PubMed Health⌕ Search

Biomedical subjects

M Kvapil

Publications and source records attributed to M Kvapil.

At least 37 records · Page 2Linked to original sources
PubMed2002

[The comparison of clinical and echocardiographic changes in diabetics 2nd type and nondiabetics in patients with shortness of breath due to left ventricular failure].

In our study we have examined 198 patients admitted to hospital for shortness of breath at rest due to left ventricle failure. We have divided the patients into two groups according to the presence of diabetes mellitus. We have excluded the patients with noncardiac cause of pulmonary congestion, with valvular or congenital heart disease and with acute coronary syndromes. We have evaluated the presence of hypertension, value of blood sugar on admission, systolic and diastolic blood pressure, heart rate and medication given for heart insufficiency. We have also compared two dimensional transthoracal echocardiogaphic examination in diabetics to nondiabetics. Finally we compared hospital mortality in both groups. Diabetes mellitus (all the patients were type 2 diabetics) was present in 94 patients (47,5 %), in the group of diabetics there were 50 women, in nondiabetics 52 women (n.s.). The average age of diabetics was 75,5 +/- 8 years and 76,6 +/- 10,1 years in nondiabetics (n.s.). History of hypertension had 45 nondiabetics (43 %) and 69 diabetics (73,5 %), p < 0.05. Systolic blood pressure was significantly higher in diabetics 151 +/- 20,8 mm Hg to 140,5 +/- 18,4 mm Hg in nondiabetics, p < 0.05. The values of diastolic pressure and heart rate were comparable in both groups. We have not noticed any significant difference in the application of ACE inhibitors, beta blockers and diuretics for heart failure in both groups. Echocardiographic examination revealed the significantly higher ejection fraction of left ventricle in diabetics as well as the thicker septum and posterior wall of left ventricle. These findings support the role of the diastolic dysfunction in pathogenesis of left ventricle failure. In hospital mortality rate was 8,5 % in diabetics and 7,6 % in nondiabetics (n.s.). Our results confirmed that in pathogenesis of left ventricle failure hypertension and elevated systolic blood pressure play the important part. Apart from the complex secondary prevention of ischemic heart disease the correct treatment of hypertension represents the very important part of the prevention of left ventricle failure. The role of the proper compensation of diabetes mellitus in the prevention of left ventricle failure is also discussed.

Aged↗
PubMed2001

[Ethylene glycol poisoning].

Ethylene glycol is a common substance in various antifreeze preparations. Intoxication is caused by ingestion either as a suicide attempt or by an accident. The clinical course of intoxication is always severe, however, immediate launching of proper treatment can reverse the poor prognosis. Intoxication clinically proceeds in three stages: 1. Depressive CNS disturbances that can lead to coma. 2. Organ manifestations. 3. Acute renal failure. The case report of 46-year-old man admitted after ingestion of ethylene glycol in suicidal attempt summarises the essential principles of therapy--monitoring of vital functions, administration of ethanol solution as an antidote and hemodialysis to remove toxic components.

Ethylene Glycol↗
PubMed2001

[Diabetes mellitus in the elderly].

Diabetes mellitus is one of the most frequent chronic diseases of the elderly population with a high prevalence after the age of 65 years. In this group it is a serious cause of increased mortality and morbidity. More than 90% of patients suffer from type 2 diabetes mellitus. The disease takes frequently for a long time an asymptomatic course and if it persists for long it may lead to microvascular complications and is an important risk factor of cardiovascular and cerebrovascular diseases. The objective of treatment of diabetes in old age is in particular to restrict symptomatic hyperglycaemia, but at the same time we must not forget prevention of hypoglycaemia. It is also important to diagnose and treat diabetic complications. As elderly diabetic patients are usually polymorbid, diabetes mellitus in old age calls for a comprehensive approach not only to the treatment of hyperglycaemia but also of hypertension, dyslipidaemia and other associated diseases.

Age Factors↗
PubMed2001

[Reversible long-term tachycardia and hypertension as a symptom of autonomic neuropathy in combination with sensorimotor polyneuropathy in a patient with newly discovered type 1 diabetic mellitus].

The case of 22 years old woman admitted with ketoacidotic coma and newly diagnosed insulin dependent diabetes mellitus is described. The signs of mixed sensoromotoric polyneuropathia in this patient have been discovered. After the correction of ketoacidotic hyperglycemic coma the significant tachycardia and hypertension with the abnormalities of diurnal rhythm with necessity of the intensive treatment persisted for the period of the several monthes. These changes we attributed to the significant dysfunction of the autonomic system. In the course of 1 year of good diabetes compensation the above mentionned hemodynamic changes subsided completely. In the same time the signs of mixed polyneuropatia and the incipient retinopathia disappeared. The causes of the described changes are discussed, mainly the importance of reversible microvascular changes.

