Úvod. Ischemická choroba dolních končetin (ICHDKK) je chronické onemocnění, které může vést k výraznému omezení kvality života pacientů. I když úspěšná revaskularizace je pilířem léčby ICHDKK, tak v některých případech není indikována anebo vůbec možná. Takoví pacienti jsou odkázáni na konzervativní terapii, mezi kterou patří i léčba pomocí sulodexidu. Cíl. V této retrospektivní studii jsme vyhodnotili efekt nově nasazeného sulodexidu u pacientů s klaudikačními bolestmi a u pacientů s chronickou končetinu ohrožující ischemií (CLTI). Metodika. V průběhu tří let byl sulodexid nově nasazen u 34 pacientů s klaudikacemi a u 38 pacientů s CLTI, u kterých nebylo indikováno nebo nebylo možné provedení revaskularizace. Stav pacientů byl hodnocen po 4 a 8 měsících, hodnocené parametry byly klaudikační interval, Rutherfordova klasifikace a přítomnost CLTI. Výsledky. V obou skupinách byl pozorován celkově pozitivní efekt léčby. Ve skupině klaudikantů došlo k prodloužení průměru klaudikačního intervalu ze 144 m na začátku terapie na 376 m po čtyřech měsících a 430 m po osmi měsících. Ve druhé skupině začínalo všech 38 pacientů s příznaky CLTI, po čtyřech měsících zůstaly projevy CLTI u šesti pacientů a po osmi měsících u dalších tří. Závěr Po nasazení sulodexidu jsme zaznamenali významné zlepšení stavu jak u pacientů s klaudikačními bolestmi, tak i u pacientů s CLTI. Efekt sulodexidu na pacienty s CLTI nebyl zatím dostatečně popsán v žádných literárních zdrojích. Dle našeho pozorování se použití sulodexidu zdá být účinnou terapií u pacientů s ICHDKK, a to i ve stadiu CLTI.
Introduction. Critical limb ischaemia (CLI) is a chronic disease that can lead to a significant reduction in the patients' quality of life. Although successful revascularisation is a pillar of CLI treatment, in some cases it is not indicated or possible at all. Such patients rely on conservative therapy, which includes sulodexide treatment. Objective. In this retrospective study, we evaluated the effect of newly introduced sulodexide in patients with claudication pain and in patients with chronic limb-threatening ischaemia (CLTI). Methodology. Over a three-year period, sulodexide was newly used in 34 patients with claudication and in 38 patients with CLTI in whom revascularisation was not indicated or possible. The condition of the patients was evaluated after four and eight months, the evaluated parameters were claudication interval, Rutherford's classification and the presence of CLTI. Results. An overall positive effect of the treatment was observed in both groups. In the group of claudication patients, the average claudication interval increased from 144 m at the beginning of therapy to 376 m after four months and 430 m after eight months. In the second group, all 38 patients began with symptoms of CLTI, after four months CLTI symptoms remained in six patients and after eight months in another three. Conclusion. After the use of sulodexide, we observed a significant improvement in both patients with claudication pain and patients with CLTI. The effect of sulodexide on patients with CLTI has not been sufficiently described in any literature. According to our observations, the use of sulodexide appears to be an effective therapy in patients with CLI, even in the CLTI stage.
- Klíčová slova
- Sulodexid,
- MeSH
- glykosaminoglykany aplikace a dávkování farmakologie MeSH
- intermitentní klaudikace * diagnóza farmakoterapie klasifikace MeSH
- kvalita života MeSH
- lidé MeSH
- onemocnění periferních arterií diagnostické zobrazování farmakoterapie MeSH
- retrospektivní studie MeSH
- stupeň závažnosti nemoci MeSH
- vředy dolních končetin etiologie farmakoterapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
Peak shapes in electrophoresis are often distorted from the ideal Gaussian shape due to disturbing phenomena, of which the most important is electromigration dispersion. For fully dissociated analytes, there is a tight analogy between nonlinear models describing a separation process in chromatography and electrophoresis. When the velocity of the separated analyte depends on the concentration of the co-analyte, the consequence is a mutual influence of the analytes couples, which distorts both analyte zones. In this paper, we introduce a nonlinear model of electromigration for the analysis of two co-migrating fully dissociated analytes. In the initial stages of separation, they influence each other, which causes much more complicated peak shapes. The analysis has revealed that the two most important phenomena-the displacement and the tag-along effects-are common both for nonlinear chromatography and electrophoresis, though their description is partly based on rather different phenomena. The comparison between the nonlinear model of electromigration we describe and the numerical computer solution of the original continuity equations has proven an almost perfect agreement. The predicted features in peak shapes in initial stages of separation have been fully confirmed by the experiments.
