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M Fortová

Publications and source records attributed to M Fortová.

8 recordsLinked to original sources
PubMed2006

[Resting energy expenditure during hemodialysis].

Very few studies have so far reported about resting energy expenditure (REE) in chronic renal failure and there is no information available on REE during hemodialysis (HD). Hypothetically, we can expect an increase in REE during HD procedure (due to the inflammatory response to extracorporeal blood circuit). However, such increase in REE could be modified by thermal balance of the procedure. In our study, REE was measured by indirect calorimetry (Deltatrac Datex) in a group of 13 HD patients (7 males and 6 females, mean age 59.8 +/- 13.5 years). In each patient, REE was assessed during two HD sessions: one isothermic and one thermoneutral. All other HD parameters were kept constant. The control group consisted of 14 healthy subjects (4 males and 10 females, mean age 41.3 +/- 20.5 years) with normal renal function. There was a significant difference in thermal balance between the two HD settings: -199 kJ/HD in isothermic and -4kJ/HD in thermoneutral HD sessions (p < 0.01). Measured REE values obtained in HD patients before HD session (7 316 +/- 919 kJ/day/1.73 m2) did not differ significantly from those of the healthy controls (7 264 +/- 1 016 kJ/day/1.73 m2). Similarly, there was no significant difference in calculated EE values (Harris-Benedict equation). In the 10th minute of the HD session, there was a slight, transitory decrease in REE (mean decrease by 3.2% during isothermic and by 2.8% during thermoneutral HD session, ns). In the 70th minute, REE returned to pre-dialysis values. After a light meal in the 110th minute REE increased by 8% during isothermic and by 6.3% during thermoneutral HD session. At the end of the HD session (i.e. in the 215th minute) REE again returned to pre-dialysis values. Intra-dialysis changes in REE were similar in both isothermic and thermoneutral HD sessions. The results of our study did not confirm the expected influence of HD procedure on REE in the two different thermal HD settings. We conclude that there is no significant difference between REE in HD patients and healthy controls and that REE values are not significantly influenced by hemodialysis procedure.

Calorimetry, Indirect↗
PubMed2006

[Blunt thoracic injury and the oxidation stress].

INTRODUCTION: Each injury is accompanied with the oxidation stress with an increase in the level of free oxygen radicals accompanied with a simultaneous decrease in the body's antioxidation capacity. The objective of the study: The objective of this study is to verify connection between the severity of an injury and the intensity of oxidation stress. METHODS: 126 patients with blunt chest injuries were evaluated during 33 months. The patients were divided into four groups, depending on the extent of trauma severity assessed by means of ISS (Injury Severity Score). Randomly selected patients in each group were administered--in addition to standard therapy--indomethacin in usual doses. Level of free oxygen radicals and the body's antioxidation capacity were observed. All tests were carried out at a significance level alpha of 0.05. RESULTS: Practically all patients, regardless of their respective subgroups, experienced an increase in the level of free oxygen radicals accompanied with a simultaneous decrease in the body's antioxidation capacity. CONCLUSION: The identified results display a connection between the severity of an injury and the intensity of oxidation stress.

Antioxidants↗
PubMed2006

[SIRS and serious blunt thoracic injuries].

