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Východiská a ciele: Prognóza infratentoriálnych mozgových infarktov sa v klinickej praxi nedá spoľahlivo predvídať, pretože ich priebeh môže byť značne variabilný. Symptomatológia býva atakovitá, s epizódami zhoršenia a rizikom náhleho úmrtia. Terapeutická rekanalizácia sa dosahuje pomocou intravenóznej a intraarteriálnej trombolýzy, ktorá býva účinná aj v neskoršom časovom intervale. Cieľom našej práce bolo analyzovať výsledky prolongovanej nízkodávkovanej rtPA trombolýzy (NDT) u pacientov so subakútnymi zadnojamovými infarktmi. Súbor a metodika: Do štúdie sme zaradili 34 pacientov so subakútnymi infratentoriálnymi infarktmi, ktorým sme podávali 20 mg i.v. rtPA v 48-hodinovej infúzii (0,125-0,150 mg/kg/hod.). Klinický stav sme hodnotili podľa NIHSS po uplynutí 24, 48 a 72 hod. od začatia liečby. Klinický výsledok sme klasifikovali ako stabilizovaný (ΔNIHSS = 0), zlepšený (ΔNIHSS ≤ 1) alebo zhoršený (ΔNIHSS ≥ 1) pri ukončení NDT liečby. Hodnotili sme prítomnosť hemoragických prejavov po liečbe na CT alebo MR mozgu a základné parametre hemokoagulácie. Výsledné mRS sme hodnotili 3 mesiace po vzniku infarktu. Výsledky: Terapeutický interval na podanie NDT liečby sa pohyboval od 4,5 do 144 hod. (priemerný interval 38,7 hod.). Priemerné vstupné NIHSS pacientov bolo 8 bodov. Pred začiatkom NDT liečby sa NIHSS zhoršilo o 4-17 bodov, priemerné NIHSS dosiahlo po zhoršení 12 bodov. V priebehu podávania NDT liečby sa klinický stav 20 z 34 (58,8 %) pacientov stabilizoval a zhoršovanie sa zastavilo; u 13 pacientov (38,2 %) sa stav zlepšil; zhoršenie stavu nastalo u 1 pacienta (2,9 %). Výsledné mRS pacientov 3 mesiace po prepustení: mRS 0 = 3 pacienti (8,8 %), mRS 1 = 10 pacientov (29,4 %), mRS 2 = 4 pacienti (11,8 %), mRS 3 = 6 pacienti (17,6 %), mRS 4 = 6 pacienti (17,6 %), mRS 5 = 1 pacient (2,9 %), mRS 6 = 4 pacienti (11,8 %). Nezávislosť po liečbe (mRS = 0-2) dosiahla plná polovina pacientov, t.j. 17 z 34 pacientov (50 %). Hemoragickú transformáciu v intrakraniu sme nezistili ani v jednom prípade NDT, ani prejavy lokálneho alebo systémového krvácania. Nezistili sme podstatnejšie zmeny v parametroch hemokoagulácie. Záver: Prolongovaná nízkodávkovaná intravenózna rtPA trombolýza môže byť účinnou a bezpečnou alternatívou liečby subakútnych infratentoriálnych mozgových infarktov s kolísavou klinickou symptomatológiou.

Background and Purpose: Prognosis of infratentorial ischemic strokes is very difficult to establish because of the variability of their clinical course. The posterior circulation symptoms are often gradual or stuttering with episodes of worsening and risk of sudden death. Therapeutic recanalization can be achieved by means of intravenous and intraarterial thrombolysis and can be effective even in later therapeutic window. The purpose of our study was to analyze the results of prolonged low-dose rtPA thrombolysis (LDT) in patients with subacute infratentorial strokes. Material & methods: 34 patients with subacute infratentorial strokes were treated with 20 mg IV rtPA in prolonged 48 hours infusion (0.125-0.150 mg/kg/h). NIHSS evaluation was performed 24, 48 and 72 hrs after start of therapy. Clinical result were classified as stabilized (ΔNIHSS = 0), improved (ΔNIHSS ≤ 1) or worsened (ΔNIHSS ≥ 1) at the end of NDT. We analyzed hemorrhagic changes on CT or MRI and standard hemocoagulation parameters. Modified Rankin scale was evaluated 3 months after stroke. Results: Therapeutic interval for LDT was 4.5-144 hours (mean 38.7 hours). Initial NIHSS was in the range between 1–31 (mean NIHSS =8, median NIHSS =6). Worsening of NIHSS before start of LDT was in the range 4-17 NIHSS, mean ΔNIHSS = 6. During LDT therapy have been 20 of 34 patients (58.8 %) stabilized and their worsening stopped; 13 patients (38.2 %) improved; 1 patient worsened (2.9 %). Results of mRS 3 months after discharge: mRS 0 = 3 pts (8.8 %), mRS 1 = 10 pts (29.4 %), mRS 2 = 4 pts (11.8 %), mRS 3 = 6 pts (17.6 %), mRS 4 = 6 pts (17.6 %), mRS 5 = 1 pt (2.9 %), mRS 6 = 4 pts (11.8 %). Half of all patients achieved independence after 3 months (mRS = 0-2). We did not observe any hemorrhagic intracranial transformation neither local or systemic hemorrhage. We did not detect any significant changes of hemocoagulation parameters. Conclusions: Prolonged low-dose intravenous rtPA thrombolysis seems to be effective and safe alternative therapy of subacute infratentorial ischemic strokes with gradual or stuttering course of posterior circulation symptoms.

