In a group of 26 patients with AIM the CKMB value was raised above the discrimination level already on admission--on average 2.7 +/- 1.4 hours after development of ischaemic pain--in 46% patients. The maximal value of CKMB mass was achieved in the group with probable reperfusion 12.1 +/- 3.8 hours after the development of ischaemic pain and this value was elevated in relation to the discrimination value 41.5 +/- 17x and in relation to the so-called basal value 145 +/- 117x. In the group without probable reperfusion the maximal value was achieved significantly later, after 19.8 +/- hours and was elevated in relation to the discrimination value 31 +/- 17x and in relation to the final value 84 +/- 42 times. The value of CKMB mass increased above the discrimination limit from the onset of ischaemic pain after 4.0 +/- 1.5 and after 5.7 +/- 3 hours in the group with probable and without probable reperfusion and declined below the discrimination limit after 00 +/- 60 and 119 +/- 98.0 hours in the same groups. On comparison of CK, CKBM, CKBM mass and troponin T on admission the CKMB mass value was elevated in 46% patients, the value of CK in 23%, of CKMB in 27% and the troponin T value in 96% patients. With regard to the assembled experience that haemolytic serum raises false troponin T values, the percentage of elevated troponin T values on admission declines from the original 96% to 81% when all haemolytic samples are eliminated. The time of reaching maximal values of CKMB mass in patients with AIM and probable reperfusion was significantly shorter than in CK values and is similar as in CKMB values. The time taken to raise the CKBMB mass value above the discrimination value is significantly shorter than the time taken by CK levels, but significantly longer than the time before troponin T levels are raised. The time of total elevation of CKMB mass levels above the discrimination limit does not differ from the time taken to raise CK values, it is however shorter than the increase of troponin T values, although the exact time of persistence of raised levels of troponin T was not assessed in our work. The time of increase above and decrease below the discrimination limit was not assessed in CKMB values. Based on mutual comparison of the impact of indicators for assessment of the diagnosis of ischaemic heart attacks the authors consider it best regardless of financial costs--to assess troponin T, possibly along with levels of CKMB mass.
- MeSH
- biologické markery krev MeSH
- infarkt myokardu diagnóza farmakoterapie MeSH
- izoenzymy MeSH
- kreatinkinasa krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- reperfuzní poškození myokardu diagnóza MeSH
- trombolytická terapie * MeSH
- troponin T MeSH
- troponin krev 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
- Názvy látek
- biologické markery MeSH
- izoenzymy MeSH
- kreatinkinasa MeSH
- troponin T MeSH
- troponin MeSH
The objective of the presentation was to assess changes of the troponin T level--a very sensitive indicator of cardiac muscle damage--in patients with acute myocardial infarction treated by fibrinolysis, and to assess differences in troponin T levels between patients with successful reperfusion and without reperfusion. The troponin T level was examined in 28 patients with acute myocardial infarction (AIM), incl. 22 (78.6%) where probably reperfusion occurred, as concluded from a maximal increase of CPK and CPK MB values within 12 hours. In six patients with a later rise of enzyme values treatment was considered as probably unsuccessful. In both groups of patients troponin T values increased, particularly markedly in the group with probable reperfusion, starting from the 3rd to the 18th hour after the onset of treatment, when the differences in troponin values between the two groups were statistically significant at the 1% and 1% level of significance. An early rise of the troponin T level suggests more rapid release of so-called free cytoplasmic troponin T in patients with successful reperfusion. From the 54th hour there is a statistically insignificant rise of troponin T level in the group of patients without probable reperfusion and it suggests a more marked release of so-called structurally linked troponin T in patients where reperfusion was not achieved. Consistent with these results, the mean maximal value of troponin T during the period of 3-24 hours after the onset of treatment is 2.37 times higher than a corresponding value during the period of 60-108 hours in the group with probable reperfusion and conversely in the group without probable reperfusion the troponin T value is 1.2 times higher during the period 60-108 hours after the onset of treatment.
- MeSH
- biologické markery krev MeSH
- infarkt myokardu krev diagnóza farmakoterapie MeSH
- izoenzymy MeSH
- kreatinkinasa krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- trombolytická terapie * MeSH
- troponin T MeSH
- troponin krev MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- biologické markery MeSH
- izoenzymy MeSH
- kreatinkinasa MeSH
- troponin T MeSH
- troponin MeSH
Based on data in the literature and his own clinical experience the author submits a historical reminiscence of the nowadays already obsolete indication of methylfenidat in the treatment of acute drug intoxications. Methylfenidat, being a central stimulant, reduces and alleviates quantitative disorders of consciousness or prevents a relapse of unconsciousness in acute drug intoxications. Even when large doses are administered by the parenteral route, it is very safe. The author recommends therefore to workers in anaesthesiology and resuscitation departments to test methylfenidate in this indication and include it again in the comprehensive treatment of acute drug intoxications. A prerequisite is the registration of RITALIN amp. à 20 mg of Ciba Geigy (British branch) in Czech Republic.
