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Indirect calorimetry application in two different insulin-resistant states - polytrauma and pregnancy
Patková, Anna ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee) ; Kacerovský, Marian (referee)
Charles University, Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Candidate: Mgr. Anna Patková Supervisor: doc. PharmDr. Miloslav Hronek, Ph.D. Title of Doctoral Thesis: Indirect calorimetry application in two different insulin-resistant states - polytrauma and pregnancy Introduction and Objective: Indirect calorimetry is the gold standard for energy expenditure (EE) determination that is currently considered to be the best indicator of individual energy requirements - both in health and in illness. Although polytrauma and pregnancy could seem as two physiologically different states, they are quite similar in metabolic terms. Both in polytrauma and in late pregnancy, catabolism increases energy expenditure and insulin resistance occurs. Not only common characteristics mentioned above distinguish these two groups from healthy individuals and non-pregnant women. The aim of this dissertation was to describe the metabolism of polytrauma patients and healthy pregnant women together with the factors that affect it. Besides energy expenditure, this work focuses on respiratory quotient (RQ; in polytrauma also in relation to indirect prognostic markers), which characterizes nutritional substrate oxidations. In pregnant women, the dissertation is also focused on the...
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Infection-related Intra-amniotic Complications in Women with Preterm Prelabor Rupture of Membranes
Štěpán, Martin ; Kacerovský, Marian (advisor) ; Ľubušký, Marek (referee) ; Záhumenský, Jozef (referee)
Preterm prelabor rupture of membranes before 37. weeks of gestation (PPROM) is responsible for approximately one third of all preterm deliveries. Infection-related complications in PPROM are represented by the presence of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI) and histological chorioamnionitis (HCA). The presence of these complications is found in approximately 20-50% of all cases of PPROM and is associated with worse neonatal outcomes. The first specific aim was to evaluate whether maternal serum CRP has a diagnostic value for diagnosis of MIAC and HCA. The study population consisted 386 women. CRP level was the highest in PPROM pregnancies complicated with MIAC and HCA. The second specific aim was to evaluate short-term neonatal outcome in women with PPROM before 34 weeks of gestation. The study population consisted 122 women with PPROM at gestation age 24+0 -34+0 weeks. In neonates was evaluated the influence of MIAC and HCA on neonatal outcome. The presence of both MIAC and HCA increased the risk of early onset sepsis. The third and fourth specific aim was evaluation of an association between periodontal status and infection-related intra-amniotic complications in pregnancies complicated by PPROM and/or evaluation of association between the local...
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Sonographic characteristics of the abdomen within 6 weeks following cesarean section
Dosedla, Erik ; Calda, Pavel (advisor) ; Kacerovský, Marian (referee) ; Záhumenský, Jozef (referee)
Caesarean section is one of the most frequently performed surgery in medicine. The Cesarean section scar in the uterus can lead to a number of pathological conditions which affect the women reproductive health. In industrialized countries, this issue relates to at least 30% of women, which means that it is a major medical problem. Ultrasound examination of the uterus after Cesarean section includes some specific features, resulting from the rapidly changing dimensions of the uterus, as well as from patient compliance in early puerperium. When dealing with postpartum complications, it is necessary to know the normal ultrasound findings and the dynamic changes of the uterus during puerperium, so that we can better distinguish between the pathological course and the normal course of puerperium. The clinical significance of ultrasound assessment of uterine size and area of the scar after Caesarean section during the postpartum is not yet adequately described. The knowledge of normal ultrasound findings in the uterus after Caesarean section could be helpful in choosing the right treatment in severe cases. We were watching the clinical outcomes of treatment of abnormal Cesarean section scars after their laparoscopic reconstruction. In our study, we have shown that the examination of uterus in early...
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Diagnosis and therapy of intrauterine pathologies associated with pregnancy.
