National Repository of Grey Literature 14 records found  1 - 10next  jump to record: Search took 0.00 seconds. 
Alternation of Glycocalyx in Critical Illness and during Major Surgery and Approaches for Glycocalyx Protection
Astapenko, David ; Černý, Vladimír (advisor) ; Cvachovec, Karel (referee) ; Adamus, Milan (referee)
Background: Glycocalyx represents a protective cellular coat on a sugar basis. It serves as a communication medium with outside environment. Glykokalyx also covers the inner apical surface of endothelial cells where it is called the endothelial glycocalyx (EG). Research from last decade declare its pivotal role in physiology and pathophysiology of microcirculation. EG is prone to be damaged in critical conditions but there are more questions than what we actually know about this complex structure. Also, there are new methods being developed for more precise description of EG condition. The aim: The aim of this thesis is to evaluate the level of contemporary evidence about EG and to evaluate methods of its assessment. To describe the condition of EG in experimental model of cardiac arrest (CA) in pig and in experimental model of iatrogenic hypernatremia in rabbit. To describe the influence of different types of anesthesia on EG in patients in perioperative care. To describe the dynamic changes of EG in patients in critical care. To evaluate response of EG to fluid challenge of 500 ml of normal saline in healthy volunteers and the response of EG to administration of lipid emulsion in patients in critical care. To describe the condition of EG in patients with dyslipidemia, with long term home parenteral...
Nitric oxide - an indicator for severity of injury in polytrauma
Beitl, Evžen ; Hoch, Jiří (advisor) ; Cvachovec, Karel (referee) ; Zeman, Miroslav (referee)
- Part I (clinical study) Background: Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated by tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide can serve as an indicator for severity of injury in polytrauma. Methods: We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers. Results: On admission, serum NOx was higher in patients with moderate polytrauma than in both controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In groups where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on...
Hemodynamic optimalization in hepatic recection
Zatloukal, Jan ; Pradl, Richard (advisor) ; Cvachovec, Karel (referee) ; Málek, Jiří (referee)
Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia
Regulatory mechanisms of fetoplacental vasculature in hypoxia
Kafka, Petr ; Cvachovec, Karel (advisor) ; Zoban, Petr (referee) ; Bláha, Jan (referee)
The placenta and the lungs are the only organs that perform a function of blood oxygenation and have a common characteristic - vasoconstriction in response to acute hypoxia. Thus the reaction is in an opposite manner than smooth muscle of systemic arteries does. In this study we focused on the mechanisms that regulate fetoplacental blood vessels in conditions associated with hypoxia. An experimental model of isolated dually perfused rat placenta was used. Our findings demonstrate an essential role of Rho kinase signaling pathway in the mechanism of this hypoxic fetoplacental vasoconstriction (HFPV). Chronic exposure to hypoxia causes a sustain elevation of vascular resistance on fetoplacental blood vessels. It was demonstrated in experiment with low-viscosity salt solution perfusion. Our current results show a significant increase of the fetoplacental vascular resistance with blood perfusion which better reflects in vivo conditions. An increase in fetoplacental vascular resistance may lead to placental hypoperfusion and consequent fetal undernutrition, which is considered one of the key causes of serious fetal and neonatal problems, especially intrauterine growth restriction. Diabetes mellitus is a well-known factor affecting fetal growth. Both chronic hypoxia and diabetes act on vessels partly...
Fibrinolysis in cardiac surgery and possibillity of its control
Špegár, Ján ; Vaněk, Tomáš (advisor) ; Cvachovec, Karel (referee) ; Stříteský, Martin (referee)
Local and systemic application of tranexamic acid in heart valve surgery: a prospective, randomized, double blind LOST study SUMMARY The study was performed to examine a possible augmentation of systemic administration of tranexamic acid by the additional topical application during heart valve surgery in the post-aprotinin era. One-hundred patients were enrolled in the study and all the patients were given tranexamic acid intravenously. The participants were randomized into two groups (A, n = 49; B, n = 51), and before commencing the sternal suturing, the study solution (group A: 250 ml of normal saline + tranexamic acid 2.5 g, placebo group B: 250 ml of normal saline) was poured into the pericardial cavity. The cumulative blood loss (geometric means [95% confidence intervals]) 4 h after the surgery was 86.1 [56.1, 132.2] ml in group A, and 135.4 [94.3, 194.4] in group B, test for equality of geometric means P = 0.107, test for equality of variances P = 0.059. Eight hours after the surgery, the blood loss was 199.4 [153.4, 259.2] ml in group A, 261.7 [205.1, 334.0] ml in group B, P = 0.130 and P = 0.050, respectively. Twentyfour hours postoperatively the blood loss was 504.2 [436.0, 583.0] ml in group A, 569.7 [476.0, 681.7] ml in group B, P = 0.293 and P = 0.014, respectively. The proportion of patients...
Hemocoagulation and its influencing of contact with body cavities lining, especially pericardium
Vymazal, Tomáš ; Cvachovec, Karel (advisor) ; Stříteský, Martin (referee) ; Vaněk, Tomáš (referee)
Body cavity surgical procedures have been arising. The surgery is complex and often extending two hours on patiens with serious comorbidities and over 65 years of age. The major cavities are the thorax, abdomen and skull. Any body cavity surgical procedure is accompanied by touch of blood and biological membrane leading to release of tissue factor and effecting clot formation pathways. The blood is due to a clear site of procedure succkled out of a body and in most cases is not transfused back: that is why it does not affect the coagulation pathways. If a masive bleeding is expected a cell - saving machine could be used to recuperate and retransfuse the patient's blood. The cell -saver membrane can separate large molecules and substances (fat, blood clot) but is not able to catch various cytokines and tissue factor. These are associated with clot formation pathways disturbances. Coagulation disorder is very serious leading to a massive hemorrhage which is ussualy treated with allogeneic blood transfusion. Allogeneic blood transfusion is associated with poor wound heeling and higher risk of infection complications in postoperative period. In the first part of my work the influence of coagulation system following contact a patient ́s blood and biological body membrane was evaluated. I also wanted to answer...
The influence of the treatment of experimental acute liver failure by FPSA/Prometheus on intracranial pressure
Pražák, Josef ; Cvachovec, Karel (advisor) ; Červinková, Zuzana (referee) ; Kieslichová, Eva (referee)
Background: Cerebral edema is a well-known and fatal complication of acute liver failure (ALF). The influence of the treatment by artificial liver devices on the cerebral damage caused by ALF is usually monitored by only measuring the intracranial pressure (ICP). The aim of this work was to determine the influence of Fractionated Plasma Separation and Adsorption (FPSA), nonbiological artificial liver device, on the intracranial pressure. The second goal of this work was to determine the potential role of cerebral microdialysis in monitoring of the efficiency of fractionated plasma separation and adsorption (FPSA) treatment of ALF. Methods: Two types of surgical resection model of ALF were used in two separate experiments in pigs. In the first study data from monitoring of the intracranial pressure of ALF group (animals with ALF only) and FPSA group (animals with ALF treated by FPSA) were compared. In the second study data from monitoring by cerebral microdialysis and ICP of the ALF group (animals with ALF only), FPSA group (animals with ALF treated by FPSA) and SHAM group (animals with only laparotomy) were compared using statistical analyses. Results: In both experiments, the ICP was significantly higher in the ALF group than in the FPSA group from the 9th hour of the experiment. In the second...
Anesthesia techniques and organ microcirculation
Turek, Zdeněk ; Kaška, Milan (advisor) ; Cvachovec, Karel (referee) ; Šrámek, Vladimír (referee)
(Anesthesia techniques and organ microcirculation) There is an increasing evidence about microcirculatory effects of different intravenous anesthetics both under physiological and specific pathological conditions. This study aimed to investigate the effects of intravenous anesthetics on hepatosplanchnic microcirculation in laparotomized mechanically ventilated rats using Sidestream Dark-field (SDF) imaging. Thirty male Wistar rats were divided into 5 groups (n = 6 each). All rats were initially anesthetized with 60mg/kg pentobarbital (i.p.) for instrumentation. This was followed by either ketamine, propofol, thiopental, midazolam or saline + fentanyl (iv bolus over 5 min. and then maintenance over 90 min.). SDF imaging of the liver and distal ileum microcirculation was performed at the baseline and at t = 5, 35, 65 and 95 min. In propofol group there was increase of functional sinusoidal density (FSD) following induction (+25%, P<0.05) and maintenance at t = 95 min. (+10.3%, P<0.05), in ketamine and midazolam group decrease of FSD was observed after induction (-20.4%, P<0.05; -10.1%, P<0.05) and during maintenance at t = 65 min. (-11.6%, P<0.05; -11.4%, P<0.05) when compared to baseline. Following induction with propofol functional capillary density (FCD) of ileal longitudinal muscle layer increased...
The use of thromboelastography (TEG) in the evaluation of coagulation in patients on intensive care unit (ICU)
Durila, Miroslav ; Cvachovec, Karel (advisor) ; Stříteský, Martin (referee) ; Kovářová Kudrnová, Zuzana (referee)
Patients in the intensive care unit are in critical condition which is often accompanied by a coagulation disorder. Sepsis as a leading cause of death in critically ill patients may be associated with both hypercoagulable state with microtrombi formation in microcirculation and with increased production of endogenous heparinoids with inhibitory effects on blood clotting. Central venous catheter and arterial catheter are established in patients for hemodynamic monitoring and these are flushed with heparin to prevent their closure. Both inputs are used for blood sampling for laboratory tests such as blood count and coagulation parameters, including thromboelastography (TEG). In the first step of the work, arterio-venous differences in coagulation parameters were investigated in patients with sepsis. Higher concentration of D-dimers and lower antithrombin activity were found in venous blood. This finding can be explained by increased antithrombin consumption in hypercoagulable state and reactive hyperfibrinolysis. Inconsistency in the site of blood sampling may then lead to misinterpretation of the pathophysiological processes in the body. No significant differences were found in TEG parameters. In the second step of the work we examined how heparin commonly used for catheter flushing affects TEG-assessed...

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