D Urbanová

Institute for Clinical and Experimental Medicine (IKEM), Praha, Praha, Czech Republic

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Publications (67)42.22 Total impact

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    ABSTRACT: In the Institute of Clinical and Experimental Medicine in Prague 101 orthotopic allotransplantations of the heart were performed in 100 patients (87 men and 13 women). The reason for transplantation were terminal stages in the first place dilated cardiomyopathies and ischaemic heart disease. 58% of the patients survive after transplantation, the mortality rate is 42%. The highest mortality is in the early postoperative period (within two weeks after operation)--21 cases (50%). The longest survival period is nine years and six months. All patients have cyclosporin immunosuppressive treatment (in combination with another drug, later with another two drugs). In the authors' group in particular incipient acute rejections are encountered, "mild" rejections are less frequent and "moderate" rejections least frequent. The patients do not reach the stage of advanced acute rejection, i.e. "severe" rejection. Acute rejections are treated as a rule with 3 g Urbason. After this treatment acute rejection improves as a rule completely after one or two weeks therapy.
    Vnitr̆ní lékar̆ství 03/1994; 40(2):75-8.
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    ABSTRACT: The potential of echocardiography in evaluating myocardial rejection was determined in 56 patients (8 females) following orthotopic heart transplantation. The patients' average age was 42.3 (range 18-67) years. Endomyocardial biopsy was used as the reference method. The study included a total of 254 results of biopsy: 137 specimens were free of any signs of rejection while 51 showed incipient rejection and mild rejection was found in 54 specimens. Moderate rejection was detected in 12 specimens; severe rejection was not present in any case. Echocardiography was used to determine ventricular size, wall thickness, left ventricular function, pericardial effusion, mitral and tricuspid flow and isovolumic relaxation time. Rejection has been found to be associated with ventricular wall thickening; the appearance of or an increase in pericardial effusion seems to be a relatively specific feature (a very low-sensitivity marker though); change in isovolumic relaxation time is believed to be the most sensitive marker. No relation between rejection and mitral and tricuspid flow was demonstrated. Echocardiography may alert the cardiologist to a rejection episode; isovolumic relaxation time and its alterations are the most informative features in this respect. The method may help postpone the intervals of biopsy which, however, must be performed on the slightest suspicion of rejection. Still, it cannot be regarded as a replacement for endomyocardial biopsy at the moment.
    Cor et vasa 02/1993; 35(6):247-50.
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    ABSTRACT: Coronary artery lesions are evaluated in a group of 43 patients surviving for more than 3 months after heart transplantation. An angiographic finding was obtained from 35 patients, autopsy findings were available in eight cases. Angiography demonstrated coronary artery lesions in 12 out of the 35 patients whereas autopsy findings were positive in five out of the eight post mortem examinations. Overall, lesions were found in 40% of patients at a mean follow-up interval of 3.5 years. While the finding of a coronary artery lesion was not related to the classic risk factors for atherosclerosis, an association to a previous cytomegalovirus or Epstein-Barr virus infection was demonstrated. The data suggest that infection caused by the two above viruses is an important factor in the development of vascular lesions in the heart transplant.
    Cor et vasa 02/1993; 35(6):267-75.
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    ABSTRACT: The data of the first 100 patients undergoing heart transplantation in the period between January 1984 and May 1993 were analyzed. Of this group, 57 patients are alive. Out of the total of 43 deaths, 14 patients died from graft failure within the first postoperative days, 6 died from surgical complications, 11 from infection, 10 deaths were due to accelerated coronary atherosclerosis, and 2 patients died from tumours. Early mortality rates (within 30 days since surgery) were 37% and 17% in patients operated on between 1984-88 and between 1989-93, respectively. The health condition of heart transplant recipients is affected by side effects of immunosuppressive therapy. Forty per cent of patients re-develop systemic hypertension within the first post-transplantation year. Five years after transplantation, hypertension is detected in 60% of patients. Elevated serum creatinine levels are present in 70% of patients by the end of the first post-transplantation year. In the ensuing period, there is no progression in renal function impairment, which does not require cyclosporin withdrawal and is not associated with the development of hypertension. In the first post-transplantation year, 45% of patients are markedly obese. All patients with overweight and obesity show markedly raised levels of serum cholesterol. Another undesirable effect (mainly due to corticosteroid therapy) is the development of ulcers in 16% of patients. Heart transplantation has become an established method at the Institute for Clinical and Experimental Medicine in Prague. Despite the above pitfalls, heart transplantation substantially prolongs the life of patients and dramatically alters the quality of their life.
    Cor et vasa 02/1993; 35(6):258-62.
  • D Urbanová, I Málek, V Vancura
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    ABSTRACT: In a group of endomyocardial biopsies (EMB), performed in 45 patients with the clinical diagnosis of suspect myocarditis or dilated cardiomyopathy, positive findings (including histologically suspect lesions) were made in 53.3% of first EMB. Myocarditis, particularly its focal or multifocal forms, is bound to pose a major challenge not only in clinical diagnosis but, often, also in histological diagnosis. Of paramount importance in this situation are 1) early specimen removal after the onset of clinical manifestations and before initiation of the appropriate therapy, 2) removal of a major number of specimens in a single EMB because of the potential of focal lesions.
    Cor et vasa 02/1993; 35(4):147-51.
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    ABSTRACT: The incidence of infectious complications was monitored in a group of the first 100 patients undergoing orthotopic heart transplantation at the Institute for Clinical and Experimental Medicine from January 1984 through May 1993. The definition of an infectious complication was a clinically manifest infection requiring treatment. Cytomegalovirus infection and Epstein-Barr virus infection were evaluated by the development of antibody against IgM. A total of 168 infectious complications were detected in 80 patients. The infectious complications were fatal in 11 patients; hence, infections were implicated in 26% of all deaths following heart transplantation. The spectrum of infections markedly varies depending on the interval since the procedure. The most frequent infections within the 30 postoperative days are bacterial (often nosocomial) infections. In the later period (30 days onward), viral infections account for 72% of cases. Of the rarer types of infections, the pulmonary form of aspergillosis was identified in 3 cases, nocardiosis and legionellosis in one case each. Infectious complications were the main cause of deaths in the period of 1 to 4 months post-transplantation, and the spectrum and rate of complications were not different from data reported by other centres.
    Cor et vasa 02/1993; 35(6):263-6.
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    ABSTRACT: In a patient with repeated dissection of the ascendent aorta where the first episode was resolved surgically by an intraluminal prosthesis the authors describe the rare consequence of the development of a new dissection manifested by an aorto-oesophageal fistula. In the described case an inoperable episode was involved which fully confirmed the clinical validity of the pathognomic Chiari triad.
    Vnitr̆ní lékar̆ství 06/1992; 38(5):501-4.
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    ABSTRACT: Administration of putrescine, a polyamine, to rats leads to endothelial injury manifesting itself by an increased number of endothelial cells circulating in blood. Moreover, putrescine affects the metabolism of the arterial wall itself, primarily by increasing the activity of phosphomonoesterases I and II and by decreasing the activities of Krebs cycle enzymes, both of which are phenomena that can be regarded as "preatherogenic" changes 5, 6, 8, 11 preceding the onset of pathological processes in the arterial wall. Putrescine significantly decreases aortic ATPase (adenylpyrophosphatase) both in the acute and chronic phases of experiment. Ultrastructural changes after 16 weeks of putrescine administration manifested themselves in increased proliferation and smooth muscle cell injury eosinophil inflitration into the adventitia. The findings support the hypothesis that high levels of PA in homocysteinemic patients and those on chronic dialysis are a common denominator accelerating atherosgenesis in these subjects.
    Czechoslovak medicine 02/1991; 14(2):97-105.
  • D Urbanová
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    ABSTRACT: Complications and causes of death in patients with transplanted heart were analyzed in various intervals after operation. They comprised early deaths in the first week, short-time survival until one year, and long-time survival over one year. Acute heart failure of varied nature prevailed in early deaths as well as in long-time survival. In short-time survival, there were different causes of death in addition to heart failure.
    Ceskoslovenska patologie 09/1990; 26(3):166-73.
  • D Urbanová, V Stanĕk
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    ABSTRACT: The authors evaluate the incidence of pulmonary embolism (PE) and its impact in patients who died in the cardiological department of the Institute of Clinical and Experimental Medicine during two five-year periods (1979-1983 and 1984-1988). These two periods are compared with the period 1974-1978 in the same department. The purpose was to assess the trend of fundamental findings (number of post-mortem examinations, number of PE, number of fatal PE, source of thrombosis in PE etc.). Based on the assembled findings it may be said that the number of p.m. examinations is increasing and thus also the number of PE. There was an obvious rise of the number of women with embolic, attacks in the cardiological department. Correct clinical diagnoses are equal in all periods.
    Casopís lékar̆ů c̆eských 07/1990; 129(24):747-50.
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    ABSTRACT: Nearly 6-year experience with EMB in patients with transplanted heart concerned especially problems of acute rejection. EMB proved to be a sensitive and for the time being unique method for the detection of acute rejection in patients treated by Cyclosporine immunosuppression. EMB were also criterion of correctness of immunosuppression because they reflected changes in treatment.
    Ceskoslovenska patologie 06/1990; 26(2):102-8.
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    ABSTRACT: In 15 patients after orthotopic transplantation of the heart the authors made repeated examinations of electromaps of the R wave and endomyocardial biopsies (TMB) during a long-term, at least one-year, investigation. In the detection of rejection EMB plays a dominating role. In three patients the authors found at the time of rejection a significant reduction of the R waves on maps, which correlated closely with the bioptic findings. It was revealed that maps of R waves are a good indicator of rejection of the transplanted heart. The examination may prove helpful when checking treatment of rejection but does not lead so far to a restriction of the number of endomyocardial biopsies of the heart.
    Casopís lékar̆ů c̆eských 02/1990; 129(3):76-80.
  • D Urbanová
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    ABSTRACT: The paper presents the experience with acute rejection and endomyocardial biopsy in heart transplantation in 28 patients over a period of five years. The authors regards endomyocardial biopsy as a sensitive marker of acute rejection, especially in patients on long-term cyclosporin immunosuppression. Some aspects of episodes of incipient acute rejection and mild acute rejection as well as their therapy are discussed.
    Cor et vasa 02/1990; 32(5):395-400.
  • D Urbanová
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    ABSTRACT: Two cases of coronary sinus thrombosis with myocardial changes suggestive of "haemorrhagic infarsation" as the cause of death of cardiac transplantant recipients are presented. The discussion points to the macroscopical and histologic findings completely different from those seen in myocardial infarction induced by coronary artery occlusion.
    Cor et vasa 02/1989; 31(3):231-7.
  • O Mrhová, J Hladovec, D Urbanová
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    ABSTRACT: Chronic administration of methionine to rats induced endothelial lesion manifested by increased endothelaemia and metabolic changes indicative of pathological processes involving the vessel wall. These changes did not spontaneously return to values observed in control animals. Long-term administration of antiatherosclerotic drugs Pyridinolcarbamate and Phtalazinole II normalized metabolic disorder in the aortic wall and reduced endothelaemia to normal values.
    Cor et vasa 02/1988; 30(1):73-9.
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    ABSTRACT: An experimental study was designed to assess the effect of intracardiac defibrillation in 15 dogs, in whom a total of 25 episodes of ventricular fibrillation were induced. Defibrillation using a Medtronic electrode catheter (model 6880), with the discharge passing between the right ventricle and atrium turned out to be of little effect even though energy discharges of 25 J were used. Discharges between an electrode placed in the right ventricle and another one placed on the thoracic left wall, with the discharge passing through the left ventricle, were more successful. While this arrangement terminated half of ventricular fibrillation episodes, its results are not sufficiently convincing for widespread clinical use. Histology documented significant myocardial damage even when intracardiac energy discharges with energy not exceeding 25 J were used.
    Cor et vasa 02/1988; 30(6):405-12.
  • D Urbanová, J Fabián, V Kocandrle
    Ceskoslovenska patologie 04/1987; 23(1):1-4.
  • D Urbanová, J Fabián, M Bulvas
    Vnitr̆ní lékar̆ství 03/1986; 32(2):124-6.
  • Journal of Molecular and Cellular Cardiology - J MOL CELL CARDIOL. 01/1986; 18:53-53.
  • J Fabián, M Bulvas, D Urbanová
    Vnitr̆ní lékar̆ství 12/1985; 31(11):1058-62.