Švabíková, Lucie ; Žižka, Zdeněk (advisor) ; Novotný, Zdeněk (referee) ; Kacerovský, Marian (referee)
Introduction: Actually 0.7-1 percent of all deliveries can be followed by secondary uterine bleeding. There is a residual trophoblastic tissue diagnosed in most of these cases and it is often managed by repeat intrauterine interventions. These operations are connected with high risk of formation of intrauterine adhesions and their early diagnosis and management can be important for next fertility. Material and methods: There were generally 188 patients included into the study. All patients underwent ultrasound examination in 6 weeks after delivery and ambulant hysteroscopy after next 2 months without anesthesia. Described intrauterine pathologies (residual tissue and adhesions) were managed in one step. Results: In cases with suspect ultrasound finding, the retained trophoblastic tissue was diagnosed by hysteroscopy in 66 percent vs. in 96 percent with sensitivity 85 percent and specificity 85 percent. Patients with intrauterine adhesions had normal ultrasound finding in 74 percent and it did not recognized patients with severe adhesions in 94 percent. Clinical signs had generally 72 percent of patients with diagnosed left residual tissue. Number of severe residual tissue is increasing with delay of instrumental evacuation from delivery (10 vs. 30 percent). When is necessary to repeat the operation...
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New Aneuploidy Ultrasound Markers in First Trimester of Pregnancy
Břešťák, Miroslav ; Calda, Pavel (advisor) ; Kacerovský, Marian (referee) ; Baxová, Alice (referee)
Prenatal diagnostics is headed in several directions - towards visualization of fetuses and biochemical, cytogenetic and molecular genetic diagnostics in laboratories. Whereas visualization of fetuses does not a priori represent any direct risk for pregnancy and does not increase the number of potential pregnancy complications, this is not always the case with the laboratory testing. There are known risks connected with invasive methods of prenatal diagnostics. The number of potential unintentional pregnancy complications and losses as well as the technical and economic aspects of invasive prenatal diagnostics lead to attempts of identifying ways of detecting any potentially affected individuals by screening methods, thus minimizing the undesirable impact of invasive diagnostics on the pregnant population. The more precise the selective criteria, the lesser the number of pregnant women exposed to invasive exams. Another way of decreasing the number of unintentional complications in relation to invasive diagnostics is to simplify and improve the fetal samples harvesting methods during pregnancy. The work primarily focused on two areas: Determination of the relation between fraction shortening of the left and right ventricles and a fetal chromosomal complement, and verification of reliability of a new method...
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Soluble form of the scavenger receptor for hemoglobin (sCD163) in pregnancies complicated by preterm prelabor rupture of membranes
Kacerovský, Marian ; Tošner, Jindřich (advisor) ; Calda, Pavel (referee) ; Procházka, Martin (referee)
Preterm prelabor rupture of membranes (PPROM) is responsible for approximately 30% of all preterm deliveries. Histological chorioamnionitis (HCA) has been found in 50-80% of PPROM cases and is associated with higher rates of adverse maternal and neonatal outcome. The scavenger receptor for hemoglobin (CD163) is a transmembrane glycoprotein expressed almost exclusively on monocytes and macrophages. Its main function is the binding of hemoglobin-haptoglobin complexes. CD163 also serves as a surface receptor that recognizes intact bacteria and triggers cytokine production function. Moreover, it participates in the late down-regulatory phase of both acute and chronic inflammation. The soluble form of CD163 (sCD163) most likely represents the extracellular domain of CD163, which can be shed from the surface and released into the body fluid. The main aim of this thesis was to investigate sCD163 in pregnancy complicated by PPROM and relationships with HCA and funisitis. The first specific aim was to determine amniotic fluid sCD163 levels in uncomplicated pregnancies. Amniotic fluid samples were taken from 31 women who underwent amniocentesis for genetic testing in the second trimester, as well as from 32 women at term, 21 of whom had and 11 of whom did not have uterine contractions. The sCD163 levels in...
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