RATIONALE & OBJECTIVE: Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. STUDY DESIGN: Prospective observational cohort study. SETTING & PARTICIPANTS: 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. PREDICTOR: Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. OUTCOME: Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. ANALYTICAL APPROACH: Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. RESULTS: During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001). LIMITATIONS: Clinical rather than population-based data. CONCLUSIONS: CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.

• Klíčová slova
• Pediatric dialysis, access dysfunction, access infection, access revision, adolescents, arteriovenous fistula (AVF), arteriovenous graft (AVG), central venous catheter (CVC), children, end-stage renal disease (ESRD), long-term hemodialysis, registry data, vascular access,
• MeSH
• arteriovenózní zkrat * škodlivé účinky   MeSH
• cévní protézy * škodlivé účinky   MeSH
• dialýza ledvin škodlivé účinky   metody   MeSH
• dítě MeSH
• internacionalita MeSH
• katetrizace centrálních vén * škodlivé účinky   MeSH
• klinické rozhodování MeSH
• lidé MeSH
• mladiství MeSH
• prospektivní studie MeSH
• registrace MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

AIMS: This retrospective study evaluates early and midterm results in patients with severe left ventricular dysfunction. TECHNIQUE: Ninety-seven consecutive patients with coronary artery disease and ejection fraction of left ventricle (LVEF) less or equal to 25 % underwent elective coronary artery bypass graft procedure between September 1998 and December 2001. Mean age at operation was 66 (47-86) years. The main symptoms were angina class III-IV Canadian Cardiovascular Society (CCS) in 78 patients (80 %) and dyspnoea class III-IV New York Heart Association (NYHA) in 43 patients (44 %). The major indications for surgery were severe angina, dyspnoea in 90 patients (93 %). Cardiac index (CI), echocardiography (ECHO), planimetry, end-diastolic pressure of left ventricle (LVEDP), end-diastolic diameter of left ventricle (LVEDd) were used to access left ventricular function preoperatively. ECHO was also used to access left ventricular function postoperatively. RESULTS: Early postoperative (30 days) mortality was 4.1 %. Complications had 25 patients (26 %) postoperatively. Two years survival was 95.7 %. Class III-IV CCS and/or NYHA had 17 patients (17.5 %) two years after surgery. LVEF (assessed by ECHO) improved from 23.1 % preoperatively to 36.0 % postoperatively (p < 0.05). CONCLUSION: The study showed that elective myocardial revascularisation in patients with severe left ventricular dysfunction and signs of myocardial viability is not necessarily associated with high operative mortality. It can be performed safely with respectable midterm survival in concordance with left ventricular function improvement, symptom relief and quality of life improvement.

• MeSH
• dysfunkce levé srdeční komory komplikace   patofyziologie   MeSH
• koronární bypass * MeSH
• koronární nemoc komplikace   mortalita   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• pooperační komplikace MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Access dysfunction presents a risk for haemodialysis patients and is costly for health care providers. Regular vascular access quality (VAQ) monitoring enables the detection of adverse access conditions early allowing timely interventions, which will presumably be less invasive, more successful and cheaper. This paper reviews all currently used assessment parameters: dynamic and static pressures, recirculation and blood flow through the access--and analyses pros and cons of each of them. Based on this overview it is concluded that access flow monitoring should be the method of choice, possibly combined with monitoring of another parameter to further enlarge diagnostic possibilities of the monitoring. The VAQ monitoring system developed and used currently in the author's dialysis centre is briefly described as an example. The issue of access flow related to haemodynamics is briefly mentioned. With the introduction of any VAQ monitoring system, one has to acknowledge a change in structure of interventions and that the demand for surgical procedures decreases with a concurrent increase in percutaneous interventions.

