Fourth branchial cleft anomalies are rare head and neck congenital lesions seen in children. They present as a neck inflammatory mass and arise essentially on the left side of the neck. We report the case of a 7-month-old female with a mass of the neck associated with respiratory distress. The mass was diagnosed as an incomplete fourth branchial cleft fistula. Surgical revision of the neck abscess from an external approach and plasma coblation of the orifice in the pyriform fossa by an endoscopic approach were performed.
- MeSH
- absces chirurgie MeSH
- branchiální krajina * abnormality chirurgie MeSH
- kojenec MeSH
- kraniofaciální abnormality chirurgie MeSH
- krk abnormality chirurgie patologie MeSH
- lékařské ilustrace MeSH
- lidé MeSH
- nemoci faryngu MeSH
- píštěle chirurgie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Aminophylline, a bronchodilator mainly used to treat severe asthma attacks, may induce arrhythmias. Unfortunately, the underlying mechanism is not well understood. We have recently described a significant, on average inhibitory effect of aminophylline on inward rectifier potassium current IK1, known to substantially contribute to arrhythmogenesis, in rat ventricular myocytes at room temperature. This study was aimed to examine whether a similar effect may be observed under clinically relevant conditions. Experiments were performed using the whole cell patch clamp technique at 37°C on enzymatically isolated healthy porcine and failing human ventricular myocytes. The effect of clinically relevant concentrations of aminophylline (10-100 μM) on IK1 did not significantly differ in healthy porcine and failing human ventricular myocytes. IK1 was reversibly inhibited by ∼20 and 30 % in the presence of 30 and 100 μM aminophylline, respectively, at -110 mV; an analogical effect was observed at -50 mV. To separate the impact of IK1 changes on AP configuration, potentially interfering ionic currents were blocked (L-type calcium and delayed rectifier potassium currents). A significant prolongation of AP duration was observed in the presence of 100 μM aminophylline in porcine cardiomyocytes which well agreed with the effect of a specific IK1 inhibitor Ba2+ (10 μM) and with the result of simulations using a porcine ventricular cell model. We conclude that the observed effect of aminophylline on healthy porcine and failing human IK1 might be involved in its proarrhythmic action. To fully understand the underlying mechanism, potential aminophylline impact on other ionic currents should be explored.
- MeSH
- akční potenciály účinky léků MeSH
- aminofylin * farmakologie MeSH
- draslíkové kanály dovnitř usměrňující * metabolismus MeSH
- kardiomyocyty * účinky léků metabolismus MeSH
- lidé MeSH
- metoda terčíkového zámku MeSH
- prasata MeSH
- srdeční komory účinky léků metabolismus MeSH
- srdeční selhání metabolismus farmakoterapie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
The increasing attendance of paediatric emergency departments has become a serious health issue. To reduce an elevated burden of medical errors, inevitably caused by a high level of stress exerted on emergency physicians, we propose potential areas for improvement in regular paediatric emergency departments. In an effort to guarantee the demanded quality of care to all incoming patients, the workflow in paediatric emergency departments should be sufficiently optimised. The key component remains to implement one of the validated paediatric triage systems upon the patient's arrival at the emergency department and fast-tracking patients with a low level of risk according to the triage system. To ensure the patient's safety, emergency physicians should follow issued guidelines. Cognitive aids, such as well-designed checklists, posters or flow charts, generally improve physicians' adherence to guidelines and should be available in every paediatric emergency department. To sharpen diagnostic accuracy, the use of ultrasound in a paediatric emergency department, according to ultrasound protocols, should be targeted to answer specific clinical questions. Combining all mentioned improvements might reduce the number of errors linked to overcrowding. The review serves not only as a blueprint for modernising paediatric emergency departments but also as a bin of useful literature which can be suitable in the paediatric emergency field.