Biomedical subjects

R Gürlich

Publications and source records attributed to R Gürlich.

54 records · Page 3Linked to original sources

PubMed2001

[Differences in the dynamics of leptin and cortisol during the non-infectious stress reaction].

UNLABELLED: Leptin is a hormone and acute phase reactant with multiple effects during both rest and inflammatory period. Effects of leptin in acute phase response cover a modulation of hypothalamo-pituitoadrenal (HPA) axis, too. In our study we evaluate the dynamics of leptin and glucocorticoid acute changes in model situations of infectious and non-infectious inflammatory reaction. PATIENTS AND METHODS: This study was realized on a group of patients 1--after operation of carcinoma coli (16 persons), 2--after laparoscopic non-adjustable gastric banding (13 persons), and patients 3--with development of postoperative intraabdominal sepsis (22 persons). Plasma levels of leptin, ACTH, cortisol, TNF-alpha, IL-6, C reactive protein (CRP), and alpha1-antitrypsin (AAT) were measured from -7 to +3 day related to surgery or 2nd day after a day when signs of sepsis were occurred. RESULTS: All tested parameters responded to surgical trauma with elevation 12 h after operation except leptin that elevated +24 h after surgery. Maximal levels of measured parameters were found 12 h after surgery (for cortisol), 24 h after surgery (for leptin, TNF-alpha, IL-6), or 36 h after operation (for CRP and AAT). Maximal levels of cortisol after a resection of coli or maximal levels of leptin after laparoscopic gastric banding fall to septic range. Other parameters in uncomplicated postoperative period significantly differed from septic levels on p < 0.01. There wasn't found statistically significant correlation between leptin and cortisol or between leptin and ACTH in all groups. DISCUSSION AND CONCLUSION: The elevation of leptin in postoperative period and during sepsis reflects a different regulation of this protein in rest period and during systemic inflammatory response. The inhibitory effect of leptin to HPA axis during stress response was documented in vitro, however, its physiological importance is not clear, yet. Our study didn't prove a statistically significant relation between plasma cortisol and leptin. The different dynamics of leptin and cortisol after surgical trauma shows that both factors have own specific regulation.

Acute-Phase Reaction↗

PubMed2000

Physiology and genetics of procalcitonin.

Procalcitonin (PCT), a protein of 116 amino-acids with molecular weight of 13 kDa, was discovered 25 years ago as a prohormone of calcitonin produced by C-cells of the thyroid gland and intracellularly cleaved by proteolytic enzymes into the active hormone. Circulating levels of PCT in healthy subjects are below detection limit. Since 1993 when its elevated level was found in patients with bacterial infection, PCT became an important protein in the detection and differential diagnostics of inflammatory states. The production of PCT during inflammation is linked with a bacterial endotoxin and with inflammatory cytokines (TNF, IL-6). PCT detectable in the plasma during inflammation is not produced in C-cells of the thyroid. The probable site of PCT production during inflammation are the neuroendocrine cells in the lungs or intestine. There is no evidence of plasma PCT binding to cellular receptors of calcitonin, and the role of PCT in calcium and phosphate metabolism during sepsis is still not clear. Other hypothetical roles of PCT (cytokine network regulation, PCT as an endogenous non-steroid antiinflammatory drug) are being considered.

Analgesics↗

PubMed2000

[Cytokines in the diagnosis of peritoneal inflammation].

Early diagnosis of peritoneal inflammation in the initial stage with equivocal clinical manifestations is not always simple. At present there are in the literature many new laboratory indicators which to a different extent describe the inflammatory process. In the present paper the authors focused attention on the practical importance of the use of cytokines in the diagnosis of peritoneal inflammations. They compare the diagnostic impact of clinical examination as compared with assessed plasma concentrations of inflammation promoting cytokines. The authors maintain that the diagnosis of secondary peritonitis is based on the clinical examination of the patient. Elevated values of PCT or IL-6 can support this clinical conclusion. In postoperative peritonitis dynamic investigation of cytokines is important. The diagnosis of tertiary peritonitis is based on laboratory findings.

