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Biomedical subjects

L Sobotka

Publications and source records attributed to L Sobotka.

At least 19 recordsLinked to original sources
PubMed2006

ESPEN Guidelines on Enteral Nutrition: Geriatrics.

Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

Aged↗
PubMed2006

[Sodium hyaluronate and an iodine complex--Hyiodine--new method of diabetic defects treatment].

UNLABELLED: Complicated diabetic defects are difficult to heal and frequently result in leg amputation. We have developed a new and unique system for wound treatment, which is based on combination of high molecular weight sodium hyaluronate with an iodine complex--Hyiodine. The aim of our study was to assess the effect of this new method of wound dressing on infected diabetic defects healing. METHODS: The effect of Hyiodine was studied on 22 patients suffering from complicated foot diabetic wounds. Hyiodine was either spread directly over the wound, or (more frequently) gauze was immersed in Hyiodine and then put on/into the wound. Then several layers of dry gauze covered the wound. RESULTS: Within 2-6 weeks after the onset of treatment all but two defects were filled with granulation tissue. Complete healing was evident in 18 patients within 6-20 weeks after the start of treatment, depending on the wound character, localization and extent. Two patients are still treated by Hyiodine, and significant improvement is apparent on their wound. Treatment was not successful in two subjects with ischemic defects due to simultaneous arterial occlusion. CONCLUSIONS: We can conclude that the hyaluronan-iodine complex Hyiodine is efficient method for treatment of difficult to heal diabetic defects without complete arterial occlusion.

Anti-Infective Agents, Local↗
PubMed2003

[Cholestatic icterus during parenteral nutrition and the therapeutic effect of enteral feeding--case report].

An acute operation was made on a 56-year woman for inflammatory perforation of colon. A series of repeated operations followed due to relapsing iatrogenic intestinal fistula and peritonitis. From the day 70 the patient was treated at the Intensive Metabolic Care Unit of the Gerontological and Metabolic Clinic of Faculty Hospital in Hradec Králové. Having cured the septic shock the authors prepared the patient to a reconstruction operation on alimentary tract by administering parenteral nutrition, treating the wounds and by motion rehabilitation. From day 150 on the patient was treated with low doses of enteral nutrition into the segment of intestine between the fistulas, in connection with the subsequent decrease of two-month lasting hyperbilirubinemia of 200-260 mumol/l. A successful reconstruction of the alimentary tract was performed on the day 205 of the treatment with the time lapse of 146 days after the last surgical intervention. A three-fold anastomosis on small intestine and a resection of the fistula on the transversal colon was made. The post-operation fistula was healed-up conservatively, while the parenteral nutrition continued, as verified on day 246 by enteroclysis. The paper draws attention to the importance of conservative metabolic care in the therapy of dishiscences of intestinal anastomoses not treated by acute surgery in time. A favourable additive effect of enteral nutrition on the persisting cholestasis during parenteral nutrition is discussed.

Cholestasis↗
PubMed2002

[Parenteral nutrition in catabolic states using Neonutrin 15%, a new amino acid solution].

Development of amino acid solutions for i.v. use proceeds worldwide, the main stimulus being the expanding physiological and pathophysiological findings of specific effects of some amino acids and their metabolism and the need to improve intensive metabolic care. New Czech preparations in this respect are the series of NEONUTRINS 5%, 10% and 15% (Infusia Ltd. Horátev). They are modern preparations which meet the pretentious criteria of contemporary amino acid solutions (balanced ratio of all essential, semiessential and assisting amino acids, a high content of essential and branched-chain amino acids, amino acids with specific pharmacodynamic effects). In a multicentre open clinical study the authors assessed the tolerance, safety and efficacy of NEONUTRIN 15% in 82 patients requiring total parenteral nutrition on account of catabolic states of different etiology. The preparation was administered repeatedly in an all-in-one mixture (together with glucose and lipid emulsions) by means of a central venous catheter. A total of 801 doses was administered. The trial provided evidence of very good tolerance and safety of the preparation with a practically zero incidence of undesirable effects. The follow-up of basic indicators of nitrogen metabolism confirmed also the efficacy of NEONUTRIN 15% in comprehensive treatment of patients (stabilization of nitrogen balance in the acute stage of a disease, normalization of the plasmatic aminogram).

