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Biomedical subjects

M Kaláb

Publications and source records attributed to M Kaláb.

At least 19 recordsLinked to original sources
PubMed2006

[Pulmonary trombendarterectomy in the patient with the symptoms of massive pulmonary embolism: case report].

The case-report of a 57-year-old patient with the symptoms of massive pulmonary embolism is presented. The patient was admitted to the hospital in the cardiogenic shock, ventilated and with high dose of inotropic support. It was impossible to find out the exact data from personal history. The patient was operated on urgently. The chronic occlusion of the right pulmonary artery due to the chronic tromboembolic disease was found out. Thromboendarterectomy of the pulmonary artery was successfully performed. Three month after operation the patient is in excellent clinical condition almost without any functional limitation. Some atypical features of this case are stressed in the discussion: the urgency of the operation for chronic tromboembolic disease with unilateral involvement, which simulated pulmonary embolism and operation in mild hypothermia without circulatory arrest.

Endarterectomy↗
PubMed2005

[Long-term pharmacological treatment of portal hypertension].

Portal hypertension is an unavoidable complication of liver cirrhosis, which usually limits the survival (bleeding from esophageal varices, ascites). Increase in portal pressure is not only due to mechanical obstruction of portal circulation, but there is also a dynamic component (endothelial dysfunction of hepatic microcirculation) and increased blood flow through the splanchnic circulation. For the long-term treatment of portal hypertension two groups of medicaments are available at present: non-selective betablockers (vasoconstriction in splanchnic bed) and nitrates (lowering of intrahepatic resistance). Long-term treatment is necessary in these situations: Primary prophylaxis of bleeding from esophageal varices (in patients, who never bled, but with "risk" varices)--non-selective betablockers; secondary prophylaxis (in patients after variceal bleeding)--non-selective betablockers (possibly with nitrates) or endoscopic treatment. It is clearly documented, that this treatment lowers the risk of the first or repeated bleeding from varices and hence lowers the mortality and morbidity due to this complication in patients with liver cirrhosis. Another serious complication of liver cirrhosis is the spontaneous bacterial peritonitis. All patients after that infection have to receive prophylactic treatment with antibiotics. This treatment should be long life, till the disappearance of ascites or till the liver transplantation.

Esophageal and Gastric Varices↗
PubMed2002

[Risk factors for transmission of hepatitis C in the the Czech population].

BACKGROUND: Recent reports from all over the world have repeatedly indicated a change in the incidence of individual risk factors for hepatitis C virus (HCV) infection transmission compared with the pattern in the late 1980s and early 1990s. In the Czech Republic, HCV is very often referred to as an addicts' disease, rare in the general population. To establish the incidence of individual risk factors for HCV infection transmission in a group of patients on follow-up at the Department of Internal Medicine I. General University Hospital in Prague 2. METHODS AND RESULTS: The group of patients included 216 individuals (127 men, 89 women) with documented HCV infection. The mean age of the patients was 40.2 years (10-81 years; SD 14.3). The risk factors were identified on the basis of evaluation of the patient's medical history, and/or their medical records if available. The presence of at least one of the following risk factors was regarded as the source of infection (the figure in brackets gives the incidence of the respective factor in the examined group in percent): blood product transmission (15%), intravenous drug injection (16%), inclusion into a regular dialysis program (12%), profession-related risk of transmission (10%), sexual contact with an infected individual (2%), surgery including dental surgery (14%), invasive examination (6%), and tattooing (1%). No risk factor for infection transmission was identified in 24% of cases. CONCLUSIONS: It has been shown a risk factor for infection transmission can be identified, through careful examination of medical history data, in the Czech population in as much as 76% of cases. An important finding is the fact the infection can be regarded as iatrogenic in as much as 57% of cases. Our data clearly show HCV infection is not exclusively a disease of intravenous drug addicts.

Adolescent↗
PubMed2002

[Importance of liver biopsy in chronic hepatitis C virus infection].