- MeSH
- antipsychotika otrava MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- methylfenidát terapeutické užití MeSH
- otrava farmakoterapie MeSH
- stimulanty centrálního nervového systému terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Názvy látek
- antipsychotika MeSH
- methylfenidát MeSH
- stimulanty centrálního nervového systému MeSH
In a 43-year-old patient with Ebstein's anomaly and a history of acute myocardial infarction by means of duplex ultrasonography and aortography the diagnosis of thrombotic occlusion of the a aorta was established, starting above the insertion of the renal arteries and reaching as far as the bifurcation of the aorta and the common iliac arteries. In the clinical picture dominated complete anuria with uraemia and marked hyperkaliaemia as a result of ischaemic affection of the extremities due to thrombosis of the aorta; at the onset of hospitalization also left ventricular failure with hyperhydration and later also signs of the hyperviscous syndrome. The latter developed after repeated haemofiltrations which led to a rise of the originally high haemoglobin and haemotocrit values a result of a righ-left shunt in Ebstein's anomaly. After improvement of the clinical condition local fibrinolytic treatment of the aortal thrombosis with urokinase (total dose 2,160,000 u. administered within 24 hours) was provided. The thrombus with a total length of 13.5 cm was dissolved except for a residual portion of 10 mm located in the area of insertion of the right renal artery. After dissolution of the thrombus it proved possible to restore the blood flow into the left kidney a and lower extremities, but not into the right kidney because of the residual thrombus. Seventy-two hours after terminated fibrinolysis - and after 31 days of anuria - the diuresis was restored and after a polyuric stage normalization of mineral, urea levels was restored and the creatinine value was slightly above the upper normal range. Concurrently with fibrinolytic therapy angioplasty of the aorta was carried out and a stent was placed on the left iliac artery. The clinical condition of the patient was improving, the patient started to mount stairs. Death occurred suddenly and the cause was cardiac failure due to very serious congenital heart disease.
- MeSH
- aktivátor plasminogenu urokinasového typu terapeutické užití MeSH
- aorta abdominalis MeSH
- dospělí MeSH
- Ebsteinova anomálie komplikace MeSH
- lidé MeSH
- nemoci aorty komplikace farmakoterapie MeSH
- obstrukce renální arterie farmakoterapie MeSH
- trombolytická terapie * MeSH
- trombóza komplikace farmakoterapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- aktivátor plasminogenu urokinasového typu MeSH
A 26-year-old patient with an irrelevant personal and family-history was treated on account of attacks of relapsing ventricular tachycardia and cardiac failure, mostly dextrolateral. After ruling out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, out other possible causes of the disease--such as embolism of the lungs, ischaemic heart disease, Ebstein's anomaly, the diagnosis of an arrhythmogenic right ventricle was established. This disease is suggested by negative T waves in the thoracic leads V1-V3 during sinus rhythm and by the shape of the QRS complex which was the type found in block of the Tawara branch with an axis of + 100 degrees during attacks of ventricular tachycardia. Moreover, ventricular tachycardia of the same type was produced during electrocardiographic examination. On angiographic examination ARVD is suggested by marked trabeculization and impaired kinetics of the outflow tract of the right ventricle. In the prevention of relapses of ventricular tachycardia beta-blockers and Cordarone were successful when used simultaneously with cardiac stimulation type AAI applied on account of a confirmed sinoatrial block.
The author explains in detail new legal regulations on admission to and detention in health institutions of citizens of the Czech Republic, as applied to people with mental disorders. The author describes three stages of implementation as regards admission of a person to a psychiatric in-patient department, i.e. prerequisites for involuntary psychiatric hospitalization, the stage of the intervention and the stage of admission to and detention in a psychiatric in-patient department. Attention is drawn to the fact that in the legal regulations are some inaccuracies and that practical implementation of involuntary hospitalization of the mentally sick is associated with some difficulties. It is recommended that after evaluation of experience with the implementation of the new regulations which are valid since Jan. 1, 1992 some of the regulations should be amended.
