in donors with acute kidney injury (p = 0.07). However, syndecan-1 levels were not associated with short-term outcomes in kidney recipients (renal function at 3 months). CONCLUSIONS: The data suggests syndecan-1 could be a potential biomarker for assessing donor kidney quality, although its implications on recipient outcomes require further study. This pilot investigation underscores the importance of syndecan-1 in evaluating organ quality but highlights the necessity for more extensive research to validate these findings and explore their implications in transplant success.
- MeSH
- biologické markery * krev MeSH
- chronické selhání ledvin chirurgie krev terapie MeSH
- dárci tkání * MeSH
- dospělí MeSH
- ledviny patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- opožděný nástup funkce štěpu krev MeSH
- přežívání štěpu MeSH
- retrospektivní studie MeSH
- syndekan-1 * krev MeSH
- transplantace ledvin * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: Excess fluid in the interstitium can adversely affect the microcirculation. We studied how gradual dilution of the blood plasma by crystalloid fluid influences microcirculatory variables and capillary filtration in 20 patients undergoing surgery. METHODS: Video recordings of the sublingual mucosal were made on four occasions during the surgery and compared with quasi-measurements of the capillary filtration rate using retrospective volume kinetic data collected over 5-10-minute periods during 262 infusion experiments with crystalloid fluid. RESULTS: The number of crossings (vessel density) increased up to plasma dilution of 15-20 % whereafter it decreased. The proportion of the vessels that were perfused (PPV) decreased and reached a nadir of -15 % at a dilution of 20-30 %. Changes in the number of crossings and the PPV correlated (r = 0.62, P < 0.001) but the curve was displaced so that crossings showed no change when PPV had decreased by approximately 10 %. However, the PPV of vessels with a thickness of ≤25 μm increased or remained constant in the dilution range of up to 20 %. The volume kinetic analysis showed that the capillary filtration was greater than expected from proportionality with the volume expansion up to a plasma dilution of 15 %, the greatest difference (+89 %) being for plasma dilution up to 5 %. CONCLUSION: Plasma dilution of up to 15 % increased the vessel density, and the capillary filtration increased by more than suggested by the volume expansion. Dilution >15 % had a negative influence on these variables.
- MeSH
- audiovizuální záznam MeSH
- časové faktory MeSH
- dospělí MeSH
- hemodiluce * MeSH
- isotonické roztoky aplikace a dávkování MeSH
- kapilární permeabilita MeSH
- kapiláry patofyziologie MeSH
- kinetika MeSH
- krystaloidní roztoky * aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrocirkulace * MeSH
- regionální krevní průtok MeSH
- retrospektivní studie MeSH
- rychlost toku krve MeSH
- senioři MeSH
- ústní sliznice krevní zásobení MeSH
- ústní spodina krevní zásobení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
This systematic review aimed to summarize the available data on the treatment of pulmonary contusions with exogenous surfactants, determine whether this treatment benefits patients with severe pulmonary contusions, and evaluate the optimal type of surfactant, method of administration, and drug concentration. Three databases (MEDline, Scopus, and Web of Science) were searched using the following keywords: pulmonary surfactant, surface-active agents, exogenous surfactant, pulmonary contusion, and lung contusion for articles published between 1945 and February 2023, with no language restrictions. Four reviewers independently rated the studies for inclusion, and the other four reviewers resolved conflicts. Of the 100 articles screened, six articles were included in the review. Owing to the limited number of papers on this topic, various types of studies were included (two clinical studies, two experiments, and two case reports). In all the studies, surfactant administration improved the selected ventilation parameters. The most frequently used type of surfactant was Curosurf® in the concentration of 25 mg/kg of ideal body weight. In most studies, the administration of a surfactant by bronchoscopy into the segmental bronchi was the preferable way of administration. In both clinical studies, patients who received surfactants required shorter ventilation times. The administration of exogenous surfactants improved ventilatory parameters and, thus, reduced the need for less aggressive artificial lung ventilation and ventilation days. The animal-derived surfactant Curosurf® seems to be the most suitable substance; however, the ideal concentration remains unclear. The ideal route of administration involves a bronchoscope in the segmental bronchi.
- MeSH
- bronchoskopie metody MeSH
- lidé MeSH
- plicní surfaktanty * aplikace a dávkování terapeutické užití MeSH
- poškození plic * farmakoterapie etiologie MeSH
- syndrom dechové tísně * farmakoterapie etiologie MeSH
- umělé dýchání metody MeSH
- výsledek terapie MeSH
- zhmoždění * farmakoterapie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
BACKGROUND: Endothelial glycocalyx (EG) plays a crucial role in maintaining the plasma proteins within the intravascular space. OBJECTIVE: We studied whether exogenous albumin protects the EG in an experimental model of EG enzymatic damage in rats. METHODS: Rats were divided into three groups of 10 animals that received (1) Evans blue (2) Evans blue + hyaluronidase, or (3) Evans blue + hyaluronidase + 20% human albumin via the tail vein. Spectrophotometric analysis was performed 2 h later to quantify the leakage of Evans blue-labeled albumin into the heart, lungs, brain, kidneys, liver, small intestine, spleen, and skeletal muscle. RESULTS: Administration of hyaluronidase numerically increased the capillary leakage of Evans blue in all examined tissues. Co-administration of albumin decreased the leakage of albumin in all tissues except the heart. In the lungs, the ratio between the absorbance and dry organ weight decreased from 5.3 ± 2.4 to 1.7 ± 0.5 (mean ± SD) (P < 0.002), and in the liver, the absorbance decreased from 2.2 ± 0.7 to 1.5 ± 0.4 (P < 0.011). CONCLUSION: Exogenous albumin decreased the capillary leakage of albumin which was interpreted as a sign of maintained EG integrity.