INTRODUCTION: Serious blunt injuries are accompanied with the worsening of the mechanics of ventilation due to the chest and lung injuries alone as well as with a systemic inflammatory response (SIRS) that always affects the lungs. The development of an injury-induced respiratory failure is multifactorial and timely pharmacological intervention is likely to contribute to the treatment algorithm, thus improving prognosis in some patients with a serious chest trauma. THE OBJECTIVE OF THE STUDY: The objective of this study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response of the body (SIRS) in serious blunt chest injuries. The study also intends to identify whether the administration of indomethacin could reduce SIRS score and prevent multiorgan dysfunction and multiorgan failure. METHODS: 126 patients with blunt chest injuries were evaluated during 33 months. The patients were divided into four groups, depending on the extent of trauma severity assessed by means of ISS (Injury Severity Score). Randomly selected patients in each group were administered--in addition to standard therapy--indomethacin in usual doses. All tests were carried out at a significance level alpha of 0.05. RESULTS: The onset of SIRS in the subgroup with indomethacin was statistically significantly postponed in groups I. and II. Groups ISS I to III showed a statistically markedly shorter time of SIRS duration in the subgroup with indomethacin. The first increase in inflammatory markers (acute phase proteins) was statistically significantly postponed in the group ISS I without the administration of indomethacin. Groups ISS II through IV did not show a statistically significant differences in the first onsets of inflammatory markers. The evaluation of all four groups did not detect any statistically significant differences in the duration of the inflammatory markers increase in the subgroup with indomethacin and in a control group. There was no statistical significance in the average time of ventilation support. An average hospitalization time was shorter in the subgroup ISS II with indomethacin. There was found statistically significant difference. Of the patients included in our file seven died during the monitored period. Lethality is thus 5.6%. A multiorgan failure was the cause of death in two patients in the non-indomethacin subgroup and in one patient in the indomethacin subgroup. CONCLUSION: We proved that the factors that can be affected by the blockade of cyclooxygenase display statistically significant changes in subgroups with the administration of indomethacin. No changes were recorded with regard to acute phase proteins whose synthesis is not mediated by prostaglandins. The administration of indomethacin positively affects the development of SIRS, reduces and diminishes its effects as well as impact on the impaired body.

Adult↗
PubMed2004

[An importance of vitamin D metabolites assessment in patients with impaired renal function].

The goal of this prospective multicentric study was to assess concentrations of vitamin D metabolites in patients with renal insufficiency and to monitor response of calcium phosphate metabolism parameters to a focused individualised therapy. The sample consisted of 184 patients, 66 of them were undergoing regular dialysis (Ccreat 0.11 +/- 0.05 ml/sec., age 57.6 +/- 16.6) and 118 patients were dispensed for renal insufficiency (Ccreat 0.42 +/- 0.23 ml/sec., age 60.8 +/- 11.0). After an assessment of basic parameters of bone metabolism (Ca, Pi, ALP) and parameters of acidobasic balance, calcidiol, calcitriol, and parathormon were assessed by radiation immunisation and than the used treatment was evaluated and adjusted according to results of the assessment. Two month later laboratory tests were done. Entry concentrations of calcidiol were in 73% of patients in reference area. However, according to clinical recommendations the bottom value of the reference area had to be reevaluated towards higher values. Such more strict criteria suited only 20% of patients. Calcitriol levels in reference area were found in 30% of patients, after treatment adjustment in 49% of patients. Treatment with vitamin D pharmaceuticals was often limited by hyperphosphataemia, low PTH or hypercalinemia. Input levels of calcitriol in nondialised patients significantly correlated with input calcidiol, 1alpha-hydroxylasis in kidneys could be stimulated in them via calcidiol administration. Attention deserve especially low calcidiol and calcitriol levels in patients with renal failure because timely, individualised and controllable supplementation of vitamin D metabolites in renal insufficiency serves as a prevention of later advanced forms of bone metabolism impairment in a period of dialysis treatment.

Calcifediol↗
PubMed2003

[Parameters of bone metabolism in patients with various degrees of kidney function damage].

