Schizofrenie a bipolární porucha jsou závažné duševní poruchy s rekurentním průběhem a častou nonadherencí k léčbě. Relaps onemocnění komplikuje její další průběh, odpověď na terapii a kvalitu života nemocných. Rozpoznání časných varovných příznaků (prodromů) umožňuje terapeutickou intervenci a případně zabránění plného rozvoje epizody a nutnosti hospitalizace nebo zkrácení její léčby. V přehledu jsou uvedeny nejčastější varovné příznaky psychózy, mánie a deprese včetně pravděpodobných spouštěcích faktorů a možností prevence vzniku nových epizod.

Both schizophrenia and bipolar disorder are recurrent mental disorders with common nonadherence with treatment. A relapse of illness complicates its course and outcome, treatment response, and quality of life of the patients. Recognition of early warning signs (prodromes) may result in timely therapeutic intervention and thus prevent from full blown episode with subsequent inpatient admission, or at least shorten duration of treatment. Our paper reviews the most frequent warning signs of psychosis, mania, and depression, including possible triggers, and potential measures preventing onset ofnewepsiode.

• Klíčová slova
• časné varovné příznaky, prodromy, relaps,
• MeSH
• adherence pacienta MeSH
• bipolární porucha diagnóza   prevence a kontrola   psychologie   MeSH
• deprese MeSH
• diagnostické sebehodnocení MeSH
• lidé MeSH
• mánie MeSH
• příznaky a symptomy MeSH
• progrese nemoci MeSH
• recidiva MeSH
• rizikové faktory MeSH
• schizofrenie (psychologie) MeSH
• schizofrenie diagnóza   prevence a kontrola   MeSH
• sekundární prevence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

OBJECTIVE: The purpose of this qualitative review is to examine prodromes, precipitants, and risk factors for repeated episodes of mania and depression in bipolar disorder. METHODS: PubMed, EMBASE, and PsychInfo were searched for "bipolar disorder" in conjunction with: "prodromes", "triggers", and "life change events". RESULTS: Phenomenology and prevalence of prodromes, precipitants, and risk factors are described, and their therapeutic implications are outlined. CONCLUSIONS: Most patients with bipolar disorder are able to recognize their prodromes. This ability depends largely on insight. Psychoeducation focused on improving various aspects of insight, including treatment adherence, reduces incidence of relapses in bipolar disorder.

• MeSH
• antidepresiva terapeutické užití   MeSH
• bipolární porucha farmakoterapie   epidemiologie   prevence a kontrola   MeSH
• incidence MeSH
• lidé MeSH
• prodromální symptomy * MeSH
• recidiva MeSH
• rizikové faktory MeSH
• sekundární prevence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

PURPOSE OF THE STUDY To evaluate, in a retrospective study, the surgical outcomes of percutaneous A1 pulley release in the treatment of trigger digits. MATERIAL The group evaluated comprised 100 digits in 88 patients. There were 65 women and 23 men. Ten patients had surgery on two digits and one patient on three digits. The patients? average age at the time of surgery was 57.9 years. This procedure was performed on 55 thumbs and 45 fingers (4 index fingers, 19 middle fingers, 19 ring fingers, and 3 little fingers). METHODS A bent hypodermic needle is used to release the A1 pulley, whose localization is determined as suggested by Froimson. The procedure is performed under local anaesthesia without tourniquet use. Pulley release is done with the needle tip. The finger/thumb is kept in hyperextension of the metacarpophalangeal joint to avoid injury to the nerve and vascular plexus. The extent of tendon release is checked by active motion of the treated digit that should move freely without snapping or locking. Subsequently, a compression bandage is applied for two days, with the digit being exercised immediately after surgery. RESULTS Of the 100 digits treated, 95 procedures led to complete relief of symptoms and restoration of a full range of motion. Five digits underwent repeat surgery (three percutaneous and two open release procedures). No complaints were reported for 79.7 % and 91.1 % of the treated digits at 2 weeks and 2 months after surgery, respectively. Better results were recorded for the treatment of thumbs. Complications included early trigger finger recurrence in two cases, late recurrence was not recorded. A restricted range of motion after surgery required repeat surgery in three cases. No serious complications such as injury to the tendon, bowstring effect, nerve damage or wound infection were recorded. DISCUSSION The results of surgery, both percutaneous and open release, in our patient group are comparable with those reported in the literature. In contrast to some authors, we carry out release on all digits. If indicated, we perform percutaneous release also at reoperations. CONCLUSIONS Percutaneous release has been adopted as a standard method at our department. Because of its minimal invasiveness, it reduces the risk of complications associated with open procedures. It can be carried out at an outpatient department, is less painful and allows the patient to return to daily activities and work in a shorter time.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• lupavý prst chirurgie   MeSH
• miniinvazivní chirurgické výkony MeSH
• ortopedické výkony metody   přístrojové vybavení   MeSH
• pooperační komplikace MeSH
• recidiva MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