- MeSH
- lidé MeSH
- ochrana zájmů pacientů zákonodárství a právo MeSH
- odmítnutí terapie pacientem zákonodárství a právo MeSH
- zodpovědnost duševně nemocného zákonodárství a právo MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- behaviorální lékařství výchova MeSH
- psychosomatické lékařství výchova MeSH
- studium lékařství specializační postgraduální * MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
The preparation Actilyse--a tissue plasminogen activator prepared by recombination--is an effective fibrinolytic drug. The authors recorded in a group of 33 patients reperfusion in 91%, evaluated on the basis of indirect criteria. In a group of 18 patients treated with streptokinase reperfusion was achieved in 74%. Based on changes of CK and CK-MB values--an earlier rise of values following Actilyse administration and conversely their more marked increase during subsequent sampling after streptokinase administration--it may be assumed that earlier dissolution of the thrombus in the coronary artery occurs after Actilyse administration, as compared with streptokinase. It may be thus assumed that there is also a smaller necrotic focus after Actilyse treatment, as compared with streptokinase. Early re-occlusion--according to indirect indicators--occurred in 8.6% in the Actilyse treated groups, as compared with 5.9% in the streptokinase treated group. The fibrinogen values decline in the Actilyse group to 40% and in the streptokinase group to 28%. Later enhanced new formation of fibrinogen occurs and the fibrinogen values rise to 160% in the Actilyse treated group and to 250% of the initial value in the streptokinase treated group. The elevated fibrinogen value, as compared with the baseline value, persists for the 12 days of the follow-up. No severe spontaneous haemorrhage was recorded, haemorrhagic manifestations were associated with blood sampling and i.v. administration of drugs only. The necessity to administer blood was due to a complication during puncture of the subclavian vein in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
- MeSH
- infarkt myokardu farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- rekombinantní proteiny MeSH
- senioři MeSH
- streptokinasa terapeutické užití MeSH
- tkáňový aktivátor plazminogenu terapeutické užití MeSH
- trombolytická terapie * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
- Názvy látek
- rekombinantní proteiny MeSH
- streptokinasa MeSH
- tkáňový aktivátor plazminogenu MeSH
The author describes in detail the activities of the psychosomatic section of the Psychiatric Society of the Czech Medical Society since its foundation in 1975 from the theoretical, organizational, research and teaching aspects. The aim of this section is above all to enforce the psychosomatic approach and bio-psychosocial model of disease in the Czechoslovak health services. The society developed its activities according to interdisciplinary principles. The perspectives of development of psychosomatic care in Czechoslovakia in the next future are in particular: 1. further enforcement of the psychosomatic approach to patients and the bio-psychosocial model of disease in clinical practice and theory; 2. development of so-called consultation-liaison psychiatry according to the concept of Z. J. Lipowski on the basis of nonpsychiatric disciplines and creation of further psychosomatic in- and out-patient units and departments, in particularly at the primary health care level; 3. further development of postgraduate and initiation of undergraduate teaching of psychosomatic and behavioural medicine; 4. development of research, in particular by the method of controlled clinical trials and prospective studies; 5. extension of possibilities to publish work and of international collaboration.
- MeSH
- dějiny 20. století MeSH
- lidé MeSH
- psychiatrie dějiny MeSH
- psychosomatické poruchy dějiny MeSH
- společnosti lékařské dějiny MeSH
- Check Tag
- dějiny 20. století MeSH
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- historické články MeSH
- Geografické názvy
- Československo MeSH
The authors describe the course of the disease in a 28-year-old woman who suffered two years following surgery of breast cancer from rapidly deteriorating dyspnoea, syncopes and laboratory manifestations of global respiratory insufficiency. The finding on auscultation of the lungs was normal, pulmonary angiography did not reveal signs of serious pulmonary embolization. The patient died after ten days in hospital despite comprehensive therapy and artificial ventilation. Necropsy revealed multiple microembolizations of tumourous cells into the pulmonary vessels as the main causes of the disease. Concurrently infiltration of the bone marrow by tumourous cells was revealed. The course of the disease was complicated by impaired haemocoagulation as a result of microangiopathic haemolytic anaemia and disseminated intravascular coagulation during the passage of erythrocytes through the pathologically altered pulmonary capillaries and impaired liver function.
- MeSH
- diseminovaná intravaskulární koagulace etiologie MeSH
- dospělí MeSH
- dyspnoe etiologie MeSH
- hemolytické anemie etiologie MeSH
- lidé MeSH
- nádorové cirkulující buňky * MeSH
- nádory prsu patologie MeSH
- plíce patologie MeSH
- synkopa etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