• MeSH
• arteriovenózní zkrat škodlivé účinky   normy   MeSH
• dialýza ledvin přístrojové vybavení   normy   MeSH
• hodnocení rizik metody   MeSH
• krevní tlak MeSH
• laser doppler flowmetrie MeSH
• lidé MeSH
• monitorování fyziologických funkcí metody   normy   MeSH
• okluze cévního štěpu MeSH
• rizikové faktory MeSH
• rychlost toku krve MeSH
• selhání zařízení MeSH
• ukazatele kvality zdravotní péče MeSH
• zajištění kvality zdravotní péče metody   normy   MeSH
• zaváděcí katétry škodlivé účinky   normy   MeSH
• zdravotnické služby - potřeby a požadavky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Chronic heart failure is very common in hemodialyzed patients due to several factors such as intermittent volume overload, anemia, and hypertension. Dialysis access flow is usually considered to have a minor effect. We hypothesized that creation of dialysis access with "normal" flow would lead to elevation of B-type natriuretic peptide (BNP), which is a sensitive marker of heart failure. METHODS: We included subjects with a newly created, well-functioning vascular access and normal left ventricular ejection fraction. They were examined before access creation (baseline), then again 6 weeks and 6 months after the surgery. Only subjects with access flow (Qa) < 1500 ml/min were included. Changes of BNP levels and their relation to access flow were studied. RESULTS: We examined 35 subjects aged 60.6 +/- 13.5 years. Qa was 789 +/- 361 and 823 +/- 313 ml/min at 6 weeks and 6 months after the surgery, respectively. Within 6 weeks after access creation, BNP rose from 217 (294) to 267 (550) ng/l (median (quartile range)) with P = 0.003. Qa was significantly related to BNP levels 6 weeks after access creation (r = 0.37, P = 0.036). Six months after access creation, there was only a trend of BNP decrease (235 (308) ng/l, P = 0.44). Creatinine, blood urea nitrogen and hemoglobin levels as well as patients' weight did not change significantly. CONCLUSIONS: Creation of dialysis access with "normal" flow volume leads to significant increase of BNP, which is related to the value of access flow. The increase of BNP probably mirrors worsening of clinically silent heart failure.

• MeSH
• analýza rozptylu MeSH
• arteriovenózní zkrat * MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• chronické selhání ledvin krev   terapie   MeSH
• dialýza ledvin škodlivé účinky   metody   MeSH
• dysfunkce levé srdeční komory krev   etiologie   patofyziologie   MeSH
• hodnocení rizik MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• natriuretický peptid typu B analýza   krev   MeSH
• normální rozdělení MeSH
• progrese nemoci MeSH
• regresní analýza MeSH
• renální oběh fyziologie   MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• srdeční selhání krev   etiologie   patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery MeSH
• natriuretický peptid typu B MeSH

Hemodialysed patients with end stage renal disease are reliant to proper function of vascular access - mostly arterio-venous fistula (AVF). AVF patency is jeopardized by stenosis formation, which needs to be treated before thrombosis. Angioplasty is primarily indicated and prolongs vascular access patency. High pressure balloons and cutting balloons aid to high technical success rate. Angioplasty needs to be repeated in order to maintain long term patency. Drug-eluting balloons prolong long term patency. Stents and stentgrafts are seldom used in inoperable patients and in selected locations. Technical advances allowed endovascular treatment in AVF thrombosis followed by angioplasty of culprit lesion. Vascular access endovascular occlusion is alternative for surgery in inoperable patients. In patients with residual renal function or iodine allergy, intervention could be ultrasound guided or carbon dioxide could be used without the need of iodine contrast.

• Klíčová slova
• Angioplasty, arterio-venous fistula stenosis, central venous stenosis, dialysis, endovascular therapy, endovascular treatment, hemodialysis,
• MeSH
• angioplastika MeSH
• arteriovenózní zkrat * škodlivé účinky   MeSH
• balónková angioplastika * MeSH
• dialýza ledvin MeSH
• lidé MeSH
• průchodnost cév MeSH
• retrospektivní studie MeSH
• stenty MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Stenoses of vascular accesses are leading factors limiting access survival. Besides physical examination, screening of access stenoses is based mainly on the "dysfunction hypothesis", which states that progressive stenosis causes graft dysfunction, such as decreased flow. We tested whether Doppler ultrasonography could detect a number of clinically hidden access stenoses in otherwise well-managed patients. Indications from clinical evaluation regarding the presence of stenosis were compared with ultrasound findings. METHODS: We made 258 examinations in 193 patients. Whole-length morphological ultrasound examinations of vascular access were done with a 7.5 MHz linear array transducer. The combination of > 50% stenosis in B-mode and at least doubling of peak systolic velocity was the criterion for significant stenosis. We compared the specificity and sensitivity of clinical diagnosis or ultrasound. RESULTS: The sensitivity and specificity of the clinical diagnosis of stenosis were 35.8% and 92.8%, respectively. CONCLUSIONS: A considerable number of otherwise appropriately managed hemodialysis patients suffer from significant access stenosis. Wider use of Doppler ultrasonography would increase the proportion of clinically hidden stenoses diagnosed in time and thus might prolong access patency. Clinical suspicion of access stenosis is highly specific and such patients should be examined directly by angiography.

