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Biomedical subjects

I Vítková

Publications and source records attributed to I Vítková.

At least 19 recordsLinked to original sources
PubMed2006

[Pulmonary endarterectomy--the surgical treatment of chronic thromboembolic pulmonary hypertension].

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) in indicated cases can be successfully treated by the endarterectomy of pulmonary arteries (PEA). Symptomatically not treated CTEPH has highly unfavourable prognosis. Five years survival of patients with mean pulmonary pressure over 50 mmHg is only 10%. PEA was not available in the Czech Republic till 2004, when PEA program was initiated it the Cardiocenter of the General teaching hospital in Prague in collaboration with leading clinics in that field (Prof. Mayer, University of Mainz, BRD). METHODS AND RESULTS: Up-to-date surgical technique, which in various modifications has been used at majority of clinics, was elaborated by Jamieson and Daily at University of California in San Diego. It is based on reverse endarterectomy performed during complete circulatory arrest with brain protection by deep hypothermia. Till September 2005 twelve patients were operated with zero mortality. In one patient a suture of atrial septum defect was necessary to perform along. Average time of the circulatory arrest was 45 minutes; duration of the extracorporal circulation was 334 minutes. Average duration of the operation was 450 minutes. Duration of the mechanical ventilation was in average 45.5 hours. After one month already haemodynamic parameters (mPA, CI, PVR) significantly improved or normalized and the average length in the test of six minutes walking increased by 132 meters. CONCLUSION: PEA represents a treatment method for patients with CTEPH and surgically accessible pulmonary artery obstruction. Centralized care of those patients is a rational necessity enabling to get maximum experience with complicated diagnostics and treatment of those patients. Multidisciplinary collaboration is the essential condition for the success of the program.

Adult↗
PubMed2006

Surgical anatomy of parathyroid glands with emphasis on parathyroidectomy.

Number, location and surrounding structures of parathyroid glands with emphasis on parathyroidectomy were studied on 101 cadaverous bodies. Number of collected samples from all known locations of parathyroid glands varied from three to five in one individual, with mean 3.71 +/- 0.62. We identified 80% of samples as parathyroid glands. Mean number of correctly identified parathyroid glands in one individual was 2.77 +/- 1.06. The rest 20% of collected samples were lymph nodes, fat particles and thyroid or lipothymic tissue. Almost 30% more of inferior parathyroid glands were found in abnormal position in lipothymic tissue in comparison with their superior counterparts. We found several abnormities of vessels and cervical extensions of thymus. We also present case of brachiocephalic trunk, reaching the inferior pole of thyroid gland. We recommend beginning of parathyroidectomy in circumscribed area 2 cm in diameter, 1 cm cranially to the intersection of the inferior thyroid artery and recurrent laryngeal nerve followed by preparation on dorsal surface of thyroid gland, along the course of inferior thyroid artery and recurrent laryngeal nerve, in cervical extensions of thymus and in paraoesophageal and retropharyngeal region. Success of parathyroidectomy is based on the knowledge and experience of surgeon.

Adult↗
PubMed2005

[Intestinal ischaemia--consequence of intestinal malrotation].

The subsets of acute intestinal ischaemia include mesenterica arterial occlusion, venous thrombosis and non-occlusive mesenteric ischaemia. Advances in pathophysiology, diagnosis and treatment, prognostic problems are associated still in mortality rates of more than 60%. Early diagnosis is the first in possibility for better prognosis. In our article is case one young man with acute non-occlusive intestinal ischaemia described, diagnosis and treatment. Mucosal surface necrosis and hemorrhage was supposed, sepsis was expected, mucosal regeneration after ten days surprising. While changes on the bowel were hard to decide to resection, there are bioptic picture of mucosal layer in the time described (Fig. 5-9). We have written about similar case of young man with Waldayer hernia in 1999.

Adult↗
PubMed2003

[A less common cause of malabsorption syndrome].

