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Biomedical subjects

J Cervinka

Publications and source records attributed to J Cervinka.

At least 19 recordsLinked to original sources
PubMed2001

[Complications of treatment of stomach cancer--case report].

The authors made in a young 48-year-old patient a subtotal gastric resection with atypical resection of the liver on account of a metastasis, the basic diagnosis being: gastric tumour, histologically diffuse carcinoma with mucus formation. On the 6th postoperative day the condition was complicated by sepsis and dehiscence of the oesophagoantroanastomosis. With regard to the complication with a relapse of a subphrenic abscess the patient was repeatedly checked. He was for a prolonged period (repeatedly) on artificial pulmonary ventilation on account of ARDS and lobar bronchopneumonia; complete parenteral and subsequently parenteral and enteral nutrition was administered. After stabilization of the condition (after 5 months from the first operation) the patient was discharged into domiciliary treatment with enteral nutrition which was administered by jejunostomy by means of a pump for enteral nutrition. Four months after discharge the oesophagus and stomach were replaced by the colon. The patient is at present in a good clinical condition, does not suffer from malnutrition. No signs of relapse of the disease. The importance of intensive, long-term although costly postoperative care reflected on the satisfactory health status of the patient is beyond doubt.

Adenocarcinoma↗
PubMed1991

[The effect of diltiazem on hemodynamic parameters in patients with liver cirrhosis].

Previous investigations of authors abroad provided evidence of a reduction of portal pressure by blockers of slow calcium channels group II by verapamil. We decided to investigate the effect of a quite new preparation dilthiazem on the portal haemodynamics in patients with compensated cirrhosis of the liver and oesophageal varices. Doppler examinations of the width, rate of blood flow and flow through the trunk of the portal vein did not prove a statistically significant effect of dilthiazem on the investigated parameters. After the preparation a significant decline of the median pressure in the pulmonary artery was recorded at the 5% level of significance. The significantly elevated pressure values in the wedged position in the hepatic vein (WHVP) as well as of the portohepatic gradient (P-H) rose further after administration of the preparation (WHVP by 12.3%, p P-H by 15%). Even maximum doses of dilthiazem did not influence the portal flow in patients and did not lead to a reduction of the portohepatic gradient. From the results it is apparent that dilthiazem is not suitable for the treatment of portal hypertension.

Diltiazem↗
PubMed1991

[The effect of glucagon on portal hemodynamics in patients with liver cirrhosis].

The authors assessed in 12 patients with compensated cirrhosis of the liver, portal hypertension and oesophageal varices, using a Doppler flowmeter Toshiba SAL 50A/SDL 01 under basal conditions, changes in the width, rate of blood flow and blood flow though the trunk of the portal vein before and after intravenous administration of 1 mg glucagon. The width of the trunk of the portal vein did not change significantly during assessment. A statistically significantly increased flow through the portal vein was recorded starting during the 5th minute, and it correlated with the increased velocity of the blood flow. The increased flow persisted to the 20th minute after glucagon administration. The drop of pressure in a wedged position assessed in the hepatic veins after administration of the drug was not significant, the pressure in the free hepatic vein increased insignificantly. On the whole the portohepatic gradient declined by 10.5%, the drop was not significant. Glucagon in pharmacological doses has an early onset of action even in cirrhotic subjects whereby the increased flow through the portal vein does not lead to a rise of the portohepatic gradient. Glucagon administration thus does not increase the risk of haemorrhage from oesophageal varices during acute fibroscopy of the oesophagus and stomach in patients with portal hypertension.

Blood Flow Velocity↗
PubMed1991

[Endoscopic sclerotization of esophageal varices and nitrates in the treatment of portal hypertension with bleeding esophageal varices].

The authors investigated changes of some haemodynamic parameters after sclerotization of oesophageal varices and after administration of isosorbide dinitrate in the preparation Iso Mack retard. Twenty patients with cirrhosis of the liver with oesophageal varices grade 3-4 were treated by endoscopic sclerotization only, while to a second comparable group of cirrhotic patients from the first stage of sclerotization oral Iso Mack retard was administered in daily doses of 80-120 mg, depending on tolerance. The haemodynamic parameters were investigated before the onset of treatment and again after completed sclerotherapy or at least three-month treatment with ISDN. After sclerotization of oesophageal varices the pressure in the portal circulation rises significantly as well as the flow through the portal vein due above all to an accelerated blood flow. On the other hand, ISDN prevents a rise of portal hypertension and leads even to a slight decline which is, however, not associated with a decline of the portal flow. A relative disadvantage is the adverse effect on systemic haemodynamics after large nitrate doses. The decline of the portal pressure caused by the vasodilatating effect of ISDN in the splanchnic and portal area is manifested in a very positive way by reduction of relapses of haemorrhage from oesophageal varices. ISDN may play a positive role in the treatment of portal hypertension with oesophageal varices, during acute haemorrhage as well as in the prevention of relapses of haemorrhage. A particularly favourable procedure is the combination with sclerotherapy of oesophageal varices. None of the procedures leads to reduction of the portal flow and preserves hepatic function.

