Je podán přehled o historii, současnosti a perspektivách do budoucna v oblasti transplantace srdce. Jsou uvedena indikační kritéria a možné komplikace v potransplantačním sledování. Na závěr jsou zmíněny možnosti, které by mohly transplantace jako alternativa v budoucnu doplnit. Jedná se zejména o využití mechanických srdečních podpor.
We provide an overview of the history, current status and future perspectives of heart transplantations. We describe indication criteria and possible post-transplantation complications. Finally, we list the options that could, as an alternative, complement transplantations in the future. This is mainly the use of mechanical heart support devices.
- Keywords
- mechanické podpory, potransplantační komplikace, indikace,
- MeSH
- Humans MeSH
- Forecasting MeSH
- Heart Transplantation adverse effects trends MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Im Zuge des europäischen E-Health Großprojektes (“ep- SOS”) kam es zu einer Vielzahl an Diskussionen über die Umsetzung einer gesamteuropäischen E-Health Infrastruktur. Dabei traten großen Unterschiede zwischen den nationalen Rechtsordnungen im Bereich E-Health zu Tage, die ernsthafte Hindernisse für den europaweiten Austausch von Gesundheitsdaten darstellen. Auch wenn es sehr schwierig ist, alle Anforderungen der betroffenen Ländern einzuhalten, ist dies eine notwendige Voraussetzung für einen reibungslosen Austausch von Patientendaten. Die rechtswidrige Verwendung von personenbezogenen Gesundheitsdaten kann zu Imageverlusten, Verwaltungsstrafen und der Notwendigkeit interne Arbeitsabläufe mit großem Aufwand umstrukturieren zu müssen, führen. Die Kenntnis der aktuellen Rechtslage hilft dies zu vermeiden. Die Kenntnis der zukünftigen Rechtslage erleichtert strategische Entscheidungen und erlaubt eine Führungsrolle im Innovationsprozess zu übernehmen. Vor diesem Hintergrund soll der gegenständliche Beitrag zu einem besseren Verständnis der aktuellen österreichischen Rechtslage und den Neuerungen, die auf Grund nationaler und europäischer Projekte zu erwarten sind, beitragen. Die Entwicklungen auf nationaler und europäischer Ebene sind nach wie vor im Gange. Der vorliegende Beitrag, insbesondere der Ausblick des Kapitels 2, beruht auf dem Informationsstand April 2012.
In the context of the European large-scale pilot on e-health (“epSOS”) numerous discussions on the implementation of a pan-European e-health infrastructure have been held. They all proved that differences among the national ehealth legislations pose serious obstacles to the Europeanwide exchange of personal health data. Even if it is very difficult to meet all requirements of the involved countries, this is an absolute pre-condition for a smooth exchange of patient data. The unlawful usage of personal health data can result in the loss of reputation, administrative fines and the need to restructure internal workflows at high costs. Being aware of the current legal framework avoids such. To know about future innovations to the legal framework facilitates strategic decisions and enables to take over leadership in the innovative process. Recognising this, the aim of this paper is to provide a better understanding of the current Austrian e-health legislation and the innovations to come, inspired by national and European projects. As development is still ongoing at national and European level, the information provided, especially regarding the outlook, is to be understood as of April 2012.
- Keywords
- epSOS,
- MeSH
- Medical Records Systems, Computerized organization & administration utilization legislation & jurisprudence MeSH
- Databases as Topic organization & administration utilization legislation & jurisprudence MeSH
- European Union MeSH
- Information Systems utilization MeSH
- International Cooperation MeSH
- Systems Integration MeSH
- Telemedicine trends utilization legislation & jurisprudence MeSH
- Information Storage and Retrieval methods legislation & jurisprudence MeSH
- Universal Health Insurance utilization legislation & jurisprudence MeSH
- Medical Informatics Applications MeSH
- Computer Security legislation & jurisprudence MeSH
- Legislation as Topic MeSH
- Geographicals
- Austria MeSH
Nedávno byla uvedena do klinické praxe nová skupina léků ovlivňujících inkretinový systém a brzy budou následovat inhibitory reabsorpce glukózy v ledvinných tubulech. Reálně tak jsou k dispozici látky s jiným mechanizmem účinku než dosavadní antidiabetika a rozšiřuje se možnost účinného ovlivnění komplexní metabolické poruchy u diabetu 2. typu. Ve fázi klinických studií jsou nepeptidové látky, ovlivňující receptor GLP 1, a inzulinová mimetika. Pokračuje výzkum modulátorů metabolických funkcí jaderných receptorů, antagonistů glukagonového receptoru a buněčných inhibitorů glukokortikoidů. Nadějné jsou látky, které zvyšují přímo utilizaci glukózy (aktivátory glukokinázy) a snižují její výdej (inhibitory fruktózo-1,6-difosfatázy). V budoucnu bude pravděpodobně využita genová terapie a biologická léčba i v léčbě diabetu 2. typu a jeho komplikací.