OBJECTIVE: Bipolar affective disorder runs a natural course of frequent relapses and recurrences. Despite significant strides in the pharmacological treatment of bipolar disorder, most bipolar patients cannot be treated only by drugs. The limitations of using medication alone in symptomatic, relapse prevention, and satisfaction/quality of life terms have long prompted interest in wider forms of management. One of the promising way how to enhance remission seems to be combination of pharmacotherapy and psychoeducation. METHODS: Studies were identified through PUBMED, Web of Science and Scopus databases as well as existing reviews. The search terms included "bipolar disorder", "psychoeducation", "psychotherapy", "psychosocial treatment", "family therapy", "individual therapy", "group therapy", and "psychoeducation". The search was performed by repeated use of the words in different combinations with no language or time limitations. This article is a review with conclusions concerned with psychoeducation in bipolar disorder. CONCLUSIONS: Randomized controlled trials of cognitive behavioral therapy, interpersonal and social rhythm therapy, individual, group and family psychoeducation show that these approaches augment stabilizing effect of pharmacotherapy. Patients and their families should be educated about bipolar disorder, triggers, warning signs, mood relapse, suicidal ideation, and the effectiveness of early intervention to reduce complications. Psychosocial approaches are important therapeutic strategies for reducing relapse and rehospitalization in bipolar disorder.

• MeSH
• bipolární porucha prevence a kontrola   psychologie   terapie   MeSH
• kognitivně behaviorální terapie metody   MeSH
• lidé MeSH
• psychoterapie * metody   MeSH
• recidiva MeSH
• rodinná terapie metody   MeSH
• sekundární prevence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

Mutations in ATP1A3 lead to different phenotypes having in common acute neurological decompensation episodes triggered by a specific circumstance and followed by sequelae. Alongside Alternating Hemiplegia of Childhood (AHC), Rapid-onset Dystonia Parkinsonism (RDP) and Cerebellar ataxia, Areflexia, Pes cavus, Optic atrophy, Sensorineural hearing loss syndrome (CAPOS), a new Relapsing Encephalopathy with Cerebellar Ataxia (RECA) phenotype was published in 2015. We describe herein eight new pediatric cases. Most of them had no specific history when the first neurological decompensation episode occurred, before the age of 5 years, triggered by fever with severe paralytic hypotonia followed by ataxia with or without abnormal movements. Neurological sequelae with ataxia as the predominant symptom were present after the first episode in three cases and after at least one subsequent relapse in five cases. Five of the eight cases had a familial involvement with one of the two parents affected. The phenotype-genotype correlation is unequivocal with the causal substitution always located at position 756. The pathophysiology of the dysfunctions of the mutated ATPase pump, triggered by fever is unknown. Severe recurrent neurological decompensation episodes triggered by fever, without any metabolic cause, should lead to the sequencing of ATP1A3.

• MeSH
• cerebelární ataxie genetika   MeSH
• dítě MeSH
• fenotyp MeSH
• genetické asociační studie MeSH
• horečka komplikace   MeSH
• lidé MeSH
• mladiství MeSH
• mutace MeSH
• nemoci mozku genetika   MeSH
• recidiva MeSH
• sodíko-draslíková ATPasa genetika   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Práce shrnuje současný pohled na etiologii a léčbu akutního zánětu středního ucha. Dále se zabývá rizikovými faktory pro výskyt recidivujícího zánětu středního ucha a na základě statistické analýzy zkoumá jejich validitu.

The páper sumarized current opinions on etiology and treatment of otitis media acuta. The author analysed risk factors of reecurent otitis media and statisticly analysed its validity.

• MeSH
• antibakteriální látky aplikace a dávkování   terapeutické užití   MeSH
• Bacteria patogenita   MeSH
• dítě MeSH
• lidé MeSH
• otitis media diagnóza   etiologie   terapie   MeSH
• recidiva MeSH
• rizikové faktory MeSH
• Check Tag
• dítě MeSH
• lidé MeSH

