Biomedical subjects

J Chlumský

Publications and source records attributed to J Chlumský.

At least 19 recordsLinked to original sources

PubMed2005

[Exercise tolerance in patients with chronic obstructive pulmonary disease].

Limitation of exercise tolerance, especially activities of daily living, is the most significant clinical experience, which greatly affects quality of life of patients with chronic obstructive pulmonary disease (COPD). Many advances in the understanding of the pathophysiological mechanisms of bronchial obstruction in patients with COPD and their meanings for diagnosis and monitoring of the disease have occurred during the last two decades. The author discusses the most significant factors, which influence tolerance of physical exercise in patients with more advanced forms of COPD, and brings the attention to a practical test of physical capacity.

Exercise Tolerance↗

PubMed2004

[Relation between diabetes compensation, albuminuria and biochemical parameters and the results of stress myocardial SPECT in asymptomatic type 2 diabetics].

The patients with diabetes mellitus and another risk factors have significantly higher risk to suffer from ischemic heart disease. Myocardial stress SPECT represents the examination which correlates very well with the results of selective coronary angiography even in asymptomatic diabetic patients. The aim of our study was to evaluate the relation of SPECT result to diabetes compensation, presence of micro/macroalbuminuria, blood level of fibrinogen, CRP, homocysteine and uric acid. Out of 126 diabetic 2. type abnormal SPECT has been found in 33 (26%). Fasting blood sugar (9.3 +/- 1.4 mmol/l in patients with abnormal SPECT vs. 9.7 +/- 1.9 mmol/l in the other diabetics, n.s.) and HbA1c (7.5 +/- 1.3% vs. 7.5 +/- 1.3%, n.s.) are not significantly different in the patients with abnormal SPECT to the other diabetics without this finding. Micro/macroalbuminuria was significantly more frequently seen in patients with abnormal SPECT (60% of patients with abnormal SPECT and 29% in the rest of diabetics, p = 0.01). Fibrinogen was significantly more elevated in diabetics with abnormal SPECT (3.76 +/- 0.5 g/l in the group with abnormal SPECT vs. 3.23 +/- 0.43 g/l, p = 0.0003). In the diabetics with abnormal SPECT we have found significantly higher CRP (3.84 +/- 1.51 mg/l vs. 2.79 +/- 1.13 mg/l, p = 0.024) and homocysteine (13.78 +/- 3.26 micromol/l vs. 10.98 +/- 2.33 micromol/l, p = 0.006). Uric acid level was not significantly different in the group of diabetics with abnormal SPECT to the rest of the patients (361 +/- 64 micromol/l in abnormal SPECT vs. 353 +/- 51 micromol/l, n.s.). When we analyse our results we have found that abnormal SPECT is rarely discovered in the asymptomatic 2nd type diabetics with the combination of negative micro/macroalbuminuria and fibrinogen level below 3.5 g/l.

Albuminuria↗

PubMed2004

[Non-alcoholic risks of alcoholic beverages].

Alcoholic beverages are a potential source of numerous health risks. The general risks are well known; first of all they result from the contents of the alcohol and their degree is directly proportional to the amount consumed. However, alcoholic beverages contain also a wide range of non-alcoholic components, which can be a source of health risks as well. Some of these substances work through allergic or pseudoallergic mechanisms and such undesired response can appear early after the consumption of a small amount of beverage. The article offers a basic survey of alcoholic beverages; it mentions important technological procedures of their production stating also the most significant resulting components of their individual types. A special attention is paid to the non-alcoholic components, which can be the cause of undesired effects on the human health.

Alcoholic Beverages↗

PubMed2003

[Importance of measurement of carotid artery distensibility].

Affections of the structure of the major blood vessels can be assessed non-invasively by ultrasound. The authors assessed the thickness of the intima-media (IMT) and distensibility (D) of the carotid arteries in patients with ischaemic heart disease (IHD) and a cerebrovascular attack (CVA). Duplex sonography was used in 234 patients (145 patients with IHD and 89 patients with CVA) incl. assessment of IMT and D. 59 patients had type 2 diabetes and 64 had atrial fibrillations. D was evaluated according to Raneman's formula (mm/100 mm Hg). Diabetic subjects had a poorer D in the group with IHD (0.16 vs. 0.20, p < 0.05) as well as in the CVA group (0.14 vs. 0.17, p < 0.05) and the finding correlated with IMT. Insulin treatment as compared with PAD treatment did not influence D in a significant way (0.15 vs. 0.16, NS). Th presence of atrial fibrillation in patients with IHD did not affect the investigated parameters (IMT 0.72 vs. 0.74 mm, NS, D 0.19 vs. 0.18, NS). In patients with CVA, as compared with patients with a sinus rhythm, better IMT findings were recorded (0.67 mm vs. 0.79 mm, p < 0.05) and D (0.19 vs. 0.10, p < 0.05). The results indicate that IMT an D correlate indirectly and this is made more apparent by the presence of diabetes. In patients with CVA the different findings in relation to the presence of atrial fibrillation indicate the possibility to use these parameters to differentiate an embolic and thrombotic etiology of the attack. The results assembled by the authors do not support a better informative value of D as compared with IMT.

Carotid Artery, Common↗

PubMed2002

[Relation between pulmonary ventilation parameters, exercise tolerance and quality of life in patients with chronic obstructive lung disease].

Patients with chronic obstructive pulmonary disease (COPD) do usually have decreased tolerance of exercise capacity and impaired quality of life. Several studies have shown that exercise capacity is related relatively weakly to lung functions in this group of patients. The aim of the present study was to find parameter which could better reflect or predict maximal exercise capacity. 19 patients with the diagnosis COPD with mean value of forced expiratory volume in one second (FEV1) 46% predicted (range 21-79%) entering pulmonary rehabilitation program were included into the study. Enrolled patients were chosen to cover the whole range of airway obstruction severity. Post-bronchodilator static and dynamic ventilation parameters were used for evaluation and calculation. Quality of live was measured using St. George's respiratory questionnaire (SGRQ), evaluating symptoms, activity and impact of the disease with range from 0 (the best level) to 100 (the worst level). Values of FEV1 (p < 0.001) and ratio of FEV1 to vital capacity (FEV1/VC, p < 0.001) were significantly positively correlated with 6 minute walking distance (6MWD). FEV1/VC were closely related to 6MWD then FEV1. The degree of hyperinflation expressed by residual volume (RV, p < 0.005) and by ratio of residual volume to total lung capacity (RV/TLC, p < 0.001) significantly negatively correlated with 6MWD. Maximal occlusion mouth pressures (PImax, p < 0.05) were positively related to 6MWD. Total score of SGRQ correlated significantly to maximal exercise capacity. Pulmonary function tests and respiratory muscle function have important impact on exercise tolerance in patients with COPD. Tolerance of exercise capacity is significantly reflected by total score of quality of life in this group of patients.

Aged↗

PubMed2002

[The comparison of clinical and echocardiographic changes in diabetics 2nd type and nondiabetics in patients with shortness of breath due to left ventricular failure].

