[Use of viscoelastic methods in surgery]. / Vyuzití viskoelastických metod v chirurgii.

INTRODUCTION: Major liver resections are associated with high morbidity and mortality. The main causes of this fact include a significant blood loss which may be associated with this surgical procedure. Hemocoagulation disorder, diagnosed by standard laboratory tests, is very frequent in the postoperative period and often requires the administration of blood derivatives. Several recent studies, however, have questioned the presence of such coagulopathy when viscoelastic methods are used to assess the coagulation process. The studies have concluded that that the coagulation disorder only exists at a laboratory level, the coagulation process itself being unaffected, and no therapeutic intervention is therefore needed. The use of viscoelastic methods may play a crucial role in deciding whether or not to correct the assumed coagulation disorder. METHOD: Our study was designed as a prospective observational study. Data were collected in the Surgical Intensive Care Unit during one year (1 January - 31 December 2016). The study included 18 patients who underwent major liver resection. When coagulation disorder was diagnosed using standard coagulation tests in the postoperative period, we performed a ROTEM examination. The results of the standard and ROTEM examination were then compared. RESULTS: Out of the total of 18 patients enrolled in the study, a coagulopathy was diagnosed in 15 cases (83%) using standard coagulation tests. In these patients, we performed rotational tromboelastometry (ROTEM) which did not show any coagulation disorder. CONCLUSION: Our study has demonstrated that when viscoelastic methods are used to evaluate the function of blood clotting in patients after major hepatic surgery, no coagulopathy has been found as opposed to the evaluation with standard blood clotting tests. Unnecessary transfusions of blood derivatives can be avoided as well as all risks linked to their administration. Viscoelastic methods of coagulation assessment (ROTEM, TEG) help provide a detailed insight into the coagulation process and our observations have shown that they should play a significant role in the postoperative assessment of patients following major hepatic resections.Key words: ROTEM - viscoelastic methods - coagulopathy.

[Catamenial pneumothorax - case reports and literature review]. / Katameniální pneumotorax - kazuistiky a literální prehled.

AIM: Catamenial pneumothorax is menstrual cycle dependent and represents the most common form of thoracic endometriosis syndrome. Recurrences are very common even after surgical resection. DESIGN: Case reports and literature overview. SETTING: Department of Respiratory Medicine, Department of Surgery I, Department of Obstetrics and Gynecology, University Hospital, Palacky University, Olomouc. CASE REPORT: Two cases of catamenial pneumothorax are presented with repeated recurrences of right-sided pneumothorax even after surgical treatment. Histopathologic finding of pelvic endometriosis was shown in both patients. CONCLUSION: Catamenial pneumothorax is usually connected with thoracic endometriosis and also includes catamenial hemothorax, recurrent catamenial hemoptysis, catamenial pleural pain as well as endometriosis lung nodules. Multidisciplinary approach including pneumologist, thoracic surgeon and gynecologist with early postoperative hormonal treatment that deals with the main chronic systemic disease may lead to improved results, mainly reduced recurrence rates of catamenial and/or endometriosis related pneumothorax.

[Chronic obstructive pulmonary disease in the light of new guidelines -  brief summary of phenotypically oriented guidelines for nonpulmonary physicians]. / Chronická obstrukcní plicní nemoc pohledem nových doporucení -  souhrn aktuálního fenotypove zamereného standardu Ceské pneumologické a ftizeologické spolecnosti pro internisty.

INTRODUCTION: COPD is a global health and social problem. Morbidity and mortality increases in the Czech Republic. There are currently several global statements and strategies. METHODS: The Czech Pneumological and Phthisiological Society (CPFS) at the end of 2011 mandated the Section of bronchial obstruction in drafting national guidelines concerning the stable COPD. Subsequently, this document was discussed during the National Consensus Conference (COPD forum) in November 2012 and presented at series of local workshops and national conferences. National guidelines has been subject to a review and eventually posted on the website for another round of comments. DIAGNOSIS: A modern approach to COPD is a view of the patient through the pulmonary function, symptoms, exacerbation rates and the presence of specific phenotypes. CPFS identified six clinically relevant phenotypes: frequent exacerbators, COPD and asthma overlap, COPD and bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and phenotype of pulmonary cachexia. TREATMENT: TREATMENT recommendations can be divided into four elementary steps: the first step is the Elimination of all risks factors. The second one is the Standard therapy including in particular inhaled bronchodilators, pulmonary rehabilitation, and treatment of severe comorbidities. The third step is the Targeted therapy centered on clinical phenotypes of COPD. The final fourth step is the treatment of respiratory insufficiency and palliative care of the terminal COPD. CONCLUSION: The optimal treatment of COPD requires a personalized approach to the patient.

