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.

• MeSH
• lidé MeSH
• předpověď MeSH
• transplantace srdce * škodlivé účinky   trendy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

Deep vein thrombosis (DVT) is a disorder with blood clot (thrombus) formation in deep veins. DVT of upper extremities (UE) is rare but serious, bearing in mind its possible complications, disease. UE DVT treatment involves subcutaneous injections of low molecular weight heparins and subsequent switch to oral anticoagulation or thrombolysis; thrombolysis by intravenous administration of a thrombolytic agent is used only if indicated (subclavian vein thrombosis). A case of a professional sportswoman is presented, who was treated for venous thrombosis of subclavian and axillary veins using local thrombolysis. Thrombosis emerged suddenly after a basketball match, during which oedema of the right arm occurred subsequent to the patient being hit with the ball to the armpit area. Venipuncture as well as all catheter repositionings were performed under the duplex ultrasound (DUS) surveillance. Proximal brachial vein was punctured and four French catheters were used to enter subclavian vein. For thrombolysis, 0.2-0.6 mg/hour alteplase (rt-PA) was used. Injury to axillary vein tunica intima was evident the following day after the subclavian and axillary thrombosis was dissolved completely, and thrombosis in the same area recurred immediately after stopping the thrombolytic infusion. Therefore, administration of a thrombolytic agent into the same area was re-introduced and acetylsalicylic acid was added to the medication. This combined therapy resulted in recanalization of the arm as well as the axillary and subclavian areas. Thrombolysis was stopped on the 3rd day of treatment. The method can be used to manage deep vein thromboses of the upper arms even without X-ray control. Local thrombolysis of deep vein thrombosis with ultrasound surveillance is, in indicated patients, a safe method even if a vein injury occurs.

• MeSH
• Aspirin terapeutické užití   MeSH
• basketbal zranění   MeSH
• fibrinolytika terapeutické užití   MeSH
• intervenční ultrasonografie MeSH
• lidé MeSH
• mladý dospělý MeSH
• opakovaná terapie MeSH
• poranění paže komplikace   MeSH
• tkáňový aktivátor plazminogenu terapeutické užití   MeSH
• trombolytická terapie * MeSH
• vena axillaris * diagnostické zobrazování   MeSH
• vena subclavia * diagnostické zobrazování   MeSH
• žilní trombóza diagnostické zobrazování   farmakoterapie   etiologie   MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• Aspirin MeSH
• fibrinolytika MeSH
• tkáňový aktivátor plazminogenu MeSH

The first heart transplantation (SHT) was performed by Professor Ch. Barnard in 1967 but it was not until 1980s that this method became an established approach to treatment of patients with end-stage heart failure. Considering the limited number of donor organs and the number of potential post-transplantation complications, the decision to perform heart transplantation at the right time in an indicated patient is difficult and complex. Subsequent pharmacological management with immunosuppressive agents and other medication becomes everyday life reality. Knowledge of drug interactions and collaboration with cardiologists are necessary in order to maintain long-term treatment success. Despite the current developments in surgical methods, examination methods and immunosuppressant therapy, a range of complications has to be dealt with. The future of care for patients with transplants will rely on the development of new immunosuppressive drugs with a minimum of adverse effects and discovery of a non-invasive technique for graft rejection diagnosis.

• MeSH
• imunosupresiva terapeutické užití   MeSH
• kontraindikace MeSH
• lidé MeSH
• rejekce štěpu MeSH
• transplantace srdce * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• imunosupresiva MeSH

Myocarditis is a disorder with a wide range of symptoms spanning from light breathlessness or chest pain, ceasing without specific treatment, through cardiogenic shock, requiring left ventricular assistance, to sudden death. Dilated cardiomyopathy with chronic cardiac failure might be the very consequence of the precedent myocarditis. Myocarditis is the most frequently caused by viral infections, less frequently by specific infections, toxic or hypersensitivity reactions to medicines, giant cell myocarditis or sarcoidosis. Prognosis and treatment differ according to the cause, clinical or haemodynamic signs inform decision-making on care provided by cardiology centres, including decisions on execution and interpretation of myocardial biopsy. The present overview aims to provide practical guidance on diagnosis and treatment of myocardial inflammation.

