Thomayer Hospital

Prague, Czech Republic

Thomayer Hospital

Prague, Czech Republic
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Chrbolka P.,Thomayer Hospital | Paluch Z.,Charles University | Hill M.,Institute of Endocrinology | Alusik S.,Institute for Postgraduate Medical Education
Steroids | Year: 2017

While not a disease entity in itself; symptoms of tinnitus (from Latin tinnio – clink) accompany a number of diseases. Tinnitus prevalence increases with age, deteriorates one's quality of life, and may even result in suicidal behavior. Tinnitus develops in response to a variety of risk factors, otoxic substances, noise exposure, hearing disorders, and psychological alterations. Tinnitus is closely related to mood, depression, and psychological state. In the present study, we focused on alterations of the steroid metabolome and particularly neuroactive, neuroprotective, and immunomodulatory steroids in patients with tinnitus. The study group consisted of 28 patients without evidence of an organic cause of tinnitus as well as without associated diseases or the effect of ototoxic medications. All patients underwent a complete audiological assessment and laboratory tests including routine biochemical markers and quantification of circulating steroids using gas chromatography/mass spectrometry and immunoassays. To rule out a pathology in the cerebellopontine angle area, CT scan or MRI were performed. To diagnose stem lesions, evoked potentials were also measured. Pearson's correlations and multivariate regression were used to assess any links between tinnitus intensity and frequency on the one hand, and steroid levels on the other. Results indicated a significant and consistent negative correlation between tinnitus indices and intensity of adrenal steroidogenesis. The circulating steroid metabolome including hormones and neuroactive, neuroprotective, and immunomodulatory steroids negatively correlates with the degree of tinnitus due to hypothalamo-pituitary-adrenal axis malfunction. Our results may help explain the pathophysiology of tinnitus and improve its diagnosis. However, further studies are needed to verify our postulation. © 2017 Elsevier Inc.

Rusina R.,Thomayer Hospital | Rusina R.,Charles University | Pazdera L.,Neurocenter Caregroup Rychnov Nad Kneznou | Kulistak P.,Thomayer Hospital | And 2 more authors.
Cognitive and Behavioral Neurology | Year: 2013

We describe a patient with corticobasal syndrome in whom neuropathological examination on autopsy revealed Pick and Alzheimer diseases in comorbidity. Corticobasal degeneration is a tauopathy usually associated with asymmetric parkinsonism, parietal lobe involvement, and cognitive impairment. Corticobasal syndrome is the clinical presentation of corticobasal degeneration without neuropathological confirmation. A 66-year-old right-handed man slowly developed speech difficulties, right-hand clumsiness, and forgetfulness. His speech apraxia progressed to mutism with preserved comprehension, and his clumsiness progressed to severe apraxia involving both hands. He developed behavioral changes and severe amnesia. All of these features were consistent with corticobasal syndrome. His loss of episodic, verbal, and visuospatial memory suggested Alzheimer disease; however, beyond his frontotemporal neuropsychological profile, he had few symptoms characteristic of frontal lobe dementia. Magnetic resonance imaging scans showed worsening temporal, frontal, and parietal atrophy, predominant in the left hemisphere. Neuropathological examination at autopsy revealed abundant neuritic plaques and neurofibrillary tangles consistent with fully developed Alzheimer disease, as well as numerous intraneuronal Pick bodies in the frontotemporal lobes. Our findings confirm the importance of clinical and neuropathological correlations in patients with atypical neurodegenerative dementias. © 2013 by Lippincott Williams & Wilkins.

Burianova I.,Thomayer Hospital | Paulova M.,Thomayer Hospital | Cermak P.,Thomayer Hospital | Janota J.,Thomayer Hospital | Janota J.,Charles University
Journal of Human Lactation | Year: 2013

Background: Breast milk is occasionally considered as a potential source of neonatal infection. Only a few cases of transmission of Streptococcus agalactiae (GBS) through breast milk have been published. The incidence of GBS in breast milk varies among studies. The incidence of GBS in breast milk in mothers with positive prenatal vaginal swabs for GBS is not known. Objective: The objective of this study was to compare the incidence of GBS in the breast milk of women colonized with GBS before delivery (GBS vaginal swabs positive) and women non-colonized with GBS (GBS negative) during the first week after term delivery. Methods: Breast milk from our sample of women was checked for the presence of GBS. A sample of 5 ml of breast milk was collected from each woman between days 3 and 7 after term delivery. Statistical analysis was carried out to test the relationship between bacterial content and GBS status of the women. Results: We identified only 2 of 243 (0.82%) GBS positive breast milk cultures during the study, both in the GBS negative group. There was found to be no GBS positive breast milk in women with positive prenatal vaginal swabs for GBS. Conclusion: The incidence of GBS positive cultures in breast milk in the study was low. When comparing the incidence of GBS positive breast milk cultures between women colonized with GBS before delivery and women non-colonized with GBS, we identified only 2 GBS positive breast milk cultures, both in GBS non-colonized women. © The Author(s) 2013.

