Úvod: Pacienti se známkami krvácení do zažívacího traktu jsou z organizačních důvodů hospitalizováni na jednotkách intenzivní péče chirurgických pracovišť. V této skupině pacientů roste podíl těch, kteří užívají různé formy antitrombotické terapie. Od nástupu endoskopických metod hemostázy je chirurgická léčba těchto nemocných spíše výjimkou a mortalita velmi nízká. Jejich léčba je nákladná personálně, organizačně i finančně a otázkou je, zda by nebylo možné nárůst počtu těchto pacientů zastavit, nebo dokonce snížit. Metody: Retrospektivní analýza pacientů hospitalizovaných pro akutní krvácení do zažívacího traktu na našem pracovišti se zaměřením na užívání různé formy antitrombotické terapie jako rizikového faktoru. Výsledky: Během 24 měsíců bylo na našem pracovišti hospitalizováno celkem 251 pacientů s akutním krvácením do zažívacího traktu. 107 z nich užívalo antiagregační, antikoagulační nebo kombinovanou terapii. Ani jeden z pacientů neužíval žádnou formu gastroprotekce. Závěr: Pacientů akutně krvácejících do zažívacího traktu je mnoho a jejich počet roste zejména ve skupině nemocných užívajících různé formy antitrombotické terapie. Navzdory všeobecně platným guidelines nejsou tito pacienti mnohdy vybaveni žádnou formou gastroprotekce. Dodržením standardů by mohlo být možné tento nepříznivý trend pozitivně ovlivnit. Klíčová slova: krvácení do GIT − antikoagulační/antiagregační terapie, Introduction: Patients with signs of acute bleeding into the gastrointestinal tract are hospitalized at intensive care units of surgical departments for organizational reasons. There is a growing proportion of those treated with various forms of antithrombotic therapy. From the onset of endoscopic methods of haemostasis, mortality is low and surgical treatment of these patients is rarely required. Their treatment takes up a lot of human and financial resources. The question remains, whether it would be possible to stop the volume growth or even reduce the number of these patients. Methods: A retrospective analysis of patients hospitalized for acute gastrointestinal bleeding at our department focused on the use of various forms of antithrombotic therapy as a risk factor. Results: A total of 251 patients were hospitalized with acute bleeding into the digestive tract during 24 months at our department. 107 of these were receiving antiplatelet, anticoagulant or combination therapy. None of the patients used any form of gastroprotection. Conclusion: The number of patients acutely bleeding into the digestive tract is high and rising particularly within the group using various forms of antithrombotic therapy. Despite the existence of accepted guidelines, these patients are often not equipped with any form of gastroprotection. Compliance with the accepted standards could positively influence this unfavourable trend. Key words: bleeding into the GI tract − anticoagulant/antiplatelet therapy, and B. East, J. Hoch
Dyslipidemia is the risk fact or of cardiovascular disease, but the relationship between the plasma triglyceride (TG) levels and total/cardiovascular mortality has not yet been analy zed in Slavs. The aim of our study was to analy ze the association between the fasting TG levels and all- cause/cardiovascular mortality. We have examined 3,143 males and 3,650 females, aged 58.3±7.1 years. 729 deaths (274 cardiovascular deaths) have been registered during up to 11.8 years of follow -up. Age -sex adjusted all -cause mortality was higher in individuals with TG values 3.01 -4.00 mmol /l (HR 1.37, 95 % CI 1.02- 1.83, P=0.035) and over 4.00 mmol /l (HR 1.66, 95 % CI 1.21 -2.27, P=0.002) when compared with a reference group (TG 1.41 -1.80 mmol /l). Elevated risk remains significant when adjusted for education, marital status and unemployment. When further adjusted for smoking, BMI and dyslipidemia interventions, HR for those in above 4.00 mmol/l group decreas ed (1.42, P=0.04). The results have been similar when cardiovascular mortality has been examined, however, results reached statistical significance only for the TG over 4.0 mmol /l (P=0.028). Our results confirmed that enhanced plasma levels of plasma triglycerides are dose dependently associated with increased risk of all- cause mortality, however, it s eems that individuals with TG values 1.8 -3.0 mmol /l are not in higher risk of death., H. Pikhart, J. A. Hubáček, A. Peasey, R. Kubínová, M. Bobák., and Obsahuje bibliografii
