[Clinical medicine and nursing. Therapy or care?].
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Czech Republic↗
Biomedical subjects
V Pacovský
Publications and source records attributed to V Pacovský.
[Clinical aspects of minor problems].
In clinical medicine we often encounter situations which seem of minor importance but which may be "pseudominor" problems. Vaguely defined conditions between health and disease can be described as "minor ailments". Clinical little things and minor ailments have a varied etiopathogenesis, manifestations and sequelae. In the evaluation of the importance or unimportance of minor problems the view of the doctor and patient (client) often differs. The patient's view is a rule decisive.
Attitude to Health↗
[Activity and inactivity in old age].
The most important characteristic of old age is quality of life. With the latter various forms of activities (psychosocial and physical) are associated. Activities in elderly and old people are influenced by many factors, the most important ones being the social atmosphere (social perception of old age), the personality of the ageing and old person, his health status and economic security. To a considerable extent everybody is responsible for his own programme of active old age. Support of his individual efforts is, however, essential.
Activities of Daily Living↗
[Ideal and real geriatric care].
The author defines ideal and real geriatric care from the aspect of patient and professionals who look after gerontological patients. The main causes of differences between ideal and real geriatric care are in the author's opinion the adverse social atmosphere, limited possibilities, objective professional restrictions, errors in professional thinking and action.
Aged↗
Hydrochlorothiazide inhibits parathormone-stimulated increase in plasma tartrate-resistant acid phosphatase in mice.
The inhibitory effect of hydrochlorothiazide (HTZ) on parathormone-induced bone changes in mice was studied with the aid of the analysis of plasma calcium and tartrate-resistant acid phosphatase. We have found that HTZ alone had no effect on plasma tartrate-resistant acid phosphatase (Tr-ACP), phosphate, and creatinine concentration. Parathormone (PTH) administration increased plasma Tr-ACP from 15.00 +/- 1.50 to 20.62 +/- 2.35 U/liter in intact mice. The increase of plasma Tr-ACP in HTZ-treated mice after PTH administration was not significant. The plasma calcium was affected in a way similar to Tr-ACP. HTZ reduced the sensitivity of bone to resorbing effects of PTH, using Tr-ACP as a useful biomarker of bone resorption.
Acid Phosphatase↗
[Hormones, aging and old age, myths and reality].
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Aged↗
[Interrelation between static parameters of trabecular bones in acromegaly, the STH levels and the duration of the condition. Histomorphometric study].
To evaluate trabecular bone formations of active acromegalic patients the authors used the method of histomorphometry and correlated the calculated variables of the trabecular volume (V), osteoid volume (Vos), osteoid surface (Sf) and width of the osseous trabeculum (MTT) with STH levels, the patients' age and the period of the acromegalic process. No correlations were found between Vos, Sf, MTT and STH levels, age and the length of the case-history. There were negative correlations (p less than 0.05) between the trabecular volume (V) and the period of the case-history and trabecular volume (V) and the patients' age. From the results it may be concluded that STH does not influence the balance between resorption and formation of the acromegalic spongiosa in favour of formation.
Acromegaly↗
[Comparative histomorphometric study of acromegalic spongy bone. Formative static parameters].
The authors used static histomorphometric parameters obtained by processing of bioptic bone specimens for comparison of normal and acromegalic spongious bone. Parameters of the bone volume (V), osteoid volume (Vos), the extent of osteoid bone surfaces (Sf) in the two groups do not differ statistically. The two groups do not differ as to age distribution. The width of bone trabeculae is greater in acromegalic bone; the difference as compared with normal bone specimens is statistically significant (p less than 0.05). The authors conclude that STH in acromegalics subjects does not stimulate osteoid production in trabecular bone to shift the balance between bone resorption and formation significantly in favour of formation. Only restructuring of trabecular acromegalic bone occurs.
Acromegaly↗
Bleomycin-induced chromosome aberrations in the lymphocytes of young and elderly patients.
Phytohaemagglutinin-stimulated lymphocytes from 20 young (16-28 years) and 20 old (70-88 years) healthy subjects were examined for chromosome aberrations before and after exposure to bleomycin in the G2 phase of the cell cycle. No differences were found in unexposed cultures between young and old donors. After treatment with bleomycin, the rate of chromosome aberrations was significantly higher in the elderly persons (p less than 0.05). As the results suggest, different interaction between the mutagen and DNA may be caused by the decreased capacity of the excision repair system in the elderly individuals cells.
Adolescent↗
[Iatropathogenic effect of Mevacor on vitamin D metabolism].