Svatonova J.,RHG City Hospital | Borecka K.,Thomayer Hospital | Adam P.,Central Military Hospital | Adam P.,Charles University | Lanska V.,Institute for Clinical and Experimental Medicine
Disease Markers | Year: 2014

Beta2-Microglobulin (β2-m) is a low molecular weight protein occurring in all body fluids. Its concentration increases in various pathologies. Increased values in cerebrospinal fluid (CSF) are ascribed to an activation of immune system. Using immunoturbidimetry, we examined concentrations of beta2-microglobulin in cerebrospinal fluid in a large group of 6274 patients with defined neurological diseases. Cell counts, total protein, albumin, glucose, lactic acid, immunoglobulins concentrations, and isofocusing (IEF) were also evaluated. We found substantial changes of CSF β2-m concentrations in purulent meningitis, leptomeningeal metastasis, viral meningitis/encephalitis, and neuroborreliosis, while in multiple sclerosis these changes were not significant. Intrathecal synthesis and immune activation were present in these clinical entities. A new normative study enables better understanding of beta2-microglobulin behavior in CSF. © 2014 Jana Svatoňová et al.

Van Kerrebroeck P.,Maastricht University | Haab F.,Hopital Tenon | Angulo J.C.,Hospital Universitario Of Getafe | Vik V.,Thomayer Hospital | And 5 more authors.
European Urology | Year: 2013

Background Storage symptoms are often undertreated in men with lower urinary tract symptoms (LUTS). Objective To evaluate the combination of an antimuscarinic (solifenacin) with an α-blocker (tamsulosin) versus tamsulosin alone in the treatment of men with LUTS. Design, setting, and participants A double-blind, 12-wk, phase 2 study in 937 men with LUTS (≥3 mo, total International Prostate Symptom Score [IPSS] ≥13, and maximum urinary flow rate 4.0-15.0 ml/s). Intervention Eight treatment groups: Tamsulosin oral controlled absorption system (OCAS) 0.4 mg; solifenacin 3, 6, or 9 mg; solifenacin 3, 6 or 9 mg plus tamsulosin OCAS 0.4 mg; or placebo. Outcome measurements and statistical analysis The primary efficacy end point was change from baseline in total IPSS. Secondary end points included micturition diary and quality-of-life (QoL) parameters. Post hoc subgroup analyses were performed by severity of baseline storage symptoms, with statistical comparisons presented only for tamsulosin OCAS alone versus combination therapy, due to the small sample size of the solifenacin monotherapy and placebo subgroups. Results and limitations Combination therapy was associated with significant improvements in micturition frequency and voided volume versus tamsulosin OCAS alone in the total study population; improvements in total IPSS were not significant. Statistically significant improvements in urgency episodes, micturition frequency, total urgency score, voided volume, IPSS storage subscore, IPSS-QoL index, and Patient Perception of Bladder Condition were observed in a subpopulation of men with two or more urgency episodes per 24 h (Patient Perception of Intensity of Urgency Scale grade 3 or 4) and eight or more micturitions per 24 h at baseline (storage symptoms subgroup) with combination therapy versus tamsulosin OCAS alone (p ≤ 0.05 for the dose-response slope, all variables). Combination therapy was well tolerated, and adverse events were consistent with the safety profiles of both compounds. Conclusions Solifenacin plus tamsulosin OCAS did not significantly improve IPSS in the total study population but offered significant efficacy and QoL benefits over tamsulosin OCAS monotherapy in men with both voiding and storage symptoms at baseline. Combination therapy was well tolerated. identifier NCT00510406 © 2013 European Association of Urology.

Wuyts W.,University Hospitals Leuven | Sterclova M.,Thomayer Hospital | Vasakova M.,Thomayer Hospital
Current Opinion in Pulmonary Medicine | Year: 2015

Purpose of review Hypersensitivity pneumonitis is a complex syndrome characterized by a combination of inflammation and fibrosis located in both the airways and the lung parenchyma. Both diagnosis and treatment are a real challenge for physicians. This review will focus on recent developments in this emerging field; furthermore, we will emphasize major gaps in the current knowledge, to stimulate further research in this field. Recent findings The main diagnostic issue is not to miss the entity as the clinical presentation is extremely variable even as the nature of the causal antigen. This article provides an overview of current ways to uncover possible causes of hypersensitivity pneumonitis. A problem of another kind is treatment of this disorder. Crucial in treatment is antigen avoidance, often in combination with immunosuppressive agents. The treatment of acute forms is rather straightforward, but the biggest endeavour, however, is treatment of chronic forms of hypersensitivity pneumonitis, which not always respond to immunosuppressive agents. Therefore, new initiatives should be taken in order to help clinicians in making a proper diagnosis and develop more efficacious treatment especially for patients suffering from chronic hypersensitivity pneumonitis. Summary Diagnosis and treatment of hypersensitivity pneumonitis remain a real challenge; this article provides an overview of our current understanding and points out new opportunities for further research. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Vasakova M.,Thomayer Hospital | Poletti V.,Gb Morgagni Hospital
Sarcoidosis Vasculitis and Diffuse Lung Diseases | Year: 2015

