Biomedical subjects
Publications and source records attributed to J Simek.
Authors present sociological view on the institute of informed consent. They show its role in the contemporary development of patient-physician relation and they also show some difficulties in its realisation from the perspective of patients who take part in decisions making in medicine.
The article gives a small reflection on the term human dignity which is sometimes used in medicine, but is not always considered what is meant by the term. Together with the development of science and health technology health care providers give more preference to physical aspects of human existence. Terms such as human dignity trail off their vocabulary. More often we meet it in codes of ethics and in different proclamations then in discussion on concrete patients. It is discussed in the text how we can understand the term from philosophical and practical perspectives and how we can use it for the benefit of our patients.
The study investigated second derivative of the finger arterial pressure waveform (SDFAP) in 120 healthy middle-aged subjects and in 24 subjects with essential hypertension. SDFAP consists of 5 sequential waves 'a'-'e'. Their normalized magnitudes (B/A, C/A, D/A, and E/A) were calculated. In multivariate regression analysis, B/A and C/A correlated only with age. D/A independently correlated with age, heart period, mean blood pressure (MBP), body height, and gender. E/A independently correlated with age and MBP. D/A and E/A were higher (0.42+/-0.16 vs. 0.33+/-0.14, p = 0.05 and 0.63+/-0.15 vs. 0.45+/-0.14, p < 0.001), while B/A and C/A were lower (1.04+/-0.16 vs. 1.20+/-0.17, p = 0.002 and 0.09+/-0.15 vs. 0.26+/-0.20, p = 0.001) in hypertensives compared to sex- and age-matched controls. After the adjustment for MBP, heart period, and body mass index (ANCOVA), independent discriminative power was preserved only for indices B/A and C/A (p = 0.001 and 0.021, respectively). Therefore, B/A and C/A provide additional information about simple clinical characteristics and might reflect the structural alteration of the arterial wall in hypertensive subjects.
The authors in their two cases describe unusual complication after successful indirect cardiac massage which was carried out in terrain. Both patients were then transferred to Dept. of gerontology and metabolic care. However the resuscitation was in both cases successful it caused in these two cachectic oseoporotic patients sternal and costal en block fractures. This iatrogenic trauma of thoracic wall showed up in further cause as a major problem. The patients could not have been disconnected from artificial support of ventilation and therefore their thoracic cage had to be surgically stabilized.
The surgical treatment of lung cancer has got a long tradition at our department. The aim of this work is to evaluate the group of 3,857 patients from the years 1948-1997. The special analysis has been performed of the group of 1572 patients from the years 1974-1997 undergoing lung resection. Evaluating our operation policy a strong trend from pneumonectomy to less extensive operations can be found. The introduction of bronchoplastic operations and modern diagnostic methods has substantially improved the possibility of surgical treatment. The utilization of TNM system enabled to compare the different groups of patients according to the unified classification. The long term survival was directly related to the stage and histological type of disease. The five years period survived 33% of patients in whom the lung resection was performed during the period 1974-1997. The operative hospital mortality has been substantially reduced to 1.7%. Even though it is our duty to provided the surgical treatment to all the patients if the resection is still possible the best results are to be expected in patients in the first stage of disease. Therefore the early diagnosis followed by adequately sized resection without delay offers the best chance for the patients long term survival.
The authors were prospectively monitoring postoperative blood loss in 23 patients, in which decortication of the lung tissue and pleurectomy was performed and in which 500,000 KIU of aprotinin was applicated locally to the operating field before closing chest. The study was performed between the years 1998 and 2001. The amount of blood loss was compared to that of a group of 23 patients who underwent the same type of surgery between 1991 and 1998 without use of aprotinin. The postoperative blood loss was monitored 6, 12 and 24 hours after completing the surgery. Postoperative blood loss was lower in the group of patients in which aprotinin was used which was found to be statistically significant compared to the group of nonaprotinin patients.