The authors examined 18 heterozygotes with familial hypercholesterolaemia and assessed vitamin D metabolites, parameters of phosphocalcium homeostasis and blood lipids. They investigated the effect of the hypolipidaemic drug lovastatin (Mevacor, Merck, Sharpe Dohme, tbl. 20 mg) on the vitamin D metabolism, using increasing doses of 20 to 80 mg per day. They found normal parameters of phosphocalcium homeostasis, normal plasma concentrations of 1,25-dihydroxyvitamin D but low basal values of 25-dihydroxyvitamin D and elevated plasma levels after three months' treatment with MEVACOR. They confirmed at the same time the hypocholesterolaemic effect of the drug. The authors conclude that heterozygotes with familial hypercholesterolaemia may suffer from vitamin D deficiency and that the positive iatropathogenic effect of MEVACOR, a substance inhibiting the activity of 3 hydroxymethylglutarate coenzyme A reductase can have a supporting effect on the vitamin D homeostasis, in particular in old people with vitamin D deficiency.
Female↗
[Chromosome aberrations induced by bleomycin in the lymphocytes of young and old persons].
Phytohemagglutinin-stimulated lymphocytes from 20 young (16-28 years) and 20 old (70-88 years) healthy subjects have been investigated for chromosome aberrations before and after exposure to bleomycin in G2 phase of the cell cycle. No differences were found in unexposed cultures between young and old donors. After treatment with bleomycin the frequency of chromosome aberrations was significantly higher in the old subjects than in the young ones (p less than 0.05). The results suggest that the different interaction between the mutagen and DNA may be caused by the decreased capacity of the excision repair system in the cells of the old individuals.
Adolescent↗
[Medicine in chronic conditions].
Conceptual work on the problem of medicine of chronic diseases. For the definition the aspect of time is important (long-term diseases, permanent diseases, diseases persisting throughout life), disorders of the functional potential and changes of the quality of life. The author draws attention to the important social impact of chronic diseases and their generally valid clinical specific features (incl. diagnosis and therapy). He deals also with the psychology and sociology of chronic conditions.
Attitude↗
Bone demineralization, biochemical indices of bone remodeling, and estrogen replacement therapy in adults with Turner's syndrome.
The study centered on a controversy about whether long-term estrogen replacement therapy may ameliorate the osteoporosis seen in patients with Turner's syndrome. This study comprised 26 adult patients with Turner's syndrome (9 treated and 17 untreated or insufficiently treated) and 12 adult women with pure gonadal dysgenesis (8 untreated and 4 treated). A low bone density below -2 standard deviations from the age- and sex-matched predicted normal mean was documented by dual-photon absorptiometry of the lumbar spine in all the untreated and insufficiently treated patients, but only in 6 treated patients. The biochemical indices of bone resorption (urinary hydroxyproline excretion and plasma tartrate-resistant acid phosphatase activity), as well as osteoblastic function (serum osteocalcin and bone alkaline phosphatase isoenzyme), were significantly increased in untreated and insufficiently treated patients compared with treated patients. A significant negative correlation was found between biochemically documented osteoresorption and spinal bone mineral density corrected for age of the patients. Significant positive correlations were found between serum osteocalcin and bone alkaline phosphatase isoenzyme and between biochemical indices of bone resorption and formation. Although in the patients there was an evidence of a high bone remodeling rate, the rate of bone mass loss seemed to be low, comparable with that seen in oophorectomized women who had already passed their accelerated phase of bone loss. The results indicate that long-term hormonal replacement therapy is justified in gonadal dysgenesis, regardless of the karyotype of the patient, to prevent further bone mass loss.
Acid Phosphatase↗
The application of plasma tartrate-resistant acid phosphatase to assess changes in bone resorption in response to artificial menopause and its treatment with estrogen or norethisterone.
Plasma tartrate-resistant acid phosphatase (TR ACP), urinary hydroxyproline excretion (UH), serum osteocalcin, and bone alkaline phosphatase isozyme were determined in a prospective study in 31 women who had undergone bilateral ovariectomy (OOX). Nine patients were followed up for 1 year without treatment and for the following 3 years when on mestranol (M) substitution. On the basis of UH, 22 patients were identified as having increased bone resorption (BR) within 3 months of OOX. Subsequently, 11 patients were treated with transdermal estradiol (E2) and 11 patients with norethisterone (norethindrone, NE). In untreated patients, the biochemical indices of BR peaked 3-6 months following OOX and biochemical indices of bone formation (BF) continued to increase from 3 until 12 months. The substitution with both E2 or M resulted in normalization in serum and urinary calcium, serum phosphate, renal threshold phosphate concentration (TmPO4/GRF), and biochemical indices of BR within 4 months of treatment. Biochemical indices of BF normalized within 6 months of treatment. In the M-treated group, these effects continued for 3 years of the follow-up. The hormonal substitution had a protective effect on cortical and lumbar spine bone mass. A significant decrease, but not to normal values, in biochemical indices of BR and a persistent elevation in indices of BF were found in NE-treated patients. Unlike E2, NE does not depress osteoblastic function. There is strong evidence supporting the utility of measurements of TR ACP in plasma in examination of women who had ovariectomies and in assessement of the efficacy of treatment.