In our study we have examined 198 patients admitted to hospital for shortness of breath at rest due to left ventricle failure. We have divided the patients into two groups according to the presence of diabetes mellitus. We have excluded the patients with noncardiac cause of pulmonary congestion, with valvular or congenital heart disease and with acute coronary syndromes. We have evaluated the presence of hypertension, value of blood sugar on admission, systolic and diastolic blood pressure, heart rate and medication given for heart insufficiency. We have also compared two dimensional transthoracal echocardiogaphic examination in diabetics to nondiabetics. Finally we compared hospital mortality in both groups. Diabetes mellitus (all the patients were type 2 diabetics) was present in 94 patients (47,5 %), in the group of diabetics there were 50 women, in nondiabetics 52 women (n.s.). The average age of diabetics was 75,5 +/- 8 years and 76,6 +/- 10,1 years in nondiabetics (n.s.). History of hypertension had 45 nondiabetics (43 %) and 69 diabetics (73,5 %), p < 0.05. Systolic blood pressure was significantly higher in diabetics 151 +/- 20,8 mm Hg to 140,5 +/- 18,4 mm Hg in nondiabetics, p < 0.05. The values of diastolic pressure and heart rate were comparable in both groups. We have not noticed any significant difference in the application of ACE inhibitors, beta blockers and diuretics for heart failure in both groups. Echocardiographic examination revealed the significantly higher ejection fraction of left ventricle in diabetics as well as the thicker septum and posterior wall of left ventricle. These findings support the role of the diastolic dysfunction in pathogenesis of left ventricle failure. In hospital mortality rate was 8,5 % in diabetics and 7,6 % in nondiabetics (n.s.). Our results confirmed that in pathogenesis of left ventricle failure hypertension and elevated systolic blood pressure play the important part. Apart from the complex secondary prevention of ischemic heart disease the correct treatment of hypertension represents the very important part of the prevention of left ventricle failure. The role of the proper compensation of diabetes mellitus in the prevention of left ventricle failure is also discussed.

Aged↗

PubMed2002

[Inflammatory parameters in patients with a cerebrovascular attack].

OBJECTIVE: Provide evidence whether there is a difference in the presence of inflammatory parameters in patients with cerebrovascular attacks (CVA) with a thrombotic etiology as compared with a CVA with an embolic etiology. PATIENTS AND METHODS: In 45 patients with an acute CVA the level of C reactive protein (CRP) was assessed, interleukin 6 (IL-6), interleukin 8 (IL-8) and the value of the D-dimer. Patients with clinical signs of inflammation were eliminated. 21 patients had a sinus rhythm (SR) and 24 patients atrial fibrillation (AF). RESULTS: Between the group of patients with SR and AF there was no difference in age or sex distribution. The CRP concentration was in the SR group, as compared with the AF group, increased (4.67 mg/l vs. 3.65 mg/l, p = 0.043), similarly as the concentration of IL-8 (12.53 ng/l vs. 8.1 ng/l, p = 0.039). The IL-6 concentrations in the two groups did not differ (5.45 ng/l vs. 5.014 n.s.), similarly as the number of patients with elevated D-dimer values (29% vs. 35% n.s.). CONCLUSION: The assembled findings of elevated inflammatory parameters in patients with CVA of a thrombotic etiology as compared with patients with CVA with embolic etiology indicate similarly as in patients with acute coronary syndrome - the possible role of inflammation in the etiopathogenesis of thrombotic CVA. The results suggest the possible use of inflammatory markers for the differentiation of the etiology of ischaemic CVA.

Aged↗

PubMed2001

[Relation between clinical severity of bronchial asthma and degree of airway inflammation assessed by the eosinophilic leukocyte count in induced sputum].

Airways inflammation, involving infiltration of bronchial wall with activated eosinophils, mast cells and T lymphocytes, is an established feature of asthma. Clinical assessment of disease severity is based upon pulmonary function tests, their variability and symptom score. The relationship between the degree of airway inflammation and disease control is probably not significant. Differential cell count in induced sputum seems to be a useful parameter reflecting the degree of airway inflammation in patients with bronchial asthma. We investigated 67 patients with bronchial asthma of different severity and have shown statistically significant correlation between percentage of sputum eosinophils and clinical and physiological parameters of disease control. Eosinophil counts in induced sputum were negatively correlated with FEV1 (p = 0.006), ration of FEV1/VC (p < 0.001) and diurnal variability of PEF (p < 0.001). According to previous studies, where percentage of eosinophils was less than 4% in healthy subject, we determined sputum eosinophilia if eosinophil percentage was more than 4%. Sensitivity of clinical markers of disease control for predicting the degree of airway inflammation ranged between 0.15-0.74, ratio of FEV1/VC having the highest sensitivity. Specificity of clinical markers ranged from 0.43 to 0.94, diurnal variability of PEF having the highest specificity. Despite of good correlation of clinical markers of asthma severity with sputum eosinophils, pulmonary function test, diurnal variability of PEF and rescue salbutamol can hardly predict the degree of airway inflammation or the efficacy of antiinflammatory treatment in a particular patient. Percentage of sputum eosinophils seems to be a useful and promising marker for measuring the degree of airway inflammation in patients with bronchial asthma, especially in more severe cases.