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Sildenafil (Viagra), the first approved and widely used oral drug for the treatment of erectile dysfunction, was occasionally associated with life-threatening ventricular arrhythmias in patients. Since inward rectifier potassium current (IK1) may considerably contribute to this arrhythmogenesis, we investigated the effect of sildenafil on the human Kir2.1 and Kir2.2, the prevailing subunits forming the ventricular IK1 channels. Experiments were performed by the whole-cell patch clamp technique at 37°C using Chinese hamster ovary cells transiently expressing the human Kir2.1 and Kir2.2 channels. Changes of both the inward and outward current components (at -110 and -50 mV, respectively) were tested to be able to consider the physiological relevance of the sildenafil effect (changes at -110 and -50 mV did not significantly differ, results at -50 mV are listed below). A significant Kir2.1 inhibition was observed at all applied sildenafil concentrations (16.1% ± 3.7%, 20.0% ± 2.6%, and 15.0% ± 3.0% at 0.1, 1, and 10 μM, respectively). The inhibitory effect of 0.1 μM sildenafil was potentiated by the presence of a low concentration of Ba2+ (0.1 μM) which induced only a slight Kir2.1 inhibition by 5.95% ± 0.75% alone (the combined effect was 35.5% ± 3.4%). The subtherapeutic and therapeutic sildenafil concentrations (0.1 and 1 μM) caused a dual effect on Kir2.2 channels whereas a significant Kir2.2 activation was observed at the supratherapeutic sildenafil concentration (10 μM: 34.1% ± 5.6%). All effects were fully reversible. This is the first study demonstrating that sildenafil at clinically relevant concentrations inhibits both the inward and outward current components of the main human ventricular IK1 subunit Kir2.1. This inhibitory effect was significantly potentiated by a low concentration of environmental contaminant Ba2+ in agreement with recently reported data on rat ventricular IK1 which additionally showed a significant repolarization delay. Considering the similar subunit composition of the human and rat ventricular IK1 channels, the observed effects might contribute to sildenafil-associated arrhythmogenesis in clinical practice.
- Publikační typ
- časopisecké články MeSH
- MeSH
- indukovaná hypertermie * MeSH
- jednotky intenzivní péče MeSH
- kritický stav terapie MeSH
- lidé MeSH
- pilotní projekty MeSH
- sepse * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
- komentáře MeSH
- randomizované kontrolované studie MeSH
Bronchodilator aminophylline may induce atrial or less often ventricular arrhythmias. The mechanism of this proarrhythmic side effect has not been fully explained. Modifications of inward rectifier potassium (Kir) currents including IK1 are known to play an important role in arrhythmogenesis; however, no data on the aminophylline effect on these currents have been published. Hence, we tested the effect of aminophylline (3-100 μM) on IK1 in enzymatically isolated rat ventricular myocytes using the whole-cell patch-clamp technique. A dual steady-state effect of aminophylline was observed; either inhibition or activation was apparent in individual cells during the application of aminophylline at a given concentration. The smaller the magnitude of the control IK1, the more likely the activation of the current by aminophylline and vice versa. The effect was reversible; the relative changes at -50 and -110 mV did not differ. Using IK1 channel population model, the dual effect was explained by the interaction of aminophylline with two different channel populations, the first one being inhibited and the second one being activated. Considering various fractions of these two channel populations in individual cells, varying effects observed in the measured cells could be simulated. We propose that the dual aminophylline effect may be related to the direct and indirect effect of the drug on various Kir2.x subunits forming the homo- and heterotetrameric IK1 channels in a single cell. The observed IK1 changes induced by clinically relevant concentrations of aminophylline might contribute to arrhythmogenesis related to the use of this bronchodilator in clinical medicine.
- MeSH
- aminofylin škodlivé účinky MeSH
- bronchodilatancia škodlivé účinky MeSH
- draslík farmakologie MeSH
- draslíkové kanály dovnitř usměrňující * MeSH
- kardiomyocyty fyziologie MeSH
- krysa rodu rattus MeSH
- srdeční arytmie MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Cílem tohoto článku je zdůraznit respektování mechanismů odpovědi na inzult při volbě nutriční strategie v časné fázi kritického stavu. Současně článek pojednává o rizicích spojených s časnou agresivní nutriční intervencí, a to jak pro energetický, tak také pro proteinový příjem. Dnes se zdá, že nejoptimálnější volbou nutriční podpory v průběhu prvního týdne pobytu na jednotce intenzivní péče (JIP) je postupné navyšování dávky jak energie, tak i bílkovin. V číselném vyjádření to přibližně znamená vzestup dávky energie o 5 kcal/kg/den a vzestup dávky bílkovin o 0,2 g/kg/den. Platí to ovšem pouze u pacientů přicházejících na JIP s normální hodnotou body mass index, tedy bez malnutrice či obezity. Obě tyto kategorie vyžadují zvláštní pozornost přesahující rozsah tohoto článku.