Adult↗
PubMed2000

[Secondary hemophagocytic syndrome in a systemic disease].

20 year old man 2 years treated for the seropositive rheumatoid arthritis was admitted for fever accompanied with jaundice, anemia and leukopenia. The underlying disease has been compensated already for long period of time, before his admission only Prednisone (in the dose of 5 mg daily) and Methotrexate (15 mg once a week) was given. His physical examination of admission was without any significant abnormalities, out of the routine laboratory examination the value of leukocytes count was 2.1 x 10(9)/L, erythrocytes 3.7 x 10(12)/L, hemoglobin 95 g/l, hematocrit 0.29, platelets 156 x 10(9)/L. Since admission to hospital the hepatic enzymes ALT, AST, GMT, ALP were about ten times elevated comparing to normal values, the coagulation examination has shown the decrease of Quick test to 55%. With respect to the permanent leukopenia the bone marrow aspiration was taken with the finding of the increase number the RES elements (18.4%) with the signs of hemophagocytosis. The phagocytic reticulum absorbs blood elements erythrocytes, normoblasts, granulocytes, platelets. According to the literature experience we started the combination of the immunosuppressive treatment consisting of corticosteroids and Cyclosporine. Already the day following the application of the high dose of corticosteroids the fever subsided, icterus went away gradually with the normalization of the liver tests. After 20 days of hospitalisation the patient was discharged in good shape. Now, after 4 months the is stabilized on the follow-up treatment of Prednisone a Cyclosporine.

Acute Disease↗
PubMed2000

[Postural trauma and rhabdomyolosis causing acute renal failure].

Rhabdomyolysis (damage of the muscles of various origin) leads to the efflux of the intracellular fluids in the circulation. The common complication of this status is the renal failure. The early diagnosis and the proper treatment makes the fall of renal function reversible. That is why the possibility of the rhabdomyolysis must be consider. The case report describes the development of renal failure in young, previously healthy men, followed by trauma mechanism after drug and alcohol abuse.

Acute Kidney Injury↗
PubMed1999

[The effect of ambulatory nutritional intervention using defined enteral nutrition on the nutritional status of selected adult patients with cystic fibrosis].

The prevalence of mild and serious nutritional disorders in patients with cystic fibrosis is high. One of the possible ways how to supplement the necessary nutrients is the administration of defined supplementary enteral nutrition. The objective of the presented work is to evaluate the effect of supplementary domiciliary enteral nutrition in adult patients with cystic fibrosis. To eight patients with cystic fibrosis, mean body weight 51.77 +/- 10.63 kg, mean age 24.7 +/- 1.9 years for a period of 6 +/- 1 months enteral nutrition was administered (containing 40 and 55.1% energy as fat) with a caloric density of 10 kcal/kg as supplementary domiciliary nutrition. The mean body weight increased from 51.77 +/- 10.63 to 53.13 +/- 10.59 kg (p < 0.02), the mean skinfold thickness increased from 7.98 +/- 6.04 to 8.65 +/- 6.30 mm (p < 0.05) and the mean serum albumin concentration increased from 33.66 +/- 0.97 to 37.29 +/- 3.33 g/l (p < 0.05). No undesirable side-effect associated with the administration of enteral nutrition were observed. The nutritional intervention by domiciliary enteral nutrition produced no undesirable side-effects and led to a statistically significant improvement of parameters of the nutritional status.

Adult↗
PubMed1999

[Evaluation of nutritional state in hospitalized patients with cerebrovascular stroke].

The cerebrovascular stroke is serious disease with the high mortality and resulting in invalidity. The result of its treatment is not yet encouraging. The stress situation which is characteristic for the acute stage of disease leads to catabolic status. This condition can be worsen if nutritional parameters are not properly monitored and the nutrition is not sufficient. We examined 30 patients admitted to our medical ward with the diagnosis of ischemic cerebrovascular stroke. We have not applied any nutritional intervention. We measured some anthropometric, biochemical and imunological parameters of nutrition at the time of admission to ward and after 14 days of hospitalization. Our results showed that nutritional status has worsen during this period according to the significant deterioration of the followed anthropometric and biochemical parameters. Malnutrition has the detrimental impact on rehabilitation and mobilization of the patients and extends time of hospitalization. Nutritional status should be monitored and corrected since the start of disease, preferably in intensive care unit.

Aged↗
PubMed1998

[Malnutrition in a patient with short-bowel syndrome].