Adult↗

PubMed2001

[Sonography findings in the carotid arteries in diabetics before aortocoronary bypass].

UNLABELLED: Neurological complications of patients during cardiac operations are closely associated with affections of the carotid arteries. The relationship of diabetes to these findings was not investigated so far. During the period between July 1 and Dec. 31 2000 the authors examined sonographically 127 patients indicated for aortocoronary bypass on account of affection of three arteries. Diabetes mellitus type 2 was present in 44 patients. A significant stenosis was detected in 4 (5%) without diabetes and in 5 (11%) patients with diabetes (p < 0.05), moreover in two patients with diabetes complete obstruction of the inner carotid was found. An insignificant stenosis (up to 70% was found in 3 (3%) of the patients without diabetes and in 3 (7%) patients with diabetes (p < 0.05). The thickness of the intima and media (IMT) was in patients with diabetes insignificantly greater (0.76 vs. 0.89 mm, NS). The mean index of echogenicity of plaques was in diabetic patients also insignificantly greater (2.1 vs. 2.9 NS). Atherosclerotic plaques greater than 2 mm were more frequent in diabetics (7.8% vs. 8 (18%), p < 0.05). A significantly more frequent finding of carotid stenosis or larger plaques was proved in patients with a history of CMP. Sonographic findings on the vertebral arteries were not associated with the presence of diabetes. CONCLUSION: Carotid sonography in patients of three arteries reveals in diabetic patients and in those with a history of CMP more frequent significant stenosis and the presence of major atherosclerotic plaques.

Aged↗

PubMed2001

[Thrombosis of the upper extremity in a female patient with protein C deficiency].

The case-record describes a 23-year-old female patient hospitalized on account of phlebothrombosis of the right upper extremity, associated with protein C deficiency and the use of hormonal contraception. The patient was treated with heparin and subsequently warfarin treatment. During the check-up examination by duplex sonography one month after discharge the thrombus was fully recanalized. The authors discuss the causes, diagnosis and treatment of thromboses of the upper extremities.

Adult↗

PubMed2000

[A dissecting aortic aneurysm in a female patient with Turner syndrome].

Female phenotype, sexual infantilism, small stature and stigmatization are typical for patients with Turner's syndrome (TS). The most frequent cardiovascular manifestations in these patients are a bicuspidal aortal valve and coarctation of the aorta. In 5% patients dilatation of the aorta is found which can develop into a dissecting aneurysm. In the submitted case-history the authors describe a 34-year-old patient where the diagnosis of TS was proved only in adult age at the time when a dissecting aneurysm of the aorta was detected. The submitted case-history supports the recommendation of regular echocardiographic check-up examinations of patients with TS.

Adult↗

PubMed2000

[Echocardiography and sonography of the carotid arteries in diabetics with cerebrovascular stroke].

