Institute Klinicke a Experimentalni Mediciny

Prague, Czech Republic

Institute Klinicke a Experimentalni Mediciny

Prague, Czech Republic
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The European Society of Cardiology (ESC 2016) annual congress took place in Rome from 27th to 31st of August 2016. It is the world's largest cardiology congress that hosted 32,897 attendees from all over the world this year. A total of 11,000 abstracts were presented and around 500 expert sessions were held during the congress. The lectures were dedicated to the latest developments in cardiovascular medicine and to the presentation of the new ESC guidelines. One of the central topics in the field of arrhythmology was the management of atrial fibrillation, including antithrombotic prophylaxis. Also presented at the congress were a number of abstracts dealing with antithrombotic treatment in non-valvular atrial fibrillation. Likewise, a number of review lectures were delivered or data from various databases were presented. This brief review introduces the most important information from this area.

Spicak J.,Institute klinicke a experimentalni mediciny
Kardiologicka Revue | Year: 2014

PPIs are weak bases metabolized in an acid environment and blocking the function of active proton pumps. They provide effective treatment for oesophageal reflux disease, Helicobacter pylori infection, functional dyspepsia and non-steroidal anti-inflammatory drug-induced gastropathy. The first generation includes omepra-zole, pantoprazole and lansoprazole; the second one consists of esomeprazole and rabeprazole. The pharmacokinetic differences between different PPIs do not always result in relevant clinical consequences. Generally, the second generation PPIs provide a more rapid effect and a more prolonged inhibition of the gastric secretion. The effect of rabeprazole, especially, is less dependent on the method of administration and has a lower influence on the cytochrome P450 function. The effectiveness of first- generation PPIs is influenced by the genetic variability of the CYP2C19 enzyme, being significantly lower in rapid metabolizers. PPIs are very safe and immediate complications are exceptional. In Helicobacter pylori infection they cause a worsening of gastritis. Although PPIs cause hypergastrinaemia, they do not exhibit any malignant potential. Their long-term administration is associated with an increased risk of spine and hip fractures, community pneumonia and clostridium bowel infection. They can lower the effectiveness of antiplatelet therapy with clopidogrel, with a consequent increased risk of cardiovascular events.

Prevention of thromboembolic complications in patients with atrial fibrillation represents a key therapeutic goal in the care of patients with this arrhythmia. Anticoagulation therapy with warfarin is capable of reducing the risk of stroke by 64%. However, treatment with warfarin is associated with a number of disadvantages, and thus only a portion of patients are treated and not all achieve the therapeutic range. Dabigatran is a direct thrombin inhibitor administered orally at a fixed dose without a need for monitoring the anticoagulant effect. Its safety and efficacy in preventing stroke and systemic embolization in patients with atrial fibrillation has been demonstrated in the RE-LY study.

The study provides an overview of possibilities of X-ray dose reduction in interventional cardiology both to patients and physicians. The main source of physicians' irradiation is the scatter radiation from patients, therefore the main way of the dose reduction is based on the reduction of X-ray dose to patients. In the first part of the study, the principle of the automatic dose rate control, which controls the amount of produced X-ray, is described. Further, an influence of the additional filtration, projection angle, magnification and frame rate (pulse rate) on the resulting dose is explained. The second part deals with the influence of the projection angle and lead shielding on the physicians' dose.

The article deals with an explanation of CTDIVOL parameter and its conversion to SSDE, which more closely reflects the dose of radiation received by the patient. The article also provides the conversion factors for CTDIVOL to SSDE conversion in relation to the LAT and/or AP dimensions of the patient for the reference PMMA phantoms of two sizes.

Netuka I.,Institute klinicke a experimentalni mediciny
Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti | Year: 2011

Severe right heart failure remains unfrequent but fatal complication of cardiac surgical procedures. Implantation of temporary right ventricular assist device may be life-saving procedure in various situations of right heart failure as: heart transplantation, LVAD therapy and post-cardiotomy failure. The aim of the study is an introduction of the implantation technique and retrospective review of current experience with the method. Since January 2007 isolated right ventricular assist device Levitronix CentriMag has been implanted in 16 patients. Patients were divided into 3 groups: post transplantation (post-Tx), post LVAD implantation (post-LVAD) and other cardiac procedures (OCP). Success rate of weaning from RVAD, 30-days mortality and major complications has been assessed. Distribution of implants in groups was: post-Tx 5 pts (31%), post-LVAD 6 pts (38%) and 5 in OCP group (31%). The mean support time was 12 days. Off-pump implantation was achieved in 9 pts. The device was successfully weaned in 13 (81%) patients. 30-days mortality occurred in 1 case only. Presented outcomes are encouraging for broader acceptance of the therapy. Excellent success rate has been reached in post-Tx and post-LVAD. This study emphasises decesive role of proactive approach in early indication of RVAD implantation for achieving satisfactory results.

Kudla M.,Institute Klinicke A Experimentalni Mediciny
Aktuality v Nefrologii | Year: 2015

Precise and flawless insertion of peritoneal dialysis catheter is essential condition for good function of peritoneal dialysis. There is a description of the major techniques of catheter insertion. The attention is chiefly directed at laparoscopic catheter insertion, its indications and contraindications with main emphasis on the surgical technique of this procedure.

Sukupova L.,Institute Klinicke a Experimentalni Mediciny
Ceska Radiologie | Year: 2015

The article deals with a comparison and assessment of imgaing performed by the clinical CT and cone-beam CT. These imaging modalities are desribed, mainly as reagrds image acquisition, image reconstruction, and image quality with related artifacts. A comprehensive description of detection mechanisms is a part of the article.

Pitha J.,Institute klinicke a experimentalni mediciny
Interni Medicina pro Praxi | Year: 2016

One of the main efforts of preventive cardiology is to detect persons at high cardiovascular risk yet before clinical manifestation of atherosclerosis, which could be fatal. In general, three approaches are discussed: 1) Algorithms calculating the risk of cardiovascular events based on traditional cadiovascular risk factors, 2) Measurements of the concentration of circulating biomarkers, including genetic parameters and 3) Morphological and functional methods assessing vascular wall or obstructive lesions; this group often labelled as detection of preclinical atherosclerosis. The contribution of these approaches could be viewed from several aspects. The most important aspect is whether particular method could help in decision to implement aggressive pharmacologic therapy focused mainly on higher levels of LDL cholesterol or high blood pressure. Historically accepted approaches are established algorithms based on traditional risk factors. More recent methods contribute to the better assessment of cardiovascular risk only moderately. In more complicated patients, however, these approaches/methods could help with treatment decisions. From this perspective the most reliable are measurement of ankle brachial index, detection of preclinical atherosclerosis at the carotid arteries by ultrasound, the pulse wave velocity and calcium score of coronary arteries.

Lipar K.,Institute klinicke a experimentalni mediciny
Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti | Year: 2011

A paper on the occasion of the fortieth anniversary of foundation of the Institute for Clinical and Experimental Medicine describes past, present and future trends in surgical technique of pancreas transplantation in the Czech Republic.

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