Casuistry of a 59-year-old woman is presented. The patient was examined for nephrotic syndrome with relapsing stenosis of vena cava inferior treated with stent implantation and with severe protein-caloric malnutrition. She had macroglosy, mild hepatomegaly, severe impairment of gastrointestinal motility, and had in her history an operation of carpal tunnel. It took two years to establish the diagnosis, which was amyloidosis of AL.

Amyloidosis↗
PubMed2002

Development of hydrogel implants for urinary incontinence treatment.

Hydrogel implants for urinary incontinence treatment based on HEMA supplemented with 10% methacrylic acid have been developed. The swelling properties of implants were tested in vitro and in vivo after implantation to laboratory mice. Biocompatibility has been determined by incubation of implants in tissue culture, by histological examination of adjacent tissues after subcutaneous application of implants to laboratory mouse in a long-term experiment, and by flow cytometry examination of blood cells. The swelling of hydrogel implants was completed in 6-24 h. There was no effect on in vitro growth of cells incubated with implants. In mice, implants were well tolerated without any sign of inflammatory reaction. The material allows an elastic compression of urethra compensating a damaged sphincter after trans-urethral sub-mucosal implantation of hydrogel cylinders.

Animals↗
PubMed2001

[Pulmonary endometriosis].

Endometriosis in less common locations can become a diagnostic pitfall both from the clinical and morphological point of view, as this diagnosis is only seldom considered in the first series of differential diagnoses. This was true also for our patient reported. 48-year-old woman underwent left superior lobectomy for the clinical diagnosis of pulmonary neoplasm. Slightly prominent subpleural whitish nodular partly cystic tissue was histologically identified as pulmonary endometriosis. It consisted of proliferative to hyperproliferative endometrial glands surrounded by proliferation type stroma. Focally slight cytological glandular atyplas and immature squamous metaplasia were present. Later another focus was located by x-ray examination. Without any surgery, it responded to six month treatment with competitive gonadoliberin agonist (GnRH analogue) Zoladex. Three years after the treatment no signs of the disease have been present. The correct clinical diagnosis accompanied with cautious morphological verification may prevent unnecessary extensive surgery. However, even some correctly diagnosed and morphologically verified cases may require radical operative removal. Either approach (conservative therapy and surgery) completed with subsequent dispensarisation may prevent both the common (cycle related progressive tissue damage) and rare (tissue destruction, malignant transformation) complications.

Diagnosis, Differential↗
PubMed2001

Fast decline of hematopoiesis and uncoupling protein 2 content in human liver after birth: location of the protein in Kupffer cells.

Hepatic hematopoiesis is prominent during fetal life and ceases around birth. In rodent liver, the decline of the hepatic hematopoiesis starts abruptly at birth being accompanied by a decrease of mitochondrial uncoupling protein 2 (UCP2) expression in monocytes/macrophages, whereas hepatocytes may express UCP2 only under pathologic situations. The goals of this study were to characterize hepatic hematopoiesis in humans around birth, and to identify cells expressing UCP2. Hematopoiesis was evaluated histologically in the liver of 22 newborns (mostly very premature neonates), who died between 45 min and 140 d after birth, and one fetus. UCP2 expression was characterized by Northern blots, immunoblotting, immunohistochemistry, and by in situ hybridization. The number of hematopoietic cells started to decrease rapidly at birth, irrespectively of the gestational age (23-40 wk) of neonates. A similar decline was observed for UCP2 expression, which was relatively high in fetal liver. UCP2 was detected only in myeloid cells (mainly in Kupffer cells), but not in hepatocytes, although sepsis or other pathologies occurred in the critically ill newborns. Kupffer cells represent the major site of mitochondrial UCP2 expression in the human newborn. UCP2 may be essential for the differentiation and function of macrophages and serve as a marker for these cells in human liver during the perinatal period.

Down-Regulation↗
PubMed2001

[Vesico-colonic fistulae in patients with chronic urinary tract infections].