Autoimunitné hepatitídy sa delia na skupinu typických hepatitíd a na skupinu tzv. variantných foriem – overlap syndrómov. Tieto ochorenia sú poddiagnostikované. Vyskytujú sa častejšie u žien a v každom veku, ale aj s dvoma vrcholmi (medzi 10.-30. a 40.-50. rokom). V etiopatogenéze je akceptovaná koncepcia vývoja (harmonogramu) autoimunitného ochorenia, pričom sa predpokladá genetická predispozícia a spúšťačmi („triggers“) sú faktory vonkajšieho prostredia, najmä vírusy, lieky a xenobiotiká. Kľúčovú úlohu zohráva dysfunkcia na úrovni T-regulačných lymfocytov. Klinický obraz je variabilný, typické je kolísanie aktivity ochorenia, t.j. striedanie období remisií s relapsmi. Asi v 30 % sa manifestuje ako akútna hepatitída, u časti pacientov môže prebiehať až fulminantne a vo zvyšných prípadoch je začiatok ochorenia pozvoľný, úskočný a ochorenie nemusí byť dlho rozpoznané. Pre diagnostiku bol vypracovaný skórovací systém, ktorý stanovuje definitívnu alebo pravdepodobnú diagnózu. Keďže neexistujú patognomické črty ochorenia, treba vylúčiť iné ochorenia. Stratégiou imunosupresívnej liečby je dosiahnuť remisiu, predchádzať relapsu a zabrániť progresii ochorenia do cirhózy. Klinická a biochemická remisia sa spravidla dosiahne rýchlo po nasadení liečby, avšak zaostávanie histologickej remisie za biochemickou je až 6-18 mesiacov. Riziko relapsu predikujú 2 parametre, t.j. trvanie liečby a remisie a histologická aktivita ochorenia. Asi 80-85 % pacientov vyžaduje pre časté relapsy dlhodobú terapiu. Vhodná imunosupresívna terapia je život zachraňujúca, zatiaľ čo neliečené ochorenie má väčšinou zlú prognózu. Heterogenita ochorenia vyžaduje veľmi individuálny prístup.

Autoimmune hepatitis are divided into the group of typical hepatitis and the group of variant forms or overlap syndromes. This illness is underdiagnosed. It occurs more frequently in women, and at any age but with two peaks (between 10-30 and 40-50 years of age). In etiopathogenesis conception of development („timeline“) of autoimmune disease is accepted and genetic predisposition is suggested. Triggers are environmental factors, mostly viruses, drugs and xenobiotics. Dysfunction at the level of regulatory T-cells (T reg) plays the key role. Clinical picture is variable, typical is fluctuation of disease activity, i.e. changing of periods of relapses and remissions. In 30 % of patients the disease is manifested as an acute hepatitis, in other group of patients it is presented as fulminate disease and in the rest of cases the onset of the disease is slowly, silent and the disease may be unrecognized. For diagnostics the score system is used that establishes definite or likely diagnosis. As no pathognomic features exist it is important to exclude other diseases. Strategy of immunosuppressive therapy is to get remission, avoid relapse and prevent progression of the disease into cirrhosis. Clinical and biochemical remission may be achieved very quickly after therapy. Retardation of histological remission after biochemical remission is 6-18 months. Two parameters predict the risk of relapse – the length of therapy and remission and histological activity of the disease. About 80-85 % of patients need long-term therapy because of repeated relapses. Appropriate immunosuppressive therapy is life preserving while wrong treated disease has usually bad prognosis. Heterogeneity of the disease requires individual approach.

Cyclosporin A was used in the treatment of 42 psoriatic patients and 13 subjects with a severe chronic state atopic eczema. The doses ranged from 2.5 to 5 mg/kg/day for a period of three months. eczema the condition improved on averacre bv 82 %. Undesirable side.effects were minimal and reversible. In the prevention of relanses denondincř on the natients. intermittent or continual reversible. In the prevention of relapses, depending on the patients, intermittent or continual cyclosporin A treatment proved useful. Some patients were changed to rotational treatment using other preparations or to balneophototherapy incl. prevention focused on trigger mechanisms. Cyclosporin A is considered a great asset in the treatment of severe autoimmune dermatoses.

• MeSH
• atopická dermatitida farmakoterapie   MeSH
• cyklosporin aplikace a dávkování   terapeutické užití   MeSH
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• psoriáza farmakoterapie   MeSH
• recidiva MeSH
• sekundární prevence MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH

S cílem přispět k problematice etiologie onemocnění recidivujícími aftami bylo provedeno imunologické vyšetření 10 pacientů s diagnózou stomatitis aphtosa minor, které bylo doplněno vyšetřením galvanických jevů v ústní dutině. Byly zjišťovány sérové hladiny IgA, hladiny sekrečního IgA ve slinách, hladiny složek komplementu v séru a tvorba IFN-g a IL-4 v supernatantech tkáňových kultur lymfocytů. Výsledky byly porovnány s hodnotami kontrolního souboru tvořeného 16 zdravými dobrovolníky odpovídajícího věku. U pacientů s recidivujícími aftami v akutním stadiu byly zjištěny nižší sérové hladiny IgA a naopak vyšší hladiny sekrečního IgA ve slinách. Byly zjištěny též nízké hladiny C3 a C4 složek komplementu. Tyto složky komplementu byly nejpravděpodobněji spotřebovávány na tvorbu imunokomplexů, jak klasic- kou, tak alternativní cestou. Výsledky tvorby IFN-g a IL-4 napovídají, že největší podíl Th2 klonů byl vyhodnocen u pacientů v akutním stadiu onemocnění. V období remise pak dochází k postupnému zvyšování počtu Th1 klonů. U zdravých jedinců byla převaha Th1 klonů nejvýraznější. Svědčí to o skutečnosti, že onemocnění recidivujícími aftami je pravděpodobně geneticky podmíněné s vrozeným typem regulace imunitní reakce s tím, že recidivy akutních exacerbací mohou být vyvolávány různými faktory, které způsobí zvýšení počtu Th2 na úkor Th1 klonů. Na základě našich výsledků se domníváme, že je vhodné mezi spouštěcí mechanismy akutní exacerbace zařadit i galvanické jevy, které mohou negativně ovlivnit jak vznik aftózních lézí, tak průběh jejích hojení. Proto doporučujeme měřit u nemocných galvanické proudy a napětí v ústech a jako možný terapeutický prostředek odstranit jejich příčiny.

With the objective to contribute to the problem of etiology of diseases with recurrent oral ulcers the authors made an immunological examination of 10 patients with the diagnosis of stomatitis aphthosa minor which was supplemented by examination of galvanic phenomena in the oral cavity. The authors assessed serum IgA levels, levels of secretory IgA in saliva, levels of complement serum components and the formation of IFN-g and IL-4 in supernatants of lymphocyte tissue cultures. The results were compared with values of a control group of 16 healthy volunteers of corresponding age. In patients with recurrent aphtous ulcer in the acute stage lower serum IgA levels were found and higher levels of secretory IgA in saliva. The authors found also low levels of C3 and C4 components of complement. These complement components were most probably used for the formation of immune complexes, by the classical as well as alternative pathway. The results of IFN-g and IL-4 formation suggest that the greatest amount of Th2 clones was found in patients in the acute stage of the disease. During the remission period a gradual increase of the number of Th1 clones occurs. This is evidence of the fact that recurrent aphtae ulcer are probably genetically conditioned with a congenital type of regulation of the immune reaction, and relapses of acute exacerbations may be caused by various factors which cause an increased number of Th2 at the expense of Th1 clones. Based on our results we assume that it is useful to include among triggering mechanisms of acute exacerbation also galvanic phenomena which may have an negative impact on the development of aphthous lesions as well as on the process of their healing. We recommend therefore t o assess in patients galvanic currents and the strain in the mouth and to eliminate as a possible therapeutic tool their causes.

• MeSH
• aftózní stomatitida etiologie   imunologie   MeSH
• elektrogalvanismus intraorální škodlivé účinky   MeSH
• finanční podpora výzkumu jako téma MeSH
• lidé MeSH
• recidiva MeSH
• vředy v ústech etiologie   imunologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• srovnávací studie MeSH

Definition of reflux as a centrifugal flow within an incompetent vein connecting both poles of the ambulatory pressure gradient and causing ambulatory venous hypertension is presented. Recurrent reflux occurs also after correctly performed crossectomy and stripping. Growth of new vessels (neo-angiogenesis) or dilatation of pre-existing venous channels (vascular remodelling) has been claimed to be the main cause of recurrences in these instances. Attempts to blockade the development of recurrent reflux in the groin by inserting mechanical barriers over the ligated saphenofemoral junction failed to prevent recurrences. The synergistic effect of two hemodynamic factors – pressure difference between the femoral vein and the saphenous remnant in the thigh on one side, and the propensity to restore centrifugal flow on the other side – may play a crucial role in the development of recurrent reflux. Pressure gradient apparently triggers the event. Restoration of centrifugal flow might be the pre-programmed phenomenon that improves compromised blood supply in arterial occlusions, but evokes recurrent reflux in incompetent superficial veins. In this way, it can be explained why recurrent reflux can occur after any therapeutic procedure.

• Klíčová slova
• obnovení centrifugálního toku, tlakový gradient, recidiva refluxu, venózní reflux,
• MeSH
• časové faktory MeSH
• dolní končetina krevní zásobení   MeSH
• hemodynamika fyziologie   MeSH
• lidé MeSH
• patologická angiogeneze etiologie   patofyziologie   MeSH
• recidiva MeSH
• třísla krevní zásobení   MeSH
• varixy chirurgie   patofyziologie   MeSH
• vena femoralis patofyziologie   MeSH
• vena saphena chirurgie   patofyziologie   MeSH
• venózní tlak fyziologie   MeSH
• výkony cévní chirurgie metody   škodlivé účinky   MeSH
• výsledek terapie MeSH
• žilní insuficience etiologie   chirurgie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH