|
|
Anesthesiological diffíeulties arising in the surgical treatment of chronic pulmonary hypertension
Kunstýř, Jan ; Lindner, Jaroslav (advisor) ; Vaněk, Tomáš (referee) ; Černá, Alena (referee)
Pulmonary hypertension is a serious syndrome with very unfavorable prognosis. It encompasses numerous diseases and the only one which is surgical ly treatable is chronic thromboembolic pulmonary hypertension. Pulmonary endarterectomy (PEA) is a curative method for select patients with surgically accessible thrombotic obstruction. It involves not only the operation itself, but also complicated diagnostics, preoperative preparation, and sophisticated postoperative intensive care. According to contemporary world reviews of professional literatuře, mortality rates following PEA, range from 5 to 24 percent. Better results with lower levels of mortality as well as morbidity are unambiguously proven in the centers with more experience where the highest numbers of such surgeries are undertaken. Good team work is an essential condition for a successíul PEA program and the anaesthetist is its indispensable member. Anaesthesia of patients with chronic right ventricle dysfunction undergoing cardiac surgery using extracorporeal circulation brings about several diffíeulties and we tried to deal with them in our work. This kind of operation was not available in the Czech Republic and the íirst goal of our work was to implement this surgical program in its complexity - including anaesthesia and intensive postoperative...
|
|
| |
|
|
Haemocoagulation changes caused by cardiopulmonary bypass
Šnircová, Jana ; Vaněk, Tomáš (advisor) ; Kvasnička, Jan (referee) ; Kunstýř, Jan (referee)
The aim of preliminary and experimental prospective, randomized study was to search for thromboelastography signs of fibrinolysis, their impact on postoperative blood loss and need of transfusion in coronary surgery. In preliminary study we had compared results in 20 patients scheduled for coronary surgery (10 patients OPCAB, 10 patients conventional CABG). Completely expressed thromboelastographic signs of hyper-fibrinolysis had been detected in 2 on-pump patients and partial signs of increased fibrinolytic activity had been noticed in other 2 patients originating from the same group, unlike OPCAB group, in which no signs of fibrinolysis had been observed. However, differences between the evaluated groups in that trial had not reached statistical significance due to a small number of study subjects. In experimental study, 65 patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated ardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of...
|
|
|
New trends in perioperative monitoring and glycaemic control.
Lipš, Michal ; Kunstýř, Jan (advisor) ; Bešík, Josef (referee) ; Beneš, Jan (referee)
Glycaemic control in critically ill patients has been a topic of considerable attention for the past 20 years. In literature and at scientific meetings, there have been ongoing debates regarding the efficacy of glycaemic control in these patients with frequently entirely opposite opinions. These range from a strict invasive approach with target glycaemia 4-6 mmol/l to a liberal approach tolerating even values higher than 12 mmol/l. In the preview of this PhD thesis we have analysed so far published literature and describe the reasons for this inconsistency. According to the results of recent studies, the most significant efficacy of tight glycaemic control has been observed in cardiac surgical patients. If we consider the concept of tight glycaemic control as efficient strategy, there are three important questions remaining unanswered as follow. Does the specific algorithm-protocol play a key part in the concept of tight glycaemic control alongside the knowledge and skills of nursing staff in safe and efficient blood glucose control? What is the ideal timing of starting the strategy of tight glycaemic control (TGC) in cardiac surgical patient? And is there any benefit in outcome respect to mortality or morbidity? Do we have any more safe and efficient option or add-on to standard perioperative...
