Biomedical subjects

J Lata

Publications and source records attributed to J Lata.

At least 19 recordsLinked to original sources

PubMed2006

[The diagnostics and therapy of hepatic encephalopathy. Recommendations of of the working group on portal hypertension in the Czech Hepatology Society and the J. E. Purkinje Czech Medical Society].

UNLABELLED: Hepatic encephalopathy (HE) is a set of reversible neuropsychic features which occur in connection with hepatic cirrhosis or acute hepatic failure. We distinguish manifest HE (with clinical symptoms) and minimal FE (normal clinical finding, abnormal psychometric or neurophysiologic exam). The diagnosis is clinical or laboratory one. From the auxiliary examinations in common practice the number connection test is sufficient. THERAPY: Presence of hepatic encephalopathy should lead to the consideration of the possibility to solve basic disease by hepatic transplantation. Conservative therapy lies in 1. Basic disease elimination, 2. Measures lowering the ammonia level in blood--optimalization of protein intake, administration of indigestible disaccharides (lactulose, lactitol) and fill sterilisation by antibiotics (Rifaxin, Metronidazol), ornitine-aspartate administration, 3. Influencing the changes in amino acid metabolism (administration of branched chain amino acids--BCAA). Prognosis depends on the advancement of the disease, after hepatic transplantation the clinical symptoms of HE are mostly fully reversible.

Adult↗

PubMed2006

[Effect of administration of Escherichia coli Nissle (Mutaflor) on intestinal colonisation, endo-toxemia, liver function and minimal hepatic encephalopathy in patients with liver cirrhosis].

The purpose of the study was to verify effects of Escherichia coli Nissle (Mutaflor) on intestinal colonisation, endotoxin levels, hepatic encephalopathy and liver function in patients with liver cirrhosis. The study involved 39 patients (22 taking Mutaflor and 17 taking placebo). Even though the number combination test showed extended reaction time in patients with described minimal hepatic encephalopathy the drop was not significant in the trend evaluation. However, the treated group displayed significant improvement of intestinal colonisation (p < 0.001) and a trend towards significant reduction of endotoxin levels on day 42 (p = 0.07) and improvement of liver function assessed with the Child-Pugh classification on days 42 and 84 (p = 0.06). Probiotic preparations can therefore represent a significant contribution to this group therapy.

Adult↗

PubMed2006

[Diagnostics and therapy of hepatorenal syndrome. Recommendations of of the working group on portal hypertension of the Czech Hepatology Society and the J. E. Purkinje Czech Medical Society].

Hepatorenal syndrome is a functional renal failure in patients with advanced cirrhosis and portal hypertension or acute liver failure. It is caused by extreme vasoconstriction in renal arterial bed. Type I HRS presents as an acute renal failure, while type II HRS is chronic alteration of renal function in patients with refractory ascites. Prognosis of HRS is very poor with survival reaching several weeks in patients with HRS type I. Causal treatment is liver transplantation, other treatment options include use of splanchnic vasoconstrictors (terlipressin) together with plasmaexpansion (albumin) and TIPS. It is important to exclude nephrotoxic medication (non-steroid anti inflammatory drugs, aminoglycosides) and properly treat all infective complications in prevention of HRS.

Hepatorenal Syndrome↗

PubMed2005

Evaluation of labeling and content of probiotics available in the Czech Republic.

Probiotics are live cultures of mikroorganisms which are good for human health and are used in human medicine as a treatment. Advantageous effect on a human health was proved in many studies in Europe and in the USA. On the other hand, many studies described lack of information about products containing probiotics - in particular the real bacterial strain or quantity of bacteria. We tried to evaluate thirteen products containing probiotics available in the Czech Republic. In all cases the leaflets contained information about the species and amount of bacteria (from seven products containing more than one species of bacteria were only in two cases declared the quantity of particular bacteria, in five cases was declared just the total quantity of bacteria). The declared species of bacteria were cultured in all tested products. Concluding; the information on the leaflets of probiotic products is sufficient for a clinical practice and the real species and quantity of bacteria come up to declared data.

