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Pertlicek J.,Ortopedicke oddeleni | Stehlik J.,Ortopedicke oddeleni | Sadovsky P.,Ortopedicke oddeleni | Musil D.,Ortopedicke oddeleni | Mezera V.,Ustav Fyziologie
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca | Year: 2015

PURPOSE OF THE STUDY Tranexamic acid is an antifibrinolytic agent which blocks plasmin-mediated fibrin degradation. It is used in surgery to reduce intra-operative and post-operative blood loss. The aim of our study was to assess the effect of tranexamic acid administration on blood loss after elective primary unilateral total knee arthroplasty. MATERIAL AND METHODS A total of 119 patients (50 men, 69 women) with an average age of 69.2 years were included. The patients were randomised into two groups: Group A received a single dose of tranexamic acid (Exacyl, 1.5 g i.v.) before the operation; Group B (control) did not receive any antifibrinolytic agent. All patients underwent surgery under spinal anaesthesia with a tourniquet applied to the operated leg. The intra-operative blood loss, post-operative blood loss based on drainage, pre- and post-operative levels of haemoglobin and haematocrit, and the number of administered blood transfusions were analysed. RESULTS The administration of tranexamic acid led to a reduction in post-operative blood loss at all intervals tested, including the total blood loss (504 ? 214 vs 815 ? 231 ml; p < 0.001), and to reduced requirements for blood transfusion (1.18 ? 0.51 vs 1.54 ? 0.84 transfusion units; p < 0.05). A similar effect was observed in the subgroups of men and women; the total blood loss was higher in men than in women in both group B (non-significant) and group A (p < 0.05) patients. There was a gradual decline in haemoglobin and haematocrit levels during the post-operative period, with no significant differences between the two groups. Nor were there any differences in intra-operative blood losses either. No severe complications such as stroke, acute myocardial infarction orthromboembolic disease were recorded. DISCUSSION The administration of tranexamic acid before the application of a tourniquet resulted in reducing post-operative, but not intra-operative, blood losses in patients undergoing elective total knee arthroplasty. Transfusion requirements were reduced as well CONCLUSIONS Our study confirmed the efficacy and safety of tranexamic acid administration in relation to blood loss after total knee arthroplasty. In this indication, the administration is in accordance with the literature data. © 2015, Galen s.r.o. All rights reserved.

Fejfar T.,II. interni gastroenterologicka klinika FN Hradec Kralove | Safka V.,Ustav Fyziologie | Jirkovsky V.,II. interni gastroenterologicka klinika FN Hradec Kralove | Hulek P.,II. interni gastroenterologicka klinika FN Hradec Kralove
Gastroenterologie a Hepatologie | Year: 2013

Acute oesophagealvariceal bleeding is still a serious and life-threatening complication of symptomatic portal hypertension. Despite the current treatment with volume expansion, appropriate hemosubstitution, broad-spectrum antibiotics, vasoactive drugs and endoscopic treatment, it is still associated with high risk of failure and early relapse. Balloon tamponade or portosystemic shunt creation are the potential salvage therapies. The use of a special coated self-expandable metal oesophageal stent as an alternative to balloon tamponade, or in cases of contraindications to portosystemic shunt creation, has been supported by more data in the last decade.

Kadlec V.,Interni Oddeleni | Kubat J.,Interni Oddeleni | Mezera V.,Ustav Fyziologie
Gastroenterologia y Hepatologia | Year: 2015

In this case report, we present the benefits of current endoscopic methods in successful treatment of proximal biliary ileus. Gastroscopic examination allowed us to establish the diagnosis. Using lithotripsy, we broke up the concrement in duodenal bulb and extracted its partial segments. This procedure led to a solution of this condition.

Pulmonary circulation is completely different compared to systemic circulation. Chronic hypoxia damages peripheral pulmonary arterioles and causes hypoxic pulmonary hypertension (HPH) which consists of vasoconstriction and remodelling of the arterioles. The release of reactive oxygen species (ROS)--mainly superoxide and nitric oxide (NO) contribute to the pathogenesis of HPH. During exposition to chronic hypoxia, the NO production is markedly elevated and it has two effects: the first, direct vasodilatory effect caused by NO, the second, contribution to remodelling of the peripheral pulmonary vessels by interaction with ROS. The interaction of superoxid and NO releases peroxynitrite which plays a role in the onset of collagen cleavage. A typical low molecular weight of collagen fragments induces remodelling of the peripheral pulmonary arterioles. These changes are typical for the first week of exposure to the chronic hypoxia which also correlates with sudden elevation of the mean pulmonary artery pressure. Continual exposition to the chronic hypoxia after first week does not cause progressive worsening of HPH.

Uhliarova B.,ORL Odd. | Calkovska A.,Ustav Fyziologie
Studia Pneumologica et Phthiseologica | Year: 2015

Surfactant is a complex of lipids and proteins with surface-active properties found in several organs and systems. Most is known about alveolar surfactant. Apart from the alveoli, however, surfactant has also been identified in the upper and lower airways. There is experimental and clinical evidence of the involvement of the qualitative and/or quantitative changes of surfactant in the pathogenesis of bronchial asthma, chronic obstructive pulmonary disease and other lung diseases related to airway obstruction. Identification of phospholipids and proteins of surfactant in the nasal cavity and paranasal sinuses of healthy subjects as well as patients with various forms of chronic rhinosinusitis indicates that surfactant may have a role in normal sinonasal function and pathology. The review summarizes the current knowledge on the presence and role of surfactant in the pathogenesis of lung diseases related to airway obstruction as well as chronic rhinosinusitis.

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