BACKGROUND: Patients with renal failure frequently have their calcium and phosphate metabolism seriously disrupted. It may result in a skeletal malady--the renal osteopathy. Late forms of this syndrome are difficult to cure. The aim of this comparative study is to follow the relation between parameters of the bone metabolism (calcitriol, calcidiol, parathormone, calcitonin, osteocalcin, Pi, Ca--total or ionised, and others) and the degree of deterioration of the kidney function. METHODS AND RESULTS: Three groups of patients were included into the study: A-hemodialyzed patients with chronic renal failure (Ccreat = 0.07 +/- 0.02 ml/s, n = 21, age 71.0 +/- 10.6 years); B--not dialyzed patients with decreased renal function (Ccreat = 0.33 +/- 0.05 ml/s, n = 19, age 65.0 +/- 9.6 years); C--patients with normal renal function (Ccreat = 1.45 +/- 0.12 ml/s, n = 16, age 85.2 +/- 4.7 years). Calcidiol concentration [microgram/l] did not differ in individual groups (A: 11.3 +/- 4.7, B: 10.7 +/- 8.2, C: 11.7 +/- 5.7, reference limits RM: 8.9-46.7). In contrast, calcitriol concentration [ng/l] was statistically different in all studied groups (A: 1.7 +/- 2.8, B: 17.6 +/- 12.4, C: 30.6 +/- 9.1, p < 0.001, RM: 19.9-67.0) and it correlated with the degree of renal function deterioration (calcitriol vs. creatinine, r = -0.76, p < 0.001). In PTH levels (pmol/l) the group C differed significantly from groups A and B (A: 27.4 +/- 32.0, B: 23.7 +/- 16.5, C: 6.2 +/- 2.4, C vs. A, p < 0.01, C vs. B, p < 0.001, RM: 1.0-6.8). PTH concentrations correlated with osteocalcine and HCO3 (r = 0.74, r = -0.56, p < 0.001). CONCLUSIONS: Results of the tested parameters have shown that abnormalities in the bone metabolism significantly correlate with the degree of renal deterioration. It demonstrates the requirements for vitamin D metabolites supplementation for patients is needed already in the pre-dialysis stage.

Aged↗
PubMed2003

[Renal bone disease].

Renal bone disease is a serious complication associated with chronic renal failure. The pathogenetic mechanisms are very complicated. The disorder develops as a result of hypophosphataemia, hypocalcaemia and calcitrol deficiency already during the period when renal functions decline below 50%. Formerly the form with an excessive bone turnover predominated, nowadays we encounter ever more frequently so-called a dynamic bone disease. A serious manifestation are extraosseous calcifications. In treatment phosphate binding substances in the gastrointestinal tract are involved (along with other provisions, correcting hypophosphataemia), supplementation of calcium in case of hypocalcaemia correction of metabolic acidosis and administration of the active vitamin D metabolite (continuously as supplementation in deficient endogenous production, in a pulsatile pattern with the aim to suppress the activity of parathyroid bodies). In case of "resistant" hyperparathyroidism surgery is indicated (parathyroidectomy). Treatment of the dynamic form is not known, prevention of suppression of excessive parathyroid activity is important. New trends in the treatment of renal bone disease are non-calcium phosphate binding substances in the gastrointestinal tract, vitamin D analogues (with a lower hypercalcaemic potential) and calcium mimetics.

Bone Remodeling↗
PubMed2003

[Pharmacologic prevention of SIRS (systemic inflammatory response syndrome) in severe thoracic injuries].

INTRODUCTION: Frequency and severity of the blunt chest injuries are increasing. Rather high letality is caused by the injury and following systemic inflammatory response. OBJECTIVE: The aim of the study is to verify the efficacy of pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries. The aim is also to find out if the administration of indomethacin as a cyclooxygenase inhibitor could prevent multiorgan dysfunction (MODS) and multiorgan failure (MOF). MATERIAL AND METHODS: Patients were divided into 4 groups according to trauma severity (Injury Severity Score). The group I. contains patients with ISS up to 17. There is no premise of the SIRS development. In the group II. there were patients with ISS 18-30, which means polytrauma group due to new definition. In the group III. there were patients with ISS 31-40 (severe trauma). Group IV. contains critically injured patients (ISS 41 and higher). Some patients involved in our study were given indomethacin (as cyclooxygenase inhibitor in arachidonic acid cycle) together with standard therapy. RESULTS: 65 patients were included into study in last 14 months, 22 patients were given indomethacin. The group with indomethacin administration has later increase of inflammatory markers in groups III. and IV. This increase also takes less time in groups II. and III. Shorter time of mechanical ventilation support in group III. in patients with indomethacin was significant. SIRS is present in time of admission approximately in 44%. All patients have low antioxidants level. 5 patients died in our group, letality was 7.7%. All the died patients came from the subgroup without indomethacin, however only one death caused by MOF. CONCLUSION: From the results of the first 14 months of the study we can conclude that certain number of patients with serious blunt thoracic trauma could benefit from indomethacin administration.

Cyclooxygenase Inhibitors↗