Bacteria↗

PubMed2005

[Diagnostics and treatment of hepatocellular carcinoma. Recommendations of the Portal Hypertension Working Group of the Czech Hepatology Society and the J.E. Purkinje Czech Medical Society ].

Hepatocellular carcionma (HCC) is almost exclusively associated with liver cirrhosis as a significant HCC risk marker in advanced countries. Applicable therapy depends on early diagnosis, and risk patients should be screened for the presence of HCC on a regular basis. Liver ultrasound and determination of alpha-fetoprotein serum levels (AFP) are the screening methods used. Spiral CT is the most often used method for HCC staging. Non-invasive methods may under certain circumstances replace aimed biopsy. There are 3 basic curative therapies for the early stage of HCC: liver transplantation, surgical resection and different methods of local destruction of tumour (i.e., ethanolisation, thermoablation, etc.). Patients at medium stage of HCC may profit from chemoembolisation. Current available systemic chemotherapy is ineffective. Patients with advanced HCC are treated symptomatically. Patient survival prognosis after the application of one of the above treatment methods may be similar with that for HCC free cirrhosis patients, however, prognosis for advanced HCC patients is bad, with survival period from one to nine months.

Carcinoma, Hepatocellular↗

PubMed2004

[Procalcitonin as an indicator of infection in patients with liver cirrhosis].

Incidence of bacterial infections in hospitalised patients with liver disease is high. Due to a liver dysfunction immune reactivity is significantly impaired and bacterial infections are more frequent. Also incidence of nosocomial infections is higher in patients with liver disease compared to patients hospitalised for other conditions. To make a differential diagnosis of infectious and non-infectious aetiology of an inflammation is very difficult. Characteristic laboratory tests for bacterial infection include test of a number of leucocytes in peripheral blood, differential count of leucocytes, erythrocyte sedimentation, procalcitonin, C-reactive protein, tumor necrosis factor alpha, interleukin-1, interleukin-6, interleukin-8, and complement fragment C3a. Clinically the most significant are C-reactive protein test and procalcitonin test. Procalcitonin is a protein, a calcitonin precursor, which is in healthy individuals produced by cells of thyroid gland. A half-life of procalcitonin in serum is 20-24 hours which makes it suitable for daily monitoring and enables to control a course of treatment and to distinguish bacterial infection from other types of inflammations. Procalcitonin levels rise in bacterial, parasite, and yeast infections. Elevated procalcitonin levels appear only in inflammations of an infectious etiology with systemic signs. In patients with liver cirrhosis bacterial infections are more frequent. They usually include spontaneous bacterial peritonitis, infection of the respiratory system, urinary infections, and bacteremia. A timely proof of a bacterial infection and an appropriate and effective antibiotic therapy lead to an improvement of the general state of a patient and to his/her better prognosis. Procalcitonin determination is appropriate for diagnosing infections and control of treatment.

Bacterial Infections↗

PubMed2004

[Large-droplet liver steatosis in celiac disease].

Authors monitored a case of a 25 years old woman who was admitted for swelling of lower limbs. Laboratory results showed hypoproteinemia, elevation of liver enzymes, and prolonged prothrombin time. Ultrasound examination proved hepatomegalia with diffusely hyperechogenic liver without central lesion. Computer tomography confirmed hepatomegalia with diffusely hyperechogenic liver and a suspicion of liver steatosis was expressed. Liver biopsy confirmed serious diffuse large droplet steatosis of unclear genesis. Carried out examinations excluded infectious and autoimmune liver diseases, metabolic diseases, and congenital liver diseases (Wilson's disease, porphyria, haemochromatosis etc.). Laboratory results showed gliadin, endomysin, and reticulin antibodies. An enteroscopy picture showed villi decrease. Histology examination of a biopsy specimen confirmed total villi atrophy with non-differentiated enterocytes and round-cell cellulisation of epithelium and proprium. Histology and histochemical findings were distinct proves of coeliac disease. A patient was prescribed a gluten free diet. Her metabolic parameters (normalisation of albumine levels, prothrombine time, and trace elements) and anino transferase levels gradually improved. This case documents development of a serious liver disorder as a result of malnutrition which developed in a young woman as a result of unrecognised coeliac disease.

