Casopís lékar̆ů c̆eských
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Sepsis is a serious high mortality disease. As regards pathophysiology, it is a systemic inflammatory response to infection. Its timely diagnosis strongly influences mortality. ⋯ The most frequently used sepsis markers in routine clinical diagnostics are C-reactive protein and procalcitonin. The detection of selected cytokines, mediators, and surface markers in immunocompetent cells gives us further chance for improvement of this diagnostics. The methods of calculating gene expression represent a technology with a potential for the discovery of new biomarkers which would improve both diagnostics and therapy in the sense of personalized medicine.
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Pelvic ring injuries occur at any age. Most injuries to the pelvis are due to high-energy trauma, these injuries are therefore associated with abdominal, thoracic and head injuries. Unstable disruption of the pelvic ring has been often coupled with massive or life-threatening haemorrhage. ⋯ In the acute period minimally invasive internal fixation with closed reduction should be used (transiliacal internal fixator, iliosacral screws). The open reduction with internal fixation can be performed after stabilization of the general state of health (after about 5 days), pelvic plates and spinopelvic fixation are appropriate for this approach. To recover the patient into normal life, bed rest and rehabilitation follows after surgical treatment.
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Neurogenic pulmonary oedema is a complication of severe central nervous system injury. The centre of neurogenic pulmonary oedema is assumed to be a group of dorsal ventrolateral medulla nuclei, which are activated by a combination of afferent pathway hyperactivity and a sudden increase of intracranial pressure. The sympathetic system plays a crucial role in the pathogenesis of neurogenic pulmonary oedema by activating a rapid cascade of processes, leading to interstitial and intraalveolar oedema, together with important haemorrhage. ⋯ There are several experimental models that can be used for studying the etiopathogenesis or treatment of neurogenic pulmonary oedema. The main goal of experimental studies is to elucidate a preventive and therapeutic approach that is able to prevent or treat neurogenic pulmonary oedema. In this context, the most promising agent is atropine.
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Casopís lékar̆ů c̆eských · Jan 2011
Review[Hyperglycemia and its control in the critically ill patient].
In the critically ill patient, hyperglycemia was believed to be a response by the body to a stressful situation. Stress-induced hyperglycemia is the consequence of increased levels of cortisol, cytokines, growth hormones, catecholamines, and glucagon resulting in the stimulation of endogenous glucose production through glycogenolysis and gluconeogenesis as well as other mechanisms including central and peripheral insulin resistance. Among other things, hyperglycemia has an effect on inflammation and function of the myocardium, kidney, central nervous system, and the immune system. ⋯ The large multicenter NICE-SUGAR study in 6,022 patients showed higher 90-day mortality in the group with tight glycemic control. The results of NICE-SUGAR led to revision of the guidelines for glycemic control in the critically, recommending to control glycemia below 10 mmol/l. The aim of this overview is to summarize available data on glycemic control in the critically ill patient.