Bilirubin is the final product of heme catabolism in the systemic circulation. For decades, increased serum/plasma bilirubin levels were considered an ominous sign of an underlying liver disease. However, data from recent years convincin gly suggest that mildly elevated bilirubin concentrations are as sociated with protection against various oxidative stress-mediated diseases, atherosclerotic conditions being the most clinically relevant. Although scarce data on beneficial effects of bilirubin had been published also in the past, it took until 1994 when the first clinical study demonstrated an increased risk of coronary heart disease in subjects with low serum bilirubin levels, and bilirubin was found to be a risk factor for atherosclerotic diseases independent of standard risk factors. Consistent with t hese results, we proved in our own studies, that subjects with mild elevation of serum levels of unconjugated bilirubin (benign hyperbilirubinemia, Gilbert syndrome) have much lower prevalence/incidence of cor onary heart as well as peripher al vascular disease. We have also demonstrated that this association is even more general, with serum bilirubin being a biomarker of numerous other diseases, often associated with increased risk of atherosclerosis. In addition, very recent data have demonst rated biological pathways modulated by bilirubin, which are responsible for observed strong clinical associations., L. Vítek., and Obsahuje bibliografii
Cardiovascular disease (CVD) and depressive disorders (DD) are two of the most prevalent health problems in the world. Although CVD and depression have different origin, they share some common pathophysiological characteristics and risk factors, such as the increased production of proinflammatory cytokines, endothelial dysfunction, blood flow abnormalities, decreased glucose metabolism, elevated plasma homocysteine levels, oxidative stress and disorder in vitamin D metabolism. Current findings confirm the common underlying factors for both pathologies, which are related to dramatic dietary changes in the mid-19th century. By changing dietary ratio of omega-6 to omega-3 fatty acids from 1:1 to 15-20:1 some changes in metabolism were induced, such as increased pro-inflammatory mediators and m odulations of different signaling pathways following pathophysiological response related to both, cardiovascular diseases and depressive disorders., J. Trebatická, A. Dukát, Z. Ďuračková, J. Muchová., and Obsahuje bibliografii
Diabetes mellitus je významným rizikovým faktorem pro rozvoj ischemické choroby srdeční. Její prevalence se u diabetiků udává v širokém rozmezí 10–55 %. Po přítomnosti ischemie myokardu je nutno u diabetiků aktivně pátrat, neboť čekání na rozvoj symptomů je u těchto pacientů spojeno s nálezem již pokročilé koronární aterosklerózy s horšími výsledky koronárních intervencí chirurgické léčby. Podle výsledků studie BARDOT se zdá, že vhodným nástrojem pro stratifikaci rizika kardiálních příhod u diabetiků by mohla být zátěžová scintigrafie myokardu. Toto vyšetření dokáže velmi dobře odhalit přítomnost ischemie myokardu, zhodnotit její rozsah i lokalizaci a odlišit, zda jde o reverzibilní ischemii. Tyto údaje jsou velmi důležité pro určení správné strategie léčby. U diabetiků často nalézáme pokročilou koronární aterosklerózu, která je vhodnější k chirurgické léčbě. Nicméně v době moderních stentů je možno i diabetiky léčit intervenčně. Každý́ diabetik by však měl mít důsledně intervenovány všechny ovlivnitelné rizikové faktory ischemické choroby srdeční a měl by být léčen tak zvanou optimální farmakoterapií. Jedná se o medikaci s prokázaným vlivem na prognózu pacientů, ovlivnění progrese koronární aterosklerózy a zmírnění ischemie myokardu., Diabetes mellitus is a major risk factor for the development of ischemic heart disease. Its prevalence in diabetic patients is reported to range broadly between 10–55 %. It is necessary to actively search for the presence of myocardial ischemia in patients with diabetes, since waiting for the development of symptoms is associated with the finding of already advanced coronary atherosclerosis in these patients, with less satisfactory outcomes of coronary interventions and surgery. Results of the BARDOT study seem to indicate that the appropriate tool for stratification of the risk of cardiac events in diabetics could be stress myocardial scintigraphy. This test is successful in detecting the presence of myocardial ischemia, assessing its size and location and identifying whether reversible ischemia is involved. Such data is very important with regard to choosing the right treatment strategy. We often find advanced coronary atherosclerosis in diabetic patients for which surgical treatment is more appropriate. Nonetheless in the era of modern stents also the patients with diabetes can be treated with intervention. All the influenceable risk factors for ischemic heart disease should be consistently treated by intervention in each diabetic patient, who should be given optimum pharmacotherapy. This involves medication with a proven impact on the patient prognosis, influencing the progression of coronary atherosclerosis and mitigation of myocardial ischemia.., and Tomáš Kovárník, Kristýna Bayerová, Karel Kopřiva