- MeSH
- albuminy * metabolismus MeSH
- cévní endotel účinky léků metabolismus MeSH
- Evansova modř MeSH
- glykokalyx * metabolismus účinky léků MeSH
- hyaluronoglukosaminidasa farmakologie MeSH
- kapilární permeabilita * účinky léků MeSH
- krysa rodu rattus MeSH
- lidé MeSH
- modely nemocí na zvířatech MeSH
- potkani Wistar MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Zhodnotit zkušenosti s obtížnou extrakcí portkatétrů v průběhu 10 let v retrospektivní studii jednoho centra. Metodika: Od ledna 2014 do prosince 2023 jsme implantovali 5731 intravenózních portkatétrů a 1588 jsme odstranili. Všechny implantace a kromě dvou pacientů i všechna odstranění žilních portových systémů byla provedena na radiologickém intervenčním pracovišti. Obtížná extrakce katétru byla definována jako odstranění pomocí vodiče zavedeného do katétru portu, disekce pomocí zaváděcího pouzdra a transvenózní extrakce pomocí lasa. Výsledky: Všechny extrakce portkatetrů byly prováděny intervenčním radiologem. Třicet osm extrakcí (2,4 %) bylo klasifikováno jako obtížné. V této skupině bylo 17 mužů a 21 žen s mediánem věku 67 let (9–82 let). Primární diagnózou pro implantaci byla u 36 pacientů malignita a u dvou pacientů neonkologické onemocnění (asthma bronchiale a hemofilie A). Krční žíla byla kanylována u 16 pacientů a axilární žíla u 21 pacientů. U jednoho pacienta byl port zaveden přes levou bazilickou žílu. Důvodem odstranění u pacientů s obtížnou extrakcí bylo ukončení terapie u 28 pacientů (73,7 %), infekce u tří pacientů (7,9 %) a dysfunkce u sedmi pacientů (18,4 %). Medián od zavedení k extrakci byl 101,5 měsíců (6 až 178 měsíců). Komůrka portu byla explantována u všech pacientů. Kompletní odstranění bylo provedeno u 28 (73,7 %) pacientů, částečné odstranění (délka katétru ponechaného v žíle byla menší než 5 cm) bylo u tří pacientů (7,9 %) a odstranění katétru bylo neúspěšné u sedmi pacientů (18,4 %). Katétr byl úspěšně odstraněn pomocí vodicího drátu v jednom případě, pomocí kožního řezu nad katétrem v jednom případě, pomocí pouzdra (sheathu) ve dvou případech a pomocí transvenózního, femorálního přístupu a lasa ve 28 případech. Ve zbýva- jících sedmi neúspěšných případech byly vodič a pouzdra použity u dvou pacientů a laso u pěti pacientů. Úspěšnost transfemorální extrakce byla 84,8% (28 ze 33) a celková úspěšnost odstranění 81,6% (31 ze 38). Během výkonu se u dvou pacientů objevila vagová reakce. Daná komplikace byla zvládnuta farmakologicky. Závěr: Incidence obtížného odstranění portkatétru byla nízká (2,4 %) a medián doby in- dikace pro obtížné odstranění portkatétru byl v našem souboru téměř 9 let (101,5 měsíců). Tedy dlouhodobé ponechání katétru přináší zvýšenou frekvenci obtížné explantace. Intervenční radiologické techniky včetně extrakce s využitím lasa jsou v případech obtížného odstranění portkatétru bezpečné a účinné.
Objective: To evaluate the experience with difficult extraction of portcatheters during 10 years in a retrospective single-center study. Method: From January 2014 to December 2023, 5731 intravenous portcatheters were implanted, and 1588 were removed in our center. All venous port system implantations and all porcatheters removals except 2 cases were performed in the radiology interventional unit. Difficult catheter extraction was defined as a removal by using a guidewire, dissection with sheath, and transvenous extraction with a snare. Results: All portcatheters were removed by an interventional radiologist. Thirthy four extractions (2.4%) were classified as difficult. There were 17 males and 21 females with a median age of 67 years (9–82 years) in this group. The primary diagnosis for implantation was malignancy in 36 patients and asthma bronchiale and haemophilia A in one patient. The jugular vein was cannulated in 16 patients and the axillary vein in 21 patients. One patient had an arm port inserted through the left basilic vein. The reason for removal in patients with difficult extraction was therapy termination in 28 patients (73.7%), dysfunction in 7 patients (18.4%), and infection in 3 patients (7.9%). The median indwelling portcatheter time in patients with difficult extraction was 101.5 months (6–178 months). The port chamber was explanted in all patients. The complete removal was performed in 28 patients, the partial removal (length of catheter left in the vein less than 5 cm) was in 3 patients and unsuccessful catheter removal was in 7 patients. The catheter was successfully removed using guidewire in 1 case and skin cut above catheter in 1 case, using sheath and guidewire in 2 cases, and using a snare in 27 cases. In the remaining 7 unsuccessful cases, the sheath was used in 2 patients and the snare in 5 patients. The success rate for transfemoral extraction was 84.8% (28 out of 33) and the overall success removal rate was 81.6 % (31 out of 38). During the procedure a vagal reflex (hypotension, bradycardia) emerged in 2 patients. It was terminated successfully by pharmacotherapy. Conclusion: The incidence of difficult portcatheter removal was low (2.4%) and the median indwelling time for difficult portcatheter removal was almost 9 years (101.5 months) in our cohort. Interventional radiological techniques including extraction with the snare under fluoroscopy is safe and effective in cases of difficult portcatheter removal.