• MeSH
• chronické selhání ledvin terapie   MeSH
• dialýza ledvin metody   MeSH
• dospělí MeSH
• hodnocení rizik MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• prospektivní studie MeSH
• průchodnost cév MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• stenóza diagnostické zobrazování   MeSH
• stupeň závažnosti nemoci MeSH
• ultrasonografie dopplerovská metody   MeSH
• zaváděcí katétry * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

OBJECTIVE: Health care for lesbian women, especially care within the competence of the gynecologist, general practitioner and sexologist, at first glance no different from heterosexual women care about, and in many issues this is really true. But there are a few specifics that differentiate this minority group. If the doctor realizes these specifics, he can offer a better care about the health of their patients and possibly also focus on the prevention of various diseases targeted prevention. This article points out the various specifics and their importance in the care of minority lesbian and bisexual women. DESIGN: Review article. SETTING: Centrum Medical s.r.o., Andrology and Sexology Clinic, Olomouc. METHODS: Analysis of literature review and our own experience dealing with differences of health care for lesbian women. CONCLUSION: Although physiologically and anatomical-ly lesbian, bisexual and heterosexual women are the same, studies show that certain diseases or risk in the population of lesbians and bisexual women are more prevalent and hence the need to particularly focus on preventive care for certain specifics.

• Klíčová slova
• gynecological diseases, health care, homophobia, lesbian, preventive care., sexual dysfunction,
• MeSH
• dospělí MeSH
• dostupnost zdravotnických služeb * MeSH
• homosexualita ženská * MeSH
• lidé MeSH
• zdravotnické služby pro ženy MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

• Klíčová slova
• Adult ADHD, Diagnosis, EPA, European Network Adult ADHD, Treatment, Updated European Consensus Statement,
• MeSH
• dospělí MeSH
• dostupnost zdravotnických služeb normy   MeSH
• hyperkinetická porucha diagnóza   terapie   MeSH
• konsensus * MeSH
• lidé MeSH
• prevalence MeSH
• psychoterapie metody   MeSH
• směrnice pro lékařskou praxi jako téma normy   MeSH
• stimulanty centrálního nervového systému terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• stimulanty centrálního nervového systému MeSH

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation can be vital to support patients in severe or rapidly progressing cardiogenic shock. In cases of left ventricular distension, left ventricular decompression during veno-arterial extracorporeal membrane oxygenation may be a crucial factor influencing the patient outcome. Application of a double lumen arterial cannula for a left ventricular unloading is an alternative, straightforward method for left ventricular decompression during extracorporeal membrane oxygenation in a veno-arterial configuration. OBJECTIVES: The purpose of this article is to use a mathematical model of the human adult cardiovascular system to analyze the left ventricular function of a patient in cardiogenic shock supported by veno-arterial extracorporeal membrane oxygenation with and without the application of left ventricular unloading using a novel double lumen arterial cannula. METHODS: A lumped model of cardiovascular system hydraulics has been coupled with models of non-pulsatile veno-arterial extracorporeal membrane oxygenation, a standard venous cannula, and a drainage lumen of a double lumen arterial cannula. Cardiogenic shock has been induced by decreasing left ventricular contractility to 10% of baseline normal value. RESULTS: The simulation results indicate that applying double lumen arterial cannula during veno-arterial extracorporeal membrane oxygenation is associated with reduction of left ventricular end-systolic volume, end-diastolic volume, end-systolic pressure, and end-diastolic pressure. CONCLUSIONS: A double lumen arterial cannula is a viable alternative less invasive method for left ventricular decompression during veno-arterial extracorporeal membrane oxygenation. However, to allow for satisfactory extracorporeal membrane oxygenation flow, the cannula design has to be revisited.

• Klíčová slova
• Extracorporeal membrane oxygenation, cannula, circulation, double lumen cannula, model, modelica,
• MeSH
• chirurgická dekomprese přístrojové vybavení   metody   MeSH
• design vybavení metody   MeSH
• dospělí MeSH
• dysfunkce levé srdeční komory chirurgie   MeSH
• kanyla * MeSH
• kardiogenní šok * patofyziologie   chirurgie   MeSH
• katetrizace centrálních vén přístrojové vybavení   metody   MeSH
• katetrizace metody   MeSH
• lidé MeSH
• mimotělní membránová oxygenace * přístrojové vybavení   metody   MeSH
• počítačová simulace MeSH
• reprodukovatelnost výsledků MeSH
• srdeční komory patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted. METHODS: The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n=421) or immediate transport for primary percutaneous coronary intervention (PCI group, n=429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0-3 h and 3-12 h after symptom onset. Maximum transport distance was 120 km. RESULTS: Five complications (1.2%) occurred during the transport. Randomization-balloon time in the PCI group was 97+/-27 min, and randomization-needle time in the TL group was 12+/-10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P=0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n=551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003). CONCLUSIONS: Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.

• MeSH
• analýza přežití MeSH
• balónková koronární angioplastika metody   MeSH
• časové faktory MeSH
• délka pobytu MeSH
• dysfunkce levé srdeční komory etiologie   MeSH
• fyzikální vyšetření metody   MeSH
• infarkt myokardu mortalita   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• odborná praxe MeSH
• transport pacientů metody   MeSH
• trombolytická terapie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH