Mokáň M, Martinka E, Galajda P. Diabetes mellitus a vybrané metabolické ochorenia

Zuzana Némethyová

Vnitr Lek 2009, 55(3):312  

Prvé angiologické pracovisko (PAP) - 35. výročie vzniku prvého klinického angiologického pracoviska v Slovenskej republike

Peter Gavorník

Vnitr Lek 2009, 55(3):310-311  

Autologous Bone Marrow Stem Cell Transplantation in Patients with End-Stage Chronical Critical Limb Ischemia and Diabetic Foot

V. Procházka, J. Gumulec, J. Chmelová, P. Klement, G. L. Klement, T. Jonszta, D. Czerný, J. Krajča

Vnitr Lek 2009, 55(3):173-178  

A total 37 patients suffering from end stage-IV Fontaine (CLI and diabetic foot) with an ulcerated limb in whom all previous therapeutic strategies failed (e. g. surgical revascularization and endovascular repair) were selected and underwent local transplantation of Autologous Bone Marrow Stem Cells (ABMSCs). The efficacy/safety of this therapy was assessed by using several endpoints such as (a) prevention of amputation, (b) wound healing and (c) degree of angiogenesis. In order to assess the limb ischemia and hypoxia the several tests and measurements were performed pre- and post transplantation at a variety of time intervals. The measurements include:...

The Salvage of Ischaemic Limb by Therapeutical Angiogenesis

R. Talapková, J. Hudeček, I. Šinák, P. Kubisz, Ľ. Laca, Ľ. Hlinka, K. Zeleňák

Vnitr Lek 2009, 55(3):179-183  

Background:Critical limb ischaemia (CLI) is defined as a chronic rest pain, lasting more than 2 weeks, requiring analgesics and/or with present skin defects. Autologous transplantation of bone marrow mononuclear cells has been used successfully in CLI. Aim:The salvage of critically ischaemic limb by endotel progenitory cells (EPCs) from patient's bone marrow. To assess efficacy and safety of critical lower limb ischaemia treatment with marrow stem cell autotransplantation. Methods:9 patients suffering from CLI have been enrolled. They did not require emergency amputation and had previously been unsuccessfully...

The use of adult human bone marrow stem cells in the treatment of spinal injury

Š. Fedorko, R. Lipina

Vnitr Lek 2009, 55(3):184-186  

The spectrum of stem cells therapeutic uses broadens with advancing knowledge about this biological material. Treatment of spinal injury is one of the areas of stem cell use. Many pre-clinical studies have shown that some cells can, for example, transdifferentiate into neuronal cells and replace those that are damaged. Through secretion of many growth and neuroprotective factors, stem cells prevent, to some extent, progressive cell death, form an environment suitable for regeneration of damaged tissue, facilitate neovascularization, remyelinization etc., and in consequence may improve post-spinal injury neurological deficit. Several clinical studies...

Our first experiences with autologous transplantation of bone marrow stem cells to treat pseudarthrosis, delayed fracture healing and long bone defects fracture

M. Šír, V. Procházka, J. Gumulec, L. Pleva

Vnitr Lek 2009, 55(3):187-189  

Traumatology and orthopaedics have undergone substantial progress in the use of new, sophisticated techniques, implants and navigation methods. Nevertheless, these new methods continue to fail in some instances. Regenerative medicine using the growth potential of stem cells that posses the ability to regenerate damaged tissues represent one of the possible ways forward. There is a potential for more comprehensive utilization of bone marrow stem cells that had for many years been used in transplant medicine. Traumatology and orthopaedics could utilise stem cells in the treatment of bone defects, i.e. in the treatment of pseudarthrosis, delayed fracture...

Venous thromboembolism prophylaxis in internal medicine

J. Malý, J. Widimský, P. Dulíček

Vnitr Lek 2009, 55(3):190-195  

Many of medical patients are significant risk of venous thromboembolism (VTE). VTE is the most common cause of preventable death in hospitalized patients. Prophylaxis is highly effective in reducing the risk of deep vein thrombosis and pulmonary embolism and should be used in most hospitalized patients. Various strategies improve adherence to evidence-based guidelines on the use of prophylaxis, including audit and feedback, and automatic reminders. The important clinical risk factors for PE (or venous thromboembolism VTE) include advanced age, general anaesthesia, prolonged immobility or paralysis, previous VTE, cancer, duration of surgery, orthopaedic...