The continuity equations that describe the movement of ions in liquid solutions under the influence of an external stationary electric field, as it is utilized in electrophoresis, were introduced a long time ago starting with Kohlrausch in 1897. From that time on, there have been many attempts to solve the equations and to discuss the results. In electrophoresis, special attention has always been devoted to the peak shapes obtained by the detector since the shapes have a tight connection with the phenomena taking place during electromigration and influence the efficiency and selectivity of the separation. Among these phenomena, the most important is electromigration dispersion. In this commented review paper, we compare various models of electromigration, try to find points that connect them, and discuss the range of their validity in light of the linear and nonlinear theory of electromigration.
The linear theory of electromigration, including the first-order nonlinear approximation, is generalized to systems with any equilibria fast enough to be considered instantaneous in comparison with the timescale of peak movement. For example, this theory is practically applied in the electrokinetic chromatography (EKC) mode of the CZE. The model enables the calculation of positions and shapes of analyte and system peaks without restricting the number of selectors, the complexation stoichiometry, or simultaneous acid-base equilibria. The latest version of our PeakMaster software, PeakMaster 6-Next Generation, implements the theory in a user-friendly way. It is a free and open-source software that performs all calculations and shows the properties of the background electrolyte and the expected electropherogram within a few seconds. In this paper, we mathematically derive the model, discuss its applicability to EKC systems, and introduce the PeakMaster 6 software.
- MeSH
- cyklofosfamid terapeutické užití MeSH
- diagnostické zobrazování metody MeSH
- diferenciální diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- plíce diagnostické zobrazování patologie MeSH
- vaskulitida * diagnóza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Cíl studie: Popis vzácného případu Cushingova syndromu v těhotenství s následnou rupturou děložní během porodu. Typ studie: Kazuistika. Název pracoviště: Gynekologicko-porodnická klinika 1. LF UK a Nemocnice Na Bulovce. Vlastní pozorování: Prezentujeme výjimečný případ Cushingova syndromu u třiatřicetileté rodičky. Sekundipara byla poprvé hospitalizována na naší klinice ve 30. týdnu těhotenství pro elevaci krevního tlaku a otoky. Během hospitalizace jsme korigovali hypokalémii a arteriální hypertenzi (dvojkombinace Dopegyt, Vasocardin). Posléze přichází ve 36. týdnu s předčasným odtokem plodové vody. Za necelých šestnáct hodin dochází ke spontánnímu porodu zdravé holčičky. Během dne se rozvíjejí u rodičky bolesti břicha. Z provedeného CT vyšetření je patrné hemoperitoneum a je vysloveno podezření na tumorózní expanzi pravé nadledviny. Indikováno je operační řešení. Při revizi nalézáme rupturu v pravé hraně děložní a provádíme abdominální hysterektomii. Na základě endokrinologického vyšetření je postpartálně stanovena diagnóza Cushingova syndromu. Tři měsíce po porodu pacientka podstupuje laparoskopickou adrenalektomii. Histologicky byl prokázán tumor nadledviny – adrenokortikální onkocytom. Závěr: Cushingův syndrom v graviditě je velmi vzácný. Diagnostika je obtížná, protože symptomy s ním spojené jsou často zaměňovány za symptomy těhotenské. Nejčastěji je stanovena diagnóza Cushingova syndromu až postpartálně. Dominantu ve vyšetřovacích metodách tvoří sonografie a magnetická rezonance. Laboratorní diagnostika je svízelná, neboť v těhotenství dochází k fyziologické elevaci kortizolu. I přes raritní výskyt tohoto onemocnění bychom u gravidní pacientky na něj měli myslet v rámci diferenciální diagnostiky při špatně korigovatelné hypertenzi, diabetu, dysbalanci mineralogramu a při typickém cushingoidním habitu.
Objective: The description of rare case of the Cushing's syndrome in pregnancy resulting in the spontaneous rupture of uterus. Designs: A case report. Setting: Department of Gynecology and Obstetrics, 1st Medical Faculty of Charles University and Hospital Na Bulovce. Case report: The authors report the case of a 33 year old woman, who was admitted to the clinic in 30th week of pregnancy for elevated blood pressure and hypokalemia. Arterial hypertension was corrected with the combination of Vasocardin and Dopegyt. In 36th week of pregnancy the patient was admitted to the hospital with premature rupture of membranes. In less than sixteen hours the patient spontaneously gave birth to a healthy girl. Subsequently the patient suffered from abdominal pain. CT scan showed haemoperitoneum and a right adrenal mass and the surgical revision was performed. During the surgery uterine rupture was identified and the patient uderwent abdominal hysterectomy. Based on the endocrinological examination the diagnosis of Cushing's syndrome was made. Three months after the delivery she underwent laparoscopic right adrenalectomy. Histological examination revealed adrenocortical oncocytoma. Conclusion: Cushing's syndrome is rare in pregnancy and misdiagnosis is common. Symptoms mimic pregnancy complications. The disease is often diagnosed with delay even after delivery. The sonography and magnetic resonance are dominant imaging methods. Laboratory diagnosis is difficult due to pregnancy related changes. In spite of rarity of Cushing's syndrome in pregnancy we should think about it in terms of the differential diagnosis of hypertension, diabetes, dysbalance of mineralogram and typical cushingoid habitus.