Blood Pressure↗
PubMed1989

[The significance of clinical findings in evaluating the degree of portal hypertension in patients with liver cirrhosis].

In 21 patients with bioptically confirmed cirrhosis of the liver catheterization of the lesser circulation and hepatic veins was performed. The portohepatic gradient was considered a measure of the portal pressure. The authors did not find a statistically significant relationship between the portohepatic gradient and the presence of oesophageal varices, haemorrhage into the gastrointestinal tract, biochemical parameters (albumin, gamma-globulin and bilirubin level) and the prothrombin time. The portohepatic gradient was not significantly related with the central venous pressure, the median pressure in the pulmonary artery and the pressure in the wedged pulmonary capillaries. It was, however, significantly higher in patients with ascites (p less than 0.05); patients in group B and C of Child-Turcott's classification had a portal gradient which was significantly higher than in patients of group A (p less than 0.01). The value of the cardiac index and the systemic vascular resistance was not related to values of the portohepatic gradient; a hyperkinetic circulation which a cardiac index above 4.5 l/min/m2 was recorded only in three patients. Based on the above results, the authors assume that a hyperkinetic circulation in patients of groups A and B according to Child-Turcott's classification is not a frequent finding and is not related to the value of the portal pressure. In the author's opinion the most suitable clinical indicator of the degree of portal hypertension is Child-Turcott's classification.

Adult↗
PubMed1989

[The effect of terlipressin (Remestyp Spofa) on hemodynamic parameters in patients with portal hypertension associated with liver cirrhosis].

Remestyp Spofa is used in wide clinical practice, among others also in the comprehensive treatment of acute haemorrhage from oesophageal varices. To patients with portal hypertension, oesophageal varices associated with cirrhosis of the liver by means of an infusion pump Remestyp was administered, 13.4 micrograms/1 kg body weight for one hour. By means of a Doppler flowmeter the rate of the blood flow and the blood flow through the trunk of the portal vein was assessed before, at 10-minute intervals during infusion, and during the 90th, 120th and 150th minute. After administration of the drug no significant effect on the investigated parameters was recorded. Therefore in the same group of patients by means of a catheter before and after infusion the following parameters were assessed: central venous pressure, pressure in the pulmonary artery, cardiac minute output, pressure in the free and wedged hepatic vein. Simultaneously changes of the systemic blood pressure were investigated. After Remestyp a significant rise of the systemic blood pressure was recorded, a rise of the central venous pressure and the pressure in the pulmonary artery. The minute volume declined slightly. The pressure in the free and wedged hepatic vein rose. The authors assume therefore that the direct effect of Remestyp on the portal circulation is not haemodynamically significant. The favourable haemostyptic action of Remestyp in patients with haemorrhage from oesophageal varices is rather due to an increased tonus of the oesophageal sphincters. With regard to the very satisfactory experience with the administration of nitrates in this indication their combined administration with vasopressin or its derivatives is considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamics↗
PubMed1989

[A new model for testing substances affecting the synthesis of heme].

A new model for experimental studies of substances influencing porphyrin metabolism has been created. The model is formed by yeast Saccharomyces cerevisiae (RIBM-75) grown semiaerobically. The main advantages of this model include simple evocation of porphyria (intracellular accumulation of porphyrins in semiaerobic conditions) and direct measurement of experimental values (intracellular and extracellular concentrations of porphyrins). The porphyrinostatic effects of drugs can be assessed on the basis of sum of experimental values. The ratio of experimental criteria enables us to compare the influence of drugs on porphyrin permeation across the cellular membrane. Antimalarials, chloroquine and pyrimethamine, used or tested for therapy of chronic liver porphyria, have been tested on the model. The experiments showed that both chloroquine and pyrimethamine inhibited porphyrin synthesis. This effect can represent the proper therapeutical action of both drugs, which has not been known so far. Chloroquine releases the intracellular porphyrins in yeast similarly as it does in hepatocytes. However, pyrimethamine causes intracellular accumulation of porphyrins booth in yeast and hepatocytes.

Chloroquine↗