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Z Marecek

Publications and source records attributed to Z Marecek.

At least 19 recordsLinked to original sources

[Hepatitis C viral infection at the beginning of twenty-first century].

The article reviews basic information on the epidemiology, origin, diagnostics and therapy of hepatitis C viral infection. Virus of the hepatitis C was identified in 1989. The most frequent transmission pathway till 1992 was the reception of blood derivatives, after that year, when transfusion centres started to use detection sets to prove anti-HCV antibodies, the incidence of post-transfusion hepatitis C dropped almost to zero. The most common route of transmission at present is the intravenous toxicomany, and significant participation represents the medical care. The basic serological marker of HCV infection is the presence of anti-HCV antibodies. Those antibodies signify markers of the human contact with the virus; they need not automatically mean the encounter of infection. More often it is contrariwise--because the C viral hepatitis develops the chronic stadium up in 85%, the anti-HVC positivity signifies usually the active form of infection. To prove the active form of infection it is necessary to identify viral nucleic acids in the serum of the examined patient. The standard therapy of the chronic form of the C viral hepatitis is at present a combination of pegylated interpherons alpha and ribavirin. Such form of therapy can result the permanent elimination of the virus in about 60% of cases. In the C viral hepatitis neither the specific pre-exposition nor post-exposition prophylaxis is available. The only prevention of the transmission of infection is the avoidance of any risk factor of transmission, namely in the medical care.

Hepatitis C↗

[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↗

Treatment of early diagnosed HCV infection in hemodialyzed patients with interferon-alpha. Treatment of hepatitis C.

BACKGROUND: Acute and early diagnosed hepatitis C virus (HCV) infections are rare diagnoses. Patients on regular dialysis treatment (RDT) are at risk of acquiring HCV infection. AIMS OF THE STUDY: (1) To determine the efficacy and safety of two-phase induction treatment of acute and early diagnosed HCV infections in patients on RDT, and (2) to establish the importance of serum HCV RNA testing at defined time points of treatment for the prediction of the therapeutic effect. THERAPEUTIC PROTOCOL: Antiviral treatment consisted of two different phases: phase A therapy was interferon (IFN)-alpha 2b 10 million units (MU) s.c. administered daily for 21 days followed by phase B with IFN-alpha 2b 3 MU s.c. administered 3 times weekly for 12 weeks. RESULTS: (1) Efficacy of the treatment: A sustained virological response (SVR) was achieved in a total of 13/18 patients (72%). SAFETY: We did not observe any serious side effects of the treatment. The most pronounced side effect was the myelosuppression caused by IFN-alpha. (2) SVR prediction: Patients with negative serum HCV RNA at day 6 achieve SVR more frequently than those with positive HCV RNA at day 6 (p = 0.074). CONCLUSIONS: Treatment of acute and early diagnosed HCV infections in hemodialyzed patients is much more effective than treatment of chronic infection. Even relatively high doses of IFN at the beginning of therapy (10 MU daily) are tolerated well by the patients.

Adult↗

[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↗

Cardiac involvement in Wilson disease.

BACKGROUND: Wilson disease is an inherited autosomal recessive disorder of copper metabolism resulting in pathological accumulation of copper in the liver, brain and other tissues. One of the reported manifestations is cardiac involvement. METHODS: We studied 42 patients with Wilson disease (19 men and 23 women, mean age 34 +/- 10 y) and 42 age- and sex-matched healthy volunteers. All subjects underwent complete echocardiographic examination; 24 h ECG Holter monitoring was performed in 23 Wilson disease patients. RESULTS: In comparison to healthy subjects, patients with Wilson disease had increased thickness of the interventricular septum (9.5 +/- 1.4 vs 8.6+/-1.1 mm, p < 0.01) and left ventriclular (LV) posterior wall (9.1 +/- 1.3 vs 8.2 +/- 1.0 mm, p < 0.01). While the two groups did not differ in LV mass index, relative LV wall thickness was significantly increased in Wilson disease patients compared to control subjects (0.39 +/- 0.06 vs 0.34 +/- 0.04 p < 0.001). Concentric LV remodelling was present in 9 patients (21%) and LV hypertrophy in one patient. Systolic LV function showed a nonsignificant trend towards lower values in Wilson disease patients (EF 62 +/- 5% vs 64 +/- 50%, p = 0.06). Diastolic filling and the frequency of valvular abnormalities were comparable in both groups. The established echocardiographic abnormalities did not correlate with the type of Wilson disease manifestation, the presence of the His1069Gln mutation, laboratory parameters or the duration and type of therapy. Twenty-four-hour ECG Holter monitoring detected ECG abnormalities in 10 patients (42%), the most frequent findings being runs of supraventricular tachycardias and frequent supraventricular ectopic beats. CONCLUSIONS: Cardiac involvement in Wilson disease patients was mild, characterized by LV parietal thickening with an increased prevalence of concentric LV remodelling and a relatively high frequency of benign supraventricular tachycardias and extrasystolic beats.

Adult↗

[Rifaximin in the treatment of hepatic encephalopathy].

Hepatic encephalopathy is a frequent and serious complication of liver cirrhosis. Usually it is treated by non-absorbable disaccharides or antibiotics and its treatment is often difficult and associated with undesirable effects. The objective of our investigation was to evaluate the safety and effectiveness of a new antibiotic used in this indication--rifaximine. With rifaximine, 400 mg three times per day, a total of 25 patients were treated for a 10-day period. Significant improvement of the manifestations of encephalopathy occurred (evaluated by the grade of encephalopathy, test of combining numerals, the degree of flapping tremor and the arterial ammonia level). None of the patients developed undesirable effects. Rifaximine seems an effective, safe drug for hepatic encephalopathy.

Anti-Infective Agents↗

[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↗

Immunoaffinity isolation of CEACAM1 on hydrazide-derivatized cellulose with immobilized monoclonal anti-CEA antibody.

Carcinoembryonic cell adhesion molecule 1 (CEACAM1) is a human membrane glycoprotein belonging to the carcinoembryonic antigen (CEA) family and to the immunoglobulin superfamily. It is expressed in apical membranes of many epithelial cells in gastrointestinal and urogenital tract and also in granulocytes and lymphocytes, and its biological effect in human tissues has recently been discussed in literature. The purpose of this study was to isolate CEACAM1 glycoprotein from bile and characterize its purity and recovery which has not been described before. Affinity chromatography of CEACAM1 on hydrazide-activated cellulose with immobilized monoclonal anti-CEA F34-187 antibody is described. The immunoglobulin carbohydrate moiety was oxidized by periodate and then bound to hydrazide-activated matrix. Crude protein fraction from bile was applied on the affinity column and after extensive washing of non-bound proteins CEACAM1 was eluted with 6 M guanidine-HCl. A single immunopositive 85 kDa band was detected on Western blots with anti-CEA antibody after SDS-PAGE. We found out that CEACAM1 was not stainable with any common method of protein staining and the only non-specific method which could detect the 85 kDa band was a lectin staining.

Antibodies, Monoclonal↗

Carcinoembryonic antigen-related cell adhesion molecule 1 is the 85-kilodalton pronase-resistant biliary glycoprotein in the cholesterol crystallization promoting low density protein-lipid complex.

A pronase resistant 85-kd glycoprotein in the Concanavalin A-binding fraction (CABF) of biliary glycoproteins has been reported to act as a promotor of cholesterol crystallization. De Bruijn et al. (Gastroenterology 1996;110:1936-1944) found this protein in a low-density protein-lipid complex (LDP) with potent cholesterol crystallization promoting activity. This study identifies and characterizes this protein. An LDP was prepared from CABF by discontinuous gradient ultracentrifugation. Proteins were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), blotting and immunochemical staining with anti-carcinoembryonic antigen, CEA-related adhesion molecule 1 (CEACAM1) cross-reacting antibodies. Biliary concentrations of CEA cross-reacting proteins were determined in patients with and without gallstones. Two isoforms of CEACAM1 (85- and 115-kd bands), CEA and 2 CEA cross-reacting protein bands of 40 and 50 kd were found in human bile. All bands were also present in CABF, but only a subfraction of the 85-kd band found in the LDP was resistant to digestion with pronase. CEACAM1-85 exhibited potent cholesterol crystallization promoting activity in vitro and accounted for most of the activity in CABF. Total CEA cross-reacting protein concentrations were the same in gallbladder biles from patients with cholesterol and pigment gallstones but only half of those in biles from nongallstone subjects. In conclusion, we have identified the protein component of the cholesterol crystallization promoting LDP to be CEACAM1-85.

Adenosine Triphosphatases↗

[Importance of hepatitis C virus infection in gynecology and obstetrics].