INTRODUCTION: The importance of liver biopsy and knowledge of the histological activity of liver les on in chronic hepatitis C virus (HCV) infections is widely discussed recently. There are attempts to find an alternative evaluation which will make it possible to avoid liver biopsy. The crucial question in patients with chronic HCV infection is to differentiate patients with already developed liver cirrhosis from those with chronic hepatitis. OBJECTIVES: 1. To evaluate the impact of the calculation of the discrimination score of liver cirrhosis (DSC) for prediction of liver cirrhosis in the histological assessment. 2. To assess the correlation of prediction of cirrhosis liver based on clinical signs and actual histological verification. 3. To evaluate the frequency of unexpected histological findings not correlating with the clinical picture. GROUP OF PATIENTS: The group was formed by 139 patients. In all patients during the baseline examination the patient's history data were analyzed as well as possible physical signs of liver cirrhosis. In all patients also, based on laboratory values before liver biopsy, the DSC according to Bonacini was calculated. Furthermore agreement between the histological finding of liver cirrhosis and chronic hepatitis with DSC values was assessed. RESULTS: 1. Based on calculation of DSC it is possible to predict accurately the existence of cirrhosis of the liver or chronic hepatitis only in 31% patients. In 69% patients even comprehensive evaluation of the type of DSC is not a sufficient guide for assessment of the hepatic lesion. 2. Even clinical signs of cirrhosis are not a quite reliable guide for its prediction. In 8% patients of our group the histological finding of liver cirrhosis was a surprise and in 3.5% patients cirrhosis of the liver was not confirmed despite the presence of clinical signs. 3. The frequency of other histological findings participating in the development of the hepatic lesion in chronic HCV infection was minimal. In the authors group as such only steatosis and toxic damage of hepatic tissue by alcohol were identified. These findings were, however, suspected already before biopsy. Steatosis can be however considered also a manifestation of HCV infection. CONCLUSION: The results of the trial support the view that liver biopsy is in the majority of cases irreplaceable for evaluation of the severity of the hepatic affection in chronic HCV infection.

Adult↗
PubMed2000

[Diagnosis and treatment of hepatic cysts].

Hepatic cysts are at the present time of widespread use of abdominal ultrasonography a frequent finding. The authors summarize contemporary diagnostic possibilities of liver cysts and submit variants of the therapeutic procedure in case of symptomatic liver cysts. They present their own experience with the treatment of hepatic cysts by the evaluation method combined with administration of 96% ethanol into the cyst. They compare this therapeutic procedure with the method of simple evaluation of the contents of the cyst. The method of evaluation of hepatic cysts under ultrasonographic control with subsequent administration of 96% alcohol appears to be more successful from the aspect of the long-term effect, manifested by the disappearance of clinical symptoms and non-refilling of the cyst.

Cysts↗
PubMed1997

[The effect of the heptoprotective agent LIV 52 on liver damage].

BACKGROUND: The action of hepatoprotective drugs is a steady subject of discussions. Despite the equivocal character of action hepatoprotective drugs are used, despite the fact that the effect is partly a placebo effect. In the literature are reports on preparation LIV 52 which is a mixture of substances of plant origin and improves the subjective complaints of patients as well as the objective condition of patients with liver disease. METHODS AND RESULTS: The effect of preparation LIV 52 was investigated in a retrospective study in 19 patients with liver damage. In the majority liver damage caused by alcohol was involved, steatosis and persisting hepatitis without the finding of chronic hepatitis B and C. The authors investigated biochemical parameters (bilirubin, ALT, AST, ALP, TZR, cholesterol). The size of the liver was assessed by ultrasonography and the subjective status of the patients was recorded. Within one year of administration of the preparation subjective improvement occurred, hepatomegaly diminished and the activity of aminotransferases declined. CONCLUSIONS: Administration of LIV 52 can improve the subjective condition and clinical parameters in patients with liver damage, in particular in alcoholic liver damage and in steatosis. The effect is certainly due also to better motivation on the patients part, better lifestyle and dietary measures. After one year of treatment no undesirable side-effects were detected.

Adult↗
PubMed1997

[The clinical picture and diagnosis of liver tumors].

In the diagnosis of hepatic tumour it is most important to differentiate primary carcinoma of the liver from secondary metastatic tumours and focal and infiltrative changes. Primary hepatocellular carcinoma is usually a complication of cirrhosis of the liver. The clinical symptoms therefore correspond especially to an accentuation of the symptomatology of cirrhosis of the liver and complications. The diagnosis is based above all on modern imaging methods such as ultrasonography, computed tomography, nuclear magnetic resonance, examination of tumour markers. Examination by needle biopsy is important and is nowadays usually done under ultrasonographic control to obtain material for histological or cytological examination. Secondary metastases into the liver usually associated with tumours of the pancreas, colon, stomach, bronchi. A frequent diagnostic problem is the recognition of some cysts, capillary, haemangiomas, focal steatosis and focal nodular hyperplasia. An abscess of the liver can also cause differential diagnostic problems. The marked advances in the diagnosis of hepatic tumours are unfortunately not always followed by therapeutic success.

Carcinoma, Hepatocellular↗
PubMed1997

[Treatment of liver tumors with ethanol injection].

