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Havlíčkův Brod, Czech Republic

Littnerova S.,Masaryk University | Parenica J.,University Hospital Brno | Parenica J.,Masaryk University | Parenica J.,University Hospital St Annes | And 37 more authors.

Background: Obesity is clearly associated with increasedmorbidity andmortality rates. However, in patients with acute heart failure (AHF), an increased BMI could represent a protective marker. Studies evaluating the "obesity paradox" on a large cohort with long-term follow-up are lacking. Methods: Using the AHEAD database (a Czech multi-centre database of patients hospitalised due to AHF), 5057 patients were evaluated; patients with a BMI <18.5 kg/m2 were excluded. All-cause mortality was compared between groups with a BMI of 18.5-25 kg/m2 and with BMI >25 kg/m2. Data were adjusted by a propensity score for 11 parameters. Results: In the balanced groups, the difference in 30-day mortality was not significant. The long-term mortality of patients with normal weight was higher than for those who were overweight/obese (HR, 1.36; 95% CI, 1.26-1.48; p<0.001)). In the balanced dataset, the pattern was similar (1.22; 1.09-1.39; p<0.001). A similar result was found in the balanced dataset of a subgroup of patients with de novo AHF (1.30; 1.11-1.52; p = 0.001), but only a trend in a balanced dataset of patients with acute decompensated heart failure. Conclusion: These data suggest significantly lower long-term mortality in overweight/obese patients with AHF. The results suggest that at present there is no evidence for weight reduction in overweight/obese patients with heart failure, and emphasize the importance of prevention of cardiac cachexia. © 2015 Littnerova et al. Source

Vyskocilova K.,Masaryk University | Spinarova L.,Masaryk University | Spinar J.,Masaryk University | Mikusova T.,Masaryk University | And 10 more authors.
Biomedical Papers

Aims. Liver pathology caused by cardiac dysfunction is relatively well recognized, however, its clinical importance has not been fully evaluated. The aim of this study was to assess the prevalence of liver function tests (LFTs) abnormalities and to identify associated factors mediating hepatic impairment in patients with acute heart failure (AHF). Methods. The AHEAD (Acute Heart Failure Database) registry is a database conducted in 9 university hospitals and 5 regional health care facilities in the Czech Republic. From December 2004 to October 2012, the data of 8818 patients were included. The inclusion criteria for the database followed the European guidelines for AHF. Serum activities of all LFTs and total bilirubin were available in 1473 patients at the baseline. Results. In patients with AHF, abnormal LFTs were seen in 76% patients (total bilirubin in 34%, γ-glutamyltransferase in 44%, alkaline phosphatase in 20%, aspartate aminotransferase in 42%, alanine aminotransferase in 35%). Patients with cardiogenic shock were more likely to have LFTs abnormalities compared to mild AHF and pulmonary oedema. LFTs abnormalities were strongly associated with AHF severity (left ventricular ejection fraction and NYHA functional class) and clinical manifestation. While hepatocellular LFTs pattern predominated in left sided forward AHF, cholestatic profile occurred mainly in bilateral and right sided AHF. Additionally, patients with moderate to severe tricuspid regurgitation had significantly higher prevalence of abnormalities in cholestatic LFTs. Conclusions. Defining the LFTs profile typical for AHF plays an important role in management of AHF patients, since it may avoid redundant hepatic investigations and diagnostic misinterpretations. © 2015 PALACKY UNIV. All rights reserved. Source

Dolezal J.,Charles University | Vizda J.,Charles University | Horacek J.,Charles University | Spitalnikova S.,Hospital Havlickuv Brod
Journal of Laryngology and Otology

Abstract Aim: To present a rare case of lingual thyroid detected using a hybrid of single photon emission computed tomography and standard computed tomography in a young woman with hypothyroidism. Materials and methods: A 29-year-old woman was screened for autoimmune thyroid disorders in early pregnancy, and found to have subclinical hypothyroidism. No thyroid tissue was found in the anterior neck upon ultrasonography, raising suspicions of an ectopic thyroid. The patient was treated with levothyroxine throughout the remainder of her pregnancy, and developed postpartum thyroiditis requiring an increase in levothyroxine dosage. Whole-body scintigraphy and zoomed static head and neck scintigraphy were performed. Abnormal 99mTc-pertechnetate uptake was observed in the oral region, whereas no uptake was found in the usual thyroid location. Hybrid imaging using single photon emission computed tomography and standard computed tomography was performed to improve three-dimensional representation of the area of increased activity. Results: The latter imaging modality detected ectopic thyroid tissue in the tongue. Conclusion: Whole body 99mTc-pertechnetate scintigraphy and a hybrid of single photon emission computed tomography and standard computed tomography are effective imaging modalities for the investigation of ectopic thyroid tissue. The latter modality is particularly recommended, as it allows more precise spatial visualisation of increased isotope uptake activity in the head and neck. © JLO (1984) Limited 2013. Source

