• MeSH
• Acute Kidney Injury * physiopathology   therapy   MeSH
• Renal Dialysis standards   statistics & numerical data   MeSH
• Hemoperfusion standards   statistics & numerical data   MeSH
• Humans MeSH
• Renal Replacement Therapy * methods   statistics & numerical data   MeSH
• Critical Care standards   statistics & numerical data   MeSH
• Randomized Controlled Trials as Topic MeSH
• Check Tag
• Humans MeSH

INTRODUCTION: Amanita phalloides poisoning is a potentially fatal cause of acute liver failure. The aim of this study was to analyze the impact of initial patients' characteristics and different treatment modalities on the outcome of patients with liver failure caused by Amanita poisoning. MATERIAL AND METHODS: We retrospectively evaluated 23 patients admitted to our center between July 2007 and August 2016. RESULTS: Mean time interval between Amanita phalloides ingestion and the onset of gastrointestinal symptoms was 12.48 ± 9.88 hours and the interval between ingestion and hospital admission 26.26 ± 15.14 hours. The treatment was intiated by oral decontamination using activated charcoal followed by intravenous rehydration and high doses of intravenous N-acetylcysteine and silibinin. Fourteen patients (61%) underwent extracorporeal elimination method. Ten patients had plasmapheresis, 1 patient had hemoperfusion, and 5 patients had fractionated plasma separation and adsorption. Seven patients who met King's College Criteria were listed for urgent liver transplantation; one of them died before transplantation. Six patients underwent liver transplantation; the mean waiting time was 6.5 ± 12.0 days (range, 1-31 days). One patient died 2 months afterward. All 16 patients who did not meet King's College Criteria and received conservative treatment survived. CONCLUSION: Our results documented a good prognostic value of standard King's College Criteria for indication of urgent liver transplantation in acute liver failure caused by Amanita phalloides poisoning. Fractionated plasma separation and adsorption may contribute to low mortality on the waiting list. Intensive care and extracorporeal elimination methods seem to be crucial points of the conservative treatment.

• MeSH
• Acetylcysteine administration & dosage   MeSH
• Liver Failure, Acute etiology   therapy   MeSH
• Amanita MeSH
• Antidotes administration & dosage   MeSH
• Antioxidants administration & dosage   MeSH
• Renal Dialysis methods   MeSH
• Adult MeSH
• Charcoal administration & dosage   MeSH
• Hemoperfusion methods   MeSH
• Conservative Treatment methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Mushroom Poisoning complications   therapy   MeSH
• Critical Care methods   MeSH
• Plasmapheresis methods   MeSH
• Prognosis MeSH
• Retrospective Studies MeSH
• Waiting Lists mortality   MeSH
• Silymarin administration & dosage   MeSH
• Severity of Illness Index * MeSH
• Fluid Therapy methods   MeSH
• Liver Transplantation methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Evaluation Study MeSH

V roce 2017 bylo na Toxikologickém informačním středisku (TIS) Všeobecné fakultní nemocnice v Praze evidováno 9 621 konzultací týkajících se otrav nebo expozic nebezpečným látkám, směsím a přípravkům u pacientů mladších 18 let. Nejčastějším důvodem konzultací byly lékové otravy. Zatímco pro případy dětí do 5 let byly charakteristické zejména náhodné expozice, u adolescentů šlo především o suicidální pokusy. Těžké otravy kojenců, batolat a předškoláků byly výjimečné. Důležité součásti procesu diagnostiky otrav jsou: sběr relevantní anamnézy, fyzikální vyšetření, využití laboratorních a RTG metod a v neposlední řadě konzultace TIS. Po expozici toxickým dávkám se co nejdříve přistupuje k primární dekontaminaci k zabránění vstřebání látky. Podání specifického antidota a sekundární eliminační metody se používají u těžkých otrav jen v indikovaných případech. Důležitou součástí léčby je symptomatická terapie. Otravám dětského věku lze do značné míry předcházet, k tomu mohou svou edukací rodičů významně přispět zdravotníci.

