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Biomedical subjects

F Polák

Publications and source records attributed to F Polák.

8 recordsLinked to original sources
PubMed2004

[Nutritional support of patients treated with continuous hemofiltration methods in intensive care units].

The use of continuous renal replacement therapy (CRRT) can directly or indirectly influence patient's metabolism and nutritional status. The loss of nutrients into the filtrate is significant. It concerns aminoacids, glucose, water-soluble vitamins, some minerals and trace elements. The loss of aminoacids is about 1.2 to 7.0 g per day. The glucose balance during CRRT depends on the concentration of glucose in substitution solutions. When concentration between 80 to 180 mg/dl is used, the glucose balance in most of patients is kept. The loss of lipids and lipid-soluble vitamins is neglectable. From the micronutrients, significant becomes the loss of magnesium, calcium, phosphorus and that of water-soluble vitamins (mainly B1, B6, C and folic acid). Contrary to it, some components can cross from the substitution solution to the blood (e.g. lactate). Indirect effect of CRRT on the nutrition and metabolism represents the release of cytokins and inflammatory mediators resulting from the first contact of the blood with the filter membrane. The decrease of glutamine level in the beginning of therapy is probably a consequence of this inflammatory reaction. Nutritional plan of most of patients treated with CRRT is therefore necessary to adjust.

Hemofiltration↗
PubMed2001

[Metabolic disorders in nonspecific inflammatory bowel diseases].

The primary function of the gastrointestinal system is to assist the intake and further processing of food and liquids. Besides that, it forms an anatomical barrier between the external environment and internal milieu. It is also highly important for its paracrine and endocrine function. Inflammatory bowel diseases, which frequently cause a gastrointestinal failure, form a specific group. Most frequently it is the ulcerative colitis and Crohn's disease. Impaired integrity of the gastrointestinal mucosa and failure of protective mechanisms lead to the increased permeability of the intestinal wall for antigens derived from food, saprophytic bacteria and pathogenic microorganisms. When the gastrointestinal failure is threatening, factors determining its residual function become more important. As decisive reveals the severity and location of the primary disease. Previous surgeries and adaptation of the residual part of the gastrointestinal system are important, as well as the possibility of peroral or enteral nutrient intake. Depending on the presence of risk factors and the degree of residual gut function, some complications can be expected: dehydration, mineral disorders, symptoms of protein and energy depletion, infection, and multiple organ dysfunction syndrome. It is highly important to decide whether the gastrointestinal system will be included into or excluded from the process of realimentation. Critically ill patients with inflammatory bowel diseases should be treated at an intensive care unit.

Deficiency Diseases↗
PubMed2001

[Nonvariceal acute upper digestive tract hemorrhage--therapeutic approach].

Nonvariceal acute upper gastrointestinal hemorrhage continues to be a frequent cause for hospital admission, consumes considerable financial resources and belongs to diagnoses associated with significant morbidity and mortality. Despite the progress in endoscopic and intensive care therapies the mortality remained unchanged. It results from the increasing number of high risk patients, namely the older ones with significant comorbidity. The cornerstone of therapeutical success is considered to be the adequate hemodynamic and ventilatory stability, initiation of pharmacotherapy with proton pump inhibitors and eventually somatostatin, and in particular, the early endoscopy using modern methods of hemostasis. In case of two unsuccessful endoscopic sessions the surgical approach is justified.

Acute Disease↗
PubMed2001

Idiopathic myelofibrosis complicated by portal hypertension treated with a transjugular intrahepatic portosystemic shunt (TIPS).

Idiopathic myelofibrosis may be accompanied by portal hypertension. The authors report a 56-year-old man with idiopathic myelofibrosis and splenomegaly complicated by hepatopathy, severe portal hypertension and recurrent variceal bleeding. A transjugular intrahepatic porto-systemic shunt (TIPS) was inserted. Variceal bleeding never recurred. A short episode of encephalopathy, which is a known complication of porto-systemic shunting, ceased promptly after conservative treatment. The patient eventually died six months later due to metabolic deterioration and hepatic failure related to his underlying hematological disease. TIPS is a promising treatment modality for alleviating symptomatic portal hypertension in hematological disorders.

Biopsy↗
PubMed2001

[Acute necrotizing pancreatitis].

Acute pancreatitis ranges from mild to severe necrotizing form complicated by multiorgan failure with high mortality rate. It has different causes, not entirely clear pathogenesis and unpredictable and variable course. Therapeutic measures are limited. The mainstay of therapy is supportive intensive care, prevention of sepsis and multiple organ failure and identification and treatment of infected pancreatic necrosis. Surgical approach is justified in verified infected necrosis. In case of sterile pancreatic necrosis complicated by organ failures is the role of surgical intervention debatable.

Aged↗
PubMed2001

[Weaning from artificial pulmonary ventilation].

Weaning from mechanical ventilation is not complicated in the majority of patients, in some, however, this process is very complicated and lengthy. These patients are described as difficult to wean. A suitable weaning strategy and properly timed extubation or decannulation is important not only from the aspect of the patient's health status but also with regard to costs of care. When selecting patients suitable for weaning it is useful to use prognostic indicators of success. The Tobin-Yang index and ratio Pa O2/FiO2 seem to be most useful. Based on available information it seems that the pressure support and weaning by means of T-piece is more effective than weaning using the SIMV regime. Promising seems the use of non-invasive ventilation but this was not proved unequivocally so far. The use of weaning protocols reduces the weaning period from mechanical ventilation. The authors summarize most recent findings on the weaning problem incl. the most frequently used ventilation regimes and prognostic indicators of successful weaning.

Humans↗