V Pidrman

Charles University in Prague, Praha, Hlavni mesto Praha, Czech Republic

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Publications (108)26.76 Total impact

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    ABSTRACT: A review of recurrent vulvovaginal candidiasis and the possibility of its treatment. Original study. Department of Obstetrics and Gynaecology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Clinical Microbiology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Biological and Medical Sciences, Faculty of Pharmacy Hradec Králové, Charles University, Prague. Department of Clinical Imunology and Allergology, Medical Faculty Hradec Králové, Charles University, Prague. Department of Psychiatry, Medical Faculty Olomouc, Palacky University, Olomouc. Analysis and discussion focused especially on our results and experience in a long time followup of patients with confirmed recurrent vulvovaginal candidiasis. Owing to the multifactorial character of etiopathogenesis, the management of recurrent vulvovaginal candidiasis would be taken into consideration the complexity of the disease, not only the treatment of individual episodes with antimycotics.
    Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne 06/2008; 73(3):179-84.
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    ABSTRACT: We report a case of a 60-year-old man with acute myocardial infarction (AMI) treated using thrombolysis, and complicated by cardiogenic shock (CS). Plasma interleukin (IL) 1 beta, IL 6, IL 8, tumor necrosis factor alpha (TNF alpha), and soluble adhesion molecule (sICAM 1, sE-selectin) levels were measured at 3-h intervals. This observation showed the effect of AMI and CS on the plasma interleukin levels. Remarkable changes were found in the plasma TNF alpha level, which reached two significant peaks. The peak of the first elevation caused by AMI (80.11 pg/ml, vs. normal value 4.35 pg/ml, SD 21.3 pg/ml) was seen 6 h after the onset of the symptoms. After the period of significant decrease, TNF alpha level was increasing until the end of the observation period because of CS (the last TNF alpha level was 204.1 pg/ml). The plasma IL 1 beta level was continually increased during the period of observation (maximal IL 1 beta level 32.1 pg/ml, normal value < 10 pg/ml). The plasma IL 6 level reached the first peak caused by AMI nine hours after the onset of the symptoms (362.85 pg/ml, normal value (10 pg/ml). Because of CS, after the short period of decrease, the plasma IL 6 level was increasing until the end of the observation period (the last IL 6 level was 859.61 pg/ml). The plasma IL 8 level was also elevated throughout the time of observation (max. value 1652 pg/ml, vs. normal value < 30 pg/ml). The soluble adhesion molecule levels (sE-selectin and sICAM 1) were elevated throughout the period of observation without any significant peak.
    Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové 02/2001; 44(4):149-51.
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    ABSTRACT: The present study was undertaken to evaluate the use of cortisol 6beta-hydroxylation in defining the effect of amiodarone on cytochrome CYP3A activity. To accomplish this goal, the in vivo activity of CYP3A was estimated by measuring the 24-hour urinary excretion of 6beta-hydroxycortisol (6beta-OHC) and by calculating 24-hour ratio of 6beta-hydroxycortisol to urinary free cortisol (6beta-OHC/UFC ratio). Nine cardiac patients scheduled for amiodarone treatment were recruited to participate in this study. Urine was collected over a 24-hour period from each subject before the first amiodarone administration and during the third day of oral administration of amiodarone (200 mg four times daily as a loading dose). Three days of amiodarone treatment caused a significant decrease (p<0.05) in both the 6beta-OHC/UFC ratio and the 24-hour urinary excretion of 6beta3-OHC. These results suggest that amiodarone is an inhibitor of CYP3A activity.
