PubMed Health⌕ Search

Biomedical subjects

M Kunovská

Publications and source records attributed to M Kunovská.

11 recordsLinked to original sources

[Resection of the pancreatic head and duodenum for the Crohn's disease of the duodenum].

The Crohn's disease rarely affects duodenum. The symptoms are unspecific and its diagnostic process may be difficult. Patients with complications-stenoses and fistules, are indicated for surgical treatment. According to literature, there is no straightforward agreement on the surgical treatment strategy. In most cases, non-resection procedures are indicated. The authors describe a case of a patient suffering from the Crohn's disease of his duodenum and chronic pancreatitis, which was managed using a radical procedure--hemipancreatoduodenectomy.

Crohn Disease↗

[Barrett's esophagus].

Barrett's oesophagus is a premalignant metaplastic change of the oesophageal mucosa. Due to its relationship with oesophageal reflux disease and the development of adenoma-carcinoma of the oesophagus the problem arouses increasing interest. In the wide pathogenesis of the disease most probably the composite effect of the refluxed HCl content and duodenal juices play a part. In the diagnosis in addition to fundamental methods--endoscopy and histology--increasingly chromoendoscopy and fluorescent endoscopy are involved. Dispensarization of patients is essential and depends on the degree of pathohistological epithelial changes. Treatment of Barrett's oesophagus can be divided into conservative, where the drug of choice are proton pump inhibitors, and surgical treatment. Promising is endoscopic ablation of the epithelium in combination with subsequent antisecretory therapy.

Barrett Esophagus↗

[Double blind randomized multicentre study of a seven-day eradication regime of Helicobacter pylori by omeprazole, clarithromycin and ornidazole vs. omeprazole, clarithromycin and metronidazole].

Effective eradication regimes of Helicobacter pylori infections are nowadays based on administration of a substance with a strong suppressive effect on production of gastric HCl combined with two antibiotics. As suppressor of gastric HCl production unequivocally some drug from the group of proton pump blockers is used. As to antibiotics, in first line therapy the following are recommended: clarithromycin, amoxicillin, metronidazole. A problem in the eradication therapy of Helicobacter pylori infection in recent years is the increasing resistance to clarithromycin and apparently also metronidazole. In the Czech Republic the resistance to clarithromycin in relation to Helicobacter pylori is stabilized at a level lower than 3.0 %. Resistance to metronidazole was reported in 1992 within the range of 24 % - 26 %, however in 2001 it was already 36.0 %. Therefore the question arises whether it is possible under our conditions to check the increasing metronidazole resistance by a drug which by its spectrum of action resembles metronidazole while it differs from it as to its chemical structure. This is the reason why the authors implemented a trial where metronidazole was replaced by tinodazole (Avrazor, Léciva Co.). The results revealed that in the group treated with tinidazole eradication was achieved after 7-day administration of ornidazole in 93.0 %, in the group where part of the eradication regime was metronidazole eradication was 82.6 %. The tolerance of both drugs was very good. The authors recommend to include the pattern omeprazole 2 x 20 mg, clarithromycin 2 x 500 mg and tinidazole 2 x 500 mg among first line therapeutic regimes.

Adolescent↗

[Helicobacter pylori and nonspecific intestinal inflammation].

In 50 subjects with non-specific inflammations of the gut the total prevalence of Helicobacter pylori positive antibodies was 28%, while in the control group of blood donors its was 54% Patients with ulcerative colitis had lower antibodies--18%, in Crohn's disease the serum positivity was 33%. The lowest value of antibodies was found in patients taking Sulfasalazine--11%. The serum positivity was substantially higher in inactive ulcerative colitis and Crohn's disease--35% than in patients with signs of high activity--13%. In 28 patients with non-specific inflammations of the gut endoscopy was performed, in 60% with a pathological outcome. Histologically confirmed gastritis was in the majority Helicobacter pylori negative. It may be stated that in patients with non-specific inflammations of the gut there is a lower incidence of Helicobacter pylori than in the general population, in particular those subjects who were or are treated with Sulfasalazine. The explanation of this fact is however only speculative.

Adolescent↗

[Helicobacter pylori negative gastroduodenal lesions in subjects treated with NSAID].

The authors examined retrospectively the frequency of NSAID use by patients with gastroduodenal ulcer without HP. The objective was to evaluate whether the use of NSAID is the predominating factor in the development of ulceration in subjects with HP negative ulceration. The group comprised 525 patients with confirmed presence of H, incl. 52 who used NSAID. From the results ensues that the incidence of ulcerous lesions with HP negativity and NSAID medication is significantly higher than in subjects who use NSAID and suffer from a confirmed HP infection.

Adult↗

[Prevalence of Helicobacter pylori infection in the Czech Republic--the South Moravia Region].

The prevalence of Helicobacter pylori is influenced in a significant way by geographical conditions and depends to a certain extent also on the economic standard of different countries. Some published work provides evidence that Helicobacter pylori infections in eastern European countries are in general more frequent than in western European countries. It cannot be ruled out, however, that in different countries there are regional differences as far as Helicobacter pylori is concerned. In a group of 309 subjects, none of those treated previously to eradicate H.pylori, at least three weeks before blood sampling no preparations of the type of H2 blockers, proton pump blockers or drugs containing bismuth were administered. In these patients serological examinations of H.pylori antibodies were made, using kits of TEST-LINE Brno. The examined subjects were divided into six age groups by decades, starting at the age of 20 years. The general prevalence of H.pylori in the examined group was 58.8%, in the group of 20-year-old ones less than 46%. The highest prevalence was recorded in subjects aged 50-59 years and amounted to 67.3%. The authors compare their own results with findings assembled in the Czech Republic and abroad and draw attention to the necessity of an extensive epidemiological survey of H.pylori prevalence in the Czech Republic. The survey should be done by regions, using the same diagnostic method.

Adult↗

[Percutaneous endoscopic gastrostomy in nutritional therapy--personal experience].

The authors have described the indications, contraindications of percutaneous endoscopic gastrostomy (PEG) and its consecutive nutritional possibilities. They have described their own experience with 11 patients. Most common indications for the placement of a gastrostomy tube were neurological, and only in one case, esophageal diverticle. The average duration of PEG was 102 days (2-732). Besides PEG, not only polymeric diet, such as Nutrison standard sol, Fresubin, Salvimulsin, was administered, but also home-made diet, for example, mixed soup, mashed potatoes, yoghurt, juice and cocoa. The diet prepared at home was tolerated well, except for subjective data about meteorism given by one female-patient. PEG complications were minimal, in one case a dry fistula was detected after the extraction of PEG; it was closed spontaneously a week later. Another female-patient showed leukocytosis and hyperpyrexia, the etiology of which could not be proved. The patient was treated symptomatically, and three days later, leukocytosis and hyperpyrexia were normalized. A patient who has had the gastrostomy tube placed for two years, showed secretion which was treated symptomatically; now the patient is without any complications. In the last patient, there was detected an inflammation around the fixation base. Although she was treated with H2 blockers, the condition has not been improved. The authors have recommended this method in correct indications as a considerate alternative application of enteral nutrition.

Adult↗

[Treatment of duodenal ulcer with pantoprazole. A multicenter study].

BACKGROUND: The inhibition of H+/K(+)-ATPase (proton pump) of gastric parietal cells by substituted benzimidazoles represents a new therapeutic approach in conditions connected with hypersecretion of hydrochloric acid. Pantoprazol is the newest member of this group of drugs. Monotherapy of duodenal ulcer with pantoprazole or ranitidine was evaluated in terms of healing rate, tolerance and compliance. METHODS AND RESULTS: A double-blind, parallel-group comparing study (double dummy technique) of treatment florid duodenal ulcer (diameter 5-20 mm) was performed in 95 subjects (age 18-74 years). The active substances were either pantoprazole (40 mg before breakfast-47 subjects) or ranitidine (300 mg before bedtime-48 subjects). The average diameter of the ulcer and subjective complaints before treatment were comparable in both groups. After 2 weeks of pantoprazole therapy 88.5% of ulcers (a) and 87.2% patients (b) were cured, whereas the corresponding values in the ranitidine series amounted to 66% (a) and 62.5% (b) only (p = 0.006 for both (a) and (b)). The rate of healing in relative values of reducing the ulcer size was significantly higher after 2 weeks of pantoprazole therapy (p = 0.026 (a) and 0.0027 (b)). All ulcers healed after 4 weeks of this regimen. The difference between the pantoprazole and ranitidine series after 4 weeks was closely above the 5% level of significance (p = 0.589 for (a) and 0.0588 for (b) respectively). This was due to the low number of patients in both groups at this time interval, particularly in the pantoprazole group. Pain during day-time and regurgitation were observed significantly more frequently after ranitidine therapy. The compliance was very good and practically no adverse effects of pantoprazole therapy were observed. CONCLUSIONS: The healing rate of duodenal ulcer with pantoprazole monotherapy (40 mg before breakfast) was significantly higher than with ranitidine (300 mg before bedtime). The compliance of patients and the tolerance of pantoprazole were very good and its administration was not associated with any side-effects.

2-Pyridinylmethylsulfinylbenzimidazoles↗

[Therapy of ulcer disease using gastrinal-sucralfate produced in Czechoslovakia].

The authors present their experience with the use of the Czechoslovak preparation Gastrinal-Sucralphate in the treatment of 40 subjects with gastroduodenal ulceration. Moreover, they compared two forms of the drug--tablets and granulate. The healing effect of the drug is very high, in tablets 77.0%, in granulate as much as 89.5%. As far as tolerance is concerned, it was obviously better after the granulate, subjective side-effects were very rare. The drug does not affect any basic biochemical parameters which were monitored during administration of the drug.

Adult↗

[Helicobacter pylori after proximal selective vagotomy].

The authors examined histologically in 40 patients after proximal selective vagotomy on account of duodenal ulceration specimens of the antral mucosa for the presence of Helicobacter pylori. The latter was detected in 38 (95%) patients. The intensity of colonization evaluated semiquantitatively was not directly related to the dyspeptic complaints. No relapses of ulcers were observed and the author's experience does not confirm the theory of a direct part played by Helicobacter in the manifestation of duodenal ulceration in patients after proximal selective vagotomy.

Duodenal Ulcer↗