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L Chrobák

Publications and source records attributed to L Chrobák.

At least 55 records · Page 3Linked to original sources
PubMed1994

[A fatal hemorrhagic condition after rodenticide ingestion].

The authors describe a fatal haemorrhagic condition in a 53-year-old man which developed after assumed ingestion of so-called "superwarfarins". Symptoms of intoxication with substances of the warfarin type include the sudden development of haemorrhagic diathesis, marked prolongation of INR and APTT with persisting pathological values of these tests after the usual substitution doses of vitamin K1. The fluctuation of INR and APTT values during repeated examinations is also striking. In the event of such a coagulation finding it is important to consider possible superwarfarin intoxication, even if it is difficult to provide direct evidence, as it is not possible to assess the ratio of vitamin K1 and K 1, 2, 3 epoxide.

4-Hydroxycoumarins↗
PubMed1994

[Dominant beta-thalassemia alleles in the Czech and Slovak population (beta-thalassemia mutations in 112(T-A) and 121(G-T) codons and the unstable Hradec Králové hemoglobin or alpha 2 beta 2 115 (G17) Ala-Asp)].

In four unrelated families of Czech and Slovak origin two nonsense dominant beta-thalassaemic alleles (CD 121 (G-T); CD 112 (T-A)) and in one family simple substitution in codon 115 (GCC-GAC) or alpha 2 beta 2 115 (G17) Ala-Asp HB-Hradec Králové were identified. Mutations in codons 112 and 115 were described for the first time. Phenotypic manifestation of beta-thal. intermedia was revealed in three families with CD 121 (G-T) and in a family with a mutation in CD 112, but the phenotypic manifestations differed markedly in individual subjects. Heinz bodies were detected in erythrocytes of the peripheral blood in two families. An exact explanation of phenotypic deviations in patients with the same mutation even within the same family were not obtained even in studies of alpha genes and the promoter area of the beta gene. The unstable variant of Hb-Hradec Králové is manifested in the mother and daughter by haemolytic anaemia with some traits of beta-thal. The authors discuss contemporary findings from the pathophysiology of recessive and dominant beta-thal. mutations and explain some of the phenotypic consequences. A relatively high incidence of dominant beta-thal. mutations in the Czech and Slovak Republic (4 of 12 families known world wide with a nonsense beta-thal. mutation in the 3rd exon) is explained by the absence of selective preference of these mutations in malaria infested areas as a result of serious clinical manifestations in heterozygotes. The haplotype in one of the families suggests a de novo origin of the mutation in CD 121.

Adult↗
PubMed1993

[Lymph node enlargement in hairy cell leukemia and problems with significant abdominal lymphadenopathy].

Enlargement of nodes in leukaemia with hairy cells (LVB) during the initial examination is rarely encountered. In the final stage of the disease it was found in six of our ten patients. A special situation is marked enlargement of retroperitoneal nodes observed in two patients. In one of them the nodes diminished after irradiation, in the second patient irradiation was not possible because of severe pancytopenia. Treatment with alpha-interferon failed previously in this patient. The question remains whether marked enlargement of the abdominal nodes is part of the picture of the disease or whether it is the manifestation of transformation of the disease into a more acute type. The authors recommend examination of the abdominal nodes by means of computed tomography (CT) already during the initial examination and during the subsequent course of the disease, in particular when there are signs of relapse.

Abdomen↗
PubMed1993

Long-term results in hairy cell leukemia treated by splenectomy.

Splenectomy as a therapeutic modality has been evaluated in a group of 24 consecutive patients. Before and after splenectomy only supportive therapy was applied with the exception of two patients in whom corticosteroids were administered because of vasculitis. Radiation therapy was applied in one patient because of massive retroperitoneal lymphadenopathy. One patient received Leukeran shortly before the fatal outcome because his response to splenectomy was poor. Out of 24 patients 14 patients died. The median survival for the partial responders and non-responders was 6 months only. Patients with a complete response did not reach median survival yet and 8 of them (33% of the whole group) have been alive for more than 9 years, one patient for more than 20 years. Two distinct groups of patients with respect to the outcome of splenectomy can be distinguished: The first group is characterized by a rapid fatal outcome mostly within two years after splenectomy, the second group has a more favorable course with a plateau and only occasional deaths after the fourth year.

Adult↗
PubMed1992

Communication with patients as a problem in undergraduate medical education.

The work is based on the following concepts: communication with patients ceases being a matter of experience learning only (the trial and error method) and should become a part of systematic training; it should not be included only into continuous education of graduated physicians but must be gradually introduced into undergraduate education as well; it is not an optional activity which may but may not be performed by physicians, but it is a specific component of their clinical competence. Today attempts to instruct medical students in communication with patients and their relatives are being made at many medical schools all over the world. Reports on such instruction are, however, scattered in various journals or in internal publications published by universities, faculties and clinics. Thus they are not available very easily. If there exist some survey works, they are mostly conceived on the national level. The objective of the study presented here is to show a comparatively comprehensive survey dealing with the medical student instruction on the international level, analyze trends in development and identify problems that have not been solved so far. The work consists of five chapters. The first one gives a short survey of current concepts in communication with patients reaching beyond the traditional training in taking medical history. Among others, the following factors are included here: explanation of both diagnostical and therapeutical methods to the patient, informing the patient about results obtained from the examination, telling him or her general conclusions and recommendations, informing patients of social associations of the disease, developing in the patients those attitudes which support their cooperation with physicians and the patient's will to live, ability to treat serious and terminal patients properly, ability to treat patients' relatives and communicate with other members of a medical team. The second chapter shows current attempts to train the medical student-patient communication in Czechoslovakia, especially at Charles University. Third chapter describes how medical students in the former USSR were instructed, especially at medical schools in Moscow. This kind of information is still difficult to be had for people from abroad. The fourth chapter is the most important. Current attempts to train medical students in communication with patients in Europe, North and South America, Asia, Africa and Australia are described there. Reference frames in which the instruction takes place (medical, educational, psychological frames) are studied.(ABSTRACT TRUNCATED AT 400 WORDS)

Communication↗
PubMed1992

[Tumor microembolization in the lungs--a cause of marked dyspnea, syncope, hemolytic syndrome and disorders of hemocoagulation].