The short bowel syndrome is a relatively frequent complication of extensive resection and by reducing the absorption capacity the function of the gut is markedly impaired. An important part of postoperative care is therefore to ensure nutrition of these patients. The authors demonstrate on the case-history of a 40-year-old patient after repeated revision of the abdominal cavity on account of adhesions the development of severe malnutrition after jejunotransversoanastomosis. As the small intestine was not resected (concurrent blind loop syndrome), the patient was indicated for surgery. After surgery all complaints disappeared and the nutritional status improved.

Adult↗
PubMed1998

[Assessment of the need for and length of hospitalization at the internal medicine department].

We used the Appropriateness Evaluation Protocol (AEP) to evaluate appropriateness of admission and continuing hospitalization (daily till discharge of maximally till 15th day of hospitalization) of 260 patients admitted consecutively to department of internal medicine of a teaching hospital. Reasons of inappropriate admissions and delayed discharges were classified and analyzed. Results of the valuation of some patients were subject to control by a committee of fully specialized hospital physicians. 63 (24%) of 260 admissions and 1005 (54%) of 1869 evaluated days of stay failed the AEP criteria. These patients could be well served by lower treatment intensity in outpatient clinics, nursery homes or their own homes. Such a shift in pattern of provided care requires profound organizational changes many of which are out of reach of individual acute hospitals. Despite some limitations we find AEP a useful tool for internal utilization review. External application of AEP in a representative sample of acute care hospitals could provide important data for future development of the Czech health care system.

Hospitalization↗
PubMed1998

[Tissue amino acids in patients with colorectal carcinoma].

Different catabolic conditions have their special characteristics of intracellular biochemical changes. The objective of the presented work is to assess the concentration of free amino acids in muscles of patients with colorectal carcinoma. In a group of 17 patients the free amino acid level was assessed in tissues and plasma. Material was collected on operation by biopsy of the rectus abdominis muscle, the concentration of different amino acids was assessed by the HPLCV method with fluorescent detection. For statistical evaluation the T-test was used. From the results ensues that in patients with colorectal cancer in plasma statistically significantly lower taurine, glutamine, valine, tyrosine levels were found, intracellularly significantly reduced levels of taurine, glutamic acid, methionine and ornithine were recorded. Significantly elevated intracellular levels of valine, isoleucine, leucine, tyrosine and phenylalanine were found. Assessment of the tissue aminoacidogram is the first step when attempting to influence the intracellular amino acid concentration by defined dietetic preparations.

Abdominal Muscles↗
PubMed1998

[Realimentation in patients with anorexia nervosa and critical malnutrition--personal experience].

The objective of the work is to find a suitable realimentation procedure for patients with anorexia nervosa and critical malnutrition, whose mortality is round 6%. In a group of 10 patients aged 22.3 +/- 2.33 years during hospitalization for 10.0 +/- 6.11 days a weight increment of 5.0 +/- 1.16 kg was achieved. According to hitherto assembled experience and consistent with data in the literature it is best to start immediately after admission complete parenteral nutrition with a hyperalimentation regime regardless of the amount of food ingested by the patient. Thus within the shortest time maximum weight increments are achieved and the patients can be referred to the care of psychiatrists, which is the only causal treatment. Attempts of realimentation by enteral nutrition or increased oral ingestion in these patients were not successful and led only to a prolonged period of hospitalization.

Adult↗
PubMed1998

[Importance of short-term administration of low doses of somatostatin analog in the development and remission of type 1 diabetes mellitus in adult patients].

The objective of the presented work was to evaluate the short-term administration of octreotide on the development, onset and persistence of remission in recent insulin-dependent diabetics. The importance of remission means for the patient a clinically favourable condition with satisfactory metabolic compensation and a greater metabolic stability during the subsequent course of the disease. The period of remission is important from the aspect of prevention of late organ complications. Two-week treatment with octreotide, 150 micrograms/day, administered during the first month after establishment of the diagnosis was not associated with serious undesirable effects. Treatment with octreotide led to more frequent development of remission, partial and complete, as compared with a control group. In the majority of diabetics in the intervened group remission started immediately after administration of octreotide. The serum value of peptide-C as part of the glucagon test made at the time of diagnosis had a predictive value for the development of induced and spontaneous remission. Octreotide administration increased the probable development of remission even in patients with a substantially lower peptide C value at the time of diagnosis as compared with controls. The preliminary results indicate also a protraction of the remission period.

Adult↗
PubMed1997

[Insulin, steroids and steroidogenesis].

Presented survey summarises insulin-steroid interactions. Beside the well known resistance to insulin induced by steroid hormones, also the central effect of insulin, its influence on the system hypophysis-adrenals, and its stimulatory effect on the generation of steroids in adrenals and ovaries are reviewed. Insulin-steroid interactions are further illustrated by pathogenesis of the polycystic ovary syndrome and by our study on dehydroepiandrosterone regulation. Insulin induced changes in the dehydroepiandrosterone level during the intravenous glucose tolerance test were described.

Adrenal Cortex Hormones↗
PubMed1997

[Nutritional status in patients with chronic obstructive pulmonary disease].

The authors examined the nutritional status of 50 patients admitted on account of exacerbation of chronic obstructive lung disease. The mean height of patients was 168 +/- 8.8 cm, the body weight 72.2 +/- 16.2 kg, BMI 25.5 +/- 5.5 kg/m2. The mean albumin concentration was 33.1 +/- 4.6 g/l, transferrin 2.3 +/- 0.6 g/l, the skinfold thickness 17.3 +/- 9.9 mm, arm circumference 28.6 +/- 7.2 cm. The mean energy expenditure at rest (REE) was 122.1 +/- 12.3%. The total number of undernourished patients was 7 (14%), there were 27 obese patients (54%). The authors did not find a relationship between respiratory parameters and values of blood gases on the one hand and body weight, skinfold thickness, BMI, REE, arm circumference, albumin, transferrin and the number of lymphocytes on the other hand. This is obviously due to the fact that the group comprised more obese than undernourished patients. Obese and undernourished patients were found in all three stages of the disease.

Aged↗
PubMed1997

[10 years' of care of adult patients with cystic fibrosis].

The authors summarized the results of ten years care of adult patients with cystic fibrosis (CF). They treated a total of 45 patients incl. 26 men and 19 women. Nineteen patients (42%) died. The most frequent cause of admission to hospital was respiratory infection (84%), planned antibiotic treatment (6.5%), pneumothorax (6%) and haemoptysis (4%). In all patients impaired ventilation of the obstructive type was found. The mean annual decline of FEV1 was 0.173 +/- 0.194 l, VC 0.303 +/- 0.323 l. The authors did not find a significant difference between live and dead patients. The mean annual increase of PaCO2 was 0.5 +/- 0.87 kPa, the mean annual decrease of PaO2 was 0.6 +/- 0.96 kPa. The difference of values in dead and live patients was significant. CF still remains an incurable disease. It is, however, possible by comprehensive treatment to prolong the patients life and to improve its quality.

Adult↗
PubMed1996

[Serum levels of sialic acid in patients with type 1 diabetes mellitus in relation to the incidence of late complications].

BACKGROUND: Sialic acid is released from terminal oligosaccharide chain of some proteins of the acute phase (fibrinogen, orosomucoid, haptoglobin, etc.). Its serum concentrations have been commonly increased during acute inflammation. Its relation diabetes mellitus or late complications of the disease have been recently studied as well. The aim of our investigation was to determine serum concentrations of sialic acid in patients with diabetes mellitus Type 1 in relation to presence or absence of late diabetic complications. METHODS AND RESULTS: The authors examined a group of 62 patients treated for diabetes mellitus Type 1, mean age 28.7 +/- 9.8 years, having been treated for this disease for 11.8 +/- 8.7 years on the average. The mean level of glycated hemoglobin HbAlc was 9.08 +/- 1.84%. In 21 patients there were signs of diabetic nephropathy, seven of them already suffering from proteinuria. Retinopathy already developed in 12 patients. The mean concentration of sialic acid in the whole cohort was 1.916 +/- 0.292 mmol/litre. The correlation of serum sialic acid with age, duration of diabetes and glycated hemoglobin was not statistically significant. There was no significant difference between the serum concentration of sialic acid in patients without apparent nephropathy and those who were affected by nephropathy, or the subgroup with proteinuria (1.945 +/- 0.328 against 1.914 +/- 0.302 mmol/litre and 1.943 +/- 0.328 mmol/litre, respectively). Statistically significantly higher concentrations of serum sialic acid were found in the subgroup of patients with present retinopathy (2.085 +/- 0.244 mmol/litre against 1.890 +/- 0.270 mmol/litre, P < 0.018). CONCLUSIONS: Our findings are in agreement with the previously proved increased concentration of proteins of the acute phase in diabetic patients and correspond well to the previously proved finding of elevated serum concentration of sialic acid in diabetic patients of Type 2 with retinopathy against other patients. It may not be excluded that the serum sialic acid could be used as a marked of the risk of late complications of diabetes mellitus.

Adult↗