• MeSH
• lidé MeSH
• myokarditida * diagnóza   etiologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• dějiny starověku MeSH
• dějiny středověku MeSH
• lidé MeSH
• vnitřní lékařství dějiny   MeSH
• Check Tag
• dějiny 19. století MeSH
• dějiny 20. století MeSH
• dějiny starověku MeSH
• dějiny středověku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• historické články MeSH
• Geografické názvy
• Česká republika MeSH

INTRODUCTION: Laser Doppler flowmetry is a sensitive modern method for evaluating the function of small veins which allows for the detection and assessment of early pathological changes in microcirculation. The method uses a low power laser beam which is emitted into the tissue where it is reflected and further recollected and analysed. The objective of the study was to compare laser Doppler flowmetry parameters for patients with chronic venous insufficiency (class 2 according to CEAP, primary varices) prior to and 1 month after surgery of varicose veins. METHODOLOGY AND PATIENT SAMPLE: The examination was performed by a Periflux laser Doppler apparatus made by Perimed. Blood flow was examined on the dorsal side of foot fingers. A total of 42 patients were examined prior to and one month following the varicose veins surgery, of whom 28 women and 14 men. The mean age of the patient sample was 49 years. A 45 minute pre-op and post-op recording of the limb was made for each patient. The protocol consisted of a 10 minute recording in rest, followed by a 4 minute ischemisation of the limb with the use of a blood pressure measuring cuff, subsequent release of the cuff, a 15 minute recording of the reperfusion and a test of vasodilatation using nitrate, and a 10 minute recording following vasodilatation. Evaluation was performed for a 4 minute period at the end of the initial rest period, for reperfusion after the release of the cuff and for the interim period of rest immediately preceding the application of nitrate, and finally for a 5 minute period after nitrate application. Statistical evaluation was performed for data acquired during the movement of blood elements and data acquired in the frequency analysis of the movement of the blood vessel wall. 3 variables were chosen for the statistical evaluation of the blood cell movement data: "the area under the curve", "the mean value of the deviation" and "the percentage change" in the different phases of the measurement, i.e. as compared with the rest recording: comparing the ischemisation and the rest recordings, comparing the vasodilatation and the rest recordings, and comparing the restitution and the rest recordings. The above variables were not assessed as absolute numbers but as the difference of values before and after the surgery. The above differences were tested in the Wilcoxon test. The intensity of blood vessel movements in the frequency range from 0.008 to 0.200 Hz and 0.210-0.420 Hz was evaluated in frequency analyses. RESULTS: Significant differences in peripheral microcirculation in lower limbs were found in the evaluation of data acquired during the movement of the different blood elements before and after varicose vein surgery (p = NS). On the contrary, evaluation of frequency analysis for both the operated and non-operated limb shows a decrease in spontaneous arterial reactivity after varicose vein surgery. This decrease is statistically significant in the frequency range from 0.102 to 0.228 on operated limbs after the removal of a varix in a T1 test (i. e. after reperfusion) as compared with the values before the surgery (p < 0.05). CONCLUSION: Varicose vein surgery results in the reduction of spontaneous vasomotion in the periphery of the operated limb.

• MeSH
• bérec krevní zásobení   MeSH
• laser doppler flowmetrie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mikrocirkulace MeSH
• varixy chirurgie   MeSH
• výkony cévní chirurgie MeSH
• žilní insuficience patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Atherosclerosis is guided by chronicle inflammation process. In the last decades of the 20th century, studies considering infection another possible risk factor of atherosclerosis development were written. Helicobacter pylori, Porphyromas gingivalis, some viruses but most frequently Chlamydia pneumonie are infection agens mentioned in these studies. Some of them emphasize also combined infections caused by more pathogenic factors having influence on vascular inflammation. Serological, epidemiological, histological and imunological studies show the pathogenic influence of acute or chronic infections. Many studies selected makrolid antibiotics as treatment in patients with ischaemic heart disease. However, existing experience with antibiotics did not bring clear results. These studies have mentioned the fact antibiotics have not been indicated as treatment in patients with acute or chronic vascular system infliction by atherosclerosis. Since the experimental and clinical research of influence of inflammations on the development of atherosclerosis moved forward a lot, no exact evidence of this complicated pathogenic mechanism was given. It will obviously take some time to confirm whether the relation between infections and artherosclerosis is causal, i.e. initiating the pathogenic process, accelerating it or keeping it alive.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• ateroskleróza farmakoterapie   imunologie   mikrobiologie   patologie   MeSH
• bakteriální infekce komplikace   imunologie   MeSH
• Chlamydophila pneumoniae MeSH
• imunita MeSH
• infekce bakteriemi rodu Chlamydophila komplikace   MeSH
• lidé MeSH
• rizikové faktory MeSH
• virové nemoci komplikace   imunologie   MeSH
• zánět MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• antibakteriální látky MeSH