    Physiological research / Academia Scientiarum Bohemoslovaca 02/2001; 50(2):191-6. · 1.53 Impact Factor
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    ABSTRACT: The aim of this randomised, double-blind, placebo controlled, parallel group study was to assess the effect of trimetazidine (TMZ), a potent antiischaemic drug, on plasma C-reactive protein (C-RP), cytokine and adhesion molecule levels. The study population consists of 18 patients (16 males, 2 females, average age 56.45 +/- 10.97 years) with acute myocardial infarction admitted within 6 hours after onset of symptoms and treated with streptokinase. Blood samples were taken at 3-hour intervals during the time of treatment. All patients were randomised blindly using a centralised randomisation process, between trimetazidine (40 mg bolus i.v. then 60 mg per day for 48 hours intravenously in glucose infusion) or placebo group. Plasma C-RP level was significantly lower in TMZ group (39.5 mg/ml +/- 9.7 mg/ml) as compared to placebo (75.7 +/- 29.4 mg/ml, p < or = 0.001) and peaked 28 hours later in TMZ group. Plasma interleukin 6 (IL 6) level showed a sharp peak 9 hours after the onset of the symptoms in TMZ group (116.9 +/- 180.2 pg/ml vs. 45.4 +/- 37.9 pg/ml) and was increased up to 30 hours after the onset of the symptoms. Plasma interleukin 1 beta (IL 1 beta) was also higher in TMZ group notably 21 hours after the onset of symptoms (26.4 +/- 9.3 pg/ml vs. 16.2 +/- 2.4 pg/ml). TMZ group showed lower plasma E-selectin levels. Plasma IL 8, TNF alpha and ICAM 1 levels were without statistical significant differences. The present study demonstrates a significant reduction of plasma C-reactive protein level in the course of acute myocardial infarction treated with streptokinase and intravenous trimetazidine infusion compared with the group of patients without trimetazidine treatment.
    Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové 02/2001; 44(4):135-40.
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    ABSTRACT: The present work was designed to determine whether the individual differences in pharmacokinetics and pharmacodynamics of amiodarone and its N-desethyl metabolite are related to cytochrome CYP3A metabolizer status. 12 cardiac patients with inducible ventricular tachyarrhythmias during the baseline electrophysiologic study were enrolled in this study. Urinary 24-hour excretion of 6 beta-hydroxycortisol (6 beta-OHC and the ratio of 6 beta-hydroxycortisol to urinary free cortisol (6 beta-OHC/UFC) were measured before the first amiodarone administration. Trough plasma concentrations of amiodarone and N-desethylamiodarone (N-DEA) were measured after 79 +/- 11 days (2nd period) and after 182 +/- 25 days (3rd period). Electrophysiologic effects of amiodarone therapy were established with serial electrophysiologic studies in 9 of these patients at the baseline and after 79 +/- 11 days (during the second period). Both the 6 beta-OHC excretion and 6 beta-OHC/UFC ratio varied approximately 6-fold between the patients. We found significant inverse correlation between the 6 beta-OHC excretion and the trough plasma concentrations of amiodarone at the time of the 3rd period (rs = -0.58, p < 0.05). Similarly, there was correlation between the 24-hour urinary 6 beta-OHC excretion and trough plasma concentrations of amiodarone during the 3rd period (rs = -0.64, p < 0.025). We were unable to detect any association between CYP3A activity and amiodarone pharmacodynamics. This study points toward important information value of CYP3A metabolizer status in the context of therapeutic drug monitoring of amiodarone.
    Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové 01/2000; 43(3):95-101.
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    ABSTRACT: The plasma levels of interleukin 1 beta (IL 1beta), interleukin 6 (IL 6), interleukin 8 (IL 8), tumor necrosis factor alpha (TNF-alpha), E-selectin, ICAM 1 and C-reactive protein (CRP) have been studied in 24 patients with acute myocardial infarction in the course of 96 h. The plasma IL 1beta and IL 6 levels were continually elevated during the 96 h study period (the peak of plasma IL 1beta level was 22.2 pg/ml, S.D. 8.6, P < 0.001, normal values of IL 1beta are less than 10 pg/ml, the mean peak plasma concentration of IL 6 was 184.9 pg/ml, S.D. 134.7, vs. normal values of 15.57 pg/ml, S.D. 2.4, P < 0.001). The mean plasma IL 8 level was increased for the duration of the study, the mean plasma IL 8 level was 103.0 pg/ml, S.D. 23.4 (normal value was below 30 pg/l, S.D. 8.0) P < 0.001. The plasma TNF-alpha level was elevated throughout the time of observation without any significant peak. The mean plasma TNF-alpha concentration was 46.8 pg/ml, S.D. 2.13, vs. normal value 4.35 pg/ml, S.D. 1.23, P < 0.001. The plasma E-selectin level reached the mean level of 145.1 ng/ml, S.D. 75.4, vs. normal value 29.1-63.4 ng/ml, P < 0.001 at an interval of 15-42 h after the onset of the symptoms. The plasma ICAM 1 level showed only a slight significant increase during the first 36 h. The plasma CRP concentration increased later than IL 6, and reached a peak at 42 h after the onset of the symptoms (69.2 mg/l, S.D. 29.9, vs. 1.2 mg/l, S.D. 4.7, P < 0.0001). We conclude that cytokines and adhesion molecules can play an important role in the mechanisms of tissue injury in the process of ischemia and reperfusion.