This article focuses on rationing of expensive medical care in the Czech Republic. It distinguishes between political and clinical decision levels and reviews the debate in the Western literature on explicit and implicit rules. The contemporary situation of the Czech health care system is considered from this perspective. Rationing reoccurred in the mid 90s after the shift in health care financing from fee-for-service to prospective budgets. The lack of explicit rules is obvious. Implicit forms of rationing, done by physicians at the clinical level prevail, implying uncontrolled power of the medical profession and lacking transparency for ethical considerations of equity to access. It seems to be acceptable for physicians to play the role of allocators, probably because of their experience with rationing during the socialist period. Traditional rationing stereotypes from the previous regime seem to persist despite the health care system transformation during the 90s.
Patients with non-penetrating chest trauma are encountered with increasing frequency. Car crash is the main cause of blunt chest trauma. Despite their nature these lesions may be life-threatening. The mortality rate of chest injuries varies from 20 to 50%. In the last 3 years 86 patients with blunt chest injuries were treated in our institution. 24 patients underwent surgical repair. We compared the outcome of surgical and conservative treatment. Early diagnosis and proper treatment reduce morbidity and mortality.
Heart Rate Turbulence (HRT) is a newly described physiological chronotropic response of sinus rhythm following a single ventricular premature beat (VPB) consisting of early acceleration and later deceleration of heart rate. Using two large independent cohorts of postinfarction patients, the absence of HRT was retrospectively validated to be a potent multivariate risk predictor, stronger than a number of currently available risk stratifiers. Although exact pathophysiological mechanism of HRT remains speculative, it is now believed that HRT arises from the haemodynamic changes and baroreceptor reflexes that occur following a VPB. Therefore, HRT descriptors (Turbulence Onset and Turbulence Slope) may serve as very reasonable, Holter--based surrogates of baroreflex sensitivity available in clinical practice. The aim of this review is to summarise the current knowledge on pathophysiological mechanisms of HRT and to discuss practical problem of its detection.
OBJECTIVE: It has been repeatedly proven that statins improve endothelial function in isolated hypercholesterolaemia but there is far less evidence in the case of combined hyperlipidaemia. Studies assessing the effects of fibrates on endothelium have been neglected. Therefore, we conducted a trial in which the effects of fenofibrate and atorvastatin monotherapy on both endothelium-dependent vascular reactivity and biochemical parameters were compared in patients with combined hyperlipidaemia. METHODS: 29 otherwise healthy males (aged 47.4+/-7.8 years) with combined hyperlipidaemia (total cholesterol 7.55+/-1.20 mmol/l, triglycerides 5.41+/-4.54 mmol/l) were included into the randomised, single-blind, cross-over study to receive either 200 mg of micronised fenofibrate or 10 mg of atorvastatin daily--each of the drugs for a period of 10 weeks. Analysed biochemical parameters were as follows: serum total-, LDL- and HDL-cholesterol, apolipoproteins A-I and B, triglycerides, fibrinogen, uric acid, C-reactive protein (CRP), insulin, and homocysteine. Endothelial function was investigated by duplex Doppler ultrasonography at the brachial artery. Two indices of endothelial-dependent postischaemic changes were used - the recently introduced index of peak blood flow (PBF) representing the level of reactive hyperaemia and traditional flow-mediated dilatation (FMD). RESULTS: We observed a small improvement in FMD after both fenofibrate and atorvastatin (from 2.26% to 2.98% and 2.87%, respectively; NS). PBF increased from 448 ml/min to 536 ml/min after fenofibrate (P=0.04) and to 570 ml/min after atorvastatin (P=0.03). The effects of both fenofibrate and atorvastatin on endothelial function did not differ significantly (P-values of 0.82 and 0.47 for FMD and PBF, respectively). Significant correlations (P<0.01) between the changes of vascular reactivity and biochemical indices were found between FMD and CRP (r=-0.60) and between both FMD and PBF, and insulinaemia (r=-0.48 and -0.56, respectively) only during treatment with fenofibrate. CONCLUSIONS: Both fenofibrate and atorvastatin significantly improved endothelium-dependent vascular reactivity without mutual difference. The PBF was superior to FMD for the detection of this improvement. The beneficial effect of both drugs did not correlate with the change of lipid profile during therapy. The improvement of vascular reactivity during treatment with fenofibrate (opposed to atorvastatin) was related to the reduction of indirect marker of chronic vessel wall inflammation and of insulin resistance. The PBF was more reproducible than FMD because of considerably lower intra-subject variability.