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) and pacemaker (PM) therapy with apical preexcitation are therapeutic options for hypertrophic obstructive cardiomyopathy (HOCM) patients with symptoms despite pharmacological therapy. AIM: evaluation and comparison of treatment results of PTSMA and PM implantation. PATIENTS: 22 HOCM patients (NYHA class III and IV) with left ventricle outflow tract gradient (LVOTG) at rest more than 30 mm Hg. In group A were evaluated 11 patients treated by PTSMA. Left ventricle outflow tract gradient (LVOTG) was 90.5 +/- 16.0 mm Hg, NYHA class 3.1 +/- 0.2. Group B included 11 patients treated by dual chamber PM implantation, LVOTG in this group was 105 +/- 48 mm Hg, NYHA class 3.0 +/- 0.4. RESULTS: NYHA class in the group A decreased after treatment to 1.8 +/- 0.6 (p < 0.01), LVOTG to 24 +/- 12 mm Hg (p < 0.001). There was observed significant decrease in grade of systolic anterior motion (SAM), interventricular septum (IVS) thickness and left atrium (LA) size. Left ventricle end systolic diameter (LV SD) and left ventricle end diastolic diameter (LV DD) increased during follow-up. Decrease of NYHA class in the group B was to 2.1 +/- 0.6 (p < 0.001), LVOTG to 25.5 +/- 21.0 mm Hg (p < 0.001). Changes of other parameters in the group B were not significant, except decrease of SAM. Comparison of both groups: NYHA class change PTSMA/PM: 1.3 +/- 0.6/0.9 +/- 0.4 (p < 0.05), LVOTG change PTSMA/PM: -66 +/- 20/-79 +/- 46 mm Hg (p = n.s.). LV SD assessment comparison of LV SD change PTSMA/PM: 5 +/- 5/1 +/- 5 mm (p < 0.05). LA assessment - comparison of LA change PTSMA/PM: 5 +/- 5/-1 +/- 4 mm (p < 0.05). Other changes were not significant. CONCLUSION: Both therapeutic approaches - PTSMA and PM implantation - resulted in significant improvement of functional capacity assessed by NYHA classification. Decrease of LVOTG was also significant and was similar in both groups, NYHA class improvement as well as LA size decrease and LV DS increase were more expressed in PTSMA group.