Amino Acids, Branched-Chain↗
PubMed2002

[Nutrition in women with diabetes in various stages of life].

The diet of diabetic women should not differ fundamentally from an ordinary healthy diet. The intake of the basic energy providing nutrients and of microelements should be balanced and if possible should be supplied in natural food products. This ensues among others from the fact that the relations between some micronutrients are not yet quite clear. During pregnancy it is however necessary to ensure in diabetic women 400 micrograms folic acid; increased attention must be paid to magnesium intake and during the menopause the vitamin D and calcium intake must be followed up.

Diabetes Mellitus↗
PubMed2002

[Artificial nutrition in acute pancreatitis].

The authors describe the administration of different types of artificial nutrition depending on the clinical condition of patients with acute pancreatitis. They summarize contemporary findings on the pathophysiology of the disease, evaluation of everity according to Ranson's criteria and the tactics of nutritional support in acute pancreatitis.

Acute Disease↗
PubMed2001

[Changes of haemostasis in obese subjects during weight reduction].

In a group of 126 obese subjects hospitalized at the obesitological unit of the Gerontological and Metabolic Clinic, Faculty Hospital Hradec Králové the authors confirmed the effect of short-term modified fasting and a low energy diet on the body weight and body mass index They also proved the influence of weight reduction on normalization of cholesterol and LDL-cholesterol and triacylglycerols. They did not prove however the influence of short-term modified fasting and a low energy diet on the concentration of some coagulation pareameters (fibrinogen, D-dimers, antithrombin). In the patients a decline of the fibrinolytic activity was observed and an increase of the fibrinolytic capacity. The authors found a close correlation between the decline of the inhibitor of plasminogen-1 activator, an indicator of the fibrinolytic activity, and body weight and lipid changes. The authors proved a close negative correlation between the rise of fibrnolytic capacity and changes of body weight and lipids. In conjunction with the presented results and based on data from the lierature it may be stated that a decline of body weight in obese subjects reduces the risk of the syndrome of insulin resistance. Activation of fibrinolysis in insulin resistance depends directly on the amount of visceral fat and changes of te fibrinolytic properties of blood in obese subsjects depend on the production of PAI-1 by adipocytes of visceral fat.

Antithrombins↗
PubMed2000

[Changes in selected biochemical parameters during a low-calorie reducing diet].

AIM OF THE STUDY: Assessment of the effect of short term modified low calorie diet on body weight and body mass index (BMI). Assessment of the effect of modified low calorie diet on blood lipids and some biochemical parameters. METHODS: Before and after diet: body weight, BMI, whole blood count, platelet count, serum cholesterol, triglycerides and HDL cholesterol, serum creatinine, uric acid, urea, bilirubin, AST, ALT, pH of urine and atherogenic index (CHOL-HDL/HDL). PATIENTS: 11 male, mean age 52 years and 19 female, mean age 53.3 years. THERAPY: Modified diet 14 days, 3.3 MJ daily, vitamins and minerals. RESULTS: No significant difference was observed in platelet count, serum creatinine, urea, bilirubin, AST, ALT, pH of urine, HDL cholesterol and atherogenic index before and after modified low calorie diet. Significant loss of body weight and decrease of BMI, cholesterol and triglycerides occurred after modified diet. Serum uric acid significantly increased after weight loss. CONCLUSION: The present result's shows that a drop of serum cholesterol and triglycerides follows a significant loss of body weight after modified diet. Our result's shows a significant increase of uric acid levels after weight loss. There was no effect of body weight loss on other biochemical parameters.

Diet, Reducing↗
PubMed1999

[Electrophysiology in hypovitaminosis A].

Electroretinographic examinations performed according to the international standard were used in two patients with alimentary hypovitaminosis A. In one instance a mentally caused long-term deficiency of dietary vitamin A intake was involved, in the second instance a fistula from the proximal jejunum into the transverse colon. In both instances night blindness was reported. The initial vitamin A values were 1.0 and 0.6 micromol/l resp. and after substitution therapy they rose to 2 micromol/l. While the rod and maximal ERG responses improved gradually, the oscillation potentials remained pathological as regards amplitudes and latencies. We consider them therefore a sensitive indicator of the electric sensitivity of the retina also in other cases of confirmed or suspected vitamin A deficiency. The existence and orientation of our metabolic and gerontological clinic provides adequate opportunities for these investigations.