Časopis

Nephrology, dialysis, transplantation

European Dialysis and Transplant Association - European Renal Association
Autor Autorita

Berlin : Springer International, c1986- | Oxford : Oxford University Press

sv.

Článek

European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care

methods, rationale and references is published in Nephrol Dial Transplant (2013) 28: i1-i71; doi: 10.1093/ndt ...

Nephrology, dialysis, transplantation. 2015 ; 30 (11) : 1790-7. [pub] 20140709

Nephrol Dial Transplant
ISSN 1460-2385
Medvik
Zdroj

The European Best Practice Guideline group (EBPG) issued guidelines on the evaluation and selection of kidney donor and kidney transplant candidates, as well as post-transplant recipient care, in the year 2000 and 2002. The new European Renal Best Practice board decided in 2009 that these guidelines needed updating. In order to avoid duplication of efforts with kidney disease improving global outcomes, which published in 2009 clinical practice guidelines on the post-transplant care of kidney transplant recipients, we did not address these issues in the present guidelines.The guideline was developed following a rigorous methodological approach: (i) identification of clinical questions, (ii) prioritization of questions, (iii) systematic literature review and critical appraisal of available evidence and (iv) formulation of recommendations and grading according to Grades of Recommendation Assessment, Development, and Evaluation (GRADE). The strength of each recommendation is rated 1 or 2, with 1 being a 'We recommend' statement, and 2 being a 'We suggest' statement. In addition, each statement is assigned an overall grade for the quality of evidence: A (high), B (moderate), C (low) or D (very low). The guideline makes recommendations for the evaluation of the kidney transplant candidate as well as the potential deceased and living donor, the immunological work-up of kidney donors and recipients and perioperative recipient care.All together, the work group issued 112 statements. There were 51 (45%) recommendations graded '1', 18 (16%) were graded '2' and 43 (38%) statements were not graded. There were 0 (0%) recommendations graded '1A', 15 (13%) were '1B', 19 (17%) '1C' and 17 (15%) '1D'. None (0%) were graded '2A', 1 (0.9%) was '2B', 8 (7%) were '2C' and 9 (8%) '2D'. Limitations of the evidence, especially the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.We present here the complete recommendations about the evaluation of the kidney transplant candidate as well as the potential deceased and living donor, the immunological work-up of kidney donors and recipients and the perioperative recipient care. We hope that this document will help caregivers to improve the quality of care they deliver to patients. The full version with methods, rationale and references is published in Nephrol Dial Transplant (2013) 28: i1-i71; doi: 10.1093/ndt/gft218 and can be downloaded freely from http://www.oxfordjournals.org/our_journals/ndt/era_edta.html.

Kniha

Speciální fyzioterapeutické koncepty a metody I. : koncepty a metody spočívající převážně na neurofyziologické bázi

zaměřené na centrální poruchy hybnosti u dětí . 54 -- Koncept Bobath: Neurodevelopmental Treatment (NDT na -- hemiplegie dospělých 96 -- Pohybová rehabilitace hemiplegiků: Brunström 96 -- Koncept Bobath (NDT

Pavlů, Dagmar, 1961-
Autor Autorita ORCID

Brno : CERM, 2003

2., opr. vyd. 239 s. ; 21 cm

Konspekt
Fyzioterapie. Psychoterapie. Alternativní lékařství
NLK Obory
terapie
rehabilitační a fyzikální medicína
neurovědy

Kniha

Speciální fyzioterapeutické koncepty a metody I : Koncepty a metody spočívající převážně na neurofyziologické bázi

Pavlů, Dagmar
Autor Autorita

Brno : CERM, 2003

2. vyd., oprav. 239 s.

Kniha

Speciální fyzioterapeutické koncepty a metody. I., Koncepty a metody spočívající převážně na neurofyziologické bázi

- zaměřené na centrální poruchy hybnosti u dětí 54 -- Koncept Bobath: Neurodevelopmental Treatment (NDT - hemiplegie dospělých . 96 -- Pohybová rehabilitace hemiplegiků: Brunström . 96 -- Koncept Bobath (NDT