A new class of drugs that affect incretin system has been introduced in clinical practice, and renal glucose reabsorption inhibitors are soon to follow. Clinical practice thus has an access to drugs with mechanisms of action that differ from those of the currently available antidiabetics, and extend our ability to influence the multifaceted metabolic disorder associated with the type 2 diabetes. Non-peptide molecules affecting GLP1 receptor and insulin mimetics are being tested in clinical trials. Research also continues in metabolic modulators of nuclear receptors, glucagon receptor antagonists and cellular glucocorticoid inhibitors. Promising are the compounds that increase glucose utilization (glucokinase activators) and decrease its release (fructose-1,6-diphosphatase inhibitors). Gene therapy is also likely to be used for the treatment of type 2 diabetes and its complications.
- Keywords
- inhibitory trávení sacharidů, inkretinová léčba, modulátory PPAR, inzulinová mimetika, antidiabetika,
- MeSH
- Diabetes Mellitus, Type 2 drug therapy MeSH
- Hypoglycemic Agents therapeutic use MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Brief summary of reasons for development of Hospital Information Systems (HIS) is described. We mention different concepts of HIS development. Primary negative attitude of physicians to the invasion of information technology to hospitals has been slowly changed. Extended teaching of fundamentals of computer science at medical universities is very important for a new generation of physicians. Modern methods of e‑learning allow using websites and medical atlases including presentations of surgical interventions in different branches of surgical medicine, physiotherapeutic methods, etc. Medical staff in hospitals may also profit from electronic tools used for education in medical informatics or for obligatory postgraduate courses. Software producing companies are obliged to teach potential users how to use implemented information systems effectively. E-learning is a good method how to teach new employees who need to start using the system. Telematics in health service and use of Internet data storages may be a trend in future development of information systems. Large amount of patient data in current databases is a big encouragement for expanded use of data mining and application of artificial intelligence methods in medical expert systems.
- Keywords
- coding systems in healthcare,
- MeSH
- Databases as Topic trends MeSH
- Information Systems history trends MeSH
- Medical Informatics history trends MeSH
- Hospital Information Systems * history trends MeSH
- Computer-Assisted Instruction trends MeSH
- Computing Methodologies MeSH
- Information Storage and Retrieval trends MeSH
- Medical Informatics Applications * MeSH
Nově vzniklé srdeční selhání či dekompenzace chronického srdečního selhání jsou ve věku nad 65 let nejčastějším důvodem hospitalizace, navíc hospitalizace s velmi vysokou mortalitou. Hlavním cílem léčby je rychlé odstranění symptomů a optimalizace hemodynamického stavu s minimem nežádoucích účinků a příznivým dlouhodobým efektem. Léčebných postupů s důkazy o naplnění těchto požadavků je bohužel stále relativně málo. Tradiční terapie diuretiky, vazodilatancii a inotropiky naráží na řadu limitací. Objevují se nové léky čekající teprve na potvrzení použitelnosti při standardní léčbě a objevují se také nové údaje o dopadech zavedených léčebných postupů. Přehled stávajících možností farmakoterapie navazuje na Doporučení České kardiologické společnosti z roku 2006 a Doporučení Evropské kardiologické společnosti z roku 2008.
A new onset heart failure or a decompensation of chronic heart failure belong to most frequent reasons of hospitalization at age over 65, moreover, hospitalizations with very high mortality. Main target of therapy is rapid relief from symptoms and optimisation of hemodynamic status with minimum adverse events aiming for a positive long term outcome. Unfortunately, evidenced medical approaches fulfilling these requirements are still rare. Standard therapy including diuretics, vasodilators and inotropes face a lot of limitations. Effectiveness of new therapeutic perspectives awaits confirmation and new data on efficacy of standard medical approaches have to be taken into account, too. This overview of the current pharmacotherapy follows on the Guidelines of the Czech Society of Cardiology 2006 and the European Society of Cardiology guidelines 2008.