Fifty-four pulmonary carcinoid tumors of surgically treated patients were diagnosed according to modified Arrigoni histological criteria (WHO 1999). Forty-seven typical (TC) and seven atypical carcinoids (AC) formed the basic groups. Four subgroups were selected from the TCs and consisted of cases with higher tumor size (T2) or those associated with nodal involvement (N1), tumor satellites, and tumorlets. Subgroup tumors were regarded as affections with possible increased proliferation potential. The proliferate activity was examined immunohistochemically by topoisomerase II-alpha (clone SWT3D1) on paraffin material and calculated by the number of positive nuclei per 10 HPF. The topoisomerase expression was found to be statistically different in both principal groups made up of typical and atypical carcinoids with a mean value of 49 and 135 positive nuclei per 10 high power field in TC and AC, respectively. The remaining subgroups of the TCs associated with examined characteristics (larger tumor diameter, metastases, satellites, tumorlets) were not found to be statistically different. The topoisomerase II-alpha is a marker giving valuable information about the diagnosis of pulmonary typical and atypical carcinoids.
The surgical treatment of lung cancer has got a long tradition at our department. The aim of this work is to evaluate the group of 3,727 patients from the years 1948-1995. The special analysis has been performed of the group of 1,456 patients from the years 1974-1995 undergoing lung resection. Evaluating our operation policy a strong trend from pneumonectomy to less extensive operations can be found. The introduction of bronchoplastic operations and modern diagnostic methods has substantially improved the possibility of surgical treatment. The utilization of TNM system enabled to compare the different groups of patients according to the unified classification. The long term survival was directly related to the stage and histological type of disease. The five years period survived 32% of patients in whom the lung resection was performed during the period 1974-1995. The operative hospital mortality has been substantially reduced to 2%. Even though it is our duty to provide the surgical treatment to all the patients if the resection is still possible the best results are to be expected in patients in the first stage of disease. Therefore the early diagnosis followed by adequately sized resection without delay offers the best chance for the patients long term survival.
Between January 1975 and June 2000 565 patients with thoracic injuries were treated at our institution. 116 of them had penetrating thoracic traumas and 42 injuries of the heart and great vessels. Study includes two groups of patients: hemodynamic stable and hemodynamic unstable ones. Different algorithms of management, techniques, treatment and prognosis are described. In the group of hemodynamic unstable patients the emergency surgical treatment had to be performed sometimes even without the benefit of any radiological imaging method. Mortality rate of patients having reached the hospital equated 23.8%. The surgical treatment results were better in the past decade because of improvement in prehospital care and higher quality of emergency medical system. The possibility of fast transportation allowed a higher percentage of critically injured patients to reach the hospital alive.
The cross-spectral analysis of heart rate (HR) and blood pressure (BP) variabilities provides "amplitude" and "phase" related measures. Compared to the amplitude measure, that is the baroreflex gain, the phase related measure characterizing the time lag between HR and BP oscillations has been studied to a much lesser extent. A population of 103 patients (73 men, 30 women, aged 53 +/- 12, range 20-82 years) referred for the management of coronary artery disease and/or hypertension were studied. In each subject, electrocardiogram and BP recordings were obtained in the supine and sitting positions of 5 minutes of rest (spontaneous respiration), 3 minutes of controlled respiration at 0.1 Hz (slow-controlled respiration), and 3 minutes of controlled respiration at 0.33 Hz (fast-controlled respiration). The frequency of maximum coherence (above the arbitrary threshold of 0.5) of BP and RR interval variabilities was searched between 0.033-0.133 Hz and 0.200-0.400 Hz to obtain baroreflex gain and phase shift in low and high frequency bands, respectively. Mean phase shifts of -79.1 and -67.0 degrees (-2.4 and -2.1 s) were found during slow-controlled respiration in the supine and sitting body positions, respectively. The mean phase shift between systolic BP and RR interval in the low frequency band was found between 83 and -109 degrees for body positions and respiration regimes. The actual baroreflex related time lag between systolic BP and RR variations was found between 3.5 and 5.1 seconds. The study concludes that the appropriate, and not always easy, selection of the frequency of maximum coherence between BP and HR oscillation is crucial for an accurate cross-spectral assessment of baroreflex sensitivity.