Adult↗

PubMed2004

[Factors participating in development of bleeding varices in portal hypertension. Part I: bacterial infection and comparison of intravenous and peroral antibiotics effects--a randomised study].

An acute bleeding from oesophageal varices as a result of portal hypertension is a frequent and at the same time serious complication of cirrhosis of the liver. One of factors influencing this bleeding can be a bacterial infection. Endotoxines can increase portal pressure and so participate in development of bleeding and simultaneously deteriorate a patient's prognosis. An antibiotic treatment is a part of a treatment algorithm, however what antibiotics to administer and in what manner is unclear. A group of 46 patients who were admitted to a hospital for an acute bleeding from varices has been compared in the study to 48 cirrhosis patients hospitalised for other reasons. An infection incidence was high in both groups (63.0 % vs. 54.2 %), bleeding patients had more often positive hemoculture (17.3 % vs. 8.6 %), and statistically significantly more often positive findings in throat swab culture (36.9 % vs. 17.3 %, p = 0.04) which is an evidence of an increased pathology colonisation of these patients. Bleeding patients were randomised for peroral norfloxacin administration (n = 25) or an intravenous administration of a combination of ampicilin and sulbactam (n = 21). There was no difference in survival of both groups. Due to a high number of bacterial infections antibiotics administration has been indicated in these patients. Intravenous administration is probably of the same effect as peroral administration.

Administration, Oral↗

PubMed2004

[Factors participating in development of bleeding varices in portal hypertension. Part II: Possible impact of kidney damage and malnutrition, mortality].

An acute bleeding from oesophageal varices as a result of portal hypertension is a frequent and serious complication of liver cirrhosis. The development of oesophageal varices and their rupture depends on the portal pressure. However, a range of other factors can contribute to a development of bleeding and its negative prognosis. A sample of 46 patients admitted for the acute bleeding has been compared to 48 cirrhosis patients hospitalised for other conditions in this work. There were significantly higher levels of nitrogenous matters in bleeding patients (urea 14.1 mmol/l vs. 7.78 mmol/l, p < 0.01, creatinine 129.8 micromol/l vs. 106.04 micromol/l, p = 0.09). Perhaps it can't be said that impaired renal functions alone increase the risk of bleeding. From this point of view they could rather be seen as definite prognostic markers of the degree of portal hypertension. Moreover, there was a decreased level of total proteins in bleeding patients (60.7 g/l vs. 69.9 g/l, p < 0.01) at a mild nonsignificant decrease of albumin (26.64 g/l vs. 28.51 g/l). Cirrhotic patients are known to suffer from malnutrition and there is a possibility that malnutrition can contribute to development of bleeding. A prognostic marker of mortality was a considerable impairment of liver function (bilirubin 97.4 micromol/l vs. 57.4 micromol/l; p = 0.1 and prolonged prothrombin time 1.99 INR vs. 1.56 INR; p = 0.09) and impaired kidney function (creatinine 166.7 micromol/l vs. 114.9 micromol/l, p = 0.09). Therefore a care of a good renal function must be a part of the complex care of bleeding patients.

Adult↗

PubMed2003

[Bacterial infections in patients with acute hemorrhage due to portal hypertension--personal experience].

Acute haemorrhage from the upper gastrointestinal tract is a frequent and serious complication which affects 20-60% patients with cirrhosis of the liver and portal hypertension. It is assumed that bacterial infections can be the direct cause of haemorrhage but accurate data on the influence of infection on the development and course of haemorrhage are lacking. Acute haemorrhage as a result of portal hypertension has a very high mortality, 30-50%, and an early relapse of haemorrhage occurs in as many as 40% of these patients. Most recent meta-analyses indicate that bacterial infection is an independent prognostic factor in failure of haemostasis and has a significant impact on the mortality of these patients. The authors examined for the presence of bacterial infection (blood, urine, throat, ascites) 25 patients with cirrhosis of the liver and acute haemorrhage as a result of portal hypertension and compared the results with a group of 25 patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. According to the results in patients with acute haemorrhage due to portal hypertension there is a significantly higher incidence of bacterial infections than in patients with cirrhosis of the liver and portal hypertension without acute haemorrhage. The results confirm the necessity to administer antibiotic prophylaxis to cirrhotic patients with varicose bleeding, not only to patients with symptoms and evidence of infection but also in their absence. Antibiotic prophylaxis extends the survival period of these patients.