In 2017, Czech Toxicological Information Center (TIC) provided 9 621 consultations concerning intoxications or exposures to hazardoussubstances, mixtures, and products in the patients under 18 years of age. The most common cause was the drug intoxication.Poisoning in children under the age of 5 years most frequently happened accidentally. In adolescents, poisonings occurredmainly due to suicide attempts. Severe intoxications of infants, toddlers, and preschoolers were rare. Important elements of thediagnostics of poisoning are: relevant medical history, physical examination, laboratory and X-ray methods and consultationwith TIC. In case of exposure to a toxic dose of hazardous substances, primary decontamination should be performed as earlyas possible. Specific antidotes and enhanced elimination methods are applied if indicated in severe cases. Supportive care is ofutmost importance. Intoxications in children could be prevented in most cases. Health care personnel can efficiently promoteprevention with educational campaigns focused on the parents.

• Keywords
• vitální funkce, toxidromy, aspirační bronchopneumonie,
• MeSH
• Antidotes administration & dosage   therapeutic use   MeSH
• Decontamination methods   MeSH
• Diagnostic Techniques and Procedures MeSH
• Renal Dialysis utilization   MeSH
• Child MeSH
• Electrocardiography utilization   MeSH
• Physical Examination MeSH
• Hemodiafiltration MeSH
• Hemoperfusion MeSH
• Hypoglycemia MeSH
• Hypoxia MeSH
• Humans MeSH
• Monitoring, Physiologic MeSH
• Poisoning * diagnosis   classification   complications   blood   urine   therapy   MeSH
• Acetaminophen administration & dosage   poisoning   MeSH
• First Aid * methods   MeSH
• Resuscitation MeSH
• Poison Control Centers MeSH
• Fat Emulsions, Intravenous therapeutic use   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Practice Guideline MeSH

• MeSH
• Liver Failure, Acute chemically induced   therapy   MeSH
• Anticonvulsants administration & dosage   adverse effects   MeSH
• Child MeSH
• Epilepsy, Temporal Lobe * diagnosis   drug therapy   MeSH
• Hemoperfusion methods   MeSH
• Clonazepam administration & dosage   MeSH
• Valproic Acid administration & dosage   pharmacokinetics   toxicity   MeSH
• Humans MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Hemoperfusion * instrumentation   MeSH
• Advertising MeSH
• Hospital Departments MeSH

• MeSH
• Renal Dialysis * methods   MeSH
• Child MeSH
• Hemoperfusion methods   MeSH
• Immunosorbent Techniques MeSH
• Humans MeSH
• Plasmapheresis methods   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH

Hlavními pilíři v léčbě těžké sepse a septického šoku jsou promptní a adekvátní hemodynamická resuscitace, cílená antibiotická léčba, odstranění nebo drenáž zdroje infekce a podpora orgánových funkcí. Navzdory adekvátní léčbě a technologicky vyspělým možnostem orgánové podpory však mortalita sepse zůstává nepřiměřeně vysoká. Vývoj podpůrných tzv. „anti-sepsis“ léčebných opatření byl však dosud s více než 30 negativními klinickými studiemi neúspěšný. Recentní pokroky v pochopení patofyziologie sepse nicméně formulovaly patogenetická paradigmata umožňující vývoj nových léčebných konceptů. Tento článek stručně diskutuje perspektivní léčebné směry na principu nových poznatků patogeneze sepse a septického šoku.

The cornerstones of therapy for sepsis and septic shock remain the prompt and adequate hemodynamic resuscitation, administration of antibiotics that target the pathogen, removal or drainage of an infected source and organ support. Despite adequate treatment and advanced life-support, the mortality remains high. However, the development of adjunctive anti-sepsis therapies has been challenging, with more than 30 unsuccessful drug trials. Fortunately, recent advances in our understanding of the sepsis pathophysiology revealed new pathogenic paradigms, and, thus, provided new exciting therapeutic concepts. In this review, we briefly discuss emerging pathogenesis-based strategies for treating severe sepsis and septic shock.