    Clinica Chimica Acta 03/1999; 280(1-2):127-34. · 2.85 Impact Factor
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    ABSTRACT: The plasma levels of interleukin 1 beta (IL 1β), interleukin 6 (IL 6), interleukin 8 (IL 8), tumor necrosis factor alpha (TNF-α), E-selectin, ICAM 1 and C-reactive protein (CRP) have been studied in 24 patients with acute myocardial infarction in the course of 96 h. The plasma IL 1β and IL 6 levels were continually elevated during the 96 h study period (the peak of plasma IL 1β level was 22.2 pg/ml, S.D. 8.6, P<0.001, normal values of IL 1β are less than 10 pg/ml, the mean peak plasma concentration of IL 6 was 184.9 pg/ml, S.D. 134.7, vs. normal values of 15.57 pg/ml, S.D. 2.4, P<0.001). The mean plasma IL 8 level was increased for the duration of the study, the mean plasma IL 8 level was 103.0 pg/ml, S.D. 23.4 (normal value was below 30 pg/l, S.D. 8.0) P<0.001. The plasma TNF-α level was elevated throughout the time of observation without any significant peak. The mean plasma TNF-α concentration was 46.8 pg/ml, S.D. 2.13, vs. normal value 4.35 pg/ml, S.D. 1.23, P<0.001. The plasma E-selectin level reached the mean level of 145.1 ng/ml, S.D. 75.4, vs. normal value 29.1–63.4 ng/ml, P<0.001 at an interval of 15–42 h after the onset of the symptoms. The plasma ICAM 1 level showed only a slight significant increase during the first 36 h. The plasma CRP concentration increased later than IL 6, and reached a peak at 42 h after the onset of the symptoms (69.2 mg/l, S.D. 29.9, vs. 1.2 mg/l, S.D. 4.7, P<0.0001). We conclude that cytokines and adhesion molecules can play an important role in the mechanisms of tissue injury in the process of ischemia and reperfusion.
    Clinica Chimica Acta. 02/1999;
  • P Cervinka, J St'ásek, V Pidrman
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    ABSTRACT: The authors present an integrated view on the role of stents in different indications in patients with IHD from the aspect of recently published or presented randomized trials.
    Vnitr̆ní lékar̆ství 02/1998; 44(1):36-41.
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    ABSTRACT: In a group of 993 patients with serious medical diseases an important deficiency of antithrombin III was found in patients with hepatic insufficiency, pulmonary embolism and with disseminated intravascular coagulation. Acquired antithrombin III deficiency in these conditions develops when the antithrombin production in the liver is low and also in patients with shock syndrome and disseminated intravascular coagulation. Assessment of antithrombin III is of diagnostic and prognostic value in thrombotic and prethrombotic conditions and its results is decisive for adequate substitution. Adequate AT III substitution without concurrent heparin administration in patients with septicaemia and manifestations of DIC improves the prognosis of patients with an increased endothelial resistance.
    Vnitr̆ní lékar̆ství 11/1997; 43(10):645-8.
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    ABSTRACT: The objective of the presented retrospective work was to evaluate the expedience of general indication of an invasive procedure in patients with non-Q myocardial infarction (non-Q IM). The group is formed by 40 patients with non-Q IM, after a first coronary attack. The authors investigated the premorbid condition, the clinical course, early and late mortality, they evaluated the coronarographic findings of those who were subjected to angiographic examination and compared conservatively treated patients with those who had a revascularization operation. The results are in favour of an invasive procedure in all patients with a non-transmural IM, in particular when the lesions are in the anterolateral area.