The authors present their experience with diagnosis and treatment of colovesical fistula, which had been diagnosed due to chronic recurrent urinary tract infection. The underlying cause of the fistula was previously unrecognized diverticulosis with diverticulitis (3 out of 4 cases). The fistula was diagnosed primarily by a urologist, who performed cystoscopy, which proved to be the most contributing useful examination of all. On the other hand, coloscopy did not reveal the true diagnosis any time and its value is doubtful since insufflation of the inflamed bowel may be followed by intestinal rupture into the peritoneal cavity. Treatment of the fistulae was always surgical, during resection of the involved bowel and resection of the neighboring bladder was accomplished. In all cases one-staged procedure was done with restoration of bowel continuity and suturing of the bladder. Three patients were cured, one died on the 5th day due to complicated ischaemic heart disease.

Chronic Disease↗
PubMed2001

[Placental and umbilical cord changes in drug-addicted women].

OBJECTIVE: The aim of the study was to gauge the impact of drugs on placental changes in heroin and pervitin addict pregnant women as one of the influence factors supporting the lower birth-weight of the neonate. DESIGN OF THE STUDY: Prospective study. SETTING: The Department of Gynaecology and Obstetrics and the Department of Pathology of the General Teaching Hospital and the 1st Medical Faculty of Charles University in Prague. METHODS: The drugs-addict pregnant women were included in the study in the period between January 1998 till the end of the year 2000. We succeeded to concentrate in total 39 drug abused pregnant women and 39 their placentas and umbilical cords were examined (19 heroin and 20 pervitin addict). The placentas were sent for the histological examination in total without the chemical fixation. There were 3 placental samples, 2 cord and 2 membranes samples examined. The controls groups were formed by non-abused pregnant women and their placentas by method of accidental choice. RESULTS: We found the statistically significant higher incidence of placental and cords abnormalities in among the addict women compared to their non abused controls (P < 0.05). In heroin addict group in 16 from 19 cases were the abnormalities present. We registrated increased intervillous and perivillous microfibrin deposits (6 times), an increased number of trophoblastic proliferation buds (7 times) increased vascularization of the villi (7 times) mikrovilli (6 times) and their necrosis (5 times). In umbilical cord we enregistered in 3 cases the only one artery, in two case the thrombosis of the vein. In 5 cases we also found the signs of infection. In pervitin addict group we registered placental changes in 9 from 20 cases. The majority of them presented as increased microfibrin deposits on the surface and also in the choriotic board (9 times), in five cases we enregistered the intervillous haemorrhage manifested in 2 cases clinically as abruption of placenta. The placental changes participate in low birth weight of neonates, IUGR and the abbreviation of the gestational duration. CONCLUSION: The microscopic changes in placenta is the expression of the circulatory disorder during the attack of the drug. They are not four-square specific, rather quantitatively expressed. In heroin abused women is the incidence of placental changes much more higher comparing to pervitin-addict. Heroin led more frequently to preterm labour, lower birth-weight and IUGR. The pervitin-addict mothers are higher risk of placental abruption.

Amphetamine-Related Disorders↗
PubMed2000

Markedly eccentric peripheral vascular stenoses: percutaneous atherectomy with an endomyocardial biopsy device.

In 23 patients, percutaneous atherectomy was performed with an endomyocardial biopsy device in 27 eccentric stenoses of lower limb arteries. The mean percentage stenosis was reduced from 82% to 14% (P: <.001). Histopathologic examination revealed no media or adventitial tissue in the extracted particles. The technical success and complication rates were similar to those reported for conventional percutaneous transluminal angioplasty of short symmetric lesions.

Aged↗
PubMed1997

Tissue metabolism and plasma levels of thyroid hormones in critically ill very premature infants.