Electroretinography↗
PubMed1998

Monitoring of TPN consumption at the University Teaching Hospital in Hradec Králové.

To standardize studies on the utilization and consumption of drugs, the World Health Organization recommends the use of the Anatomical Therapeutic Chemical (ATC) classification system, using the defined daily dose (DDD value) as a technical unit of measurement of drug consumption. DDD values of total parenteral nutrition have not been established yet. In our descriptive study the methodology by E. Frankfort et al. (1993) is used. This methodology allows the calculation of both the total number of DDD values for TPN and the number of DDD values for the individual substances. Suggested DDD values and consumption of total parenteral nutrition by E. Frankfort et al. (1994) were compared with the values at the Teaching Hospital in Hradec Králové. During 3 months 142 patients administered only TPN were included in the study. The following data from every patient were collected: sex, age, the main diagnosis, composition of TPN each day and duration of this administration. The mean PDD value for carbohydrates was 200 +/- 41 g, for fat emulsion 77 +/- 27 g and for amino acids 93 +/- 16 g. The difference between our and Frankfort's results were found.

Adolescent↗
PubMed1997

Inulin as the soluble fiber in liquid enteral nutrition.

Dietary fibers are a necessary part of human nutrition. Inulin is a fermentable fiber that improves bacterial ecology in the large bowel and is also a relevant substrate for short-chain fatty acid (SCFA) production. The aim of the present study was to evaluate the clinical effect of inulin, added as dietary fiber into the fiber-free enteral nutrition (Nutrition Standard). Inulin (30-35 g/d) was administered for 1 wk to a group of patients requiring the nutritional support of a liquid enteral diet. A significant increase in flatulence, an indication of rapid bacterial fermentation, was apparent during its infusion in comparison with a fiber-free enteral diet. Moreover, an increment in ability to dehydrate the cecal stream (stool consistency) was apparent in nearly half of patients. No changes in SCFA concentration in stool and indican output in urine were apparent after 1 wk of inulin administration. Intestinal permeability (51Cr-EDTA absorption test) was not influenced by either enteral nutrition or inulin and enteral nutrition administration. Because of good tolerance inulin seems to be a potential source of dietary fiber in clinical enteral nutrition.

Acetates↗
PubMed1997

An information system for metabolic intensive care unit.

The metabolic intensive care unit (MICU) is a special department where patients requiring long-term metabolic and nutritional support are treated. Parenteral nutrition is of primary importance in the MICU. The optimal organisation of many different data within the MICU, requires an information system which is computerised. However, the problem of paramount importance is data collection. To prevent data losses, we have constructed our computerised information system for MICU as the only information channel for mutual communication of physicians, nursing staff, laboratories, etc. The following modules are typical and necessary for work in the MICU: (1) module for parenteral nutrition; (2) module for enteral nutrition; (3) biochemical module; (4) drug therapy administration module; (5) clinical microbiology database; (6) nursing therapeutic module. At present we have 6-years experience of full computerisation of the MICU. According to this experience the assumption that the logical central point of medical information system must be close to the physician, nurse and patient proved to be correct.

Biochemical Phenomena↗
PubMed1994

Hypercaloric lipid and glucose infusion reduces the mitochondrial respiratory activity in the regenerating rat liver.

In order to evaluate the liver mitochondrial response to an increased energy load, eight groups of rats were studied: a control group (no surgery), a sham-operated group, and 6 groups that had undergone partial hepatectomy (PH). The PH rats either had no infusion following surgery, saline, isocaloric lipid, hypercaloric lipid, isocaloric glucose or hypercaloric glucose infusion. After isolation of liver mitochondria 6, 12, 18 and 24 h after surgery states 3 and 4 of respiration were measured in vitro in the presence of succinate. State 3 and 4 mitochondrial respiration was higher in the sham-operated rats 6 h after surgery than in the control animals, and a gradual decrease towards control values occurred in the 12-24 h period following surgery. Results in mitochondria from PH rats showed variable results, in most cases both State 3 and 4 respiration was higher after PH, while the respiratory control index in general was lower. State 3 respiration was significantly increased in the PH isocaloric lipid and glucose infused groups 6, 12 and 18 h, but not 24 h after partial hepatectomy. The PH hypercaloric glucose and hypercaloric lipid infused rats showed decreases in the liver mitochondrial oxygen consumption after 6, 12 and 18 h of liver regeneration, this was more pronounced after hypercaloric lipid infusion. These results suggest that, in vitro, the surgery tends to increase Status 3 and Status 4 mitochondrial respiration. The hypercaloric parenteral nutrition, both lipid and glucose based, significantly decreased liver mitochondrial oxygen consumption in partially hepatectomized rats, particularly in the first hours of liver regeneration, with restoration 24 h after surgery.