• Keywords
• mimotělní očišťovací metody,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Cytokines secretion   MeSH
• Endotoxins genetics   adverse effects   MeSH
• Hemodiafiltration MeSH
• Hemofiltration MeSH
• Hemoperfusion MeSH
• Immune Tolerance MeSH
• Immunosuppression Therapy * MeSH
• Clinical Trials as Topic MeSH
• Complement System Proteins MeSH
• Humans MeSH
• Inflammation Mediators MeSH
• Multiple Organ Failure * immunology   prevention & control   MeSH
• Receptors, Pattern Recognition antagonists & inhibitors   physiology   therapeutic use   MeSH
• Sepsis * etiology   physiopathology   therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Úvod: Laser Speckle Contrast Analysis (LASCA) je metodou detekující hemoperfuzi v mikrocirkulaci kůže a podkoží. Cílem této práce bylo stanovit délku léčby popálené plochy u dětí, právě na základě jejího prokrvení v období pěti dnů po popáleninovém traumatu. Materiál a metodika: Jedná se o retrospektivní monocentrickou studii, kdy byly do kohorty pacientů zahrnuty všechny opařené děti přijaté na Kliniku popálenin a rekonstrukční chirurgie FN Brno v období prvních tří měsíců roku 2012. Popálené plochy byly skenovány přístrojem PeriScan PIM 3 System, firmy PERIMED, vždy od 2. do 5. dne od vzniku popáleninového traumatu a získané výsledky krevní perfuze zaznamenávány do elektronické databáze v jednotkách perfusion unit (PU). Výsledky: Celkem bylo do studie zahrnuto 49 popálených ploch u 15 dětí. Průměrná délka hospitalizace byla 6,7 dní, průměrný rozsah postižení byl 5,7 % total body surface area (TBSA) a průměrný rozsah skenované oblasti 668,9 mm2. Průměrný věk pacientů v souboru byl 1,7 let a průměrná délka hojení 8,2 dní. Všechny skenované oblasti měly v průměru hodnotu krevní perfuze 261,8 PU. Závěr: Pilotní studie prokázala jednoznačný přínos LASCA v objektivizaci hloubky popálené plochy. Ve studii se nám podařilo vytvořit, pomocí LASCA, vyšetřovací algoritmus, který je již nyní implikován do každodenní praxe, čímž je ulehčeno určení délky doby hojení popálených ploch u dětí.

Introduction: Laser Speckle Contrast Analysis (LASCA) is a method detecting a hemoperfusion in a microcirculation of cutis and subcutis. This work was aimed to determine the time of healing of burnt area in children based on the assessment of its circulation for 5 days following burnt trauma. Material and methods: This is a retrospective single centre study enrolling every scalded child admitted to the Clinic of Burns and Reconstructive Surgery of Faculty Hospital Brno during the first trimester of 2012. Burnt areas were scanned by PeriScan PIM 3 System, manufactured by PERIMED, always in the period between Day 2 and 5 from the burnt trauma and collected results of hemoperfusion were recorded in an electronic database in perfusion units (PU). Results: The study enrolled 49 burnt areas in 15 children in total. The mean time of hospitalization was 6.7 days, the mean size of impairment was 5.7% of a total body surface area (TBSA) and the mean size of scanned area was 668.9 mm2. The mean age of patients in our group was 1.7 years and mean time of healing was 8.2 days. All scanned areas had mean level of hemoperfusion of 261.8 PU. Conclusion: The pilot study demonstrated unambiguous benefit LASCA in the objectification of a depth of a burnt area. In our study we were able to create, by the use of LASCA, an algorithm of examination, which is now integrated in our everyday practice and thereby it helps to determine the time of healing of burnt areas in children.

• Keywords
• popáleninové trauma, PU, retrospektivní monocentrická studie, krevní perfuze, PeriScan PIM 3 System, LASCA, Laser Speckle Contrast Analysis,
• MeSH
• Length of Stay statistics & numerical data   MeSH
• Child, Hospitalized MeSH
• Child MeSH
• Hemoperfusion instrumentation   statistics & numerical data   instrumentation   statistics & numerical data   MeSH
• Wound Healing MeSH
• Infant MeSH
• Lasers diagnostic use   MeSH
• Humans MeSH
• Microcirculation physiology   MeSH
• Pediatrics MeSH
• Burns diagnosis   therapy   MeSH
• Body Surface Area MeSH
• Child, Preschool MeSH
• Regional Blood Flow MeSH
• Retrospective Studies MeSH
• Statistics as Topic MeSH
• Severity of Illness Index MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Child, Preschool MeSH

