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An Analysis of Pathogenetic Processes Evolving in Comatose Survivors After an Out-of-Hospital Cardiac Arrest
Kleissner, Martin ; Kettner, Jiří (advisor) ; Vojáček, Jan (referee) ; Rokyta, Richard (referee)
In comatose out-of-hospital cardiac arrest victims, there is insufficient evidence for the timing of coronary angiography (CAG) in the absence of ST elevations on the baseline electrocardiogram, for the optimal body temperature during the temperature control pro- cedure, or for S100 protein levels and regional brain saturation values measured by near- infrared spectroscopy regarding neurological prognostication. The aim of this study was to compare the six-month survival and neurological outcome, evaluated by the Cerebral Performance Category (CPC) scale, in patients with- out ST-segment elevations indicated to immediate CAG and those initially treated conservatively, six-month CPC and acute complications according to the temperature target range of 34 - 36 řC versus 32 - 34 řC during therapeutic hypothermia, and S100 protein levels and regional brain saturation values with regard to the six-month CPC score. We analysed a prospective registry of 283 unconscious patients after an out-of- hospital cardiac arrest undergoing therapeutic hypothermia. We evaluated the neurolog- ical outcome as the numerically lowest CPC score from 72 hours to six months after hospital admission: we defined a favourable outcome as CPC 1-2, while unfavourable as CPC 3-4. We included all registry patients in the target...
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Treatment of pulmonary hypertension affect the metabolism of cyclic guanosine monophosphate
Al-Hiti, Hikmet ; Kettner, Jiří (advisor) ; Ošťádal, Petr (referee) ; Goncalvesová, Eva (referee)
Chronic damage to pulmonary vessels leads to pulmonary hypertension (PH). Different forms of PH are quite frequent and are associated with significant morbidity and mortality. The treatment of PH is most successful, if its cause can be identified and removed before irreversible damage to the pulmonary vascular bed occurs. For patients, in whom the elimination of the underlying cause is not possible or where the cause is unknown, the treatment is aimed at reduction of pulmonary vascular resistance and improvement of cardiac and circulatory response to pressure overload of the right ventricle. One option for the PH treatment is modification of metabolism of cyclic guanosine monophosphate (GMP), which is the second messenger of nitric oxide and induces vascular vasodilation. Cyclic GMP is degraded by phosphodiesterases (PDE 5). In the clinical part, we tested the hypothesis that acute inhibition of PDE5 by sildenafil provides more selective pulmonary vasodilation than high doses of prostaglandin E1 (PGE1). The study showed that the vasodilator effects of sildenafil on pulmonary circulation is more pronounced than in the systemic circulation and that sildenafil had a greater ability to detect reversible component precapillary PH due to advanced chronic heart failure than PGE1. The aim of our...
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Treatment of pulmonary hypertension affect the metabolism of cyclic guanosine monophosphate
Al-Hiti, Hikmet ; Kettner, Jiří (advisor) ; Ošťádal, Petr (referee) ; Goncalvesová, Eva (referee)
Chronic damage to pulmonary vessels leads to pulmonary hypertension (PH). Different forms of PH are quite frequent and are associated with significant morbidity and mortality. The treatment of PH is most successful, if its cause can be identified and removed before irreversible damage to the pulmonary vascular bed occurs. For patients, in whom the elimination of the underlying cause is not possible or where the cause is unknown, the treatment is aimed at reduction of pulmonary vascular resistance and improvement of cardiac and circulatory response to pressure overload of the right ventricle. One option for the PH treatment is modification of metabolism of cyclic guanosine monophosphate (GMP), which is the second messenger of nitric oxide and induces vascular vasodilation. Cyclic GMP is degraded by phosphodiesterases (PDE 5). In the clinical part, we tested the hypothesis that acute inhibition of PDE5 by sildenafil provides more selective pulmonary vasodilation than high doses of prostaglandin E1 (PGE1). The study showed that the vasodilator effects of sildenafil on pulmonary circulation is more pronounced than in the systemic circulation and that sildenafil had a greater ability to detect reversible component precapillary PH due to advanced chronic heart failure than PGE1. The aim of our...
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