The incidence of cerebrovascular attacks (CVA) in diabetics is 2-3 times higher as compared with the non-diabetic population. The objective of the present work was to evaluate etiological factors by means of echocardiography and sonography of the carotid arteries. The authors evaluated retrospectively findings of these examinations in 253 patients with CVA in a group of diabetic and non-diabetic patients as well as in a group of patients with atrial fibrillations or sinus rhythm. In patients with a sinus rhythm the presence of diabetes was associated with a more frequent finding of atherosclerotic changes, significant stenoses of the carotid vessels (2% as compared with 8%, p < 0.05) as well as thickness of the intima in the carotid bulbus (0.78 as compared with 0.96 mm, p < 0.05). Conversely when evaluating signs of thromboembolic risk, i.e. the size of the left ventricle (42 vs. 40 mm, n.s.) and ejection fraction of the left ventricle (55% vs. 50%, n.s.) no statistical significance in the difference of parameters was found. In the sub-group of patients with atrial fibrillation, who accounted for 28% of the group, the authors did not find when comparing diabetic and non-diabetic patients, any difference as regards the presence of significant stenoses in the carotid arteries nor in the thickness of the intima. There was no statistically significant difference in the size of the left atrium and left ventricular function. The findings suggest the possibility that the increased risk of ischaemic CVA in diabetic patients is caused by the atherosclerotic process in the carotid vessels and not a higher risk of embolism of cardiac origin.

Aged↗

PubMed1999

[Doping in sports].

The first organized doping controls were carried out in the 1970s. In 1993, the Czech Antidoping Charter was signed and the Antidoping Committee was established. The medical commission of International Olympic Committee decides, which substances and methods are prohibited. The current classification is as follows: I. prohibited classes of substances--stimulants, narcotics, anabolic agents, diuretics and some hormones. II. prohibited methods--blood doping and pharmaceutical, chemical or physical manipulation. III. classes of drugs subject to certain restrictions--alcohol, marijuana, local anesthetics, corticosteroids and beta blockers. All substances are characterized from the ergogenic viewpoint and health risks are particularly emphasized. In practice, doping control starts by drawing the athletes and ends by urine sample analysis in a special laboratory. In case of positive results, the sportsman is banned from sports activity for 3 months, 2 years or for the rest of his life. In 24 worldwide laboratories in 1995 93,938 urine samples were analyzed. 1516 (1.61%) proved to be positive, including 986 anabolic steroid use. In 1997, the Czech laboratory carried out 843 checks, of which 15 (1.7%) were positive. The largest positive doping group were body builders. Doping poses a major risk among junior sportsmen. Prevalence worldwide is estimated at 2-10% of the male population. In the future a severe antidoping attitude, as well as antidoping enlightenment, are certain to continue. By these standards the activity of the Czech Antidoping Committee is on a very high level.

Czech Republic↗

PubMed1998

[Assessment of the need for and length of hospitalization at the internal medicine department].

We used the Appropriateness Evaluation Protocol (AEP) to evaluate appropriateness of admission and continuing hospitalization (daily till discharge of maximally till 15th day of hospitalization) of 260 patients admitted consecutively to department of internal medicine of a teaching hospital. Reasons of inappropriate admissions and delayed discharges were classified and analyzed. Results of the valuation of some patients were subject to control by a committee of fully specialized hospital physicians. 63 (24%) of 260 admissions and 1005 (54%) of 1869 evaluated days of stay failed the AEP criteria. These patients could be well served by lower treatment intensity in outpatient clinics, nursery homes or their own homes. Such a shift in pattern of provided care requires profound organizational changes many of which are out of reach of individual acute hospitals. Despite some limitations we find AEP a useful tool for internal utilization review. External application of AEP in a representative sample of acute care hospitals could provide important data for future development of the Czech health care system.

Hospitalization↗

PubMed1998

[Plasma homocysteine levels in patients with indications for cardiac revascularization].