Ethanol injection into the focus by means of a thin needle under ultrasonographic guidance has become part of treatment of primary carcinoma of the liver-hepatocellular carcinoma. It is a palliative method suitable for the treatment of small foci of hepatocellular carcinoma in a uniocular or oligolocular form. The limiting factor are in particular the number of foci, their size, depth and stage of hepatic cirrhosis in the remainder of the live parenchyma. Treatment is well tolerated and the survival of patients, if they are properly selected, is similar as in surgical resection.

Carcinoma, Hepatocellular↗
PubMed1996

[Treatment of chronic viral hepatitis B with interferon alfa. Experience of the last 3 years].

BACKGROUND: interferon alpha is nowadays the drug of choice in the treatment of chronic viral hepatitis. The objective of the present work was to assess the effectiveness of interferon alpha in the treatment of chronic active hepatitis B in our population and to test whether the known "prognostic factors" of successful treatment are applicable in our patients. METHODS AND RESULTS: In 1991-1994 a total of 25 patients were treated (15 men, 10 women, mean age 46.1 years, range 18-69 years) suffering from chronic active hepatitis B (HBsAg and HBeAG positive) with interferon alpha 2b (Intron A, Schering-Plough International ). Seroconversion to anti-HBe and the drop of serum aminotransferase activity was achieved in 15 patients (60%). Only in one patient within one year after termination of treatment a relapse developed. In the group of successfully treated patients the activity of serum aminotransferases before treatment was significantly higher. The mean duration of the disease was surprisingly longer than in the group where treatment failed (106 vs. 62 months), but this difference was not statistically significant. Only in two successfully treated patients during the second and third month of treatment acute exacerbation of the inflammation occurred and manifestations of hepatic insufficiency with subsequent slow improvement developed. In the remainder the activities of serum aminotransferases declined slowly to normal values.

Adolescent↗
PubMed1996

Immunoreactivity of new antibodies anti-p53 and anti-MDM-2 in paraffin embedded tissue samples.

Detection of various epitopes of the p53 and MDM-2 proteins, using new antibodies was performed on formalin-fixed and paraffin-embedded tissue samples from breast cancer and compared with results obtained using well-characterized antibodies. The results show that the distribution of positive nuclei and intensity of staining varies significantly depending on the antibody used, as well as on the microwaving procedure. Antibodies DO-14, DO-13 and SMP-14 have very good characteristics and are available for immunohistochemical analysis of p53 and MDM-2. Our results indicate, that immunohistochemical expression of p53 and MDM-2 is a not stable and unitary phenomenon and from this point of view a single antibody is not sufficient for its determination. Since, characteristics of p53 and MDM-2 molecules can vary from one sample to the next, panel antibodies capable of determining a wide range of wide type and mutant conformations must be used.

Antibodies↗
PubMed1993

[Trimethoprim in the therapy of symptomatic liver porphyria].

Administration of antimalaria drugs to patients with symptomatic hepatic porphyria (porphyria cutanea tarda) at the First Medical Clinic made it possible due to previous experimental studies, to influence the porphyrim metabolism of yeasts. The effect of trimetoprim was investigated in clinical work in 12 hitherto not treated patients with the manifest form of symptomatic hepatic porphyria. The group comprised 9 men, mean age 56.4 years, and 3 women mean age 43.6 years. During the two-year clinical study dermatological symptoms of the disease became milder or receded. Concurrently there was a significant regression of porphyrinuria. In the whole group porphyrinuria declined to 11% of the original values. The porphyrin content of hepatic tissue declined considerably after two years treatment. In the group as a whole to 40% of the original values. Trimetoprim is another drug which influences porphyrin metabolism. The authors did not detect any undesirable side-effects of trimetoprim treatment. The effect of trimetoprim on clinical and biochemical parameters of the disease is less marked than the effect of chloroquine. This new treatment can be used in patients resistant to chloroquine or in combination with other anti-malaria drugs.

Adult↗
PubMed1993

[Measurement of impedance in liver tissue].

At the First Medical Clinic (First Medical Faculty, Charles University) a new method of assessment of impedance of hepatic tissue was developed. A special thin injection electrode was designed which makes it possible to take readings in deep tissue. The measurements are made and aimed throughout the procedure under ultrasonographic control. From the sites of assessment specimens were taken for cytological and histological examination. So far 44 operations were completed. In 33 patients according to ultrasonography focal changes were involved, in the remainder the liver parenchyma was homogeneous or there were slight diffuse changes. Based on the results of the histological examination, the group was divided into 11 subgroups some of which are very small and thus difficult to interpret. Therefore this is only a preliminary study. Its objective is to introduce the technique of a new method because even from the small hitherto assessed values of impedance by means of the injection electrode under ultrasonographic control the conclusion can be drawn that the assessed impedance values could provide more detailed information on the character of focal changes.