OBJECTIVES: Extracorporeal liver support (ELS) may play a role in bridging therapy in patients with acute liver failure (ALF). The aim of this study was to compare the influence of nonbiological and biological methods on intracranial pressure (ICP) in an animal model of ALF. METHODS: A surgical devascularization model of ALF in pigs (35-40 kg) was used. Elimination therapy started after the onset of hypoglycemia. Biochemical parameters (bilirubin, ammonia, lactate, etc.) as well as ICP and cerebral perfusion pressure (CPP) were monitored for 12 hours. Of the total 31 pigs with ALF, 14 animals were treated by fractionated plasma separation and absorption (FPSA), 10 were treated with a bioartificial liver (BAL), and 7 animals were used as a control group. RESULTS: FPSA and BAL treatment started on average 3 hours 17 minutes and 2 hours 21 minutes, after devascularization and lasted for 5 hours 54 minutes and 5 hours 43 minutes, respectively. Ammonia levels were lower in the FPSA group, and bilirubin levels differed significantly in both the FPSA and BAL groups compared with controls. However, ICP values were reduced more effectively in pigs treated by FPSA: 19.1 vs. 27.0 mm Hg at 9 hours, 22.5 vs. 28.7 mm Hg at 11 hours, and 24.0 vs. 33.0 mm Hg at 12 hours (p<0.05). CONCLUSIONS: The artificial liver support system FPSA reduced ICP values more effectively than the Performer O. Liver RanD BAL system. Compared with this BAL system, the nonbiological elimination method of FPSA is a simpler application with the advantage that it can be applied in a more continuous way.

• MeSH
• Liver Failure, Acute blood   complications   physiopathology   therapy   MeSH
• Ammonia blood   MeSH
• Bilirubin blood   MeSH
• Biomarkers blood   MeSH
• Time Factors MeSH
• Equipment Design MeSH
• Hemoperfusion instrumentation   MeSH
• Intracranial Hypertension blood   etiology   physiopathology   therapy   MeSH
• Intracranial Pressure * MeSH
• Liver, Artificial * MeSH
• Lactic Acid blood   MeSH
• Disease Models, Animal MeSH
• Cerebrovascular Circulation MeSH
• Plasmapheresis instrumentation   MeSH
• Swine MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

Akutní jaterní selhání je u dětí vzácný, ale velmi závažný stav s 80–90% úmrtností. K jeho léčbě se dosud používají metody eliminace, které jsou zaměřené na selhání ledvin (dialýza), otrav (hemoperfuze) a komplexní očišťování organismu u kritických stavů (kontinuální eliminační metody). Naše pracoviště je vybavené přístrojem Prometheus, který je konstruován k cílené eliminaci toxinů při jaterním selhání. Dosud jsme léčili dvě děti ve věku 7 let a 15 měsíců. Obě zemřely pro mozkový edém. Prokázali jsme dobrou eliminační schopnost systému. Pro výsledek léčby má zásadní význam vhodné načasování jejího zahájení.

Acute liver failure is a rare but potentially fatal condition with mortality reaching 80–90 %. Dialysis, haemoperfusion and countinuous renal replacement therapy are currently the methods of choice in patients with this critical condition. Prometheus has been recently introduced in our PICU. This liver replacement device is designed to eliminate toxins produced during the liver failure state. So far two critically ill children – aged 7 years and 15 months – have been treated with Prometheus. Although unfortunately both the patients died of brain oedema, we witnessed a good elimination efficiency of the system. Ideal timing of the initiation of the therapy appears to be a crucial factor.

• Keywords
• King's College Criteria,
• MeSH
• Liver Failure, Acute diagnosis   etiology   therapy   MeSH
• Dialysis methods   instrumentation   utilization   MeSH
• Child MeSH
• Brain Edema diagnosis   complications   mortality   MeSH
• Fatal Outcome MeSH
• Hemoperfusion methods   instrumentation   utilization   MeSH
• Infant MeSH
• Critical Illness MeSH
• Humans MeSH
• Critical Care methods   utilization   MeSH
• Prognosis MeSH
• Serum Albumin isolation & purification   metabolism   toxicity   MeSH
• Statistics as Topic MeSH
• Liver Transplantation methods   instrumentation   utilization   MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH