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F Straka,
J Pirk,
M Pinďák,
I Skalský,
V Vančura,
R Cihák,
T Marek,
P Lupínek,
D Schorník,
J Mašín,
M Zeman,
J Skrobáková,
Z Dorazilová, J Skibová
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ABSTRACT: Cardiac resynchronization therapy is not commonly used in the early postoperative period in patients undergoing cardiac surgery who have left ventricular (LV) dysfunction and a history of heart failure. We performed a prospective randomized clinical trial to compare atrial synchronous right ventricular (DDD RV) and biventricular (DDD BIV) pacing within 72 hours after cardiac surgery in patients with an EF ≤35 %, a QRS interval longer than 120 msec and who had LV dyssynchrony detected by real-time three-dimensional echocardiography (RT3DE). Epicardial pacing was provided by a modified Medtronic INSYNC III pacemaker. An LV epicardial pacing lead was implanted on the latest activated segment of the LV based on RT3DE. The study included 18 patients with ischemic heart disease, with or without valvular heart disease (14 men, 4 women, average age 71 years). Patients undergoing DDD BIV pacing had a statistically significant greater CO and CI (CO 6.7±1.8 l/min, CI 3.4±0.7 l/min/m(2)) than patients undergoing DDD RV pacing (CO 5.5±1.4 l/min, CI 2.8±0.7 l/min/m(2)), p<0.001. DDD BIV pacing in the early postoperative period after cardiac surgery corrects LV dyssynchrony and has better hemodynamic results than DDD RV pacing.
Physiological research / Academia Scientiarum Bohemoslovaca 12/2011; 60(6):877-85. · 1.55 Impact Factor
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ABSTRACT: The aim of our study was to assess safety and effectiveness of therapy of critical limb ischaemia by autologous stem cells and evaluation of potential adverse events.
Fourteen patients were included into the study (11 men, 3 women, mean age 61.9 +/- 9.6 years, mean diabetes duration 23.5 +/- 11.1 years, mean glycated hemoglobin 6 +/- 1%). Eight patients were treated by bone marrow stromal cells, 6 patients by peripheral blood progenitor cells after stimulation by filgrastim. The suspension of stem cells was then applied into the muscles of ischemic limbs. We evaluated transcutaneous oxygen tension (TcPO2), subjective pain sensation assessed by Visual Analog Scale (VAS) and wound healing.
TcPO2 significantly increased in all patients from 10 +/- 8.7 mm Hg before the treatment to 39.4 +/- 9.5 mm Hg after 6 months (p = 0.0005) after stem cell therapy. We also observed significant area defect reduction and pain decrease during the follow-up period. Median of area defect was reduced from 4.3 (0.7 - 31.7) before the treatment to 0.06 (0 - 0.5) cm2 after 6 months from the treatment (p = 0.0078). Decrease in rest pain was observed in all patients, mean VAS decreased from 5.3 +/- 1.8 to 1.1 +/- 1.3 after 6 months (p = 0.002).
Our study suggests that stem cell therapy of diabetic foot disease is an effective therapeutic option with no adverse events for patients with severe peripheral arterial disease. This treatment leads to increase of transcutaneous oxygen tension, improves wound healing and decreases the rest pain.
Vnitr̆ní lékar̆ství 05/2011; 57(5):451-5.
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ABSTRACT: Was to analyze in detail perioperative changes of renal function during orthotopic liver transplantation (OLT) and to identify risk factors, that were associated with the need of renal replacement therapy (RRT) during the first week after liver transplantation.
Prospective study of 50 consecutive patients undergoing OLT was performed. Selected laboratory and clinical parameters were monitored prior to the procedure, after reperfusion, at the end of the procedure, and at 12 hours after the procedure. In the first post-transplant week, necessity to use RRT in the presence of acute kidney injury was monitored and the analysis of risk factors for the need for RRT was performed. Patient survival, graft function, need for dialysis and selected laboratory parameters were assessed at one year post-transplant.
During OLT, there was an increase in S(cr) and S(urea), which persisted as late as 12 hours post-transplant. There was a decrease in U(cr) and U(urea) and an increase in S(Na) and S(K). During the procedure any increase in S(cyst) were observed, increase the values were recorded 12 hours after surgery. S(bili) level decreased. There was a rise in the urinary levels of total protein, albumin and beta2-microglobulin. U(prot)/U(cr) increased significantly after reperfusion, with a peak after the procedure. At 12 hours after the procedure, there was a decrease in U(prot)/U(cr), but the values were still many times higher than those seen preoperatively. RRTwas necessary in 14% cases. Risk factors for acute kidney injury requiring RRT included a higher APACHE score, higher BMI, higher preoperative S(cr) and S(urea), hepatorenal syndrome pretransplant, blood loss and intraoperative hemodynamic instability, postoperative complications and dysfunction of the liver graft. One year after OLT, there was no difference in followed laboratory values between patients requiring postoperative RRT and others; no patient was treated with dialysis.
OLT has a major impact on glomerular and tubular renal functions. Our data suggest that patients surviving acute renal injury treated with RRT in the early postoperative period have a high chance of restoring renal function. A sensitive marker of renal injury during OLT seems to be perioperative proteinuria.
Vnitr̆ní lékar̆ství 12/2009; 55(12):1126-34.
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ABSTRACT: Development of biological and non-biological artificial liver devices in the previous 20 years enabled effective treatment of acute liver failure (ALF) of patients waiting for liver transplantation or for spontaneous liver parenchyma regeneration. Aim of the study was the evaluation of the effectiveness of biological (BAL - bioartificial liver) and non-biological (FPSA - Fractionated plasma separation and adsorption) methods in the treatment of experimental ALF on large laboratory animal.
Surgical model of ALF with liver devascularization in pigs (weight 25-40 kg) was provided following monitoring of ALF markers (AST, ALT, bilirubin, ammoniac, glycaemia, INR) including intracranial pressure (ICP). Control group included animals without treatment of ALF. Results of both experimental groups were compared and statistically worked-out with that of controls by T-test and Mann-Whitney non-parametric test by EXCEL and QUATRO. BAL group: 10 pigs (weight 30 +/- 5 kg) with ALF were treated by BAL with isolated hepatocytes. When plasma bilirubin was compared, significant differences (p < 0.05) in 6 and 9 hours interval were found favouring BAL group (18.1 vs. 13.1, 22.9 vs. 13.2 mmol/l). The value of ICP in both groups was no significant. Prometheus group: 14 pigs weight 35 kg (35 +/- 5 kg) with the identical ALF were treated by Prometheus (FPSA). Level of serum bilirubin in experimental group when compared to control group was significantly lower (p < 0.01) at 6 hour interval 12.81 +/- 6.54 vs. 29.84 +/- 9.99 at 9 hour 11.94 +/- 4.14 vs. 29.95 +/- 12.36 and at 12 hour 13.88 +/- 6.31 vs. 26.10 +/- 12.23 mmol/l. No significant difference in serum ammonia level was found. ICP was significantly different from 9 hour to 12 hour interval in favour of FPSA group (p < 0.01): 9 hour 19.1 +/- 4.09 vs. 24.1 +/- 2.85, 10 hour 21.9 +/- 3.63 vs. 25.1 +/- 2.19, 11 hour 22.5 +/- 3.98 vs. 26.3 +/- 3.50 and 12 hour 24.0 +/- 4.66 vs. 29.8 +/- 5.88 mm Hg.
Significant improvement of bilirubin and ICP levels resulting from the treatment with fractionated plasma separation and adsorption (Prometheus) were observed in the case of experimental ALE Except the bilirubin levels, bioartificial liver provided by O. liver Performer with isolated hepatocytes did not bring any significant improvement of laboratory markers, including ICP.
Casopís lékar̆ů c̆eských 01/2008; 147(7):367-75.
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ABSTRACT: Women tend to gain weight with age, especially fat mass which shows also regional changes. A cross-sectional study was done on 213 Czech women with the conclusion that there is a progressive weight increase up to the menopause, an increase in absolute and relative fat contribution and fat centralisation up to the postmenopause and these changes seemed to occur even before the weight increase occurs. The same cohort was examined the same way after 3 years for further analysis. The aim was the assessment of weight gain, body composition and fat distribution changes in four age groups representing the reproductive phases in Czech women in 3-year period. 146 healthy Czech women aged 20-65 were classified according to four reproductive phases: fully reproductive women (n=34, mean age 26.96, SD 4.47), pre-menopausal women (n=34, mean age 42.23, SD 2.78), menopausal women (n=45, mean age 51.56, SD 2.61) and postmenopausal women (n=33, mean age 59.55, SD 2.82). Body weight, body composition and fat distribution were determined using classical anthropometric methods in 2000 and 2003. BMI increased significantly in all the groups except for the premenopausal group and was the greatest in the menopausal group. Increase in fat percentage was significant in the fully reproductive (p < 0.001) and menopausal women (p < 0.001), there was no change in the postmenopausal group. Waist, WHR, hip and subgluteal thigh circumference increase significantly in the menopausal group (p < 0.01, p < 0.05, p < 0.05, p < 0.001 respectively). The highest mean values of waist, WHR and even abdominal circumference remain in the postmenopausal group. Changes of all 14 skinfolds and the sum of the peripheral and central skinfolds are shown; the sum of peripheral skinfolds shows the same values at the end of the study while the sum of central skinfolds increases from the fully reproductive to the postmenopausal women. These results permit us to state the following conclusions: the greatest weight gain in the menopausal group suggests weight gain acceleration around menopause. Body fat mass increase terminates in the early postmenopause. Fat centralisation was proved in the menopausal women with still preserved fat deposition in the gluteofemoral area, which was also apparent in the postmenopausal group, however, the postmenopausal women show the highest values of central fat indicators.
Prague medical report 01/2007; 108(3):226-42.
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ABSTRACT: A sample of 213 healthy Czech women was classified into four groups according to their reproductive phase: fully reproductive, premenopausal, menopausal and postmenopausal women. Changes in body weight, body composition and fat distribution were studied in those four groups using the classical anthropometric method. Body weight rises till the menopause with no further increase. A decrease in relative contribution of muscle and bone mass was observed. The progressive increase in fat mass with age was clearly demonstrated, both the fat mass weight (r = 0.38, p < 0.001) and its percentage contribution (Matiegka r = 0.40, p < 0.001, Parízkovi r = 0.42, p < 0.001). There is a stronger correlation of central fat indices as WHR (r = 0.57, p < 0.001), abdominal (r=0.56, p < 0.001) and waist circumference (r = 0.50, p < 0.001) than for hip circumference (r = 0.27, p < 0.001) to the age. WHR and waist increase most when fully reproductive and premenopausal women were compared (p < 0.001); less when premenopausal to menopausal women are compared (NS) and the least when menopausal to postmenopausal women were compared (NS). The mean values of 14 skinfolds thickness are shown, the skinfold at the abdomen shows the strongest correlation to the age (r = 0.49, p < 0.001). The results are consistent with the hypothesis of progressive fat centralisation.
Prague medical report 01/2007; 108(1):13-26.
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ABSTRACT: The glomerular filtration rate (GFR) could be estimated on the basis of serum creatinine concentration (Scr) and some simple variables and demographic data. In clinical practice the most used methods for GFR estimation are Cockcroft-Gault (CG) formula and abbreviated MDRD equation (MDRD abr). The aim of this study was to evaluate how far obesity could affect GFR estimation based on the above formulas.
In 291 patients with chronic renal impairment (S(cr) 45-489 micromol/l) GFR was examined on the basis of renal inulin clearance (C(in)) and estimated using MDRD abr and CG (without correction for body surface area-BSA and CG corrected for BSA) (CGkorig). The group of nonobese patients (A) consisted of 229 patients (BMI <30 kg/m2) and the group of obese patients (B) consisted of 62 patients (BMI 30 kg/m2). The values of r (r2) for MDRD abr, CG and CG(korig) in group A of patients was as follows: 0.893 (0.797), 0.810 (0.651), 0.853 (0.727) and 0.853 (0.727). In obese patients (group B) the corresponding values were as follows: 68.3% (82.6%), 28.6% (39.7%) and 46% (61.9%). Predicted GFR within 30% and 50% of C(in) (in brackets), CG and CG(korig) (for BSA) were for group A: 70.2% (87.3%), 50.4% (67.1%) and 55.7% (75%) and for group B: 68.3% (82.6%), 28.6% (39.7%) and 46% (61.9%). The ratio MDRD abr/Cin did not correlate with BMI. A weak, but significant correlation was found between BMI and CCcorig/Cin ratio (r=0.22, p<0.05).
The obtained results suggest that estimation of GFR based on MDRD abr is not influenced by obesity. Estimation of GFR based on CG formula is significantly affected by obesity. A weak but significant relation could by found between CGkorig/Cin and BMI.
Casopís lékar̆ů c̆eských 01/2006; 145(10):772-6.
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Clinical nephrology 11/2005; 64(4):326-7. · 1.17 Impact Factor
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ABSTRACT: Renal dysfunction in patients after the orthotopic liver transplantation (OLT) is frequent and it significantly contributes to the morbidity and mortality. The aim of our work was to assess the level of glomerular function (GFR) within the first to fifth year after OLT.
Serum creatinine concentration (Skr), creatinine clearance (Ckr) and predicted value of creatinine clearance using the Cockcrofta a Gaulta formula (CG) were assessed in 75 patients. Normal values of the given parameters (Skr <110 umol/l, Ckr > or = 1.3 ml/s/1.73 m2) were found only in 16% of all patients. Significant decrease of GFR (Ckr < 0.5 ml/s/1.73 m2) was found in 24% of cases, acute renal failure, which required transitory haemodialysis developed in 4% of patients. In 60% of patients various degree of GFR decrease was found without the necessity of haemodialysis.
Level of renal functions was not significantly related to the blood pressure or serum lipids concentration. An important factor appeared to be the level of renal function before OLT. Because the level of renal function after OLT can significantly influence the post transplantation development, regular follow up of GFR is recommended.
Casopís lékar̆ů c̆eských 01/2005; 144(2):119-22.
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ABSTRACT: The aim of this study was to create an easily reproducible model of the acute hepatic failure (ASJ) in a minipig, which may allow to test supporting eliminating systems. The aim of this report was to describe the surgical technique with the anaesthesiological procedure and to demonstrate the experimental results on a group of the laboratory animals.
The ASJ was mocked using surgical devascularization of the liver: a ligature of the a. hepatica propria and v. portae, creating a portocaval anastomosis end-to-side. The animals were analgosedated during the experiment and were on a ventilatory support. Biochemical indicators of the hepatic failure, the ICP and the haemodynamics parameters were monitored. Hypoglycaemia with levels below 3.5 mmol and any increase of the intracranial pressure (ICP) were considered the onset of the hepatic failure.
20 minipigs weighing 25-30 kg and divided in 3 groups, were included in the experiment: I--10 animals were assigned to the acute hepatic failure (ASJ) group, II--5 animals with the mock acute hepatic failure (ASJ), whose ICP was monitored in conjunction with the standard monitoring and III. 5 animals without the acute hepatic failure (ASJ)--a control group.
We proved significant differences in the AST levels (33.44 +/- 39.96 vs. 1.56 +/- 0.50 mmol/l), the lactate levels (2.97 +/- 1.16 vs. 1.18 +/- 0.61 mmol/l), and the ammonium levels (264.3 +/- 93.05 vs. 42.5 +/- 12.98 micromol/l) in the acute hepatic failure (ASJ) group compared with the control group (p < 0.01) 6 hours after the surgery and significant changes in the glycaemia levels and the intracranial pressure (ICP) measurements 4 hours after the surgical procedure. Increase in the pulse frequency, the blood pressure, decrease of the mean arterial pressure (MAP) and decrease in the systemic venous resistence index (SVRI) in the acute hepatic failure (ASJ) group was recorded 6 hours after the procedure compared with the initial findings, with significant differences between the acute hepatic failure (ASJ groups and the control group as late as during the 12th hour following the procedure (SVRI: 953 ASJ vs. 1658 control, p - 0.05, MAP: 58.1 ASJ vs. 76 control, p - 0.05). No statistically significant differences in the heart index between the acute hepatic failure (ASJ) group and the control group were recorded. The animals with the acute hepatic failure (ASJ) survived 13 hours following the surgical procedure, on average.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 10/2004; 83(9):436-42.
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ABSTRACT: The equation developed from the MDRD (Modification of Diet in Renal Disease) study provides more accurate estimate of GFR than other commonly used equations. The aim of this study was to compare prediction of GFR based on MDRD and Cockcrof-Gault (CG) method. The study was performed in 111 patients (mean age 42 +/- 5 years) with chronic renal impairment (Scr = 281 +/- 83 micromol/l). The mean of MDRD was 0.480 +/- 0.345 ml/s/1.73 m2 and that of CG 0.608 +/- 0.336 ml/s/1.73 m2. The difference is highly significant (p < 0.0001). The mean of CG/MDRD ratio was 1.24 +/- 0.17. This ratio was significantly higher (p < 0.01) in obese patients (1.59 +/- 0.14 vs 1.22 +/- 0.09). The CG/MDRD ratio did not show relation to Scr. The results are in keeping with the assumption that the difference between MDRD and CG method cannot be explained by increased tubular secretion of creatinine in residual nephrons. Obesity seems to be on of the factors responsible for the difference between CG and MDRD values.
Vnitr̆ní lékar̆ství 08/2004; 50(7):507-9.
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ABSTRACT: Parathyroids dysfunction is a key disorder in the spectrum of renal osteopathy, occurring after renal transplantation and, occasionally, after parathyroidectomy. In our subjects, dysfunction is understood as plus or minus activity.
Parathyroidectomy as the primary procedure was performed in 179 patients for all types of hyperparathyrodism. In 70% of cases the secondary hyperparathyroidism was treated, believed to be the most severe condition. Present assessment was focused on postoperative parathyroid hormone levels (pg/ml) in three groups of patients (n = 92). Group 1 with parathyroid gland autoimplants following total parathyroidectomy; Group 2 after partial or subtotal surgery; Group 3 after autologous implantation of cryopreserved parathyroid glands in severe hypoparathyroidism. Group 1 (32 dialysis and 9 non-dialysed patients): 228.9 vs 85.9 pg/ml; ns; hypofunction in 50% and in 33% respectively, afunction in 12.5% of dialysed patients, in non-dialysed patients it was not detected. Group 2 (25 dialysis and 24 non-dialysed patients): 603.3 vs 169.8 (pg/ml); p = 0.01; hypofunction in 16% and in 8% respectively, afunction was not detected. Complete groups 1 and 2 of patients: 197.5 vs 382.3 pg/ml (p = 0.0016). Dialysed patients in Group 1 and 2: 228.9 vs 603.3 pg/ml (p = 0.007); non-dialysed patients: 85.9 vs 169.8 pg/ml; ns. Group 3 (15 dialysed patients): 63.0; hypofunction and afunction in 40%. This group (63.0 pg/ml) vs Groups 1 and 2 of dialysed patients (p = 0.031 and 0.0004), respectively. Basic laboratory findings before operations of tertiary hyperparathyroidism were shown.
After total parathyroidectomy with parathyroids autoimplantation, parathyroid hormone is acceptable to dialysis and non-dialysis patients. Partial parathyroidectomy prevents development of hypoparathyroidism. It is associated, however, with a risk because of hyperparathyrodism recurrence. Cryopreserved autologous parathyroids reach lower parathyroid levels compared with "fresh" parathyroid tissue autoimplants. Parathyroidectomy after successful renal transplantation may be indicated.
Casopís lékar̆ů c̆eských 02/2003; 142(4):229-34.
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ABSTRACT: Renal function after orthotopic liver transplantation (OTL) is very frequently reduced and its level exerts a significant effect on the morbidity and mortality of these subjects. One of the main factors with a negative impact on renal function after OTL is the nephrotoxic action of cyclosporin A (CsA). Renal function after OTL is usually evaluated on the basis of glomerular filtration (GF). As chronic nephrotoxicity of CsA is manifested in the histological picture by significant tubulointerstitial affection, in 75 subjects after OTL the spontaneous concentrating and acidifying capacity of the kidneys was investigated. The value of urine osmolality (UOSM) assessed after noctunal withdrawal of fluids was in 72.7% lower than in healthy subjects and did not reach 600 mOsm/kg H2O, although the serum creatinine concentration (Scr) was still within the normal range. The pH value of the morning urine did not reach in 38.2% the required value of 6.0 although Scr was within the normal range. Between values of UOSM after nocturnal liquid withdrawal and GF assessed on the basis of inulin clearance (Cin) was a significant direct relationship, however the scatter of values was considerable (r = 0.226, p < 0.05). Between pH values of the morning urine and Cin no correlation was found. The assembled results support the idea that the concentrating activity of the kidneys in subjects after OTL treated with CsA is reduced. This reduced concentrating capacity is already apparent on the basis of UOSM of morning urine after nocturnal fluid withdrawal. Although this defect is also frequent in subjects with a normal Scr value, the authors assume that the use of this simple evaluation of the concentrating capacity (it does not burden the patient nor the attending staff) could be useful in the early diagnosis of tubulointerstitial affection.