Biomarkers↗

PubMed2000

[Postoperative immunosuppression--a physiological process and source of complications. Minireview].

Postoperative immunosuppression reflects non-specific neurohumoral stress responses to surgical trauma. Surgical stress in the early stage is characterised by a dysbalance of the adrenocortical response, the index of the formation of glucocorticoids and dehydroepiandrosterone is shifted to the glucocorticoids. This non-specific hormonal response has an impact on the balance between TH1 and TH2 lymphocyte response. Inhibition of the TH1 response occurs, the clinical reflection of which is a decline of cell-mediated immunity. Postoperative immunosuppression and dysbalance of cell-mediated and humoral immunity are physiological processes, part of the neurohumoral stress response to surgical trauma. Its potential pathological consequences, although proved so far only experimentally, make it on the one hand an important factor for evaluation of the risk of postoperative complications and on the other hand a possible of object of therapeutic intervention in oncological or high risk patients.

Adjuvants, Immunologic↗

PubMed1999

[A preventive ostomy in low rectal resections].

Dehiscence of the anastomosis after low resection of the rectum is a serious complication with the possible development of sepsis and multiorgan failure. This complication is reported in 10-20% of operations. The incidence of dehiscences can be reduced when known principles of preoperative care are respected but in particular by correct surgical technique. The serious character of this surgical complication can be reduced by a primary derivative stomy. Based on their experience the authors recommend to implement a preventive ileostomy in low resections of the rectum which can be closed already two weeks after the primary operation.

Aged↗

PubMed1999

[Preventing the development of secondary infections in severe acute pancreatitis].

Severe acute pancreatitis is in its first stage characterized by the syndrome of systemic inflammatory response (SIRS). The extent of activation of the mediator defense cascade of the organism depends on a hitherto unknown primary insult which cannot be influenced by therapeutic care. The cause of the development of sepsis or multiorgan failure is the supraliminal action of secondary insults (ischaemic reperfusion syndrome, hypoxia, impaired physiological function of the gut). By early and aggressive therapeutic action the effect of these adverse factors can be markedly reduced. Then also better therapeutic results in severe acute pancreatitis may be expected.

Humans↗

PubMed1999

[Use of procalcitonin in surgery].

Procalcitonin (PCT) is a new early indicator of developing systemic bacterial infection. As compared with other anti-inflammatory markers (cytokines, acute stage proteins), the attained plasma levels during extensive but uncomplicated surgery are by orders lower than maximal levels during sepsis. The authors assume that PCT will be used in surgical practice as an early indicator of developing systemic bacterial infection (in multiple injuries, after surgery) and for subsequent evaluation of the effectiveness of treatment of septic conditions.

Bacterial Infections↗

PubMed1999

[Anti-Xa activity during administration of low-molecular weight heparin in the prevention of postoperative thromboembolic complications].

The authors evaluate the follow-up of the anti-Xa level during the prophylactic administration of two different low molecular heparins (enoxaparin, reviparin) in 40 patients with a planned resection of the large intestine, resection of the pancreas, laparoscopic cholecystectomy and laparotomic cholecystectomy. The assessed amounts of anti-Xa did not reach recommended levels even during the perioperative period. The selection of the preparation and the extent of the operation did not influence the anti-Xa levels.

Adult↗

PubMed1999

[Pathophysiology of development of acute pancreatitis].

Acute pancreatitis is a severe illness with unclear prognosis and mortality rate ranging from 5 to 70%. Dynamic observation of changes in systemic inflammatory response of the body may be helpful in estimating the development of acute pancreatitis as well as giving an idea of therapeutical possibilities. It is obvious, that the intensive therapeutic intervention may reduce the influence of secondary insults (ischemic-reperfusion syndrome, hypoxia, disrupted physiological function of the bowel) on pancreatic tissue. Surgery is limited only for precisely specified indications in the latter stage of acute pancreatitis (secondary inflammation of the necrosis). In this paper we conclude some pathophysiological mechanisms involved in the development of acute pancreatitis.