Fibrosing interstitial lung diseases (ILDs) are a large group of diseases triggered by external or internal stimuli that can have similar outcomes, i.e. lung fibrosis. Some ILDs are primarily fibro-proliferative disorders in which alveolar loss and epithelial/fibroblastic proliferation and dysplasia lead to lung fibrosis and architectural derangement, while other ILDs are considered inflammatory disorders in which specific underlying conditions (with either an external or an internal origin) can shift the pathogenic process to the fibro-proliferative pathway. The treatment of primarily inflammatory ILDs, regardless of their tendency to switch to lung fibrosis usually consists of anti-inflammatory drugs (e.g. corticosteroids, cytostatic + immunosuppressive agents), targeted 'biologic treatment' (e.g. anti TNF-alpha, anti CD20) and combinations thereof. However, we have entered an era in which new drugs that specifically target fibrosing ILDs, namely IPF, have emerged. Continuing laboratory research and clinical studies will hopefully provide us with a more complete understanding of the pathogenesis of fibrosing ILDs. Additionally, we are optimistic about the discovery of new pharmacological targets for the treatment of these serious diseases. The complex issues concerning fibrosing ILDs were addressed and passionately discussed during the Prague postgraduate course and conference devoted to these diseases (June 19th - 21th, 2014). © Mattioli 1885.

Sebkova S.,Thomayer Hospital
Prague medical report | Year: 2012

A term newborn with a hypocontractile myocardium complicating persistent pulmonary hypertension of the newborn was successfully treated with a low-dose phosphodiesterase III inhibitor milrinone. Echocardiography diagnosed heart failure with a left ventricular ejection fraction of 35% and a left ventricular shortening fraction of 18% and severe persistent pulmonary hypertension of the newborn with oxygenation index of 28. Milrinone was started at an initial dose of 50 mcg/kg, followed by continuous infusion of 0.20 mcg/kg/min. With lowdose milrinone oxygenation index decreased to 3 within 6 hours, left ventricular ejection fraction and left ventricular shortening fraction increased to 57%, and 30%, respectively. Low doses of milrinone might be promising in the treatment of heart failure and persistent pulmonary hypertension of the newborn in term newborns.

Wong C.-M.,Georgetown University | Bansal G.,Georgetown University | Pavlickova L.,Georgetown University | Pavlickova L.,Thomayer Hospital | And 2 more authors.
Antioxidants and Redox Signaling | Year: 2013

Significance: Pulmonary hypertension is a devastating disorder without any available treatment strategies that satisfactorily promote the survival of patients. The identification of new therapeutic strategies to treat patients with pulmonary hypertension is warranted. Recent Advances: Human studies have provided evidence that there is increased oxidative stress (lipid peroxidation, protein oxidation, DNA oxidation, and the depletion of small-molecule antioxidants) in patients with pulmonary hypertension. A variety of compounds with antioxidant properties have been shown to have beneficial therapeutic effects in animal models of pulmonary hypertension, possibly supporting the hypothesis that reactive oxygen species (ROS) are involved in the progression of pulmonary hypertension. Thus, understanding the molecular mechanisms of ROS actions could contribute to the development of optimal, antioxidant-based therapy for human pulmonary hypertension. One such mechanism includes action as a second messenger during cell-signaling events, leading to the growth of pulmonary vascular cells and right ventricular cells. Critical Issues: The molecular mechanisms behind promotion of cell signaling for pulmonary vascular cell growth and right ventricular hypertrophy by ROS are not well understood. Evidence suggests that iron-catalyzed protein carbonylation may be involved. Future Directions: Understanding precise mechanisms of ROS actions should be useful for designing preclinical animal experiments and human clinical trials of the use of antioxidants and/or other redox compounds in the treatment of pulmonary hypertension. © 2013 Mary Ann Liebert, Inc.

Adamek T.,Thomayer Hospital
European Geriatric Medicine | Year: 2016

Recurrence of stroke has been estimated at 3-4% yearly after TIA or stroke. There is no clear agreement in choosing antiplatelet therapy at this time. Europeans, Americans and British guidelines have been different. Aspirin is still used in secondary prevention of ischemic stroke, because of the longest experience with the best-achieved results in different studies and low price. Other used drugs are a combination of aspirin and dipyridamole, P2Y12 receptor antagonists - clopidogrel, ticlopidine, prasugrel and ticagrelor, or inhibitor of phosphodiesterase cilostazol, which was effective with Chinese and Japanese population. The common agreement is not to use a dual antiplatelet therapy in long term, because it does not carry a higher reduction of ischemic attacks than monotherapy. The other negative effect is causing more incidents with severe hemorrhage. According to the American recommendation, the combined therapy is promising early after having TIA and light stroke when the risk of recurrence of stroke is high. © 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

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