- Keywords
- akutní dekompenzace chronického srdečního selhání,
- MeSH
- Acute Disease therapy MeSH
- Adrenergic beta-Antagonists administration & dosage pharmacology MeSH
- Diuretics administration & dosage pharmacology MeSH
- Drug Therapy MeSH
- Heparin administration & dosage pharmacology MeSH
- Hypertension diagnosis drug therapy classification MeSH
- Angiotensin-Converting Enzyme Inhibitors administration & dosage pharmacology MeSH
- Cardiotonic Agents administration & dosage pharmacology MeSH
- Humans MeSH
- Morphine Derivatives administration & dosage pharmacology MeSH
- Heart Failure etiology drug therapy MeSH
- Check Tag
- Humans MeSH
This case-based discussion describes the management of a 66-yr-old man who presented to the emergency department with gross hematuria. His urine cytology was benign, and computed tomography (CT) with nephrographic phase revealed a 2.5 cm filling defect within the left renal pelvis and luminal narrowing in the right proximal ureter with hydronephrosis. CT showed no lymphadenopathy and no sign of metastatic disease. Cystoscopy was normal. In a progressive case-based discussion fashion, we will discuss the diagnostic and treatment options with two different perspectives: (1) guidelines-based current standard of care and (2) an outlook on future perspectives using the latest scientific advances that may soon become the standard of care. PATIENT SUMMARY: This presentation of a real-life clinical scenario will be useful in describing the current standard of care and future perspectives regarding the diagnosis and treatment of upper urinary tract tumors.
- MeSH
- Cystoscopy MeSH
- Carcinoma, Transitional Cell * diagnosis pathology therapy MeSH
- Humans MeSH
- Urinary Bladder Neoplasms * MeSH
- Ureter * pathology MeSH
- Urologic Neoplasms * diagnosis therapy MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
Background: The prognosis of patients diagnosed with locally advanced and metastatic gastric and esophago-gastric junction cancer is critical. The optimal choice of systemic therapy is essential to optimize survival outcomes. Methods: A comprehensive literature review via PubMed and analysis of major oncology congresses (European Society for Medical Oncology and American Society of Clinical Oncology websites) were conducted to ascertain the current status and latest developments in the systemic treatment of patients with localized or advanced gastric and esophago-gastric junction adenocarcinoma. Results: While neoadjuvant and perioperative chemotherapy for localized tumor stages is the preferred approach in the Western Hemisphere, adjuvant chemotherapy remains the preferred course of action in East Asia. The administration of chemotherapy, typically in the form of combinations comprising platinum and fluoropyrimidine compounds in combination with docetaxel, represents a standard of care. Investigations are underway into the potential of immunotherapy and other biologically targeted agents in the perioperative setting. To select the most appropriate therapy for advanced gastric cancer, including adenocarcinoma of the esophago-gastric junction, it is essential to determine biomarkers such as HER2 expression, PD-L1 combined positive score (CPS) (combined positive score), Claudin 18.2, and microsatellite instability (MSI). In the present clinical context, the standard first-line therapy is a combination of fluoropyrimidine and a platinum derivative. The selection of chemotherapy in combination with antibodies is contingent upon the specific biomarker under consideration. Conclusions: This article reviews the current state of the art based on recent clinical trial results and provides an outlook on the future of systemic therapy.
- Publication type
- Journal Article MeSH
- Review MeSH
PURPOSE: Prostate cancer (PCa) screening, which relies on prostate-specific antigen (PSA) testing, is a contentious topic that received negative attention due to the low sensitivity and specificity of PSA to detect clinically significant PCa. In this context, due to the higher sensitivity and specificity of magnetic resonance imaging (MRI), several trials investigate the feasibility of "MRI-only" screening approaches, and question if PSA testing may be replaced within prostate cancer screening programs. METHODS: This narrative review discusses the current literature and the outlook on the potential of MRI-based PCa screening. RESULTS: Several prospective randomized population-based trials are ongoing. Preliminary study results appear to favor the "MRI-only" approach. However, MRI-based PCa screening programs face a variety of obstacles that have yet to be fully addressed. These include the increased cost of MRI, lack of broad availability, differences in MRI acquisition and interpretation protocols, and lack of long-term impact on cancer-specific mortality. Partly, these issues are being addressed by shorter and simpler MRI approaches (5-20 min bi-parametric MRI), novel quality indicators (PI-QUAL) and the implementation of radiomics (deep learning, machine learning). CONCLUSION: Although promising preliminary results were reported, MRI-based PCa screening still lack long-term data on crucial endpoints such as the impact of MRI screening on mortality. Furthermore, the issues of availability, cost-effectiveness, and differences in MRI acquisition and interpretation still need to be addressed.
Modern aging research ; Vol. 5
532 s. : onr., tab.