Prevention of venous thromboembolism in surgery, laparoscopic surgery and urology

J. Gumulec, M. Zänger, V. Procházka, R. Urbanec, P. Klement

Vnitr Lek 2009, 55(3):196-203  

Deep venous thrombosis and pulmonary embolism are major health problems with potential serious outcomes. Acutely, pulmonary embolism may be fatal. In the long term, pulmonary hypertension can develop from recurrent pulmonary embolism. Often overlooked is post-thrombotic chronic venous insufficiency occurring as a result of deep venous thrombosis causing deep venous reflux or obstruction with skin changes and ulceration with adverse impact on quality of life and escalation of health care costs. Almost all hospitalized patients have at least one risk factor for venous thrombosis and approximately 40% have three or more risk factors. Without thromboprophylaxis,...

Venous thromboembolism prophylaxis in orthopaedics and traumatology

P. Kessler

Vnitr Lek 2009, 55(3):204-210  

The paper formulates the following recommendations:1. Patients with total hip or knee replacement should be prescribed higher prophylactic dose of low molecular weight heparin (LMWH) or fondaparinux or rivaroxaban or dabigatran, patients with proximal femur fracture should be prescribed higher prophylactic dose of LMWH or fondaparinux. Pharmacological prophylaxis should in patients with knee replacement be administered for at least 14 days and longer in patients with increased risk of venous thromboembolism (VTE). It is recommended that the prophylaxis lasts 28 to 35 days in patients with hip replacement or with a proximal femur fracture....

Antithrombotic prophylaxis during pregnancy

M. Penka, P. Dulíček, T. Binder

Vnitr Lek 2009, 55(3):211-215  

Coagulation disturbances with their symptoms of thromboembolic - especially venous - disease play the most important role in the incidence of maternal mortality. The attention is focused on precise diagnostic procedures and on the treatment of all the disorders generally accompanied by coagulopathies. First-degree step is prevention of above mentioned complications, and the aim of its treatment is prevention of longterm complication or consequences. Actually is VTE resolved under the condition of the recommendation of 8th ACCP Conference.

The profylaxis of venous thromboembolism in gynecology

P. Dulíček, J. Malý, R. Malý

Vnitr Lek 2009, 55(3):216-218  

The venous thromboembolism is a serious disease, but it is possible to some extend eliminate it by proper thromboprophylaxis. The recommendations in gynecology result from guidelines not only in surgery and the internal medicine, but also from specific gynecologic conditions. The early and frequent mobilization is recommended for minor gynecological surgery and laparoscopic procedures. For major gynecological surgery and laparoscopic procedures in whom additional VTE risk factors are present, low molecular weight heparin is indicated. In major gynecological surgery for malignancy, low molecular heparin is needed in dose at least 4,000 antiXa IU. The...

Prophylaxis and treatment of thromboembolism in oncology

P. Kessler

Vnitr Lek 2009, 55(3):219-222  

In this article, following guidelines for clinical practice are formulated. 1. For patients undergoing cancer surgery, pharmacological thromboprophylaxis is recommended. Low molecular weight heparins (LMWH), unfractionated heparin (UFH) 5 000 U three times daily, or fondaparinux are recommended; in the Czech Republic, LMWH are most frequently used. For patients undergoing major cancer surgery extended prophylaxis for 4 weeks is recommended. For patients with a high risk of bleeding, intermittent pneumatic compression presents a reasonable alternative. 2. For cancer patients, who are bedridden, or hospitalized with an acute illness, thromboprophylaxis...

Thrombotic Complications in Children with Cancer

O. P. Smith

Vnitr Lek 2009, 55(3):223-226  

The last decade has seen advances in treatment of life-threatening disease in children - especially cancer where the overall cure rate is now in the region of 80%. Similar to adults, children with cancer are at a substantial risk of developing thromboembolism (TE). One of the costs of achieving this has been more children developing thrombotic disease, the majority of which are related to indwelling vascular catheters and as a result TE is being diagnosed with increasing frequency in these younger patients. In the Canadian Paediatric Thrombophilia Registry, 20% of the patients with TE had cancer. This figure is in contrast to only 2.3 cases of malignancy/1000...