    Vnitr̆ní lékar̆ství 07/1997; 43(6):363-5.
  • V Pidrman, I Tůma
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    ABSTRACT: Obsessive-compulsive disorder is a chronic psychiatric illness, affecting up to 3% of the general population, to the middle of 60-th it was supposed to be untreatable. Antidepressant pharmacotherapy is one of the treatment alternatives today. We compared efficacy and safety of citalopram versus clomipramine (serotoninergic antidepressants) in 6 weeks in double blind therapy of obsessive-compulsive disorder. The second objective was to compare prolactin response to a fenfluramine challenge test before the treatment of patients and after 6 weeks of the treatment. In a sample of 14 patients we confirmed significant therapeutic response after 3 weeks of pharmacotherapy, better in obsession than in compulsion. We found low level of adverse effects in the first week of therapy--dry mouth, anxiety, nausea, somnolence, tremor, and sexual adverse events. There were no changes in the laboratory, test EEG, and ECG examinations. Fenfluramine challenge test showed statistically significant decrease of prolactin levels 1 hour after administration of fenfluramine. It was not observed after six weeks of the therapy. Statistically significant negative correlation between prolactin plasma levels at the 6th hour after administration of fenfluramine and obsession item of YBOC Scale was showed after the 3rd and 6th week of the therapy. The correlation was not observed for compulsion item YBOC Scale. Side effects observed during and after the challenge test were anxiety and nervousness and gastrointestinal problems, lasted from 1 hour to 10 hours. These preliminary result could support the idea, that obsessions and compulsions have not necessary the same biological background. The challenge paradigm appears to be a possible way to clarify the pathogenesis of OCD. Our study will continue.
    Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové 02/1997; 40(4):99-102.
  • Atherosclerosis 01/1997; 134(1):183-183. · 3.71 Impact Factor
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    ABSTRACT: The authors revealed some changes in the platelet activity in patients with invasive cardiological procedures. Changes of the platelet function were manifested by an enhanced aggregation of platelets in vivo, an increased secretion from alpha granules and increased release of prostaglandin metabolites from platelets and from the vascular wall. Acetylsalicylic acid (ASA) suppressed the formation of circulating platelet aggregates in vivo, but the platelet activity was manifested by another mechanism, independent on ASA. The authors recorded therefore an increase of prostaglandin metabolites and PF4 even in patients who were treated with ASA before the invasive examination.
    Vnitr̆ní lékar̆ství 06/1996; 42(5):314-9.
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    ABSTRACT: So far no final solution was found as regards the relationship of impaired conduction in the His-Purkynĕ system and the incidence of cardiac and in particular sudden deaths. The objective of the present work was to assess by long-term prospective follow-up of subjects with a normal and pathological prolongation of the intra- and infrahisian conduction in the heart, based on the electrogram of the bundle of His, the importance of these findings for assessment of the patient's prognosis. After elimination of subjects with ventricular preexcitation the authors included in the group 340 patients (243 men, 97 women, aged 16-81 years, mean 49 +/- 16), where they recorded the electrogram of the bundle of His (without cardiac stimulation, during graded and programmed stimulation of the atria, after i.v. administration of ajmaline). In 206 cases they implemented at the same time programmed stimulation of the ventricles. The HV interval or the length of the H wave were in 286 patients normal and in 54 patients protracted. All patients were followed up by the authors for 6 to 144 months (mean follow up period 56.1 months). In the group of subjects with normal intra- and infrahisian conduction, as compared with the group with protracted conduction in the same area, the number of cardiac deaths was lower, i.e. 10.1 %, as compared with 22.2 %, sudden "cardiac" deaths (death within one hour after the onset of symptoms), i.e., 6.6 % as compared with 11.1 %, and sudden bradyarrhythmic" deaths (sudden "cardiac" death except subjects with diagnostic programmed ventricular stimulation), i.e. 2.8 % as compared with 11.1 %. The results support significantly the prognostic impact of pathological conduction in the His-Purkynĕ system as regards the occurrence of cardiac deaths and sudden "brady arrhythmic" deaths (p < 0.05). Conversely, the differences as regards the occurrence of sudden "cardiac" deaths were not significant.
    Casopís lékar̆ů c̆eských 06/1996; 135(10):308-12.
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    ABSTRACT: Severe acute response, the synthesis of human acute-phase proteins and the increase of plasma cytokines and adhesion molecules occur in patients in the course of acute myocardial infarction. We examined the plasma tumor necrosis factor alpha (TNF alpha), plasma creatinkinase (CK) and C-reactive protein (C-RP) levels in patients with acute myocardial infarction (AMI) in the course of 96 hours. Venous blood samples were taken at 3-hour intervals during the first 48 hours, and at 6-hour intervals during the next 48 hours. All patients were treated using thrombolytic therapy (streptokinase). Detection of the reperfusion was based on the method of measuring the time to achieve peak serum creatinkinase activity. The study was done on a group of 24 patients. Plasma levels of the parameters were compared between the group of patients with expected reperfusion versus the group of patients in which reperfusion is not suggested. The plasma TNF alpha level was elevated constantly without any significant peak. The mean plasma TNF alpha concentration was 46.8 pg/ml, SD 2.13, vs. normal level 4.35 pg/ml, p < 0.001. The plasma TNF alpha level in the group of patients with reperfused coronary artery showed a significant decrease especially during the 3rd and 4th day (the mean peak plasma TNF alpha concentration was 35.2 pg/ml, SD 15.8, vs. 66.9 pg/ml, SD 38.3 pg/ml, p < 0.005). The plasma C-RP levels were elevated throughout the time of observation in the both groups. The elevation of the plasma C-RP levels was more significant in the group of patients without successful reperfusion (80.6 mg/ml, SD 31.2, the mean plasma C-RP level of the group of the patients with successful reperfusion was 45.7 mg/ml, SD 18.1, p < 0.005). We conclude, that TNF alpha can play a role in the mechanisms of tissue injury. The successful reperfusion of coronary artery leads to significant decrease of plasma TNF alpha and C-RP levels.
    Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové 01/1996; 39(4):149-53.
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    ABSTRACT: Extracorporeal elimination of LDL-cholesterol is at present an important part of comprehensive treatment of patients with very high cholesterol levels. An absolute indication for their use are patients with the homozygous form of familial hypercholesterolaemia. Treatment is, after individual consideration, indicated also patient with severe heterozygous familial hypercholesterolaemia, with a positive family history of IHD, if it is not possible to reduce LDL-cholesterol by diet and hypolipidaemic agents below 5.2 mmol/l; also patients with severe IHD and severe hypercholesterolaemia, included in secondary prevention where it is not possible to reduce LDL-cholesterol by diet and pharmacotherapy below 3,4 mmol/l. Another indication for treatment by LDL apheresis are patients where cardiosurgery cannot be performed because of angiosclerosis. These are patients with severe hypercholesterolaemia which does not respond to drugs and with diffuse changes of the coronary circulation in young age, which cannot be treated by angioplasty or coronary bypass, and also patients after a coronary bypass with a refractory disorder of the lipid metabolism. LDL apheresis is furthermore indicated in patients with severe hyperlipidaemic crises which eventually develop into necrosis of the pancreas. Long-term LDL-apheresis leads to regression of manifestations of xanthomatosis of the skin and tendons, it prevents progression and starts regression of atherosclerosis in patients with severe hypercholesterolaemia. In homozygotes with familial hypercholesterolaemia treatment by LDL-apheresis leads to prolongation of life and improves the quality of life. In heterozygotes neither prolongation of the life span nor a lower incidence of IHD is observed, while the quality of life improves and regression of atherosclerosis occurs. A combination of LDL-apheresis, dietary provisions and hypolipidaemic treatment in heterozygotes is the most effective method to reduce the LDL-cholesterol level. Extracorporeal elimination of LDL-cholesterol can be done by non-selective centrifuging or membrane plasmapheresis. More recent methods of LDL-apheresis are more selective and effective. They use active columns or capsules to remove atherogenic particles from plasma. These methods include cascade filtration, immunoadsorption heparin-induced LDL precipitation, thermofiltration and dextran-induced LDL precipitation.