Electric Impedance↗
PubMed1991

[The effect of diltiazem on hemodynamic parameters in patients with liver cirrhosis].

Previous investigations of authors abroad provided evidence of a reduction of portal pressure by blockers of slow calcium channels group II by verapamil. We decided to investigate the effect of a quite new preparation dilthiazem on the portal haemodynamics in patients with compensated cirrhosis of the liver and oesophageal varices. Doppler examinations of the width, rate of blood flow and flow through the trunk of the portal vein did not prove a statistically significant effect of dilthiazem on the investigated parameters. After the preparation a significant decline of the median pressure in the pulmonary artery was recorded at the 5% level of significance. The significantly elevated pressure values in the wedged position in the hepatic vein (WHVP) as well as of the portohepatic gradient (P-H) rose further after administration of the preparation (WHVP by 12.3%, p P-H by 15%). Even maximum doses of dilthiazem did not influence the portal flow in patients and did not lead to a reduction of the portohepatic gradient. From the results it is apparent that dilthiazem is not suitable for the treatment of portal hypertension.

Diltiazem↗
PubMed1991

[The effect of glucagon on portal hemodynamics in patients with liver cirrhosis].

The authors assessed in 12 patients with compensated cirrhosis of the liver, portal hypertension and oesophageal varices, using a Doppler flowmeter Toshiba SAL 50A/SDL 01 under basal conditions, changes in the width, rate of blood flow and blood flow though the trunk of the portal vein before and after intravenous administration of 1 mg glucagon. The width of the trunk of the portal vein did not change significantly during assessment. A statistically significantly increased flow through the portal vein was recorded starting during the 5th minute, and it correlated with the increased velocity of the blood flow. The increased flow persisted to the 20th minute after glucagon administration. The drop of pressure in a wedged position assessed in the hepatic veins after administration of the drug was not significant, the pressure in the free hepatic vein increased insignificantly. On the whole the portohepatic gradient declined by 10.5%, the drop was not significant. Glucagon in pharmacological doses has an early onset of action even in cirrhotic subjects whereby the increased flow through the portal vein does not lead to a rise of the portohepatic gradient. Glucagon administration thus does not increase the risk of haemorrhage from oesophageal varices during acute fibroscopy of the oesophagus and stomach in patients with portal hypertension.

Blood Flow Velocity↗
PubMed1989

[The effect of terlipressin (Remestyp Spofa) on hemodynamic parameters in patients with portal hypertension associated with liver cirrhosis].

Remestyp Spofa is used in wide clinical practice, among others also in the comprehensive treatment of acute haemorrhage from oesophageal varices. To patients with portal hypertension, oesophageal varices associated with cirrhosis of the liver by means of an infusion pump Remestyp was administered, 13.4 micrograms/1 kg body weight for one hour. By means of a Doppler flowmeter the rate of the blood flow and the blood flow through the trunk of the portal vein was assessed before, at 10-minute intervals during infusion, and during the 90th, 120th and 150th minute. After administration of the drug no significant effect on the investigated parameters was recorded. Therefore in the same group of patients by means of a catheter before and after infusion the following parameters were assessed: central venous pressure, pressure in the pulmonary artery, cardiac minute output, pressure in the free and wedged hepatic vein. Simultaneously changes of the systemic blood pressure were investigated. After Remestyp a significant rise of the systemic blood pressure was recorded, a rise of the central venous pressure and the pressure in the pulmonary artery. The minute volume declined slightly. The pressure in the free and wedged hepatic vein rose. The authors assume therefore that the direct effect of Remestyp on the portal circulation is not haemodynamically significant. The favourable haemostyptic action of Remestyp in patients with haemorrhage from oesophageal varices is rather due to an increased tonus of the oesophageal sphincters. With regard to the very satisfactory experience with the administration of nitrates in this indication their combined administration with vasopressin or its derivatives is considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamics↗
PubMed1989

[Experimental study of the action of antimalarial agents with respect to therapy in porphyria. Combined effect of chloroquine and pyrimethamine].

On an experimental model created from semiaerobically cultivated yeast cells of Caccharomyces cerevisiae (RIMB-75) the authors tested the effect of antimalarics used or tested for treatment of symptomatic liver porphyria. Chloroquine and pyrimethamine inhibited the synthesis of porphyrins, whereby pyrimethamine was more effective. Chloroquine released moreover intracellular porphyrins, contrary to pyrimethamine, which caused their intracellular cumulation. An equimolar combination of the two preparations preserved the inhibitory action of pyrimethamine, and the intracellular porphyrin content was reduced. Based on experimental results the suggested combination of chloroquine and pyrimethamine was successfully tested in clinical work.

Chloroquine↗