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Craniofacial Abnormalities in Sleep Apnoea Syndrome
Dostálová, Simona ; Šonka, Karel (advisor) ; Čáp, Jan (referee) ; Peterka, Miroslav (referee)
The thesis is based on a series of cephalometric studies of patients with SAS, acromegalic patients with or without SAS as well as control groups. The studies presented in this thesis produce following results: There are important differences in orofacial skeleton and soft tissue of nasopharynx measured by cephalometry in the patients with sleep apnoea compared to the control group of women and men. Proved skeleton changes (increased lower gonion angle, increased anterior facial heights, decreased depth of the upper face) and elongated soft palate predisposes patients to narrowing of upper airways in oropharyngx, which significantly contributes to development of SAS. Cephalometric differences in the size of the soft palate, the rotation of the mandible and the size of lower gonion angle can be found in men with mild and severe sleep apnoea. We conclude that the severity of the SAS depends on the degree of changes in the orofacial skeleton and adjacent soft tissues. The results, which reveal a significant differences in BMI and in the circumference of the neck between groups with mild and severe SAS, confirm the idea that the most important predisposing factor for SAS is obesity, in particular deposition of adipose tissue in the posteriolateral parapharyngeal space. Patients with acromegaly (of both sexes)...
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Aspiration biopsy of the thyroid - the significance of evaluation according to Bethesda classification, differentiated carcinoma incidence in autoimmune thyroiditis
Srbová, Libuše ; Čáp, Jan (advisor) ; Fryšák, Zdeněk (referee) ; Jiskra, Jan (referee)
Aspiration biopsy of the thyroid - the significance of evaluation according to Bethesda classification, differentiated carcinoma incidence in autoimmune thyroiditis. Introduction: Improved diagnostics led to an increased number of detected thyroid nodules. Sonography and fine needle thyroid biopsy has become the basic method for thyroid nodules evaluation. Since 2010 the Bethesda System for Reporting Thyroid Cytopathology is used in some centres. Another common thyroid disease is autoimmune thyroiditis. According to some older studies a nodule in a patient with thyroiditis has a higher risk of malignancy. Current opinions dispute these findings. The difference in data appears to depend primarily on whether cytological or surgical findings are analysed. Objective: The aim of our study was to reclassify thyroid biopsy results according to the Bethesda categories in patients who underwent thyroidectomy and to determine the malignant potential of the individual categories. We then determined in equivocal cytological findings whether the recommendations for surgery, the type of cytologic atypia and the results of repeated biopsies had an impact on the incidence of malignant findings. Another objective was to identify how autoimmune thyroiditis affects the risk of thyroid cancer, particularly by comparing...
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The incidence of thyroid in selected regions of the Czech Republic in terms of saturation with iodine
Dvořáková, Marcela ; Zamrazil, Václav (advisor) ; Topolčan, Ondřej (referee) ; Stárka, Luboslav (referee) ; Čáp, Jan (referee)
24 9. SUMMARY 1. Natural sources such as water or soil contain iodine in low amounts in the Czech Republic. 2. Clinical manifestations of iodopenia were severe and occured in certain geographical areas in the past. 3. Iodization of table salt started in the fifties of the last century as a result of extensive epidemiological research and since then it has significantly improved iodine saturation in general. 4. Further steps in iodine prophylaxis in the mid-nineties of the 20th century have improved iodine saturation according to ICCIDD/WHO criteria. 5. Resolution of iodine deficiency does not represent, however, a closed chapter. 6. Individuals at risk, such as pregnant or breastfeeding women and patients on a salt- restricted diet, are worthy of public health concern. 7. There needs to be increased awareness of chronic excess of iodine with respect to an increasing prevalence of autoimmune thyroid disorders. 8. There is a need to continue education of the general population focused on adequate iodine intake from various foods (see products, milk) and to maintain a daily iodine intake in the "optimal ranges". Based on the international criteria, the Czech Republic is iodine sufficient country. This happened due to a multidisciplinary collaboration coordinated by the Regional Iodine Deficiency Council...
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Impairment of hypothalamo-pituitary function and its evaluation in various pathologic situations.