OBJECTIVE: Diagnostic methods of hepatitis C-virus. SUBJECT: A review article. SETTING: 1st Internal Clinic, General Faculty Hospital in Prague, 1st Medical Faculty, Charles University. SUBJECT AND METHOD: Hepatitis C virus infection importance is increasing during the last few years, in concordance with this fact therapeutical options are being developed very rapidly, too. Majority of cases of HCV infection has a silent clinical course for a long time and patients are often diagnosed in the late stage of liver disease. This is the reason why the diagnosis should be established as early as possible. Gynecologist can be the first person who can observe the symptoms of the infection and therefore he may become the key person in the diagnostic process. CONCLUSION: The basic facts about the diagnostic methods and clinical course of the disease are mentioned in this review. The differences in clinical course of HCV infection in pregnancy and the vertical transmission is discussed in details.

Female↗

Extracorporeal shock wave lithotripsy of gallstones with oral dissolution. Results in course of ten years in Czech Republic in correlation to indication criteria.

BACKGROUND/AIMS: We compared the results of treatment of gallbladder stones by extracorporeal shock wave lithotripsy with dissolution during two periods to different criteria of indication. In the first period (1990-1991) we treated patients with stones up to 3 cm in diameter. In the second period (1992-1994) the indication included stones up to 1.5 cm with gallbladder contraction on cholecystography, which was also quantitatively determined by USG exceeding 60% of fasting volume. METHODS: We used Czech made lithotriptors MEDILIT. The shock waves (SW) are produced by an underwater high voltage discharge and the concentration of SW is achieved by reflection. The localization of stones is performed by means of a sonographic probe. After stone localization usually 700 SW are applied to a patient lying in prone position. Oral dissolution was started in both groups of patients two weeks before shock wave application. Ursodeoxycholic acid and chenodeoxycholic were administered in doses of 7.5 mg/kg body weight/day. RESULTS: In the first group of 260 patients (average age 42), which had moderate indication criteria, disappearance of fragments during one year was found only in 148 (57%). The remaining patients were treated symptomatically or recommended to cholecystectomy. In a second group of 160 patients (average age 45), disappearance of fragments during one year was achieved in 125 (78%). We used stricter indication criteria and our results are much better compared to the first group. Only 208 patients from both groups were controlled for more 5 years, in 89 cases of this number was a recidivity of lithiasis and at 20 of them we indicated cholecystectomy, 22 of the patients refused to continue in the therapy, because the stones are asymptomatic. CONCLUSION: In our opinion, this therapy (ESWL combined with oral dissolution) is suitable in 7% patients with gallbladder stones. Its side effects are very small, practically negligible. It can be performed without general anaesthesia and on an out-patient basis. After the advent of laparoscopic cholecystectomy we observed diminished interest of both patients and their physicians for gallbladder ESWL, however, after it has reached a widespread use, a new interest in ESWL and dissolution therapy is emerging, which we attribute to its above-mentioned advantages.

Administration, Oral↗

An absence of changes in kidney tissues after an enormous number of shock waves.

Repeated sessions of unilateral extracorporeal shock wave lithotripsy (ESWL) were performed in a patient with multiple bilateral calycolithiasis who suffered from Crohn's disease of long duration and from recurrent gastric ulcers. To achieve complete clearance of stones from the left kidney it was necessary to apply 10,000 shock waves during seven sessions within five weeks. This number is exceedingly high compared to average total doses which were applied to other patients of our group (920 SW per one session). For the treatment was used an electrohydraulic lithotripter (Medipo). A surgical reconstruction of the abdominal wall which had been planned long before was made six weeks after the last ESWL session. The postoperative course was complicated by bleeding gastric ulcer of which the patient died despite an intensive treatment. The autopsy and histology revealed no damage of kidney tissue or adjacent organs caused by ESWL.

Crohn Disease↗

Artificial lipid-protein complexes accelerate cholesterol crystallisation in model bile.

Cholesterol gallstone disease is one of the major health problems in the world. Substances which can affect the crystallisation of cholesterol from human bile have been given considerable attention. Various substances (among them natural lipid-protein complexes) have been tested for cholesterol crystallisation-promoting activity. Various artificial lipid-albumin complexes have been prepared of which taurodeoxycholate-human serum albumin-calcium ions (TDC-HSA-Ca(2+)) had the highest cholesterol crystallisation-promoting activity. This cholesterol crystallisation-promoting activity is similar to that for the lipid-protein complex isolated from native human bile [concanavalin A nonbinding fraction (con A(-) fraction)]. Addition of cholesterol to the TDC-HSA-Ca(2+) complex further increased the cholesterol crystallisation-promoting activity whereas the addition of lecithin had an opposite effect. The interaction of individual components of the TDC-HSA-Ca(2+) complex was followed using several methods. A new effect of Ca(2+) ions (increase in the number of binding sites for bile salts) on the interaction of TDC with HSA was found by equilibrium dialysis. Interaction of TDC with albumin and Ca(2+) did not induce any modification of the secondary structure of albumin. The results of fluorescence spectroscopy may indicate that TDC is at least partially bound to not essentially fatty acid free HSA somehow via admixtures, probably fatty acids. Difference absorption spectrum of the TDC-HSA-Ca(2+)-cholesterol complex was very similar to that of the "natural" lipid-protein complex (con A(-) fraction). From the three drugs with different albumin binding characteristics, only sulphadimethoxin had an observable effect on the cholesterol crystallisation-promoting activity. The action of the TDC-HSA-Ca(2+) complex decreased significantly after the addition of sulphadimethoxin. The addition of TDC modified the absorption spectrum of the sulphadimethoxin-HSA-Ca(2+) complex. It can be suggested that the complex of HSA with bile salts (TDC mainly) and Ca(2+) forms a nucleation centre for cholesterol crystallisation in bile.