The amino acid homocysteine is a further possible risk factor for the development of atherosclerosis. The authors examined at the First Medical Clinic, Second Medical Faculty Charles University in the course of 1994-1996 59 patients with manifest IHD who were examined by coronarography and because of a major finding were indicated for revascularization surgery. This group was compared with a control group of subjects of equal age without major findings on the coronary circulation. The control group differed from the former group significantly only as regards the triglyceride level which was higher in the former group and the group comprised a larger number of diabetic patients. As regards cholesterol, HDL-cholesterol, uric acid, fibrinogen levels there was no significant difference. The authors found an insignificant difference in homocysteine levels. In the investigated group of patients indicated for revascularization surgery the mean homocysteinaemia was 12.3 mumol/l (sigma 4.3 mumol/l) and in the control group 11.8 mumol/l (sigma 3.8 mumol/l). The mean homocysteine level in the investigated group did not exceed the level of 15 mumol/l reported in the literature as the borderline of normal homocysteine blood levels. The authors did not reveal a statistically significant correlation between homocysteine levels, diabetes mellitus type II and smoking.

Arteriosclerosis↗

PubMed1998

[Tactics of hypolipidemic therapy after myocardial revascularization].

Previous investigations revealed that hypolipidaemic treatment of patients with IHD in the Czech Republic is inadequate. Patients after revascularization operations are discharged from cardiosurgical departments without suitable medication and moreover the values of the lipid spectrum are affected by the surgical intervention. The objective of the investigation was to evaluate the indication of hypolipidaemic treatment during hospitalization or later during check-up examinations by attending physicians. The authors evaluated retrospectively 100 patients after revascularization operations of the heart discharged without hypolipidaemic treatment and 40 patients treated with fluvastatin because of the lipid values before surgery. Using questionnaires it was revealed that in the group without pharmacological intervention in 36% patients the lipid levels were checked and hypolipidaemic treatment was started in 14% of the patients. In the patients with pharmacological treatment 100% adherence to treatment and improvement of the lipid spectrum was found similarly as in comparable trials. Fluvastatin treatment was well tolerated. In the authors view hypolipidaemic treatment after revascularization should be started before discharge from hospital with regard to preoperative results of the lipid spectrum.

Anticholesteremic Agents↗

PubMed1997

[Esophageal echocardiography in patients with cerebrovascular stroke and atrial fibrillation].

Atrial fibrillation is an important risk factor of embolization into the CNS. Thus affected patients should receive permanent anticoagulant therapy. Oesophageal echocardiography (TEE) can help our decision in patients with relative contraindications of anticoagulant therapy. TEE was performed in 52 patients with atrial fibrillation and cerebrovascular attack (CMP) with an ischaemic aetiology. Transthoracic echocardiography did not reveal the source of embolization. In 10% patients a thrombus was found in the appendage of the left atrium, in another 9% patients a spontaneous echocontrast was found in the left atrium (prethrombotic condition) and in 5% patients an open foramen ovale. The results indicate the highly probable etiology of embolization in patients with cerebrovascular attacks and atrial fibrillation. This supports the recommendation of absolute indication of anticoagulant treatment in patients with cerebrovascular attacks and atrial fibrillation.

Adult↗

PubMed1996

[A modern approach to the treatment of bronchial asthma].

The view on etiopathogenesis of bronchial asthma has changed considerably in recent years. Bronchial asthma is now understood as an inflammatory disease of the airways which show characteristic pathologic features: infiltration of the airways with inflammatory cells (especially eosinophils and T lymphocytes), epithelial shedding, airway smooth muscle thickening, subepithelial fibrosis, mucus gland and goblet cell hyperplasia with hypersecretion of mucus. Classification based on etiology unfortunately has not the immediate influence on the treatment of patients with asthma and therefore classification based on severity of disease was approved by several international consensus reports, which divide asthma into four groups: intermittent asthma, and mild, moderate and severe persistent asthma. From the second step (mild persistent asthma) antiinflammatory drugs are considered as the first line therapy, of which inhaled glucocorticosteroids are both in adults and children the most effective controllers. There is increasing evidence that early intervention with inhaled corticosteroids can prevent development of irreversible airway obstruction. Most patients with asthma can get their disease under optimal control and reach the goals of treatment by long-term management in the stepwise approach. Self-monitoring and regular follow-up with ongoing education is one of the most important part of long-term management program.

Asthma↗