Vnitr̆ní lékar̆ství 02/2003; 49(1):45-50.
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ABSTRACT: Patients with diabetes represent 50 to 70% of patients who undergo nontraumatic foot or leg amputation, caused mostly by infection and necrosis of soft tissues accompanied with osteomyelitis. Signs and symptoms of infections may often be absent in patients with infected foot ulcers--the syndrome of "diabetic foot" (DF). The course and consequences of the infection may be influenced by the immune system dysfunction. The aim of our study was to assess presence of the chronic inflammation and specific immune responses, both humoral and cellular in patients with diabetic foot infection.
34 patients treated over one month for an infected DF in our foot clinic (mean age 54 +/- 8 years, mean duration of diabetes 20 +/- 9 years, mean HbAlc 8.8 +/- 1.5%), were matched with 27 healthy subjects. All patients were without clinical signs of acute deep foot infection and without critical leg ischemia. The inflammatory response was assessed by white blood cells count and C-reactive protein (CRP), humoral immune response was assessed by immunoglobulins (Ig) and cellular immunity was evaluated by T lymphocytes subpopulations. Patients with DF compared with healthy controls exhibited the laboratory signs of infection--significantly increased white blood cells count (7.6 +/- 2.1 vs. 6.4 +/- 1.3.10(9)/l, p < 0.01) and neutrophil count (4.6 +/- 1.8 vs. 3.8 +/- 0.9.10(9)/l, p < 0.05) and significantly increased CRP (7 +/- 12 vs. 2 +/- 6 mg/l, p < 0.01). Patients with DF had also significantly higher IgA levels (3.5 +/- 1.6 vs. 2.7 +/- 1.1 g/l, p < 0.05) and significantly more CD3+ T cells (76 +/- 8 vs. 71 +/- 10%, p < 0.05) and suppressor/cytotoxic CD8+ T cells (32 +/- 11 vs. 26 +/- 10%, p < 0.05). Other followed parameters IgG, IgM and serum monocyte and lymphocyte counts, CD4+ helper T cells and CD4+/CD8+ T-cell ratio did not differ between patients with DF and healthy controls.
We did not anticipate a severe secondary immunodeficiency in followed cellular and humoral immune parameters in patients with chronic bacterial foot infection. It is necessary to assess the sufficiency of immune system activation with respect to chronic inflammation in next research.
Casopís lékar̆ů c̆eských 08/2002; 141(15):483-6.
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ABSTRACT: Urinary tract infections (UTI) are the most frequent infectious complications after renal transplantation (Tx). We tried to analyse whether the urinary tract infection was one of the factors which participated in the lower allograft survival rates and in the reduced allograft function in urologically complicated (UC) patients.
We observed 77 patients after Tx whom 42 had urinary fistula, 32 had urinary tract dilatation a 3 suffered from both complications. They were observed from January 1992 through December 1999. 100 patients without urological complications represented a control group (N). Obtained data was statistically evaluated using t-test, chi 2-test, correlation analysis. Graft and patient survival rates were assessed using the Kaplan-Meier method. We have found that UC patients after Tx had worse renal function compared with patients not suffering from this complications. Using Kaplan-Meier methods we have found that graft survival rate in patients with UC is significantly lower than that in the control group (5-year graft survival 0.6 vs 0.82, p < 0.01). On the other hand there were no differences in the 5-year patients survival rate between the followed groups of patients (0.74 vs 0.83). There was no significant correlation between predicted creatinine clearance and followed indicators of UTI--total time of positive urine bacterial cultivation, number of infectious periods and total time of antibiotic therapy. There were no significant differences in graft survival during 5 years between patients with UTI and control group.
Our results suggest that patients with UC are at increased risk of urinary tract infection. Our findings are in keeping with the assumption that UTI in patients with UC do not significantly participate in the decreased level of graft function and in the shorter graft survival rates.
Casopís lékar̆ů c̆eských 06/2002; 141(11):346-50.
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ABSTRACT: Patients with diabetes mellitus undergo more amputations due to peripheral vascular disease, neuropathy and especially to infection requiring long-lasting antibiotic therapy than non diabetic patients. The aim of our study was to assess the association between the presence of resistant pathogens presented in diabetic ulcers and the frequency of lower limb amputations.