Treatment of deep vein thrombosis with continuous intravenous infusion of LMWH in children - an alternative to subcutaneous application when needed

J. Blatný, V. Fiamoli

Vnitr Lek 2009, 55(3):227-232  

Incidence of thrombosis is age dependent with the lowest risk in the childhood. Children mostly suffer from vein thrombosis. Incidence of thrombosis in children is only 0.07/10 000, but it increases among hospitalized children (3.5/10 000). Subcutaneous administration of low molecular weight heparin (LMWH) is preferred treatment of deep vein thrombosis in children. In this study we present group of 33 children with deep vein thrombosis, who were treated with LMWH for their first thrombosis from 2003 till 2006. Twenty-one (63.6%) patients were treated with LMWH by continuous infusion and 12 (36.3%) patients by subcutaneous injection. Duration of the...

Cardiac surgery as a significant interference with a patient coagulation status

R. Brát

Vnitr Lek 2009, 55(3):233-235  

Cardiac surgery has been advancing intensively in recent years. However, it is often forgotten that cardiac surgery interventions represent a significant interference with patient's coagulation status. This paper summarizes the main processes in the course cardiac surgery that lead to coagulation disorder. These include: * haemodilution resulting from extracorporeal circuits crystalloid priming and the use of cardioplegic solutions leading to the reduction in coagulation factors concentration and the thrombocytes count * full heparinisation during extracorporeal circulation that represents a significant interference with coagulation that may persist...

Pre-operative care for cardiac surgery patients with cold antibody disorder, cryoglobulinaemia and cryofibrinogenemia

J. Gumulec, R. Brát, M. Kolek, B. Chrástecký, M. Kořístka, Z. Čermáková, L. Nováčková, L. Šáchová, K. Chasáková, A. Ranochová, M. Ryzí, P. Návratová, J. Zuchnická, C. Bodzásová, H. Plonková, P. Slezák

Vnitr Lek 2009, 55(3):236-241  

We present an example of a patient with confirmed cold agglutinin disease who underwent cardiac surgery in hypothermia to illustrate a known fact that, when exposed to cold, cold agglutinins induce haemolysis of erythrocytes and that cryoglobulins and cryofibrinogens may, upon exposition to cold during a surgery under hypothermia, precipitate or gelify and thus increase plasma viscosity and damage microcirculation. Detailed immunological and haematological investigations in all patients awaiting cardiac surgery with a risk of developing hypothermia is not advantageous considering the low number of patients with clinical and laboratory signs of cold...

Thrombophilic states: their relevance in prevention and treatment of venous thromboembolism

H. Poul, P. Kessler

Vnitr Lek 2009, 55(3):242-252  

Thrombophilic states are congenital or acquired haemostasis disorders with pathophysiological and statistical association to increased risk of thrombosis. Venous thromboembolism is their most important clinical manifestation. More than 50% of patients with unprovoked thrombosis have one of the known thrombophilias. Patients with congenital thrombophilias have, in comparison to those without thrombophilia, increased risk of the first thromboembolic event, while the impact of genetically defined thrombophilic states on recurrence is less evident. The risk of recurrence in patients with idiopathic thrombosis is 7-10% per year even in the absence of a...

Antiphospholipid syndrome in the year 2009

A. Buliková, J. Zavřelová, M. Penka

Vnitr Lek 2009, 55(3):253-262  

Antiphospholipid syndrome is a prothrombotic disorder characterized by vascular occlusions and/or pregnancy morbidity in the presence of antiphospholipid antibodies. These autoantibodies represent a large and heterogenous family of circulating immunoglobulins usually identified as anticardiolipin antibodies and antibodies directed against β2-glykoprotein I or as lupus anticoagulant. A number of criteria for diagnosis of antiphospholipid syndrome have been proposed. In this review, we focused on long-term process of diagnostic procedures development and future directions in scientific research in this field.

Blood platelets metabolic and activation processes and options for their inhibition

M. Pecka, J. Malý

Vnitr Lek 2009, 55(3):263-266  

A range of activation processes and confirmatory and metabolic changes take place in blood platelets following their activation. The paper discusses some of the blood platelet activation steps and describes the specific processes that take place on this level. Furthermore, the points at which it is possible to actively interfere with the blood platelet metabolism or activation processes are described. Antiplatelet treatment focuses on these points and there are efforts to identify active substances that either inhibit access to certain receptors or targets or, alternatively, inhibit the enzymes participating in these processes.