Acid Phosphatase↗
Prospective trial of ossein-hydroxyapatite compound in surgically induced postmenopausal women.
Women with increased bone resorption induced by bilateral oophorectomy 1-5 years previously (of a total of 48 women in the study, 20 were controls, and 28 were the treatment group) were studied during a 3 year follow-up. The ossein-hydroxyapatite compound (OHC) treatment provided 1.6 g calcium, 0.74 g phosphorus and 1.94 g noncollagen peptides a day. Biochemical indices of bone remodeling (urinary hydroxyproline/creatinine and calcium/creatinine ratios, bone alkaline phosphatase isoenzyme in serum and plasma tartrate resistant acid phosphatase) decreased significantly in both treatment and control groups compared with their baseline values. Biochemical indices were significantly lower in the treatment group compared to the controls after the first year, but in only half the patients after three years. By the third year these responders had significantly higher cortical area than controls. In an additional 13 women a transient response to OHC was followed by an accelerated bone loss and a return to the control values of the biochemical indices of bone resorption. In the poor responders an estrogen/progesterone substitution resulted within 6 months in a complete normalization in the biochemical parameters and in no further cortical bone loss. The results confirm a heterogeneous pattern of bone mass loss in menopause and indicate that OHC treatment is of value in preventing cortical bone loss in a portion of at-risk postmenopausal women, provided that the efficacy of the treatment is monitored.
Alkaline Phosphatase↗
Castrated men exhibit bone loss: effect of calcitonin treatment on biochemical indices of bone remodeling.
To test the hypothesis that the reduction in gonadal function can lead to bone mass loss, a group of 12 men who had undergone bilateral orchidectomy at the age of 28.2 +/- 6.8 yr was evaluated. A progressive loss of the lumbar bone density was observed as a function of time after orchidectomy. Both the biochemical indices of bone resorption (urinary hydroxyproline/creatinine ratio and plasma tartrate-resistant acid phosphatase) and bone formation (serum osteocalcin and bone isoenzyme of alkaline phosphatase) were significantly increased in the patients compared with healthy controls. A positive correlation was found between urinary hydroxyproline excretion and percent change in spinal bone mineral density per yr. Because of this increase in the biochemically indicated bone resorption, nine of the patients were studied again after 1-3 yr and were thereafter treated with intranasal calcitonin. Urinary hydroxyproline excretion normalized after 3 months of treatment, and a significant decrease, but not to normal levels, was also observed in the mean values for the other biochemical indices of bone remodeling. Thus, testosterone deficiency, like estrogen deficiency, is associated with accelerated bone loss. The increase in osteoresorption was partially corrected by calcitonin treatment.
Adult↗
[Energy support with parenteral nutrition in patients with chronic intestinal inflammation].
Parenteral nutrition (PN) was administered to 24 patients with chronic enteritis. Their mean age was 37 years (range 17 to 69 years). Seventeen times Crohn's disease was involved, five times ulcerative colitis and twice postprandial enteritis. The mean period of PN was 24.6 +/- 12.9 days and its energy value was 7.79 +/- 1.63 MJ/24 hours. Some patients had a restricted oral intake, on average 5 MJ/24 hours. The energy output at rest assessed by indirect calorimetry was 7.62 +/- 1.06 MJ/24 hours. Along with PN the patients had aimed antiinflammatory treatment. In the majority of patients clinical improvement was recorded. The nutritional status improved in 13 patients, was not affected in 9 and in two it deteriorated. The improvement of the nutritional status was not always associated with regression of manifestations of the local enteritis. In particular affections of the rectum in Crohn's disease were resistant to treatment and the position changed after a derivation stoma operation.
Adolescent↗
High cardiovascular reactivity to psychological challenge associated alternatively with high density of beta-adrenergic receptors or with high resting level of catecholamines.
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Cardiovascular System↗