The CR1 C5507G polymorphism is not involved in susceptibility to idiopathic pulmonary fibrosis in two European populations.

Idiopathic pulmonary fibrosis (IPF), a severe lung disease with unknown aetiology, is thought to have an important genetic component. Single nucleotide polymorphism, C5507G, of the complement receptor 1 (CR1) gene, which affects the number of CR1 molecules on erythrocytes, has been associated with susceptibility to IPF in a single European population. To replicate this finding, 53 Czech IPF patients with 203 Czech healthy control subjects and 70 English IPF patients with 149 English controls were investigated. In both populations, there were no significant differences in distribution of CR1 C5507G variants between IPF patients and their appropriate control groups. In conclusion, the association of the CR1 C5507G polymorphism with susceptibility to IPF was not reproducible in Czech and English populations.

Expression of CCX CKR in pulmonary sarcoidosis.

OBJECTIVE: CCX CKR is a decoy chemokine receptor that specifically binds the chemokines CCL19, CCL25 and CCL21. CCL19 was previously found to be upregulated in pulmonary sarcoidosis. We have, therefore, investigated CCX CKR expression in this inflammatory disease. METHODS AND RESULTS: CCX CKR mRNA was semiquantitated using RT-PCR in unseparated bronchoalveolar (BAL) cells from sarcoidosis patients (S, n = 29) and healthy control subjects (C, n = 9). CCX CKR transcripts were upregulated in patients (mean +/- SEM); S, 0.82 +/- 0.10; C, 0.44 +/- 0.04; p = 0.01; this upregulation paralleled the disease course as assessed by the chest radiographic stage (p < 0.02). Immunocytochemistry localised the CCX CKR protein to ciliated bronchial cells. Flow cytometric fluorescent ligand uptake assay showed that these cells are able to internalize its ligand. CONCLUSION: These observations implicate CCX CKR in the modulation of the inflammatory response in sarcoidosis.

Advantages of intrathecal nalbuphine, compared with intrathecal morphine, after cesarean delivery: an evaluation of postoperative analgesia and adverse effects.

UNLABELLED: We performed a prospective, randomized, double-blinded, multicenter study to compare the analgesic efficacy and adverse effects of intrathecal nalbuphine, at three different doses, and intrathecal morphine for postoperative pain relief after cesarean deliveries. Ninety healthy patients at full term who were scheduled for elective cesarean delivery with spinal anesthesia were enrolled in the study. They received 10 mg of hyperbaric bupivacaine 0.5% with either morphine 0.2 mg (Group 1), nalbuphine 0.2 mg (Group 2), nalbuphine 0. 8 mg (Group 3), or nalbuphine 1.6 mg (Group 4). Only patients in Groups 1 and 2 reported pain during surgery. Postoperative analgesia lasted significantly longer in the morphine group, compared with the nalbuphine groups (P: < 0.0001). In the nalbuphine groups, postoperative analgesia lasted longest with the 0.8-mg dose. The additional increase to 1.6 mg did not increase efficacy. The incidence of pruritus was significantly higher in Group 1 (11 of 22), compared with Group 2 (0 of 22, P: < 0.0002), Group 3 (0 of 23, P: < 0.0001), and Group 4 (3 of 20, P: < 0.02). Postoperative nausea and vomiting were more frequent in Group 1 (5 of 22), compared with Group 2 (0 of 22, P: < 0.05), Group 3 (0 of 23, P: < 0.05), and Group 4 (3 of 23, not significant). There was no maternal or newborn respiratory depression. Neonatal conditions (Apgar scores and umbilical vein and artery blood gas values) were similar for all groups. This study suggests that intrathecal nalbuphine 0.8 mg provides good intraoperative and early postoperative analgesia without side effects. However, only morphine provides long-lasting analgesia. IMPLICATIONS: Small doses of intrathecal nalbuphine produce fewer adverse effects, such as pruritus and postoperative nausea and vomiting, compared with intrathecal morphine. This may allow earlier discharge of patients from the recovery room.

[Appearance and symptoms of giardiasis in the Olomouc region]. / Das Auftreten und Ausserungen der Giardiasis in Olomoucer Region.

A group of 118 patients, aged 1-73 years, suffering from giardiasis in their gastrointestinal tract was studied in the period of 1988-1990. The analysis consisted in determination of frequency, sex distribution, age categories and incidence within the period of 12 months. Patients older than 15 years were asked about the possible sources of infection, subjective and objective symptoms and therapy. The information obtained for our region were compared with data reported in literature.