In hardly any other field of treatment of a chronic disease more evident progress can be seen than in the therapy of hearth failure. Till the end of eighties of the previous century we were not able to influence the adverse development of the disease. With the critical prognosis, chronic heart disease represents more serious case than majority of tumours. In the meantime the only approach to decrease mortality has been modulation of the maladaptively activated regulatory mechanisms--the rennin, angiotensin, aldosteron axis and the sympatoadrenal system. During the previous decades we became witnesses of the development of new pharmacologic approaches aimed at the heart failure: New inotropics (e.g. lavosimendan and pomobendan) have been introduced, effects of anti-arrhythmiatics (amiodaron, dronedaron and others) and metabolically active drugs (trimetazidine, ranolazine and others) has been tested as well as methods decreasing fluid retention (aquaarretics) has been used. It is too early to conclude that such ethiopathogenetical approach can decrease mortality or morbidity. Along with the advance of new possibilities to interfere directly with the pathogenesis of the heart failure, approaches aimed at the treatment of deteriorating processes have been developing: prothrombotic state, atherogenesis or complications of anaemia.
- MeSH
- lidé MeSH
- srdeční selhání komplikace farmakoterapie patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
Pyogenic liver abscesses are caused by appendicitis in less than 10%. Also the ascending septic inflammation of portal vein (pylephlebitis) could be a serious complication of intra-abdominal infection. Although pylephlebitis is not frequent today, its' mortality and morbidity rates remain high. We describe a case of young man with fever, abdominal pain, and multiple hepatic abscesses. After the symptomatic relief due to antibiotic therapy the pain returned as a result of the development of portal and mesenteric vein thrombosis. The cause of either hepatic abscesses or thrombosis was not clear at the time of dismissal. 2 months later the patient underwent acute abdominal revision with appendectomy for acute phlegmonous and gangrenous appendicitis. Since that time he has been without any clinical symptoms.
- MeSH
- absces jater komplikace diagnóza MeSH
- akutní bolest břicha etiologie MeSH
- apendicitida komplikace MeSH
- dospělí MeSH
- lidé MeSH
- mezenteriální cévní okluze komplikace MeSH
- vena mesenterica MeSH
- vena portae * MeSH
- žilní trombóza komplikace diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
Atherosclerosis and its complications represent the most frequent cause of death in the developed countries. Pathophysiology of the atherosclerosis development has been described in details. Much less is known what is the extent of reversibility of pathophysiological changes. Several angiographic studies have proved that statin administration can slow down the progression of the coronary arteries atherosclerosis. However, only intravascular ultrasound analysis is able to give a detailed description of atherosclerotic plaque development during the treatment with statins. Studies have shown apparent stagnation of atherosclerosis progression and in voluminous plaques also signs of regression. Beside changes in the size of atherosclerotic plaques, alteration in their chemical composition was described. During the treatment with statins, amount of lipids in plaque decreases, which indicates the stabilisation of plaques. Plaques are less prone to a rupture and to the subsequent development of an acute coronary syndrome. Beside statins, which influence namely LDL cholesterol, attention is given to drugs enabling to elevate HDL cholesterol level, because it is the way in which cholesterol is transported from tissues back to the liver. It appears that elevation of HDL cholesterol level could bring about more effective regression of atherosclerotic plaques and together with stagnation of the plaque progression it can significantly improve the conservative methods in the treatment of atherosclerotic disease of the coronary and peripheral arterial system.
- MeSH
- arterioskleróza diagnostické zobrazování farmakoterapie patologie MeSH
- cévy diagnostické zobrazování patologie MeSH
- intervenční ultrasonografie MeSH
- lidé MeSH
- prognóza MeSH
- statiny terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- statiny MeSH
Remodelling of the left ventricle after myocardial infarction is a major cause of the heart failure development with possible death. Despite application of pharmacological, catheter and surgical interventions and the use of new mechanical devices, the myocardium lost during myocardial infarction cannot be regenerated. Implantation of bone-marrow stem cells into the heart might be a new method to restore myocardial viability. In animal experiments, attempts to replace fibrotic zone by transplanting stem cells have regularly succeeded in reconstituting myocardial structure--cardiomyocytes and capillary vessels. Repair of myocardium using bone-marrow derived multipotent stem cells was shown in experimental and in the first few clinical studies. Current status of our knowledge about the use of stem cells in the myocardial regeneration is described in this article, as well as the cautions, which are necessary during early period of this mode of treatment in humans.
- MeSH
- infarkt myokardu terapie MeSH
- lidé MeSH
- myokard cytologie MeSH
- regenerace * MeSH
- transplantace kmenových buněk * MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
Direct PTCA is a treatment of choice in patients with acute myocardial infarction with ST segment elevations (STEMI). Fibrinolysis remains important modality of treatment in these patients. Currently, there are more then 100 tissue plasminogen activator mutants available with different fibrin specificity. In a clinical practice, tissue-type plasminogen activator (t-PA), recombinant tissue-type plasminogen activator (rt-PA), tenecteplase (TNK-tPA) and lanoteplase (n-PA) are most important examples. Fibrinolytic treatment in STEMI patients should be used in patients presenting in first 4 hours after beginning of chest pain, when it is sure, that direct PTCA cannot be started within next 90 minutes. Concomittant therapy of acute STEMI patients consists of anticoagulans, antiplatelet and antiagregatory treatment.