    Vnitr̆ní lékar̆ství 11/1995; 41(10):724-9.
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    ABSTRACT: The objective of the submitted work was to assess, using programmed stimulation of the cardiac ventricles during antiarrhythmic treatment (amiodarone and propafenon administered orally), the presence of indicators suggesting imminent ventricular ectopic proarrhythmia. The authors included in the group, after elimination of subjects with ECG (Holter monitoring) signs of proarrhythmias 50 patients (43 men, 7 women, 23-78 years, mean age 54.0 +/- 14.2 years), where they used initial programmed stimulation of the ventricles, not sooner than three months after acute cardiac disease. On account of electric instability of the ventricles the authors administered to 39 patients amiodarone by the oral route (200 to 400 mg/day) and to 11 subjects propafenon also by the oral route (900 mg/day). A subsequent programmed stimulation of the ventricles was repeated after amiodarone treatment after an interval of 4-144 weeks and after propafenon treatment after 1-48 weeks. They included among indicators of proarrhythmic action of antiarrhythmics (as compared with the initial examination): induction of diagnostic tachycardia at a lower grade of stimulation or with a smaller number of extrastimuli, the change from non-persisting unimorphous ventricular tachycardia into permanent unimorphous ventricular tachycardia, an increase of the frequency of tachycardia, marked deterioration of the patient's symptoms during tachycardia and the necessity to eliminate tachycardia by an electric discharge (during the initial examination an electric discharge was not used). The authors described in the group on indicator of proarrhythmic effect conditioned by programmed stimulation of the ventricles in 24 patients (48%). In one subject they found simultaneously two indicators in 12 instances (24%) and three indicators in 5 instances (10%).(ABSTRACT TRUNCATED AT 250 WORDS)
    Vnitr̆ní lékar̆ství 10/1995; 41(9):581-5.
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    ABSTRACT: The authors examined some indicators of platelet activity in patients with hypertension stage II (according to WHO). They revealed an increased platelet activity which was manifested by an increased concentration of platelet factor 4 (50.2 +/- 28.2 ng/ml) and thromboxane B2 (49.9 +/- 20.1 pg/ml) in plasma. The increase of indicators of platelet activation associated with hypertension is a molecular marker of activation of haemostasis and according to data in the literature it is an indicator of vascular complications in hypertension. It is not clear whether the increased platelet functions in hypertension is primary or an induced change.
    Vnitr̆ní lékar̆ství 08/1995; 41(7):458-61.
  • J Horácek, B Král, J Bures, V Pidrman
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    ABSTRACT: Malnutrition occurs in 23-70% of patients with chronic obstructive pulmonary disease and appears to be an independent factor connected with poor prognosis. Malnutrition stems from a long-term negative balance of energy and nutrients. That is caused by hypermetabolism, with possible role of an increased thermic effect of food, and probably by (at least intermittently) a limited intake of food. The adverse effect of malnutrition may be mediated by a decreased respiratory muscle strength but also by other mechanisms (electrolyte disorders, disturbed respiratory control, immunosuppression). In these patients, realimentation may be difficult to achieve, especially on the out-patient basis. However, with an increased effort of the health professionals and a good compliance of the patients, a substantial improvement is feasible, which might in turn improve the patients' prognosis.
    Vnitr̆ní lékar̆ství 08/1995; 41(7):493-7.
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    ABSTRACT: Data derived from indirect calorimetry in patients with stable chronic pneumopathies were evaluated together with their pulmonary function data (spirometry, diffusing capacity, blood gases). Their basal metabolic rate was significantly higher (116.1% of the predicted value), this increase being more expressed in the patients with hypoxemia and with more severe obstructive disorder. In chronic obstructive pulmonary disease, the increased energy expenditure in hypoxemia was accompanied with increased lipid oxidation. There also was a correlation between the patients' nutritional status (evaluated by their body mass index) and their pulmonary function. These results confirm the impairment of pulmonary function in malnourished patients.
    Vnitr̆ní lékar̆ství 07/1995; 41(6):390-4.