Journal Article↗
PubMed1993

[Microbiological study of patients with enterocutaneous fistulae treated with long-term total parenteral nutrition].

The authors followed up 12 patients with dehiscences of surgical wounds and postoperative enterocutaneous fistulas treated by on a long-term basis by complete parenteral nutrition. Previous operations were performed on account of different non-tumorous (11/12) and tumourous (1/12) diseases of the gastrointestinal tract. Microbiological examinations were made in every patient on admission and during total parenteral nutrition, always once a week for a total period of 2-8 weeks (mean 4.4; median 4.5). The authors examined aerobic and facultatively anaerobic bacteria in smears from the fistulas, stomies, dehiscent surgical wounds and from the rectum. The findings did not confirm the suspicion of local nosocomial infection. Strikingly often bacteria producing indole were found (in 8/12 examined subjects) and/or bacteria with positive urease (12/12) and lecithinase activity (9/12 patients). In the detected strains of Pseudomonas aeruginosa (in 8/12 examined patients) lecithinase activity was confirmed in all. It cannot be ruled out that the above described enzymatic bacterial activities may have contributed to the failure of conservative therapy in the majority of patients (10/12).

Adult↗
PubMed1993

Immunoglobulin G subclasses in Crohn's disease with and without bowel resection.

Increased immunoglobulin G2 [IgG2] in Crohn's disease in contrast with increased IgG1 in ulcerative colitis was reported in literature data. The aim of our study has been focused on serum IgG subclasses in Crohn's disease with resected bowel (11 patients) and without previous surgery for Crohn's disease (12 patients). All patients were in active stage of the disease on total parenteral nutrition. Serum IgG subclasses were estimated by means of radial immunodiffusion. There was no significant differences between in IgG subclasses in Crohn's disease with and without bowel resection. IgG2 over 4.5 g/l was found only in 2/12 with resected bowel and 1/11 without previous surgery for Crohn's disease. Surprisingly, IgG1/IgG2 ratio below 1.5 was found only in 5/23 persons. In 3/23 patients IgG1 was over 10.5 g/l although there was no doubt about the diagnosis of Crohn's disease. IgG subclasses failed to help in confirmation of the diagnosis of Crohn's disease. Serum IgG subclasses alterations probably are not influenced by bowel resection and/or nutritional status.

Adolescent↗
PubMed1993

[Eye manifestations of hypovitaminosis A].

Two cases of a heavy hypovitaminosis A (tumor of the pancreas and an insufficient resorption accompanying the syndrome of a short intestine) are presented. The eye symptomatology consisted of lowered dark-adaption curve, absent electrical reactivity and lowered contrast sensitivity. After restoring the normal vitamin A level in the blood the eye symptoms vanished.

Adult↗
PubMed1991

[The effect of occupational exposure to styrene on the metabolism of lipids and lipoproteins].

A total of 53 subjects with working exposure to styrene (1-29 years) has been investigated. On lipid and lipoproteins examination, only 8 persons (15%) showed normal values. The amount of 26 (49%) persons had the increase in HDL-cholesterol values. Subjects with protracted exposure to styrene (11-29 years) had higher level of cholesterol, absolute HDL-cholesterol values, total VLDLs and atherogenic index as compared to those which have worked at risk of styrene for 1-10 years. However, there was no statistically significant difference. Occupationnaly styrene exposed persons had statistically higher HDL-cholesterol (expressed both absolutely and relatively) in comparison with 21 clinically healthy controls. Changes of total cholesterol, VLDLs and of atherogenic index may partly be explained with factor of age. However, this is no such an explanation for HDL-cholesterol, since in adverse to that it decreases with more age in a normal population. Authors assume the pathologically higher HDL-cholesterol levels may exhibit causal interaction with occupational exposure to styrene, probably through the induction of microsomal liver enzymatic systems.

Adolescent↗