The aim of this article is to emphasize the importance of taking into account the mechanism of host's response to insult when choosing a nutritional strategy in the early phase of a critical illness. At the same time, the article discusses the risks associated with early aggressive nutritional intervention for both energy and protein intake. Today, it seems that the most optimal choice of nutritional support during the first week of stay in the ICU is a gradual increase in both energy and protein intake. In numerical terms, this means a daily increase in energy dose of approximately 5 kcal/kg/day and a daily increase in protein dose of 0.2 g /kg/day. However, this only applies to patients admitted to the ICU with a normal body mass index, i.e. without malnutrition or without obesity. Both of these categories require special attention beyond the scope of this article.
- Klíčová slova
- překrmování,
- MeSH
- autofagie MeSH
- hibernace MeSH
- kritický stav MeSH
- lidé MeSH
- nutriční podpora * metody MeSH
- nutriční terapie MeSH
- péče o pacienty v kritickém stavu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Pokračující celosvětová pandemie virem SARS-CoV- 2 významně ovlivnila zaměření publikací věnujících se tématu aneste ziologie a intenzivní péče v pediatrii také v roce 2021. Částečné uvolnění restriktivních opatření vedlo postupně k obnově elektivní operativy a změně spektra kriticky nemocných pediatrických pacientů (pooperační péče, traumata atd.). Přes dostupné očkování zůstává nicméně covid-19 i v roce 2021 důležitým tématem, naštěstí již ne dominantním. Cílem článku Rok 2021 v přehledu – Anestezie a intenzivní péče v pediatrii je ve zkratce přiblížit čtenářům klíčové publikace v oblasti dětské anesteziologie a intenzivní péče a upozornit na práce, které by neměly uniknout vaší pozornosti s ohledem na jejich význam pro běžnou každodenní klinickou praxi a kvalitu jejich zpracování.
The ongoing SARS-CoV-2 pandemic had significant impact on publication activities in the field of paediatric anaesthesi ology and intensive care also in year 2021. The partial lossening of the restrictions had been associated with the elective surgery renewal and modification of intensive care patient´s characteristics (post-operative care, injuries, etc.). Despite the available vaccination, COVID-19 remains signifficant topic, fortunately not the single one. The aim of the article Year 2021 in paediatric anaesthesia and intensive care is to highlight the important publications that should not be missed due to their impact on daily clinical practice.
The current density (J) is a parameter routinely used to characterize individual ionic membrane currents. Its evaluation is based on the presumption that the magnitude of whole-cell ionic membrane current (I) is directly proportional to the cell membrane capacitance (C), i.e. I positively and strongly correlates with C and the regression line describing I-C relation intersects the y-axis close to the origin of coordinates. We aimed to prove the presumption in several examples and find whether the conversion of I to J could be always beneficial. I-C relation was analysed in several potassium currents, measured in rat atrial myocytes (in inward rectifier currents, IK1, and both the constitutively active and acetylcholine-induced components of acetylcholine-sensitive current, IK(Ach)CONST and IK(Ach)ACH), and in rat ventricular myocytes (transient outward current Ito). I-C correlation was estimated by the Pearson coefficient (r). A coefficient (k) was newly suggested describing deviation of the regression intercept from zero in currents with considerable r value. Based on mathematical simulations, I was satisfactorily proportional to C when r ≥ 0.6 and k ≤ 0.2 which was fulfilled in IK1 and IK(Ach)ACH (r = 0.84, k = 0.20, and r = 0.61, k = 0.06, respectively). I-C correlation was significantly positive, but weak in IK(Ach)CONST (r = 0.42), and virtually missing in Ito (r = 0.04). The impaired I-C proportionality in IK(Ach)CONST and Ito likely reflects heterogeneity of the channel expression. We conclude that the conversion of I to J should be avoided when I-C proportionality is absent. Otherwise, serious misinterpretation of data may arise.
- MeSH
- acetylcholin chemie MeSH
- buněčná membrána fyziologie MeSH
- elektrická kapacitance MeSH
- elektrofyziologie MeSH
- genotyp MeSH
- ionty MeSH
- kardiomyocyty účinky léků MeSH
- krysa rodu rattus MeSH
- membránové potenciály účinky léků MeSH
- myokard MeSH
- potkani Wistar MeSH
- srdeční síně patologie MeSH
- svalové buňky cytologie MeSH
- teoretické modely MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