AIM: On the basis of known Ki-67 dependence on tumor malignancy in some lesions, we compared this marker expression quantitatively in pulmonary typical and atypical carcinoid tumors and attempted to predict their biological behavior especially in cases associated with tumorous lymphadenopathy, satellites, and carcinoid tumorlets. METHOD: Using material from surgically treated patients, we examined 54 cases of pulmonary carcinoids divided into five groups. 1. Forty-two typical carcinoids (TC), 2. Twelve atypical carcinoids (AC) diagnosed according to modified Arrigoni's criteria (Travis et al., 1998), 3. Thirty-two TC without metastases, satellites, and tumorlets (M, S, T), 4. Eight AC without M, S, T, and 5. Fourteen TC and AC associated with M, S, T. Groups 3, 4, and 5 were formed of cases selected from group 1 and 2. The proliferate activity was evaluated by Ki-67 (MIB-1, Immunotech France, 1:25). Its nuclear labeling was counted in more than 50 HPF and calculated as a number of positive nuclei in 10 HPF. The Fisher exact test was used for statistical analysis. RESULTS: The Ki-67 nuclear expression was found in 19 (45%) out of 42 TC and in 9 (75%) out of 12 AC. In the set of TC without metastases (M, S, T), the Ki-67 positive labeling was found in 14 (44%) out of 32 cases (group III) and in six (75%) out of eight AC (group IV). In all TC and AC tumors with M, S, T (group V), the Ki-67 expression was encountered in 8 (57%) out of 14 cases. The Fisher exact test showed no significant difference between all examined groups. CONCLUSION: No statistically significant difference was found in Ki-67 expression in pulmonary typical and atypical carcinoids. It appears to be a factor which can not be used for tumor prognosis prediction or adjuvant therapy indication in surgically treated patients.
Abdominal type of obesity is linked to risk factors of metabolic diseases. The determination of visceral fat with the ultrasound assessment by Armellini is a very simple method. 55 obese patients were such examined including other parameters during the weight reduction. The results of our small experimental group are shown in the Tab. 1 and 2.
The present indications for surgery are mainly large or increasing bullae that result in compression of apparently good lung tissue, and the complications of bullous diseases such as pneumothorax. The results of local resection of localized giant bullae are dramatic. The resection of small bullae generally has little effect on lung function. Lobectomy should not be done until bullae have been removed locally and the remaining lung has been tested by positive ventilation. The indications for the resection of large bullae in the presence of diffuse emphysema require very careful individual study. Pulmonary function tests are mandatory but computed tomography is the single most useful method of assessing the extent of the bullous disease and the underlying lung disease. If the underlying lung is diffusely cystic then any surgical treatment is palliative only.
An appropriate choice for a suitable diet during liver regeneration still remains an enigma. To investigate the effect of isocaloric enteral feeding with medium-chain triacylglycerols (MCT) and long-chain triacylglycerols (LCT) supplement (MCT+LCT, 40%:60% w:w) (178 kJ/kg b.w./24 h), rat liver regeneration was studied 24 and 72 h after partial hepatectomy. The liver DNA synthesis 24 h after partial hepatectomy was significantly higher in the MCT+LCT-supplemented rats (30.2+/-8.2 x 10(3) dpm/mg liver DNA) compared to MCT-treated animals (18.1+/-5.7 x 10(3) dpm/mg liver DNA). Liver protein synthesis was non-significantly elevated both 24 and 72 h after surgery in MCT+LCT-supplemented rats (13.7+/-1.1 and 10.9+/-3.1 x 10(3) dpm/mg liver protein). Seventy-two hours after partial hepatectomy, the hepatocyte mitotic activity was significantly increased in MCT+LCT- supplemented group vs. LCT- or MCT-fed rats (3.3+/-0.7 vs. 1.9+/-0.7 or 1.0+/-0.6 mitoses per 1000 hepatocytes), thus exhibiting an increased proliferative potential. The results showed a qualitative difference according to the proportion of MCT to LCT in the enteral supplements. Overfeeding with MCT decreased body weight, increased liver weight by its fatty infiltration, increased rat mortality rate and reduced spontaneous caloric intake. We conclude that the balanced supplement of MCT+LCT (40%:60% w:w) preserves liver regeneration, whereas overfeeding with MCT seems to be deleterious.