Statins are powerful lipid-lowering drugs, widely used in patients with hyperlipidemia and coronary artery disease. It was found, however, that statins appear to have a pleiotropic effect beyond their lipid-lowering ability. They exert anti-inflammatory, antithrombotic and antioxidant effects, increase nitric oxide production and improve endothelial dysfunction. The aim of our study was to examine the effect of chronic and acute treatment with simvastatin on the contractile function of the isolated perfused rat heart after ischemia/reperfusion injury. Contractile function was measured on isolated rat hearts, perfused according to Langendorff under constant pressure. The hearts were subjected to 20 min of global ischemia, followed by 40 min of reperfusion. To investigate the acute effect, simvastatin at a concentration of 10 μmol/l was added to the perfusion solution during reperfusion. In chronic experiments the rats were fed simvastatin at a concentration of 10 mg/kg for two weeks before the measurement of the contractile function. Acute simvastatin administration significantly increased reparation of the peak of pressure development [(+dP/dt)max] (52.9±8.2 %) after global ischemia, as compared with the control group (28.8±5.2 %). Similar differences were also observed in the time course of the recovery of [(+dP/dt)max]. Chronic simvastatin was without any protective effect. Our results reveal that the acute administration of simvastatin during reperfusion, unlike the chronic treatment, significantly reduced contractile dysfunction induced by ischemia/reperfusion injury. This supports the idea of possible cardioprotective effect of statin administration in the first-line therapy of the acute coronary syndrome., O. Szárszoi, J. Malý, P. Ošťádal, I. Netuka, J. Bešík, F. Kolář, B. Ošťádal., and Obsahuje bibliografii a bibliografické odkazy
Erektilní dysfunkce je definována jako neschopnost dosáhnout a udržet ztopoření dostatečné k realizaci uspokojivého sexuálního styku. Výskyt erektilní dysfunkce je běžný na celém světě. Erektilní dysfunkce může být první klinickou manifestací endoteliální dysfunkce. Erektilní dysfunkce představuje rizikový faktor kardiovaskulárních onemocnění a u mužů 30–60 let a u diabetiků jde o prediktor závažného kardiovaskulárního onemocnění v časovém horizontu 2–5 let., Erectile dysfunction is defined as an inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. Erectile dysfunction incidence is common worldwide. Erectile dysfunction may be the first clinical manifestation of endothelial dysfunction. Erectile dysfunction shares risk factors with cardiovascular disease and is a predictor of a serious cardiovascular event in men who are 30–60 years of age and in diabetic patients over a period of two to five years., and Šrámková T.
Moderately elevated plasma/serum triglycerides (2 -10 m mol/l) signalize increased risk for cardiovascular disease or presence of non- alcoholic steatohepatitis. Extremely elevated triglycerides (more than 10 mmol/l) signalize increased risk for pancreatitis and lipemia retinalis. The concentration of triglycerides is regulated by many genetic and nongenetic factors. Extremely elevated triglycerides not provoked by nutritional factors, especially inappropriate alcohol intake are more likely to have a monogenic cause. On the contrary, mildly to moderately elevated triglycerides are often caused by polygenic disorders; these could be also associated with central obesity, insulin resistance, and diabetes mellitus. Concentration of triglycerides is also closely interconnected with presence of atherogenic remnant lipop roteins, impaired reverse cholesterol transport and more atherogenic small LDL particles. In general, there is tight association between triglycerides and many other metabolic factors including intermediate products of lipoprotein metabolism which are freq uently atherogenic. Therefore, reliable evaluation of the independent role of triglycerides especially in atherosclerosis and cardiovascular disease is difficult. In individual cases values of HDL cholesterol, non -HDL cholesterol (total minus HDL cholester ol), non -HDL/nonLDL cholesterol (total minus HDL minus LDL cholesterol, especially in nonfasting status), atherogenic index of plasma and/or apolipoprotein B could help in decisions regarding a ggressiv eness of treatment., J. Piťha, J. Kovář, T. Blahová., and Obsahuje bibliografii
It is believed that atherogenesis is a multifactorial process, which could already start in utero. Development of atherosclerosis progresses over decades and leads to the cardiovascular morbidity and mortality in adulthood. At present, we have no exact explanation for all the risk factors acting in the pathogenesis of atherosclerosis. This review should provide an overview about the possible role of intrauterine undernutrition in the development of risk factors for cardiovascular disease. Intrauterine undernutrition leads to changes in fetal growth and metabolism and programs later development of some of these risk factors. A number of experimental and human studies indicates that hypertension as well as impaired cholesterol and glucose metabolism are affected by intrauterine growth. Intrauterine undernutrition plays an important role and acts synergistically with numerous genetic and environmental factors in the development of atherosclerosis. There is evidence that undernutrition of the fetus has permanent effects on the health status of human individuals., P. Szitányi, J. Janda, R. Poledne., and Obsahuje bibliografii