- MeSH
- aktivátory plazminogenu terapeutické užití MeSH
- infarkt myokardu farmakoterapie MeSH
- kontraindikace MeSH
- lidé MeSH
- trombolytická terapie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- aktivátory plazminogenu MeSH
Subclinical hypothyroidism is comparatively frequent disorder with incidence between 3 to 7% in the general population; in females over 60 it can exceed 10%. There is no unequivocal view on the clinical significance of the syndrome; however, it may correspond with increased risk of atherosclerosis and its complications. Especially in elderly women, screening for subclinical hypothyroidism is recommended with possible hormone replacement according to given criteria. Decision about the therapy of subclinical hypothyroidism should be done together with cardiologist, psychiatrist or neurologist in order to correct possible clinical impacts and prevent further manifestations.
- MeSH
- arterioskleróza etiologie MeSH
- hypotyreóza komplikace diagnóza patofyziologie terapie MeSH
- kardiovaskulární nemoci etiologie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
Cardiogenic shock belongs to the most severe and immediately life-threatening complications of the acute myocardial infarction. Despite development of modern diagnostic and therapeutic methods the incidence and mortality of cardiogenic shock has not significantly declined in the past decades. Early reperfusion strategy with percutaneous revascularization has become a cornerstone of therapy. The complex approach to cardiogenic shock comprises pharmacological and mechanical hemodynamic support, ventilatory support utilizing new ventilator regimens, metabolic and renal support/replacement with continuous renal replacement therapies and psychological, eventually psychopharmacological support. All these measures enable prevention of the multiple organ failure syndrome development and positively influence high mortality of patients suffering from cardiogenic shock.
- MeSH
- kardiogenní šok diagnóza terapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
BACKGROUND: Primary coronary angioplasty (PTCA) has a beneficial effect on the immediate prognosis for patients with acute myocardial infarction. Number of information about effects of direct PTCA on the long-term prognosis are less numerous. The aim of the work was to establish the long-term prognosis for not-selected patients treated by direct PTCA. METHODS AND RESULTS: The studied group consisted of 279 patients with acute myocardial infarction treated by direct PTCA in years 1995 to 1999 for the period of 38 +/- 12 months. Part of them were out-door patients of our clinic. The necessary data of the other patients were obtained by a questionnaire and by a telephone contact. 45 (16%) patients were lost from the follow up. The mortality rate of the study group was compared with data in the central register of Czech Republic. Positive angiographic effect of the direct PTCA (residual stenosis < 50% + flow TIMI 3) was achieved in 90% of patients. 30-day mortality was 6.8%, after excluding patients with cardiogenic shock it decreased to 3.2%. 6 patients (2.2%) had non-fatal infarction within 30 days after the first attack. From 259 patients who survived the acute infarction phase 24 died during the next period of follow up, 18 (7%) patients had a relapse of non-fatal infarction. PTCA of the infarcted artery was done in 15% of patients, PTCA of another artery in 9% of patients. The aorthocoronary bypass was indicated in 6% of patients. Almost half of relapses occurred during the first year after the hospitalisation. The risk factors of the death during the follow up were the age > 70 years, ejection fraction < 35%, impairment of 3 or more coronary artery branches, i.m. in the history, duration of ischemia > 4 hours, and diabetes mellitus. The total mortality was 11.4% in the first year, 1.4% in the second and 3.3% in the third year of the follow up. CONCLUSIONS: The beneficial prognostic effect of the direct PTCA on patients with acute infarction carries through the whole period of follow up. Prognosis of the risk patients remains critical. Next revascularization of the infarcted artery was in our cohort of patients necessary in 21% of patients.
- MeSH
- balónková koronární angioplastika * škodlivé účinky MeSH
- infarkt myokardu terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- prognóza MeSH
- stenty MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
The article summarises present knowledge on the differences in the structure of atherosclerotic plaques in patients with stable angina pectoris and in those with acute coronary syndrome during intravascular ultrasound examination. Authors describe differences in the pathologic anatomy and also in the clinics. The review includes pictures of the typical structural features and references of papers with similar topics.
- MeSH
- akutní nemoc MeSH
- angina pectoris komplikace diagnostické zobrazování MeSH
- intervenční ultrasonografie * MeSH
- koronární cévy diagnostické zobrazování MeSH
- lidé MeSH
- nemoci koronárních tepen komplikace diagnostické zobrazování MeSH
- nestabilní angina pectoris diagnostické zobrazování MeSH
- syndrom MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- srovnávací studie MeSH
Interventional procedures are becoming increasingly popular in the treatment of impaired patency of deep venous system caused most often by extensive phlebothrombosis. Restoration of patency to affected venous segments while preserving the valvular function with a high degree of success in a relatively short period of time can be achieved by combination of endovascular methods such as catheter guided thrombolysis followed by percutaneous transluminal angioplasty and stenting. This approach enables not only the resolution of acute vascular complications but also the prevention of postthrombotic syndrome. This case report of a 52-year-old man with retroperitoneal fibrosis causing chronic compression of vena cava inferior further complicated by travelling associated bilateral ileofemoral thrombosis clearly demonstrates the wide ranging applications of the endovascular techniques.
- MeSH
- balónková angioplastika * MeSH
- lidé MeSH
- stenóza MeSH
- stenty * MeSH
- syndrom MeSH
- trombolytická terapie MeSH
- vena cava inferior patologie MeSH
- vena femoralis MeSH
- vena iliaca MeSH
- žilní trombóza komplikace terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