Acute Disease↗

PubMed1998

[The significance of cytokines in the early diagnosis of postoperative intraabdominal sepsis].

The objective of the investigation was to evaluate the possible use of selected cytokines and cytokine receptors in the early diagnosis of postoperative intraabdominal sepsis. The investigation was focused on the dynamics of plasma levels of tumour necrotizing factor-alfa (TNFalfa), interleukin (IL)-1beta, IL-2, IL-6, IL-8, IL-10, soluble receptors IL-2 and IL-6 (sIL-2R and sIL-6R) and the receptor antagonist IL-1 (IL-1ra). The investigated parameters were tested on model operations (resection of large bowel and resection of pancreas). These two groups were compared with values recorded in patients with sepsis and with healthy subjects. Based on the assembled results the authors recommend to use for postoperative investigations the first 48 hours and to follow up the following parameters: IL-6, IL-ra or sIL-2R. During the first 48 hours these indicators differentiate sufficiently specifically incipient sepsis from an uncomplicated postoperative condition. During the subsequent period, i.e. more than 48 hours after surgery, it is useful to include in the examination pattern also some acute stage proteins (C reactive protein, alfa1-antitrypsin and haptalobin) which differentiate sepsis between the 3rd and 5th day after surgery.

Abdomen↗

PubMed1996

[Obturator hernia].

Obturator hernias are a rare type of hernias. Their incidence reported in large studies is 0.7% of all hernias. An obturator hernia may be the cause of otherwise unexplainable long-term dyspeptic complaints or subileous complaints and in the acute stage the cause of etiologically obscure obturation ileus. The difficulty of diagnosis is apparent also from the fact that a correct preoperative diagnosis is made only in 25-33%. Usually the diagnosis is established on operation of acute ileus. In these patients the mortality varies within a wide range of 12-70%. The authors recommend therefore to focus attention in chronic repeated dyspeptic or subileous conditions on predisposing factors in the case-history (female sex, 7th-8th decade, concurrent chronic disease, marked weight loss) and to examine also the only specific symptom of this hernia (Howship-Romberg sign).

Aged↗

PubMed1996

[The surgery patient with gastroduodenal ulcers].

The authors evaluate the contemporary change of indications for surgery of gastroduodenal ulceration. From a group of 670 patients operated in the course of three years at the Second Surgical Clinica of the General Faculty Hospital in Prague 46 patients were subjected to acute surgery. Among these operations surgery on account of perforating pyloric ulcers (34%) predominated followed by bleeding duodenal ulcers (23%). In the remaining patients with a prolonged history of conservative treatment the authors observed a more complicated local situation (infiltrate, penetration) which influenced not only the surgical operation but also the pretentiousness of postoperative care, but unfortunately also a higher lethality rate-18.3%. In the conclusion the authors reflect on the possibility of earlier indication of surgery in particular in ulcers poorly controlled by conservative treatment or those after haemorrhage treated successfully by conservative treatment.

Female↗

PubMed1996

[Acute resection of the large intestine].

The authors evaluate the results of 32 acute resections of the large intestine on account of a malignant process or an inflammatory aetiology causing obstruction. They recommend to prefer this method to multi-stage operations even in patients of advanced age, if their general condition permits it.

Adult↗

PubMed1996

[Unexpected major perioperative blood loss (case analysis)].

In this study we are discussing a necessity of sufficient monitoring and therapy of unexpected perioperative massive blood loss, which a case of 4 of our patients. Cell saver system wasn't available. Complete monitoring system maximum intensive care and a broad substitution is essential in these cases. We have pronounced the influence of massive blood loss on multiorganic postoperative failure as well as a necessity of sufficient time of an intensive care.

Adult↗

PubMed1994

[Evaluation of laparoscopic and laparotomy cholecystectomy by comparing the dynamics of acute phase proteins].

