Vnitr̆ní lékar̆ství
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Vnitr̆ní lékar̆ství · Feb 2004
Review[Procalcitonin as an indicator of infection in patients with liver cirrhosis].
Incidence of bacterial infections in hospitalised patients with liver disease is high. Due to a liver dysfunction immune reactivity is significantly impaired and bacterial infections are more frequent. Also incidence of nosocomial infections is higher in patients with liver disease compared to patients hospitalised for other conditions. ⋯ They usually include spontaneous bacterial peritonitis, infection of the respiratory system, urinary infections, and bacteremia. A timely proof of a bacterial infection and an appropriate and effective antibiotic therapy lead to an improvement of the general state of a patient and to his/her better prognosis. Procalcitonin determination is appropriate for diagnosing infections and control of treatment.
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Vnitr̆ní lékar̆ství · Aug 2002
Review[Role of cytokines in the development of local and systemic inflammation and septic shock].
A central position in the development of systemic inflammation is played by activation of the vascular endothelium and monocyte- macrophage system. Both are associated with the formation of inflammatory cytokines, the primary mission of which is mobilization of the organism to cope with the infection. The so-called acute stage response develops with typical clinical manifestations and laboratory values. ⋯ The compensatory antagonistic mechanism which develops due to the formation of anti-inflammatory cytokines leads sometimes to the development of a balanced state of immunity which is most favourable from the prognostic aspect. In case of their excess however immunodepression develops which is equally dangerous for the patient as excessive cytokine activity. From what has been said ensues the need of regular monitoring of patients with sepsis and thus also detailed investigation of their immune system.
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Vnitr̆ní lékar̆ství · Dec 2001
Review[Extravascular lung water in acute respiratory distress syndrome: pathophysiology, monitoring and therapeutic possibilities].
Excessive amount of extravascular lung water (EVLW) resulting from increased permeability of alveolo-capillary membrane is a pathophysiological hallmark of acute respiratory distress syndrome (ARDS). Increased EVLW produces hypoxemia by interference with gas exchange. ⋯ The presented paper briefly reviews the mechanisms involved in lung edema formation and describes current options to measure EVLW. In addition, it discusses clinical implications of EVLW measurement in intensive care setting with particular focus on transpulmonary indicator dilution technique.
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Vnitr̆ní lékar̆ství · Nov 2001
Review[Prevention of septic conditions in adult patients with functional hyposplenism and after splenectomy].
Splenectomy and functional hyposplenism predispose the patient to serious life threatening infections. The most frequent pathogenic organism which causes serious infections in splenectomized adults or hyposplenic patients is Streptococcus pneumoniae. In the etiology of these conditions however also a number of other bacterial and non-bacterial microorganisms may be involved. The risk of serious infections and deaths may be markedly reduced by simple preventive measures, education of the patient, vaccination and antibiotic prophylaxis.
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Weaning from mechanical ventilation is not complicated in the majority of patients, in some, however, this process is very complicated and lengthy. These patients are described as difficult to wean. A suitable weaning strategy and properly timed extubation or decannulation is important not only from the aspect of the patient's health status but also with regard to costs of care. ⋯ Promising seems the use of non-invasive ventilation but this was not proved unequivocally so far. The use of weaning protocols reduces the weaning period from mechanical ventilation. The authors summarize most recent findings on the weaning problem incl. the most frequently used ventilation regimes and prognostic indicators of successful weaning.