Acute Disease↗

PubMed2003

[Drug therapy of portal hypertension].

The author presents a list of preparations used to influence portal hypertension resulting from cirrhosis of the liver, in particular in treatment or prevention of haemorrhage from oesophageal varices or gastropathy. The author describes the mechanism of action of drugs administered in acute haemorrhage (vasopressin, terlipressin, somatostatin, octreotide)) and preparations used in primary or secondary prevention of this haemorrhage (beta-blockers, nitrates, newly tested preparations or combinations). In the conclusion are recommendations for practical procedures according to principles of evidence-based medicine.

Humans↗

PubMed2003

[Antibiotic prophylaxis in patients with acute hemorrhage due to portal hypertension--personal experience].

Acute bleeding from upper part of gastrointestinal tract is a frequent and serious complication affecting 20 to 60% of patients with liver cirrhosis and portal hypertension. It is associated with a high death rate of 30 to 50% and a frequent relapse of bleeding occurs in up to 40% of these patients. The most recent meta-analyses have shown that bacterial infection is an independent factor in the failure of blood hemostasis and significantly influenced mortality in these patients. The authors investigated 25 patients with acute bleeding from the upper part of gastrointestinal tract due to portal hypertension in patients with liver cirrhosis. Irrespective of the proved bacterial infection the patients were given antibiotic prophylaxis. In 13 patients the authors administered norfloxacin orally and 12 patients were treated intravenously with ampicilin/sulbactam. The prophylaxis of the bleeding cirrhotic patients by norfloxacin (orally) resulted in a statistically significant prevention of early relapse as compared with the therapy by ampicilin/sulbactam (intravenously). The death rate reached 40% in spite of the antibiotic prophylaxis. There was no significant difference in the death rate between the two groups with different treatments.

Acute Disease↗

PubMed2002

[Spontaneous bacterial peritonitis in the Czech Republic].

The objective of the study was to assess the prevalence and more detailed data pertaining to the incidence of spontaneous bacterial peritonitis (SBP) in the Czech Republic. The authors examined 99 patients with cirrhosis of the liver and ascites. SBP was diagnosed in a high percentage--35 patients, i.e. 35.4%. It was found more frequently in patients with an alcoholic etiology of cirrhosis who had a history of subfebrile and febrile temperatures and increasing trend of ascites. For the diagnosis the increase of leucocytes in serum and C reactive protein levels may prove useful. Lower values of total protein and albumin in ascites predispose to the development of this infection. Reduction of the number of thrombocytes in the group of patients with SBP indicates the influence of portal hypertension in the etiology of this disease.

Adult↗

PubMed2002

[Rifaximin in the treatment of hepatic encephalopathy].

Hepatic encephalopathy is a frequent and serious complication of liver cirrhosis. Usually it is treated by non-absorbable disaccharides or antibiotics and its treatment is often difficult and associated with undesirable effects. The objective of our investigation was to evaluate the safety and effectiveness of a new antibiotic used in this indication--rifaximine. With rifaximine, 400 mg three times per day, a total of 25 patients were treated for a 10-day period. Significant improvement of the manifestations of encephalopathy occurred (evaluated by the grade of encephalopathy, test of combining numerals, the degree of flapping tremor and the arterial ammonia level). None of the patients developed undesirable effects. Rifaximine seems an effective, safe drug for hepatic encephalopathy.

Anti-Infective Agents↗

PubMed2002

[Influence of bacterial infection on the development and course of acute haemorrhage from oesophageal varices].