Albumins↗

[Essential phospholipids in the treatment of hepatic encephalopathy].

THE AIM: To evaluate the effect of treatment with intravenous essentiale phospholipids in patients with liver cirrhosis and hepatic encephalopathy grade III-IV. PATIENTS AND METHODS: 12 patients with hepatic encephalopathy grade III-IV due to decompensated liver cirrhosis, age 35-67 years, were randomized to two groups: Essentiale 2.0 g i.v. daily was given to 6 patients in combination with standard therapy for 2 weeks; 6 patients had only standard therapy. The patients were followed up for 90 days. The diagnosis of hepatic encephalopathy was based on clinical examination, psychometrical tests and neurophysiological examination-EEG and evoked potentials. RESULTS: Mean survival in the group treated with Essentiale i.v. was 50.3 days in comparison to 34.7 days in control group. P300 latencies improved significantly in the Essentiale group in comparison to control group (427.5 ms before vs 366.3 ms after treatment period in the treated group; 346.6 ms before vs 347.5 ms after treatment period in controls). Ammonia level decreased form 95 mumol/l. 5 to 49.7 mumol/l in the treated group, while in controls remained unchanged (46.5 mumol/l before vs 53.5 mumol/l after treatment period). No adverse reactions were observed during the treatment with Essentiale i.v. CONCLUSION: Administration of Essentiale i.v. is a safe treatment of advanced liver disease. In the group of patients treated with Essentiale i.v. was observed prolonged survival, as an improvement of hepatic encephalopathy in comparison to control group.

Adult↗

[Pronuclear and antinuclear factors in the pathogenesis of cholesterol cholelithiasis].

Contrary to hitherto published results, the authors provided evidence of significant pronucleation activity in the protein fraction which is not linked to concanavaline A. Delipidation or proteolysis markedly reduce the pronucleation activity of this fraction. Albumin was identified as the main protein in this fraction. The lipid-protein complex formed by albumin and lipids had a high pronucleation and crystallization activity in relation to cholesterol. Calcium ions increased the crystalization activity. Complexes formed by proteins and lipids can be vectors of the main pronucleation activity in bile. In investigations of the main cholesterol fraction the authors provided evidence that only part of so-called pronucleation proteins is linked to vesicles--i.e. IgM, IgA and biliary glycoprotein BGP I and II. The authors assume that only proteins firmly linked to vesicles can participate in the process of cholesterol crystallization. Biliary glycoprotein BGP I and II was present in vesicles and when added into a model bile it presented a high pronucleation activity. Biliary glycoprotein is a new hitherto not identified pronucleation protein in bile.

Bile↗

[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↗

[Vesicular and pronuclear glycoproteins in the pathogenesis of cholesterol lithiasis].

BACKGROUND: Several biliary proteins have been known to accelerate fusion of cholesterol rich phospholipid vesicles. Some of them are present in vesicular membrane, localisation of other proteins is unknown. Biliary glycoprotein has not been studied in consequence with pathogenesis of cholesterol lithiasis. METHODS AND RESULTS: Low molecular extravesicular proteins were separated from vesicles by gel filtration on a 1200mm column of Sephacryl S-300 HR. Immunoglobulins IgM, IgA, haptoglobin, biliary glycoprotein I (BGP I) and nonspecific crossreactive antigen were eluted along with vesicles. Albumin and alpha 1-acid glycoprotein were eluted later and must be extravesicular. CONCLUSIONS: Fact that BGP I (85 kDa membrane glycoprotein) eluted along with vesicles and not in albumin fraction suggests that it might be bound in vesicular membrane. As a known adhesion molecule it could thus play an important role in pathogenesis of cholesterol cholelithiasis.

Bile↗