The authors investigated in two groups of surgical patients subjected to laparoscopic (n = 10) and laparotomic (n = 10) cholecystectomy changes in the levels of nine acute stage proteins. The objective was to evaluate the extent of surgical stress of the two surgical procedures with regard to changes of serum levels of albumin, transfirrin, prealbumin, alpha 1-antitrypsin, alpha 1-acid glycoprotein, alpha 2-macroglobulin, haptoglobin, ceruloplasmin and C-reactive protein. Before operation no significant differences (p < 0.05) were found between the investigated indicators. Changes of acute stage proteins up to the third day following surgery indicate a lower surgical trauma and more favourable course during the early postoperative period in patients operated by the laparoscopic route.

Acute-Phase Proteins↗

PubMed1993

[Early diagnosis of septic complications in the postoperative period by determination of acute phase proteins].

The authors submit the results of the follow-up of the dynamics of 10 acute stage plasma proteins (up to the 7th day) in two surgical model situations: 1. planned operation of colorectal carcinoma by an intraabdominal approach and 2. operation of extensive varicosities of the lower extremities. As reference groups 3. healthy subjects (blood donors) were used and 4. patients with developed postoperative sepsis. Based on the results, the authors provide evidence of the asset of some selected indicators they assessed such as transferrin, prealbumin, alpha-1 acid glycoprotein (orosomucoid) and C reactive protein, for the early diagnosis of postoperative septic complications.

Acute-Phase Proteins↗

PubMed1992

[Treatment of hemorrhoids with elastic ligature].

The authors present a report on the treatment of haemorrhoids by elastic ligature at the Second Surgical Clinic in Prague in 93 patients. In 75% they evaluate the results as excellent, in 22% as very good, only two patients, i.e. 3%, did not improve. The method is reliable, provides very good results and involves a low risk.

Female↗

PubMedDate not supplied

Ghrelin and leptin elevation in postoperative intra-abdominal sepsis.

BACKGROUND: Both ghrelin and leptin are important signals in the regulation of food intake and energy balance. Leptin concentrations are elevated in the majority of obese individuals, and its levels usually correlate with adiposity and body mass index. Ghrelin as a new growth hormone (GH)-releasing peptide was discovered in 1999. Ghrelin stimulates food intake and exhibits gastroprotective properties. Many other regulatory effects of both ghrelin and leptin involving cardiovascular, gastrointestinal, renal, and endocrine systems were revealed. New experimental studies show both hormones as new acute phase reactants in animal models of inflammatory reaction. The aim of this study was to characterize the levels of circulating ghrelin and leptin in relation to systemic inflammatory response. We used a postoperative bacterial sepsis after large abdominal surgery as a model of cytokine network hyperstimulation. PATIENTS AND METHODS: The prospective study was performed on 25 surgical patients with proven postoperative intra-abdominal sepsis after large abdominal surgery. Plasma levels of ghrelin (RIA), leptin, TNF-alpha, IL-1beta, sIL-2R, IL-6 (ELISA analysis), CRP and alpha1-antitrypsin (nephelometric analysis) were analyzed. RESULTS: Authors demonstrate statistically significant elevation of plasma ghrelin (492.3+/-70.6 ng/l) and leptin (31.6+/-12.2 microg/l) compared with the control group (336.5+/-46,1, p<0.01 for ghrelin, 3.5+/-1.2 microg/l, p<0.001 for leptin). The regression coefficient was the highest for ghrelin and IL-6 (r=0,44, p<0.05), and for ghrelin and TNF (r=0.43, p<0.05) in the sepsis group. In regard to leptin, the regression coefficient was the highest for IL-6 and leptin (r=0.53, p<0.05) and for leptin and CRP (r=0.51, p<0.05). There was no significant correlation between ghrelin and IL-1beta, ghrelin and sIL-2R, and leptin and IL-1beta. CONCLUSIONS: During postoperative intra-abdominal sepsis, both ghrelin and leptin plasma levels are elevated and positively correlate with both inflammatory cytokines (TNF-alpha, IL-6) and main APP member (CRP). It supports experimental finding that TNF-alpha and IL-6 can be important regulatory factors of their synthesis. This hormonal reaction is not specific to sepsis--the significant increase of both ghrelin and leptin occurs during an uncomplicated postoperative response, although in a lesser extent than was shown in sepsis.

Abdomen↗