Acute haemorrhage from the upper portion of the gastrointestinal tract is a frequent complication which develops in ca 35-66 % of patients with cirrhosis of the liver and portal hypertension. It is assumed that one of the trigger mechanisms of varicose haemorrhage can be bacterial infection. However accurate data on the influence of infection on the development and course of haemorrhage are still lacking. The mortality of patients bleeding from oesophageal varices is very high (30-70%). Usually the cause of death is not haemorrhagic shock but haemorrhage-induced changes which lead to hepatic failure. It is assumed that in this very process an important part is played by bacterial infection with subsequent release of endotoxins. Most recent metaanalyses indicate that bacterial infection is an independent prognostic factor as regards failure to arrest haemorrhage and influences in a significant way the mortality of these patients. Antibiotic treatment of patients with varicose haemorrhage increases the survival period of these patients. Therefore to cirrhotic patients with varicose haemorrhage antibiotics should be administered prophylactically, i.e. not only to patients with evidence of infection but also those without these symptoms. The authors consider as the optimal antibiotic treatment administration of quinolones orally or by the i.v. route, possibly cephalosporins which seem to be equally effective as quinolones.

Acute Disease↗

PubMed2001

Cytotoxicity of natural compounds in hepatocyte cell culture models. The case of quaternary benzo[c]phenanthridine alkaloids.

The quaternary benzo[c]phenanthridine alkaloids (QBA) produce a plethora of species- and tissue-specific effects but the molecular basis of their biological activities remain mysterious. The objective of the present study was to investigate the cytotoxicity of QBA alkaloids, sanguinarine (SA), chelerythrine (CHE), fagaronine (FA), and the extract from Macleaya cordata in primary cultures of human and porcine hepatocytes. The cellular damage was assessed by the MTT assay, lactate dehydrogenase (LDH) leakage and the determination of intracellular glutathione (GSH) levels. The results are summarised as follows: (i) The alkaloids tested in doses 0.1 and 10 microM did not display statistically significant cytotoxicity for 0-3 h incubation; (ii) SA and CHE showed the dose- and time-dependent toxicity within the range 25-100 microM whereas FA was not toxic; (iii) the LDH leakage into the medium was higher for SA than for CHE, thus revealing a potent potential of SA to disturb cell-membrane integrity; (iv) after 3 h incubation with 100 microM SA/CHE, mitochondrial dehydrogenase activity (MTT assay) and the cellular GSH levels decreased to residual values of about 40% suggesting that mitochondria are unlikely to be a primary target for SA/CHE in the cell; (v) no differences were found in the response to QBA application in human vs porcine hepatocyte.

Alkaloids↗

PubMed2001

Incidence of chronic pancreatitis in the Czech Republic.

There have been only a few studies dealing with the incidence of chronic pancreatitis published. Over the last 80 years, original studies describing the incidence of chronic pancreatitis were undertaken, including studies in Scandinavia, Switzerland, Hungary and Poland. Incidence varied geographically, from 1.6 new cases per year among 100,000 inhabitants in Switzerland to 23 new cases among 100,000 inhabitants in Finland. The aetiology of 70% of all cases was alcoholic pancreatitis. The incidence of chronic pancreatitis in the Czech Republic is 7.9 per 100,000 inhabitants per year, similar to that of Denmark and Germany, but higher than that of Poland or Switzerland. In our study, the main aetiological factor was alcohol (65.4% of all cases, with consumption of alcohol of > 75.0 g/day).

Adult↗

PubMed2001

[Acute hemorrhage of the upper digestive tract--personal experience].

The authors submit a retrospective investigation of 50 patients hospitalized at the intensive care unit of the Medical gastroenterological department, Faculty Hospital Brno treated in 1999 with the diagnosis of acute haemorrhage into the upper digestive tract. In the investigated group the most frequent cause of haemorrhage was portal hypertension (21 patients, 32.8%) and a peptic gastroduodenal lesion (15 patients, 23.4%). During the investigation period 12 patients died (18.8%), 6 developed haemorrhage as a complication of a serious condition (decompensated cirrhosis of the liver). In haemorrhage from oesophageal and gastric varicosities pharmacotherapy is equally important as endoscopic intervention.

Acute Disease↗