191 diabetic patients consecutively treated for the diabetic foot in our foot clinic were included into two years retrospective study. Peripheral ischemia, the presence of osteomyelitis and the incidence of all Gram positive and negative resistant pathogens (defined as resistance to all oral antibiotics) especially of resistant Staphylococcus species presenting in diabetic foot ulcers were determined.
50/191 (26%) patients underwent amputation, of whom 44/50 (88%) had minor and 6/50 (12%) had major amputations. 53/181 (29%) patients with diabetic foot ulcers had resistant pathogens in their defects. Amputated patients had significantly more resistant microorganisms than patients without amputations--24/42 (57%) vs. 29/139 (21%); p < 0.001. Resistant Staphylococcus species were found in 21% (38/181) of all patients. Patients with amputations had significantly more resistant Staphylococcus species in comparison with patients without amputations--18/42 (43%) vs. 20/139 (14%); p < 0.001. Significantly higher incidence of peripheral vascular disease--79% (38/48) vs. 60% (81/136); p < 0.05 and osteomyelitis--69% (33/48) vs. 13% (18/140); p < 0.001--were found in patients with amputations in comparison with patients without amputations.
The presence of pathogens resistant to all oral antibiotics and especially of resistant Staphylococcus species was significantly higher in diabetic patients with lower limb amputations in comparison with patients without amputations.
Vnitr̆ní lékar̆ství 04/2002; 48(4):302-6.
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ABSTRACT: Chronic bacterial ulcers infection is a frequent cause of non-healing diabetic foot. The major factors of a non-specific immune response are phagocytic cells including polymporphonuclear (PMN) leukocytes, and humoral systems (complement). PMN leukocytes remove microorganisms by phagocytosis a part of it is intracellular killing and degradation in a process requiring energy and associated with "respiratory burst". The aim of our study was to assess non-specific immune response in patients with diabetic foot syndrome and chronic bacterial infection. 30 patients treated over one month with antibiotics for an infected diabetic foot in our foot clinic had significantly lower values of "oxidative burst" of PMN leukocytes in basal state (396 +/- 228 vs. 574 +/- 337, p < 0.05) in comparison with 25 matched healthy controls. There were no significant differences neither in the count of active phagocyting PMN leukocytes and their initial phagocytic activity nor in the humoral component of non-specific immunity (in circulating immunocomplexes, C3 and C4 components of complement) between both groups. The results of our study show a slightly altered non-specific immune response in patients with diabetic foot syndrome and chronic bacterial infection.
Vnitr̆ní lékar̆ství 02/2002; 48(2):142-6.
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ABSTRACT: The aim of the study was to select parameters of power spectral analysis appropriate for clinical evaluation of various degrees of diabetic cardiovascular autonomic neuropathy. The diagnosis of autonomic neuropathy was based on Ewing's battery of cardiovascular autonomic function tests and on short-term power spectral analysis of heart rate variability during a modified orthostatic load (in positions supine-standing-supine). 52 diabetic patients and 24 age-matched controls were included. Diabetic patients were divided into two groups according to the total Ewing score. Groups of 14 subjects with early autonomic neuropathy and 38 subjects with severe AN were comparable in age and diabetes duration. RESULTS: Cumulative spectral power of the total frequency band in all three positions (Total Power LFHF 1 + 2 + 3) proved to be the most selective and discriminating parameter of power spectral analysis between the control group and diabetic patients with severe autonomic neuropathy in stepwise discriminant analysis. Spectral power of low-frequency band in positions 1 + 2 + 3 (Power LF 1 + 2 + 3) proved to be the most selective and discriminating parameter between diabetic groups with early and severe autonomic neuropathy. CONCLUSION: The most discriminating parameters of power spectral analysis of heart rate variability for the determination of autonomic function seem to be Total Power LFHF 1 + 2 + 3 and Power LF 1 + 2 + 3.
Vnitr̆ní lékar̆ství 11/2001; 47(10):682-8.
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ABSTRACT: Supplement with keto acids/amino acids (KA) and erythropoietin can independently improve the metabolic sequels of chronic renal insufficiency. Our study was designed to establish whether a supplementation with keto acids/amino acids (KA) exerts additional beneficial metabolic effects in patients with chronic renal insufficiency (CRF) treated with a low-protein diet (LPD) and recombinant human erythropoietin (EPO). In a prospective randomized controlled trial over a period of 12 months, we evaluated a total of 38 patients (20 M/18 F) aged 32-68 years with a creatinine clearance (CCr) of 20-36 ml/min. All patients were receiving EPO (40 U/kg twice a week s.c.) and a low-protein diet (0.6 g protein/kg/day and 145 kJ/kg/day). The diet of 20 patients (Group I) was supplemented with KA at a dosage of 100 mg/kg/day while 18 patients (Group II) received no supplementation. During the study period, the glomerular filtration rate slightly decreased (CCr from 28.2 +/- 3.4 to 26.4 +/- 4.1 ml/min and 29.6 +/- 4.8 to 23.4 +/- 4.4 ml/min in groups I and II, respectively and Cin); this however was more marked in Group II (Group I vs. Group II, p < 0.01). The serum levels of urea also declined (p < 0.01), more pronouncedly in Group I (p < 0.025). In Group I, there was a significant rise in the levels of leucine (p < 0.01), isoleucine (p < 0.01), valine (p < 0.02) and albumin (p < 0.01) and a decrease in protein-uria (p < 0.01). Analysis of the lipid spectrum revealed a mild yet significant decrease in total cholesterol and LDL-cholesterol (p < 0.02), more pronounced in Group I. In Group I, there was a decrease in plasma triglycerides (from 4.2 +/- 0.8 down to values a low as 2.2 +/- 0.6 mmol/L; p < 0.01) whereas HDL-cholesterol levels increased (from 0.9 +/- 0.1 to 1.2 +/- 0.1 mmol/L, p < 0.01). A further remarkable finding was a reduction in the serum concentration of free radicals (p < 0.01). We conclude that a KA supplementation in patients with CRF receiving LPD and EPO potentiates the beneficial effects on metabolism of proteins, amino acids and surprisingly, also lipids. Long-term co-administration of KA, EPO and LPD was also associated with a delay in progression of renal insufficiency and a reduction in proteinuria. Thus, concomitant administration of KA and EPO during a low-protein diet presents an effective treatment modality in the conservative management of CRF.
Wiener klinische Wochenschrift 09/2001; 113(17-18):661-9. · 0.81 Impact Factor
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ABSTRACT: To assess calcaneal ultrasonometry in Charcot osteoarthropathy (CO) and to compare it with densitometry measured by dual energy X-ray absorptiometry (DEXA) and with bone remodelling markers.
A group of 16 diabetic patients in the acute stage of CO with a mean age (+/- SD) of 51 +/- 13 years was compared with 26 sex- and age-matched control subjects. Both calcaneal quantitative ultrasound (QUS) parameter stiffness and bone mineral density (BMD) measured in lumbar spine and femoral neck by DEXA were compared. Collagen type I cross-linked C-telopeptides (ICTP) were used for assessment of bone resorption.
Patients with acute CO had significantly lower stiffness of the calcaneus in the Charcot and non-Charcot foot (both P < 0.001) and significantly lower femoral neck BMD (P < 0.05) in comparison with the control group. The T-score of stiffness was significantly lower in the Charcot foot compared with the non-Charcot foot (-3.00 +/- 1.39 vs. -2.36 +/- 1.12; P < 0.01) and significantly lower than the mean T-score of BMD in the lumbar spine (-0.57 +/- 1.28; P < 0.001) and femoral neck (-1.58 +/- 1.24; P < 0.05). A significant difference in ICTP (8.49 +/- 4.37 vs. 3.92 +/- 2.55 ng/ml; P < 0.001) between patients with CO and the control group was found, and a significant correlation was demonstrated between ICTP and the T-score of stiffness (r = -0.73; P < 0.01).
The lower calcaneal QUS parameter stiffness in the Charcot foot in comparison with the control group, with the non-Charcot foot and with BMD in the lumbar spine and femoral neck, and its association with increased bone resorption indicate that calcaneal ultrasonometry may be useful in diagnosing the acute stage of CO and in assessing the risk of foot fracture. Diabet. Med. 18, 495-500 (2001)
Diabetic Medicine 07/2001; 18(6):495-500. · 2.90 Impact Factor