|
|
|
Denial of Benefits and Article 17 of the Energy Charter Treaty
Kunstýř, Jan ; Balaš, Vladimír (advisor) ; Beránek, Milan (referee)
The so called "Denial of Benefits" clause (DOB) gives the respondent state an opportunity to exclude third parties to the investment protection treaties from enjoying the benefits of the treaty without assuming reciprocal obligations. No less than seventy-three investor-state disputes have been brought to arbitration under the ECT since its entry into force back in 1998. The DOB clause in ECT, Art. 17 has never been successfully invoked. States have tried to exercise their right in at least ten cases without success. This paper poses two research questions. First, what are the distinguishing features of Art. 17 of the ECT that make it function differently from other DOB clauses? Second, given the arbitral decisions, can the Art. 17 of the ECT be effectively invoked by respondent states? The paper is divided into five chapters. The first chapter introduces the topic of DOB clauses and the purpose of this paper. The second chapter is theoretical and addresses the topic of DOB clauses in general and further outlines their past, present and future. The third chapter focuses specifically on the Art. 17 of the ECT it examines the ECT arbitral awards and decisions that touched upon the clause. Chapter four aims to show the procedural issues of DOB clauses from the perspective of respondent states, it...
|
|
| |
|
|
Haemocoagulation changes caused by cardiopulmonary bypass
Šnircová, Jana ; Vaněk, Tomáš (advisor) ; Kvasnička, Jan (referee) ; Kunstýř, Jan (referee)
The aim of preliminary and experimental prospective, randomized study was to search for thromboelastography signs of fibrinolysis, their impact on postoperative blood loss and need of transfusion in coronary surgery. In preliminary study we had compared results in 20 patients scheduled for coronary surgery (10 patients OPCAB, 10 patients conventional CABG). Completely expressed thromboelastographic signs of hyper-fibrinolysis had been detected in 2 on-pump patients and partial signs of increased fibrinolytic activity had been noticed in other 2 patients originating from the same group, unlike OPCAB group, in which no signs of fibrinolysis had been observed. However, differences between the evaluated groups in that trial had not reached statistical significance due to a small number of study subjects. In experimental study, 65 patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated ardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of...
|
|
|
Concept of the Alliance: US-Japanese Security Cooperation
Kunstýř, Jan ; Bečka, Jan (advisor) ; Raška, Francis (referee)
This thesis examines the U.S.-Japan security alliance. The strategic and security environment of the Northeast Asia region is currently undergoing a rapid change. The strong position of the United States in this region is challenged by China, whose ongoing territorial disputes with Japan may test the resilience of the U.S.-Japan alliance. Although the U.S.-Japan partnership is commonly denominated as an alliance (U.S.-Japan Alliance, Pacific Alliance), it might not fulfil all the basic attributes of the concept of military alliance. This thesis analyses the U.S.-Japan alliance in terms of the concept of military alliance and its essential elements. The concept of alliance as understood by this paper is defined in the first chapter. The second chapter applies this concept to the nature of the U.S.-Japan alliance and subsequently discusses to what degree each of the parties of the alliance meets the requirements of the essential elements of the concept. By investigating how the reality of the U.S.-Japan alliance corresponds with the concept of military alliance, this thesis offers the basis for further research of the U.S.-Japan military cooperation.
|
|
| |
|
|
Anesthesiological diffíeulties arising in the surgical treatment of chronic pulmonary hypertension
Kunstýř, Jan ; Lindner, Jaroslav (advisor) ; Vaněk, Tomáš (referee) ; Černá, Alena (referee)
Pulmonary hypertension is a serious syndrome with very unfavorable prognosis. It encompasses numerous diseases and the only one which is surgical ly treatable is chronic thromboembolic pulmonary hypertension. Pulmonary endarterectomy (PEA) is a curative method for select patients with surgically accessible thrombotic obstruction. It involves not only the operation itself, but also complicated diagnostics, preoperative preparation, and sophisticated postoperative intensive care. According to contemporary world reviews of professional literatuře, mortality rates following PEA, range from 5 to 24 percent. Better results with lower levels of mortality as well as morbidity are unambiguously proven in the centers with more experience where the highest numbers of such surgeries are undertaken. Good team work is an essential condition for a successíul PEA program and the anaesthetist is its indispensable member. Anaesthesia of patients with chronic right ventricle dysfunction undergoing cardiac surgery using extracorporeal circulation brings about several diffíeulties and we tried to deal with them in our work. This kind of operation was not available in the Czech Republic and the íirst goal of our work was to implement this surgical program in its complexity - including anaesthesia and intensive postoperative...
|
guest ::