Thyroid status was characterized in very preterm infants (gestational age < or =32 wk; n = 61) from birth through d 14, and in infants who died within 16 d after delivery (n = 10), where it was also correlated with metabolism of iodothyronines in peripheral tissues (brain, liver, kidney, skeletal muscle, and adipose tissue). At 3 d of life, mean plasma levels of thyroxine, triiodothyronine, and TSH started to decrease, being lower in the critically ill compared with healthy premature neonates. Activities of the three iodothyronine deiodinases enzymes (type I, II, and III, respectively) were detected in all postmortem tissue samples, except for absence of the type II activity in kidney. All activities were the highest in liver and differed in other tissues. Lack of correlation between the type I activity in liver (and kidney), and plasma levels of thyroid hormones suggested that the thyroid was the primary source of circulating triiodothyronine. On the other hand, namely in brain, correlations between activity of the deiodinases and plasma hormone levels were found which suggested a complex control by thyroid hormones of their own metabolism. High activity of type III in liver, adipose tissue, and skeletal muscle demonstrated a role of these tissues in thyroid hormones degradation. Results support the view that peripheral tissues of very preterm infants are engaged in local generation of triiodothyronine, and inactivation of thyroid hormones, but do not represent a major source of circulating triiodothyronine.

Adipose Tissue↗
PubMed1997

[Squamous intraepithelial lesions in young female university students].

The authors investigated the frequency of squamous intraepithelial lesions (SIL) in young women, in particular university students with special attention to morphological signs of the presence of human papilloma virus (HPV) in SIL low grade-SIL, LG-HPV. As compared with data in the world literature, they revealed a significantly lower rate of SIL LG, HPV-2.81% as compared with 5.5% reported in WHO studies of young women. The authors analyzed the biological behaviour of SIL, LG-HPV. As compared with data in the literature on known values of spontaneous regression which are 50-62% in the course of three years, they demonstrated during a time interval from 3 months to 2 years spontaneous regression in 39.1%. Further possibilities of regression in a longer time interval are expected in the group of clinically latent cytologically persistent LG lesions (18.1%) and in the group of patients which after termination of their studies were lost from the records (24.3%). During the investigated time interval no case of progression to a higher grade lesion was recorded. The authors reflect on diagnostic and therapeutic procedures with regard to the application of results of HPV typing.

Adolescent↗
PubMed1992

[Congenital liver fibrosis].

In two siblings-girls who died as a result of infectious complications after previous protracted hypoxic brain damage at the age of weeks and 5 months postmortem examination revealed congenital fibrosis of the liver. Morphological examination of hepatic tissue of the younger infant revealed in the small porto-biliary spaces malformation of the ductal trabeculae and in the periphery of the major and large and unequal hyperplasia of the minor interlobular bile ducts which partly penetrated from the periportal area into the lobules which were not structurally altered. In the older infant there was a more marked ductal hyperplasia associated with connective tissue proliferation and the course of the disease was complicated by abscedent cholangitis.

Female↗
PubMed1992

[Liver cholestasis in neonates and young children].

Liver cholestasis was found in 50 autopsies (23 per cent) among 221 neonates and infants who died in intensive care units. It developed from the 4th postnatal day, was mostly mild and present in biliary capillaries as well as in small interlobular biliary ducts, later there was found phagocytosis of biliary pigment by Kupffer cells. In protracted jaundice there was an irregular increase of small cholangioles derivable from a ductal transformation of periportal hepatocytes. Bile ducts proliferation was connected with a slight widening of portal tracts in infants surviving until the 6th and 8th week. The cause of cholestatic liver lesion remained obscure.

Bile Ducts, Intrahepatic↗
PubMed1990

[Is the argon laser suitable for angioplasty procedures?].

Laser angioplasty is a perspective method for the treatment of complications of atherosclerosis of peripheral and coronary arteries. The present study deals with the effects of an argon laser on cadaverous coronary arteries with atherosclerotic plaques. Radiation of the argon laser created in the plaque a circular defect with a singed margin. The energy of radiation being equal, the size of the defect depended on the position of the optic fibre -- it was greatest when the optic fibre was in contact with the plaque. The defect thus formed had uneven margins with adjacent layers of thermal damage which were larger in calcified plaques than in fibrous and fibrolipomatous plaques. Penetration of radiation into the plaque depended on its composition -- being least in calcified plaques. When the arteries were rinsed with saline during irradiation, the effect of radiation on the tissue was reduced as the tissue was cooled. The argon laser causes greater thermal damage of the arteries than pulsed lasers and therefore its clinical application will be restricted.

Angioplasty, Laser↗