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Pes equinovarus:New Treatment Strategies and Pathogenetic Mechanisms
Ošťádal, Martin ; Herget, Jan (advisor) ; Vízek, Martin (referee) ; Poul, Jan (referee)
Idiopathic pes equinovarus (also referred to as clubfoot) is a congenital deformity of the foot and lower leg; it has five components: equinus, varus, adductus, cavus and supination of the foot. At present two principle methods are mostly used for the treatment of clubfoot: physiotherapy and continuous motion without immobilization and the Ponseti method (serial manipulation, cast application, Achilles tenotomy and transposition of m. tibilalis ant.). This method has been reported to have short-term success rates approaching 100%, and the long-term results have been equally impressive. We believe, however, that the data on the success rate may be significantly influenced by the duration of the period after termination of the treatment. The purpose of the first part of our study was, therefore, to compare the short-term (up to three years) and long-term (three to seven years) results of treatment of idiopathic clubfeet with the Ponseti method and to determine the factors for recurrence. We have tested the hypothesis whether is it possible to cure all clubfeet with the Ponseti method only. We have found significant difference between the evaluation of the short- term and long-term results: the number of relapses during the first three years of treatment, indicated for surgical intervention, was...
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název v anglickém jazyce není uveden
Klusáčková, Pavlína ; Pelclová, Daniela (advisor) ; Hajduková, Zdeňka (referee) ; Vízek, Martin (referee)
Early diagnosis of occupational asthma is important especially for the prognosis of this disease. The confirmation of the diagnosis of occupational asthma is sometimes difficult using diagnostic methods available nowadays. That is why searching new methods is very important. Analysis of exhaled breath condensate (EBC) by liquid chromatography combined with mass spectrometry enables the separate detection of cysteinyl leukotrienes (LT) - LTC4, LTD4, LTE4; LTB4 and 8-isoprostane. If patients with occupational asthma and controls were compared, only LTC4 was significantly higher among all EBC parameters studied in asthmatics (despite corticosteroid treatment). This marker could be used in the future diagnostics. Monitoring of 24-hours variability of EBC parameters in patients, in whom occupational asthma is suspected, showed relatively high intraindividual and interindividual variation. It is evident therefore, that if only one daily measurement in asthmatics would be possible (which is common in articles of several authors), it should be collected in the same period of day in all persons. In negative bronchoprovocation tests significant changes of EBC parameters were not found. The evaluation of positive bronchoprovocation tests was limited by small number of patients, however in five persons from six, the...
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Feeding artery of vascular accesses for hemodialysis: model of arterial adaptation to high blood flow
Tuka, Vladimír ; Malík, Jan (advisor) ; Vízek, Martin (referee) ; Zicha, Josef (referee)
Background: Arteries adapt their diameter to changing haemodynamic conditions to maintain constant wall shear stress, the force generated by flowing blood on endothelial cells. The feeding artery of haemodialysis vascular accesses is a human model of arterial adaptation to chronically high blood flow and thus to high wall shear stress. The process of arterial adaptation is endothelium dependent. Endothelial dysfunction related to End-Stage Renal Failure, diabetes mellitus, dyslipidemia may impair also the dilatation of the feeding artery of vascular accesses. First the review of the literature presents in three parts different aspects of arterial adaptation: 1) arterial adaptation with focusing on the role of haemodynamic factors, 2) the influence of end-stage renal disease on arterial adaptation, 3) feeding artery of vascular accesses as a model of arterial response to chronic increase in blood flow. Methods: We examined the feeding artery of radial and brachial polytetrafluoroethylene grafts shortly after and one and two years after access creation. We used duplex ultrasonography to obtain internal diameter and blood velocity in the feeding arteries. We calculated wall shear rate as 4 x blood velocity / internal diameter and used it as approximation of wall shear stress. Results: In the first study we...
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Resistance of immature heart muscle to insufficient oxygen
Charvátová, Zuzana ; Ošťádal, Bohuslav (advisor) ; Vízek, Martin (referee) ; Kuneš, Jaroslav (referee) ; Škovránek, Jan (referee)
Dle údajů Světové zdravotnické organizace jsou v zemích střední a východní Evropy nejčastější příčinou úmrtí choroby srdce a cév. Více než polovinu z tohoto množství zaujímá jediné onemocnění, jímž je akutní a chronická ischemická choroba srdeční (ICHS). Cílem klinických i experimentálních kardiologů, kteří se výzkumem prevence a terapie ICHS zabývají, je proto tuto nepříznivou situaci zlepšit. ICHS vzniká jako důsledek nerovnováhy mezi množstvím kyslíku (a substrátů) dodávaného srdeční buňce a množstvím kyslíku, které buňka aktuálně potřebuje ke splnění metabolických nároků. Při ischemii (na rozdíl od hypoxie) je navíc kromě dodávky živin narušen i odvod produktů a nežádoucích zplodin buněčného metabolizmu. Výsledkem je pak přechod srdečního svalu na anaerobní metabolizmus, hromadění metabolitů a porucha energetické a iontové homeostázy; to vede k poruchám kontraktility a konečným důsledkem omezení perfuze myokardu může být zánik srdeční buňky a vznik infarktu myokardu. V tom, zda poškození bude reverzibilní či ireverzibilní, hraje rozhodující roli délka trvání ischemie. Jedinou možností, jak zabránit či alespoň zmírnit nevratné poškození srdečního svalu, je včasné obnovení průtoku krve koronárním řečištěm v postižené oblasti. Rozsah ischemického poškození srdečního svalu nezávisí pouze na intenzitě a...
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Some aspects of the pathophysiology of macrovascular complications of type 2 diabetic patients and of their assertion in practice
Adamíková, Alena ; Svačina, Štěpán (advisor) ; Anděl, Michal (referee) ; Vízek, Martin (referee)
Pacienti s diabetem 2. typu a dalšími rizikovými faktory (dyslipidémie, mikroalbuminurie) mají vysoké riziko asymptomatického kardiovaskulárního onemocnění. Pozitivní mikroalbuminurie ve skupině asymptomatických diabetiků 2. typu byla prokázána u 11,6% pacientů a u všech se vyskytla různě závažná forma kardiovaskulárních onemocnění. Dysfunkce endotelu, aktivní zánětlivý proces v cévní stěně, poruchy lipidového spektra, porucha reverzního transportu cholesterolu se podílejí na akceleraci aterosklerotického procesu u diabetiků 2. typu. Vysoká hladina zánětlivého markeru hs-CRP 3,053±2,668 mg/l přetrvávající ve studovaném souboru i přes zavedenou terapii poukazuje na nutnost systematického a trvalého aktivního terapeutického přístupu k diabetikům 2. typu s rizikovými faktory. Statisticky významný vztah dlouhodobé kompenzace diabetu dle HbA1c a parametrů transientní ischemické dilatace levé komory (TID) u těchto pacientů dokumentuje riziko hyperglykémie pro pseudodilataci levé komory srdeční způsobenou difuzní subendokardiální ischemií (p=0,035). Aktivní přístup k těmto rizikovým pacientům jak po stránce diagnostiky (zátěžové EKG, zátěžový SPECT myokardu), tak po stránce terapie, může podstatně ovlivnit jejich další kvalitu života a životní prognózu.
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Tissue factor in acute coronary syndromes
Malý, Martin ; Hampl, Václav (advisor) ; Wilhelm, Jiří (referee) ; Vízek, Martin (referee) ; Málek, Ivan (referee)
In this review are summarized essentials of the physiology and the pathophysiology of TF in terms of the literature sources. But still, until today, there are many questions to be answered: the source and the level of TF in healthy subjects, the method how to measure the "trombogenic" potential of TF because its role in many biological processes, the "normal" levels, the possible impact of risk factors and possibility of risk stratification of "healthy" subjects according to the levels of TF like marker of the blood with procoagulant potential. Answering these questions and impact of the blocking of TF as a therapeutical approach in acute coronary syndromes is a challenging field of investigation in blood coagulation. Powered by TCPDF (www.tcpdf.org)
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The relationship of pulmonary function tests and exercise tolerance in patients with chronic obstructive pulmonary disease
Chlumský, Jan ; Vízek, Martin (advisor) ; Radvanský, Jiří (referee) ; Mareš, Jan (referee)
Výsledky studie přinesly několik zásadních zjištění: 1. Tolerance zátěže je u pacientů s CHOPN významně omezena, přičemž různé typy zátěže jsou tolerovány značně rozdílně. Hlavní limitací obou typů zátěže však zůstává nemožnost zvyšovat VT (a následně VE) v odpovědi na zvýšený ventilační drive doprovázející fyzickou zátěž. 2. Limitace vzestupu VT (a následně VE) je určována stupněm plicní hyperinflace a její změnou v průběhu zátěže samotné, která se dá při absenci náročné přístrojové techniky nepřímo odhadovat podle hodnot IC nebo IVC. 3. 6-MWT je na rozdíl od ergometrie doprovázen rychlejším nárůstem dynamické plicní hyperinflace, která je odpovědná za významnou poruchu oxygenace. Proto lépe, než jiné testy tolerance fyzické zátěže odráží schopnost běžných denních aktivit.
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Skin equivalents in basic and applied research: Development of human hair equivalents
Havlíčková, Blanka ; Arenberger, Petr (advisor) ; Pánková, Růžena (referee) ; Salavec, Miloslav (referee) ; Vízek, Martin (referee)
In this study, three novel organotypic human folliculoid assays for basic and applied hair research were developed. Two organotypic "sandwich" systems consist of a pseudodermis (collagen I mixed with and contracted by human interfollicular dermal fibroblasts) on which one of two upper layers is placed: either a mixture of Matrigel™ and follicular dermal papilla fibroblasts (DPC), with outer root sheath keratinocytes (ORSK) layered on the top ("layered sandwich" system), or a mixture of Matrigel™, DPC and ORSK ("mixed sandwich" system). Third, the patented new technique generating human folliculoid microspheres (HFM), consisting of human DPC and ORSK within an extracellular matrix was established. Studying a number of different markers (e.g. proliferation, apoptosis, cytokeratin- 6, versican), it was shown that these folliculoid systems, cultured under well-defined conditions retain several essential epithelial-mesenchymal interactions characteristic for human scalp hair follicle. Selected, recognized hair growthmodulatory agents modulate these parameters in a manner that suggests that all developed organotypic systems allow the standardized pre-clinical assessment of test agents on relevant human hair growth markers under substantially simplified in vitro conditions that approximate the in vivo situation....
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Regulation of parameters of biological activity of colorectal cancer
Svobodová, Šárka ; Svačina, Štěpán (advisor) ; Beneš, Zdeněk (referee) ; Vízek, Martin (referee)
Colorectal cancer (CRC) has been considered to be the most frequent cancer disease based on prevalence rate and mortality rate. The earlier diagnostics provides the better therapy outcomes. Many new laboratory tests and techniques for early detection of CRC have been developed recently. Not many of the can be used for daily routine clinical practice so far. The aim of this dissertation thesis was to measure a large spectrum of parameters in patients with early stage of CRC and to evaluate them for routine practice, as they may play a potential regulatory role in cancer development and control process. (...) Our finding of a very low sensitivity of tumor markers CEA and CA 19-9 for CRC in early stages I.-III. is fully corresponding with literature data. When monitoring some parameters during chemotherapy course we have found that only TK seems to be important for adjuvant therapy control, but TK and CEA and CA 19-9 can be used of palliative therapy monitoring. TK increases after every chemotherapy cycle but it decreases before the beginning of the following cycle if the therapy is successful. But it is continuously increasing if the therapy is unsuccessful. CEA and CA 19-9 are permanently within reference intervals in adjuvant therapy. Before palliative therapy beginning all the parameters are elevated and...
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Prediction of chemosensitivity to 5-fluorouracil and its derivates in patients treated with chemotherapy for colorectal cancer
Zimovjanová, Martina ; Nečas, Emanuel (advisor) ; Cibula, David (referee) ; Vízek, Martin (referee)
Aim: 5-Fluorouracil (5-FU) is the most commonly used anticancer drug for colorectal cancer (CRC). Initially, we aimed to compare expression of 5-FU metabolic enzymes genes: thymidylate synthase (TS), thymidin phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) in colorectal cancer and normal colon mucosa. We have tried to prove the correlation of the mRNA levels in fresh frozen tissues and protein expression using immunohistochemistry in paraffin-embedded colorectal cancer and adjacent normal tissues. Finally, we aimed to clarify the prognostic and predictive value of the expression of the 5-FU metabolic enzyme genes in patients with early colorectal cancer. (...) Results: We have found significantly higher DPD mRNA levels in normal colon tissue than in tumor tissue (p=0,03), but no significant differences in TS mRNA (p=0,34) and TP mRNA (p=1,0) levels in tumor and normal tissue. Immunohistochemically we have determined significantly higher TS expresion in tumor than in normal tissue (p=0,02) and significantly higher TP expression in stroma 9 cancer tissue than in normal tissue (p<0,001). No linear relationships were found between mRNA expression and protein TS and TP expression (p=0,28 resp. p=0,87). High TP mRNA expression associated with worse prognosis (p=0,05 HR 4,1), also high protein...
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