Inferior vena cava filters in pulmonary embolism prevention

V. Čížek, D. Kučera, M. Válka, P. Bartoš, D. Maděřič, M. Pleva

Vnitr Lek 2009, 55(3):267-271  

Pulmonary embolism (PE) is the most serious sign of venous thromboembolism and the 3rd most frequent cause of cardiovascular death. Therapy with anticoagulants represents, among other measures, the mainstay of PE treatment. However, anticoagulant therapy does not prevent recurrence of pulmonary embolism in 3-20% of patients. Most frequently, the source of pulmonary embolism is in venous circulation of lower limbs and pelvis. Interception of the inferior vena cava, originally surgical, later using inferior vena cava filters, is used as a preventive measure. Indications and contraindications of inferior vena cava filters have been redressed and modified...

Preparation of patients on anticoagulant treatment for invasive surgery

M. Brejcha, J. Gumulec, M. Penka, D. Klodová, M. Wróbel, E. Bogoczová

Vnitr Lek 2009, 55(3):272-275  

The management of warfarin therapy in patients undergoing surgery or other invasive procedures involves a balance between the risk of hemorrhage, and the risk of thrombosis. Risk of hemorrhage and the trombosis depends on the type of procedure and on pre-existing conditions. Procedures with low risk of hemorrhage (dental, dermatologic or ophtalmologic procedures, endoscopy) can be provided with continuing anticoagulant therapy. Surgery with high hemorrhagic risk need stop warfarin and start bridging anticoagulant therapy, such as unfractionated heparin or low molecular weight heparin, prior and after surgery. In patients requiring emergency surgery,...

Bleeding complications of anticoagulant therapy

J. Gumulec, P. Kessler, V. Procházka, M. Brejcha, M. Penka, M. Zänger, E. Machytka, P. Klement

Vnitr Lek 2009, 55(3):277-289  

Anticoagulant therapy is one of the most common forms of medical intervention. It is the mainstay of prevention and treatment of thrombotic events. Omission of adequate anticoagulant prophylaxis at least for moderate-risk and high-risk patients is a widely recognized medical error. Bleeding is one of the most feared complications of anticoagulant therapy, and is a risk of all anticoagulants. Whereas unfractionated heparin and warfarin, the oldest and most widely used anticoagulants, have specific antidotes for their anticoagulant effect, many of the newer agents (direct and indirect inhibitors of coagulation factors Xa and/or IIa) do not have specific...

Laboratory procedures following thrombocytopenia diagnosis

L. Šáchová, A. Urgasová, J. Gumulec

Vnitr Lek 2009, 55(3):290-294  

Thrombocytopenia - decrease in the blood platelets count below 100 × 10⁹/L - may represent a significant clinical complication - bleeding. A risk of haemorrhagic complications increases with the severity of thrombocytopenia. Even severe thrombocytopenia, however, may be a sign of a condition with predominant symptoms of thrombosis where bleeding is on the background (thrombotic microangiopathy, for example) or where bleeding occurs concurrently with symptoms of thrombosis (so called thrombohaemorrhagic syndromes). It is necessary to exclude pseudothrombocytopenia when thrombocytopenia is first diagnosed. It is then recommended to follow...

Advances in antithrombotic treatment - antithrombotics with anti-Xa effect

A. Bátorová

Vnitr Lek 2009, 55(3):295-301  

The use of anticoagulants in the prophylaxis and treatment of arterial and venous thrombosis has substantially expanded during the last years. Increasing knowledge about the inherited and acquired thrombophilia and the risk factors predisposing to the recurrency of thromboembolic events result in a new indications for primary and secondary thromboprophylaxis with prolonged or even life-long duration. The limitations of classical anticoagulans, heparin and vitamin K antagonists support the development of medicaments with a specific antithrombotic action. The new generation anticoagulants inhibit in a specific way either particular coagulation enzyme...

Molecular methods in thrombophilic states diagnostics

L. Slavík, V. Krčová, A. Hluší, J. Procházková, J. Úlehlová

Vnitr Lek 2009, 55(3):302-309  

Molecular genetic methods passed into the field of investigation of thrombophilic states in 90th years of last century, along with the first discoveries of coagulation inhibitors (AT III, protein C and protein S). They have acquired a widespread use above all with the detection of the molecular basis of activated protein C (APC) resistance in 1994 by prof. Bertina. At the present time, a wide range of molecular genetic markers, linked with a clearly documented increased risk of thrombophilia are adapted. They include mutations of factor V Leiden 506R/Q, of protrombin 20210G/A, MTHFR 677C/T in homozygous form, mutation of PAI-1 4G/5G, mutations of different...

XV. Pařízkovy dny. Nový Jičín, 26.-27. březen 2009. Sborník abstrakt

Vnitr Lek 2009, 55(3):313-319