- Klíčová slova
- adrenokortikální onkocytom,
- MeSH
- adrenokortikální nádory * diagnóza chirurgie MeSH
- Cushingův syndrom * diagnóza terapie ultrasonografie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- hypertenze etiologie farmakoterapie komplikace MeSH
- komplikace těhotenství MeSH
- lidé MeSH
- methyldopa aplikace a dávkování terapeutické užití MeSH
- metoprolol aplikace a dávkování terapeutické užití MeSH
- ruptura dělohy diagnóza chirurgie MeSH
- vzácné nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY Recent trends in the experimental surgical management of a partial anterior cruciate ligament (ACL) rupture in animals show repair of an ACL lesion using novel biomaterials both for biomechanical reinforcement of a partially unstable knee and as suitable scaffolds for bone marrow stem cell therapy in a partial ACL tear. The study deals with mechanical testing of the newly developed ultra-high-molecular-weight polyethylene (UHMWPE) biomaterial anchored to bone with Hexalon biodegradable ACL/PCL screws, as a new possibility of intra-articular reinforcement of a partial ACL tear. MATERIAL AND METHODS Two groups of ex vivo pig knee models were prepared and tested as follows: the model of an ACL tear stabilised with UHMWPE biomaterial using a Hexalon ACL/PCL screw (group 1; n = 10) and the model of an ACL tear stabilised with the traditional, and in veterinary medicine used, extracapsular technique involving a monofilament nylon fibre, a clamp and a Securos bone anchor (group 2; n = 11). The models were loaded at a standing angle of 100° and the maximum load (N) and shift (mm) values were recorded. RESULTS In group 1 the average maximal peak force was 167.6 ± 21.7 N and the shift was on average 19.0 ± 4.0 mm. In all 10 specimens, the maximum load made the UHMWPE implant break close to its fixation to the femur but the construct/fixation never failed at the site where the material was anchored to the bone. In group 2, the average maximal peak force was 207.3 ± 49.2 N and the shift was on average 24.1 ± 9.5 mm. The Securos stabilisation failed by pullout of the anchor from the femoral bone in nine out of 11 cases; the monofilament fibre ruptured in two cases. CONCLUSIONS It can be concluded that a UHMWPE substitute used in ex-vivo pig knee models has mechanical properties comparable with clinically used extracapsular Securos stabilisation and, because of its potential to carry stem cells and bioactive substances, it can meet the requirements for an implant appropriate to the unique technique of protecting a partial ACL tear. In addition, it has no critical point of ACL substitute failure at the site of its anchoring to the bone (compared to the previously used PET/PCL substitute). Key words: knee stabilisation, stifle surgery, ultra-high-molecular-weight polyethylene, UHMWPE, nylon monofilament thread, biodegradable screw, bone anchor.
- MeSH
- biokompatibilní materiály * MeSH
- biomechanika MeSH
- kostní šrouby * MeSH
- ligamentum cruciatum anterius patofyziologie chirurgie MeSH
- modely nemocí na zvířatech MeSH
- polyethyleny * MeSH
- poranění kolena patofyziologie chirurgie MeSH
- poranění předního zkříženého vazu MeSH
- prasata MeSH
- protézy - design MeSH
- testování materiálů MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Although the classical formula of peak resolution was derived to characterize the extent of separation only for Gaussian peaks of equal areas, it is often used even when the peaks follow non-Gaussian distributions and/or have unequal areas. This practice can result in misleading information about the extent of separation in terms of the severity of peak overlap. We propose here the use of the equivalent peak resolution value, a term based on relative peak overlap, to characterize the extent of separation that had been achieved. The definition of equivalent peak resolution is not constrained either by the form(s) of the concentration distribution function(s) of the peaks (Gaussian or non-Gaussian) or the relative area of the peaks. The equivalent peak resolution value and the classically defined peak resolution value are numerically identical when the separated peaks are Gaussian and have identical areas and SDs. Using our new freeware program, Resolution Analyzer, one can calculate both the classically defined and the equivalent peak resolution values. With the help of this tool, we demonstrate here that the classical peak resolution values mischaracterize the extent of peak overlap even when the peaks are Gaussian but have different areas. We show that under ideal conditions of the separation process, the relative peak overlap value is easily accessible by fitting the overall peak profile as the sum of two Gaussian functions. The applicability of the new approach is demonstrated on real separations.
