Casopís lékar̆ů c̆eských
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Casopís lékar̆ů c̆eských · Jan 2004
Review[Examination of exhaled breath condensate in patients with asthma and chronic obstructive pulmonary diseases].
Considerable interest of specialists all over the world has focused on the measurement of the markers of inflammation and oxidative stress in the exhaled breath condensate in patients with asthma or chronic obstructive pulmonary diseases recently. Use of exhaled condensate is based on the hypothesis that aerosol particles exhaled in human breath reflect the composition of the bronchoalveolar extracellular lining fluid. The standard collection of the material requires condensation of exhaled air and the samples have to be kept in biologically inert containers. ⋯ The examination of exhaled breath condensate is absolutely non-invasive method, which can be repeated as often as needed and it is extremely well tolerated both by children and seniors. Markers in the condensate enable detection and quantification of the inflammation process, the disease monitoring, and assessment of the response to the treatment. The breath condensate diagnostics is a new progressive method and in the patients with asthma and chronic obstructive pulmonary disease it can bring complementary information to the very sensitive method of determination of exhaled nitric oxide.
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With growing number and seriousness of traffic accidents and with improving quality of the rescue system, an increasing number of patients with blunt chest injury and injury of intracardiac organs arrive at the hospital facilities. Heart and thoracic aorta can be wounded simultaneously and by similar mechanisms. ⋯ Blunt injury may affect any part of the heart and thoracic aorta, most frequently the right ventricle and aortic isthmus. While diagnosis and treatment of serious injury of the heart seems unequivocal, there is no agreement about the appropriate duration and intensity of monitoring, the use of echocardiography and about the assessment of myocardial markers in stable patients with blunt chest injury.
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Hemodynamic support during the circulatory failure with vasodilation, most frequently during the septic shock, is based on volume recovery and administration of inotropic drugs. If such therapy is not sufficient, vasoconstriction drugs are subsequently or parallel added to maintain the perfusion pressure. As a standard therapy, norepinephrine or other catecholamines with alpha-adrenergic effect are used in rising doses. ⋯ In shock states with the deficit of endogenous vasopressin, which are resistant to high doses of catecholamines, administration of vasopressin analogues represents a new perspective therapy. The treatment should be studied from the point of morbidity and mortality. A careful approach has to be used in septic patients with pre-existing obliterative vassal disease.
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Casopís lékar̆ů c̆eských · Aug 2002
Review[Fluid resuscitation in conditions with disorders of capillary permeability].
Fluid resuscitation remains a cornerstone in the treatment of various types of circulatory failure. Alterations in microvascular permeability are a hallmark of a number of inflammatory conditions including sepsis, septic shock, burns and the acute respiratory distress syndrome. As a result, the loss of plasma fluid into the interstitial space leads to hypovolaemia and tissue hypoperfusion. ⋯ This strategy, however, involves the risk of interstitial edema formation, which in turn may further impair tissue oxygen distribution. The presented paper briefly reviews the principles of transvascular fluid exchange and the pathophysiology of capillary permeability. It discusses the ongoing controversy on the optimal way and the end points of volume replacement as well as the choice of fluid in conditions associated with capillary leakage.
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Sudden onset of tachyarrhythmias in an operating theatre or an intensive care unit can be a frustrating experience for an attending physician and sometimes even for his patient, not only because of severity of patient's clinical state, but also for the mental stress loaded on him by collaborating surgeons. From that reason, a diagnosis and treatment of such condition should be intensive, simple, effective and safe for the patient. ⋯ In this review article, the author highlights a basic electrophysiology and molecular pathophysiology of heart rhythm disturbances, and on the background of recent clinical studies he tries to propose a simplified therapeutic algorithm for treatment of these difficult states. Beta-blockers and group III, antiarrhythmics of Vaughan-Williams classification (amidarone) are recommended as the optimal remedies for the treatment of tachyarrhythmias in the perioperative period.