The authors describe the course of the disease in a 28-year-old woman who suffered two years following surgery of breast cancer from rapidly deteriorating dyspnoea, syncopes and laboratory manifestations of global respiratory insufficiency. The finding on auscultation of the lungs was normal, pulmonary angiography did not reveal signs of serious pulmonary embolization. The patient died after ten days in hospital despite comprehensive therapy and artificial ventilation. Necropsy revealed multiple microembolizations of tumourous cells into the pulmonary vessels as the main causes of the disease. Concurrently infiltration of the bone marrow by tumourous cells was revealed. The course of the disease was complicated by impaired haemocoagulation as a result of microangiopathic haemolytic anaemia and disseminated intravascular coagulation during the passage of erythrocytes through the pathologically altered pulmonary capillaries and impaired liver function.

Adult↗
PubMed1992

[Prognostication of chronic Ph+ myeloid leukemia using the PHCML.EXE computer program].

In 193 patients with Ph-positive chronic myeloid leukaemia (CML) Sokal's calculation formulae prognosticating initial risk status were applied, using the computer program PHCML. The aim of this study was to the prognostic reproducibility of these prognostic staging systems in our patient population. Our results confirm the previous conclusions that prognostic discrimination is possible at the time of diagnosis of CML but in our patients with poorer prognosis the stratification seems to be more accurate. No significant advantage was achieved when we prognosticated our patients younger than 46 years using the formula recommended by Sokal et al. specifically for younger patients. We analyzed different criteria when segregating patients in groups with better or poorer prognosis. We found that the coefficient of the patient's relative risk as the boundary, was 1.9 our patient's group contrary to 1.2 in Sokal's studies.

Adolescent↗
PubMed1990

[Successful treatment of the superior vena cava syndrome caused by thrombosis and a fibrous septum in a patient with a permanent cardiac pacemaker].

A patient with a ten-year permanent implantation of a pacemaker was admitted on account of a clinically serious syndrome of the vena cava superior. The cause of the syndrome was an angiographically confirmed extensive thrombosis and after its dissolution a fibrous septum in the area of the orifice of the vena cava superior into the right atrium. The septum caused by a fibrous strip at the orifice of the vena cava superior into the right atrium was removed by surgical operation during thoracotomy by dilatation of the original opening in the fibrous septum by a Broca dilator and digitally. The authors recommend, based on their own experience and data in the literature, to use fibrinolytic therapy in clinically severe thrombosis in the area of the vena cava superior or the right atrium caused by an electrode--during temporary or permanent pacing--or by a catheter used for parenteral nutrition.

Aged↗
PubMed1990

[A heparin-like anticoagulant in a patient with Wegener's granulomatosis].

We identified a circulating, heparin-like anticoagulant in a patient with Wegener's granulomatosis. Routine coagulation studies revealed a significant prolongation of the coagulation time, thrombin time, prothrombin time and activated partial thromboplastin time. Thrombin time and activated partial thromboplastin time failed to improve in a 1:1 mixture with pooled normal plasma. Both test were corrected in vitro by addition of protamine sulfate or toluidine blue and in vivo by intravenous administration of protamine sulfate. Recognition of the existence of this or other similar inhibitors in bleeding patients is of value because of the possibility of treatment with protamine sulfate, which neutralizes the anticoagulant.

Adult↗
PubMed1989

[Eosinophilic leukemia].

On the example of a patients with eosinophil leukaemia, which at first was manifested as eosinophilia in the peripheral blood stream and bone marrow without involvement of other organs and only after three years acquired the character of malignant growth, the authors draw attention to difficulties in the differential diagnosis of hypereosinophil syndrome. At the same time the authors review briefly views on the origin of eosinophil leukaemia, morphological and cytogenetic findings considered useful as evidence of this rare type of leukaemia.

Adult↗
PubMed1984

Acute phase protein profiles in hairy-cell leukemia. Study in 50 patients. Effects of splenectomy.

Serum levels of 15 "positive and negative acute-phase proteins" were measured in 50 patients with hairy-cell leukemia (HCL) and in normal controls. The specific analysis of the protein levels was completed with the combined data of total serum protein and zonal electrophoresis. In HCL patients all electrophoretic globulin fractions were significantly increased, while the albumin fraction was decreased. The changes in albumin levels were more apparent in the nonsplenectomized patients, while the total protein was increased in the splenectomized cases as well as in the total HCL series. Compared with the control groups, in the nonsplenectomized patients both the mean relative increments in the level of some positive acute-phase proteins (such as orosomucoid) and the mean relative decrements in the level of some negative acute-phase proteins (such as alpha 2HS-glycoprotein) were 3 times the values found in the splenectomized patients. The occurrence of elevated values of C-reactive protein was significantly higher in the nonsplenectomized patients than in the splenectomized ones. These differences between the acute-phase proteins of the two subgroups of HCL patients were in agreement with erythrocyte sedimentation rate values. This indicates that the acute-phase protein formula is generally more favorable in splenectomized cases than in nonsplenectomized patients, at least during the first two post-splenectomy years.

Acute-Phase Proteins↗