Zajicek R.,Charles University | Pintar D.,Hospital Havlickuv Brod | Broz L.,Charles University | Suca H.,Charles University | Konigova R.,Charles University
Journal of the European Academy of Dermatology and Venereology

Background Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are skin disorders characterized by extensive necrosis of the mucous membranes and the epidermis caused by an autoimmune response. Objectives To present experience of treating TEN and SJS at the Prague Burn Centre (PBC) 1998-2008. Methods 22 patients with the diagnosis TEN or SJS were enrolled. We collected data including the extent of the skin involvement, the ratio of men: women, the average age, the mortality rate, presence of comorbidities, the length of hospital stay, the period from the first symptoms to the admission to the PBC, corticosteroids administration prior to admission. Results 82% patients had injuries larger than 30% of body surface area. The ratio of men: women was 1: 1.5; the average age was 48.4 years; the mortality was 32%. Significant comorbidities were present in 41% of the cases. The average length of hospital stay was 12.9 days. The period from the first symptoms to the admission to the PBC was 9.6 days; corticosteroids were administered to 68% of the cases. Conclusion Treatment strategies at the PBC are based upon a multidisciplinary approach and focus on the general principles of treating patients with extensive skin loss. Corticosteroids must be avoided, antibiotics are not indicated and intravenous immunoglobulins are not justified in the standard therapy. Early diagnosis, prompt transport to a burn center are essential for patients outcomes. The medical community should be informed about these rare but potentially life threatening diseases. © 2011 European Academy of Dermatology and Venereology. Source

Knoll P.,Wilhelminenspital | Kotalova D.,Charles University | Kochle G.,Wilhelminenspital | Kuzelka I.,Hospital Havlickuv Brod | And 4 more authors.
Zeitschrift fur Medizinische Physik

Aim: Corrective image reconstruction methods which produce reconstructed images with improved spatial resolution and decreased noise level became recently commercially available. In this work, we tested the performance of three new software packages with reconstruction schemes recommended by the manufacturers using physical phantoms simulating realistic clinical settings. Methods: A specially designed resolution phantom containing three 99mTc lines sources and the NEMA NU-2 image quality phantom were acquired on three different SPECT/CT systems (General Electrics Infinia, Philips BrightView and Siemens Symbia T6). Measurement of both phantoms was done with the trunk filled with a 99mTc-water solution. The projection data were reconstructed using the GE's Evolution for Bone ®, Philips Astonish ® and Siemens Flash3D ® software. The reconstruction parameters employed (number of iterations and subsets, the choice of post-filtering) followed theses recommendations of each vendor. These results were compared with reference reconstructions using the ordered subset expectation maximization (OSEM) reconstruction scheme. Results: The best results (smallest value for resolution, highest percent contrast values) for all three packages were found for the scatter corrected data without applying any post-filtering. The advanced reconstruction methods improve the full width at half maximum (FWHM) of the line sources from 11.4 to 9.5. mm (GE), from 9.1 to 6.4. mm (Philips), and from 12.1 to 8.9. mm (Siemens) if no additional post filter was applied. The total image quality control index measured for a concentration ratio of 8:1 improves for GE from 147 to 189, from 179. to 325 for Philips and from 217 to 320 for Siemens using the reference method for comparison. The same trends can be observed for the 4:1 concentration ratio. The use of a post-filter reduces the background variability approximately by a factor of two, but deteriorates significantly the spatial resolution. Conclusions: Using advanced reconstruction algorithms the largest improvement in image resolution and contrast is found for the scatter corrected slices without applying post-filtering. The user has to choose whether noise reduction by post-filtering or improved image resolution fits better a particular imaging procedure. © 2011. Source

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