Kosák, Mikuláš ; Hána, Václav (advisor) ; Čáp, Jan (referee) ; Fryšák, Zdeněk (referee)
Traumatic brain injury represents serious medical problem. Besides various types of complications, endocrine dysfunction of hypothalmo-pituitary units can occur. Aim of our work was to determine whether chronic subdural haematoma, as specific type of traumatic brain injury, is associated with a risk of developing hypopituitarism as well. In a prospective study, pituitary functions in a cohort of 49 patients after surgery for chronic subdural haematoma, were evaluated. Patients were tested for hormonal deficits including dynamic tests, soon after surgery, in 3 and 12 months thereafter. 10 patients were tested retrospectively 12 months after surgery. Gonadotropic axis was impaired in 9 patients (25,7 %) in acute phase and reamained impaired in 3 (12 %) after 12 months. Growth hormone deficiency was present in 23 (46,9 %) patients during the acute phase and in 15 (46,9 %) patients in evaluation 12 months after the surgery. Serious hormonal deficiencies due to impairment of the most important axes (HPA a thyrotropic) were not proved in our patients. The second part of this work is devoted to the novel methods in diagnostic assesement of hypothalamo-pituitary-adrenocortical axis. Aim of our work was to evaluate and compare reliability of cortisol measurements in serum and saliva simultaneously during the...
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Acipimox during Short-Term Exercise Exerts A Negative Feedback of Growth Hormone on Ghrelin Secretion in Patients with Bulimia Nervosa and in Healthy Women: The Role of Lipolysis
Smitka, Kvido ; Nedvídková, Jara (advisor) ; Kršek, Michal (referee) ; Čáp, Jan (referee)
Title: Acipimox during Short-Term Exercise Exerts A Negative Feedback of Growth Hormone on Ghrelin Secretion in Patients with Bulimia Nervosa and in Healthy Women: The Role of Lipolysis Objective: Eating disorders, such as bulimia nervosa (BN) and anorexia nervosa (AN), are characterized by abnormal eating behavior. The main features of BN are binge-eating and inappropriate compensatory methods to prevent weight gain. The appetite-modulating peptide ghrelin is secreted by the stomach and shows a strong release of growth hormone (GH). A potential GH-ghrelin feedback loop between stomach and the pituitary has been recently reported. Acipimox (Aci), an analogue of nicotinic acid, inhibits lipolysis in adipose tissue (AT) and reduces plasma glycerol and free fatty acids (FFA) levels. Exercise and Aci are stimulators of GH secretion. We suppose that a negative feedback from increased GH levels during exercise may play a role in reducing plasma ghrelin levels. We surmised that altered baseline activity and exercise-induced activation of the sympathetic nervous system (SNS) results in excessive stimulation of lipolysis associated with negative energy balance and may lead to abnormal AT metabolism in patients with BN. Disruption of the gut-brain-AT axis might be involved in the pathogenesis of BN. The...
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Steroid metabolome in human physiology and pathophysiology.
Hána, Václav ; Hill, Martin (advisor) ; Meloun, Milan (referee) ; Čáp, Jan (referee)
Many studies have shown steroid hormone changes in adrenal incidentalomas with subclinical hypercortisolism and various forms of Cushing's syndrome. The aim of our work was to measure, using novel steroid GC-MS/MS measurement procedure, complex picture of many steroids in these patients. With the knowledge of these changes we could better explain causal pathophysiologic changes. In the study on patients with adrenal incidentalomas we described complex steroid changes in patients with subclinical hypercortisolism. Previous studies showed decrease of DHEAS in subclinical hypercortisolism. We confirmed this finding and described a decrease in other androgens and their metabolites. We also evaluated their sensitivity and specificity when compared to routinely used parameters for diagnosis of subclinical hypercortisolism. Furthermore, we looked at the alterations in all measured steroids and their changes in the 1 mg dexamethasone suppression test. In another study, we analyzed steroid changes in various forms of Cushing's syndrome. We confirmed the decrease of adrenal androgens in the ACTH independent forms and mild increase in the ACTH dependent forms. We also described elevations of mineralocorticoid precursors in central and ectopic forms of ACTH secretion. In the distinction of ectopic and central...
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