• MeSH
• hypertrofická kardiomyopatie chirurgie   terapie   MeSH
• kardiostimulátor * škodlivé účinky   MeSH
• katetrizační ablace * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• srdeční septum chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Radiofrequency ablation of common atrial flutter requires the creation of a complete transmural ablation line across cavotricuspid region to achieve bidirectional conduction block. Irrigated tip catheters facilitate rapid achievement of this block by creation larger and deeper lesions. The EASTHER registry was organized to collect data about the efficacy of the procedure in small and middle volume centres in Central and Eastern Europe, all using THERMOCOOL catheter technology. METHODS: Easther is a prospective registry (April 2002-February 2003). 133 consecutive patients (81.1% male, age 59.0 +/- 10.4 years, range 30-81 years) with common atrial flutter were enrolled. Coincidence with atypical flutter was observed in 2.7%. Patients had a history of flutter of 31.0 +/- 53.6 month (range 1-403) and concomitant atrial fibrillation was observed in 42.9%. Structural heart disease was present in 38.9%. Amount of re-ablated cases was 14%. RF energy was applied during 60 sec in power-controlled mode at a setting between 40 to 50 W with an average flow rate of 19.0 ml/min. RESULTS: Acute success rate defined as bi-directional block was achieved in 93.1%, although 94.7% of cases were assessed successful by the treating electrophysiologist. Average number of RF applications was 12.0 +/- 7.0 (range 2-40) per procedure. Average delivered power varied between a minimum of 36.1 +/- 15.1 W till a maximum of 45.3 +/- 13.0 W, while the average maximum temperature observed at the same time was varied between 39.0 +/- 3.4 degrees C and 45.4 +/- 4.0 degrees C. Total procedure time was 100.1 +/- 42.7 min (range 20-280 min) and fluoroscopy time was 15.8 +/- 9.6 min (range 4-45 min). In comparable French TC registry Average total and fluoroscopy time were 46.4 +/- 33.6 min, and 10.0 +/- 6.8 min resp. In the Middle European centres total and fluoroscopy time was 96.1 +/- 40.9 min, and 15.0 +/- 8.9 min resp. In centres from Eastern Europe it was 120.3 +/- 51.2 min, and 20.4 +/- 11.9 min resp. Two adverse events were reported. Both patients had strong chest pain during ablation. These results are comparable with the literature data published. CONCLUSIONS: Irrigated tip catheters are effective and safe in ablation of common atrial flutter. This technology helps to accelerate and facilitate achievement of bi-directional isthmus block. Most of procedures were terminated to one hour in experienced centers in France as early as 2002. Procedures not exceeding one hour are feasible in case of spreading this method as method of first choice with gaining of experiences in centres of Middle and Eastern Europe.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• elektrokardiografie MeSH
• flutter síní diagnóza   chirurgie   MeSH
• katetrizační ablace * přístrojové vybavení   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• multicentrická studie MeSH

GOAL: To make out a methodology and assessment of peripheral microcirculation with laser Doppler flowmetry (LDF) in patients with type I diabetes mellitus and to compare their results to findings in healthy control people using frequency analyses. METHODOLOGY: A group of 32 patients suffering from type I diabetes on an average for 14 years (group A) has been examined. The patients suffered from a basic angiology disorder in arteries of lower extremities. Peripheral circulation in lower extremities has been examined via laser Doppler flowmetry. The same tests have been done in a group of 40 healthy people (group B). RESULTS: Basic evaluation revealed no statistical differences between groups A and B at rest (TO). Significant differences showed up during vasodilation test (T2). Intensity of perfusion in group A was 37 +/- 23 arbitrary perfusion units (PU) compared to 81 +/- 43 PU in group B (p < 0.001). During perfusion following ischemisation (T1) levels of blood circulation in groups A and B were 71 +/- 39 PU compared to 121 +/- 89 PU (p < 0.018). During frequency analyses the intensity of slow vasomotion (SV) in group A was already generally lower at rest (TO) 0.46 +/- 0.42 PU compared to 1.12 +/- 0.62 PU (p < 0.011) in group B. During the reperfusion phase following ischemisation (T1) intensity of SV was 1.8 +/- 0.78 PU compared to 2.82 +/- 1.58 (p < 0.17). Following vasodilation test (T2) perfusion was 0.79 +/- 0.65 PU compared to 1.86 +/- 1.31 (p < 0.009). In areas of fast vasomotion (FV; frequency 0.210 - 0.420 Hz) there were significant differences between group A and B at rest (TO) and during vasodilation test (T2). At rest 0.08 +/- 0.02 PU compared to 0.19 +/- 0.05 PU (p < 0.006). During vasodilation test 0.14 +/- 0.03 PU compared to 0.28 +/- 0.11 PU (p < 0.004). CONCLUSION: This study presents an original examination protocol and findings. Significant differences were identified in peripheral circulation of patients suffering from solely type I diabetes mellitus and control people. So called spontaneous venous reactivity (vasomotion) was in type I diabetics significantly lower already at rest and especially in reaction to vasodilation stimulus. The differences can't be still clearly explained but there is a suspicion they are a result of an impaired endotelial and autonomous function in type I diabetes mellitus. The method of frequency analyses of LDF records enables to give precision to peripheral blood circulation evaluation. It could be used to detect early changes in blood circulation as early as at rest.

• MeSH
• bérec krevní zásobení   MeSH
• diabetes mellitus 1. typu patofyziologie   MeSH
• diabetické angiopatie diagnóza   MeSH
• dospělí MeSH
• laser doppler flowmetrie * MeSH
• lidé MeSH
• mikrocirkulace patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH