Slavnostní konference

Vnitr Lek 2013, 59(8):653  

30 years of liver transplants in Brno

J. Černý

Vnitr Lek 2013, 59(8):654-657  

On 3 February 1983 the first successful liver transplant in Czechoslovakia took place at the 2nd Surgery Clinic in Brno. This operation was preceded by 14 years of experiments, including more than 150 orthotopic liver transplants in pigs. Josef Mynář, a patient who suffered from an extensive liver tumour - hepatoma - has been living ever since, i.e. for 30 years after the transplant, leading a very active life in a good health condition.

Liver transplant indication and waiting list inclusion

L. Husová

Vnitr Lek 2013, 59(8):658-662  

The authors have presented an overview of indications and inclusion of patients to the liver transplant waiting list in the Brno transplant centre over a period of 30 years from the first liver transplant performed in the Czech Republic (the then Czechoslovakia). The first clinical liver transplant in the Czech Republic was performed on 2 February 1983. Indication for the transplant was a malignant liver tumour. For a period of 30 years (from 2 February 1983 to 15 January 2013) a total of 592 patients were placed on the waiting list and a total of 453 liver transplants were performed. An urgent liver transplant was carried out in 32 patients over the...

Liver transplant outcomes in Brno

V. Mejzlík, L. Husová, M. Kuman, S. Štěpánková, J. Ondrášek, P. Němec

Vnitr Lek 2013, 59(8):663-667  

The first liver transplant in the former Czechoslovakia took place in Brno on 2 February 1983; the patient concerned has lived for more than 30 years with a normally functioning liver and is one of the longest surviving patients after a liver transplant in Europe. The Cardiovascular and Transplantation Surgery Centre (CTSC) in Brno has experienced an increased development in the area of liver transplants since the mid-1990s. At present, about 30 patients a year undergo a transplantation, with 451 liver transplants in total as of 31 December 2012. The primary indication concerns liver cirrhosis of various etiologies, with an increasing number of cases...

Development of immunosuppressant treatment after liver transplant

P. Studeník, P. Němec

Vnitr Lek 2013, 59(8):668-670  

The history of liver transplants extends over more than 60 years. During the first 10 years the operations were carried out only as experiments and primarily focused on designing complex surgical techniques. In the 1960s the research focused on the development of immunosuppressants and the first clinical operations were performed. However, the outcomes of these interventions were very poor. The subsuquent 2 decades witnessed the development of new and very efficient immunosuppressants, significantly improving patient survival rates. The number of operations and sites performing these interventions increased. In the United States in 1983, liver transplants...

Immunosuppression after liver transplant, now and in future

P. Trunečka

Vnitr Lek 2013, 59(8):671-677  

The development of immunosuppression has significantly affected the development of liver transplantation and has helped to switch from the experimental method to a standard treatment of life threatening liver conditions. Tacrolimus is the basic immunosuppressant for patients after a liver transplant and thanks to its prolonged-release dosage form, which due to its simplicity and reliability of use, replaces tacrolimus twice daily early after the transplant and in the long-term administration, will apparently, for a while, defend its position. Other widely used medicines include mycophenolic acid and mTOR inhibitors, sirolimus and everolimus. The induction...

Deceased organ donors, legal regulations governing diagnosis of brain death, overview of donors and liver transplants in the Czech Republic

E. Pokorná

Vnitr Lek 2013, 59(8):678-681  

The key restriction of transplantation medicine globally, as well as in the Czech Republic, concerns the lack of organs. The number of deceased donors, and thus the availability of organ transplants, has been stagnating in our country. The paper describes current legal regulations governing the diagnosis of brain death and primary legal and medical criteria for the contraindication of the deceased for organ explantation, gives an overview of the number of liver transplants, age structure, and diagnoses resulting in brain death of the deceased liver donors in the Czech Republic.

Surgical techniques to counter the lack of donors

M. Oliverius

Vnitr Lek 2013, 59(8):682-685  

It has been 30 years since the first successful transplant in the Czech Republic. The number of interventions and their demand has been continuously growing. As a result of a continuous lack of donors, many new techniques have been developed, aimed at increasing the number of liver grafts suitable for transplant, and thus reducing the number of deaths among patients on the waiting list. In the field of paediatric liver transplants, especially in the groups of the lowest body weight, this need is the most urgent. The paper addresses the respective techniques and their availability in the Czech Republic. The most frequently used techniques include liver...

Interventional radiology options to address certain complications of the orthotopic liver transplant

I. Suškevič, J. Vaníček, P. Studeník, V. Mejzlík, J. Křístek, L. Husová

Vnitr Lek 2013, 59(8):686-688  

At the clinic of imaging method St. Anna's University Hospital solved complications arising after ortotopic liver transplantation. For more than 15 years of cooperation with CKTCH Brno intervention was performed on both the arterial and venous system, but most on the biliary tract. The order was a unit patient's, which correlates with other comparable work. In the years 1998-2013 we conducted one intervention on arterial bed, 3× intervention in hepatic venous system and we solved biliary complications in 7 transplant.

Biliary (cholestatic) complications in the liver graft biopsy samples early after transplantation

E. Honsová

Vnitr Lek 2013, 59(8):689-693  

During the first three months after a liver transplant, cholestasis of various type and degree represents 1 of the most frequent morphological findings in liver graft biopsies. The morphology of cholestasis is typical for all conditions with bile duct impairment but also for other conditions with more severe impairment of hepatocytes, including rejection and recurrence of viral hepatitides. Histological diagnosis represents the gold standard in addressing liver graft dysfunction causes, and in the majority of cases it allows for distinguishing between the main categories of diseases resulting in cholestasis. Usually a combination of various changes...

Liver transplants in viral hepatitides

L. Husová

Vnitr Lek 2013, 59(8):694-697  

The authors present their own results of liver transplants over the last 30 years (from 2 February 1983 to 31 December 2012). For the respective period, 451 patients underwent a transplant in the Brno Transplantation Centre. Ten out of 451 patients (2.2%) underwent transplants for the indication of cirrhosis caused by viral hepatitis B in the Brno Transplantation Centre. The first liver transplant indicated due to viral hepatitis B was performed in 1994. Out of the ten patients, 3 died (30%). Forty-one out of 451 patients (9%) underwent liver transplant for cirrhosis caused by viral hepatitis C. The first liver transplant indicated due to viral hepatitis...

Liver transplants in tumours and alcoholic cirrhoses

V. Mejzlík, L. Husová, M. Kuman, S. Štěpánková, J. Ondrášek, P. Němec

Vnitr Lek 2013, 59(8):698-704  

The treatment of hepatocellular carcinoma requires a multidisciplinary approach; liver transplant is suitable only in the minority of strictly selected patients. The CSTC Brno applies the so-called Milan criteria. As of 31 December 2012 the CSTC Brno performed liver transplants in 16 patients with hepatocellular carcinoma in cirrhosis, with a five-year survival rate of 40% and a 10-year survival after transplant of 20%. It is a paradox that the longest living (30 years) patient of CSTC Brno underwent the transplant for a large fibrolamellar hepatocellular carcinoma, which emphasises the prognostic significance of the tumour histology - criterion taken...

XXV. JUBILEJNÍ VANÝSKŮV DEN

Vnitr Lek 2013, 59(8):706  

Cardiorenal syndrome by heart failure

J. Vítovec, J. Murín, L. Špinarová, L. Vítovcová, J. Špinar

Vnitr Lek 2013, 59(8):707-711  

Cardiorenal (CR) syndrome is defined for the purposes of the following text mainly as primary cardiac dysfunction with a consequent failure of renal haemodynamics. Heart failure leads to a decrease in cardiac output and to the activation of vasoconstrictors; this gradually precipitates a decrease in the level of renal perfusion, the vasoconstriction of renal vessels and a decrease in glomerular filtration with a gradual development of renal failure. The following paper analyses the pathophysiological mechanisms, the characteristics of the patients, the role of medication during CR syndrome, the relationship between proteinuria and anaemia during CR...

New drugs in type 2 diabetes mellitus therapy

M. Kvapil

Vnitr Lek 2013, 59(8):713-718  

The objective in developing a new type 2 diabetes therapy is to achieve greater safety and better efficacy. Newly registered drugs include lixisenatide, QW exenatide, dapagliflozin and insulin degludec. Once weekly gliptins and other substances are under development.

Where is the treatment of hypertension heading?

M. Souček

Vnitr Lek 2013, 59(8):720-723  

High normal blood pressure is defined as pressure of 130-138/85-89 mm Hg. The term prehypertension is used for systolic blood pressure of 120-139 mm Hg and diastolic pressure of 80-89 mm Hg. The question is whether blood pressure at those levels should be treated and if so, in which patients. Another question is, whether the therapy can affect the incidence of hypertension and cardiovascular complications.

Renal denervation 2013

J. Špinar, J. Vítovec, L. Špinarová

Vnitr Lek 2013, 59(8):724-729  

Arterial hypertension is a worldwide serious clinical problem. It affects 30-40% of the adult population. Resistant hypertension is defined as systolic blood pressure that remains ≥ 140mmHg while in the doctor's surgery and/or as average systolic blood pressure during a 24-hour monitoring of an outpatient ≥ 130mmHg after a combination of three antihypertensive agents (including a diuretic) has been administered in the maximum tolerated dose amounts. Renal denervation is an invasive method of catheter radio frequency ablation of sympathetic nerves located in the walls of renal arteries. The results of the Symplicity HTN-1 and HTN-2 trials proved...

The strategy of the Czech Society for Oncology of the Czech Medical Association of J. E. Purkyně for the organisation of oncological care in the Czech Republic

J. Vorlíček

Vnitr Lek 2013, 59(8):730-737  

The Czech Society for Oncology of the Czech Medical Association of J. E. Purkyně (ČOS ČLS JEP) builds on intensive collaboration at all levels of medical care during the organisation of oncological care. Over 77,000 malignant neoplasms are diagnosed in the Czech Republic annually. Every year, over 27,000 patients with a malignant tumour die in the Czech Republic. A total of over 450,000 patients with malignant tumours or patients with a history of an oncological disease are living in the Czech Republic. The specialised society analyses available data about the treatment history and offers them to the individual regions; it also plans population-based...

Metformin: the overlap of diabetology and oncology

M. Anděl, P. Škrha, J. Trnka

Vnitr Lek 2013, 59(8):738-742  

Type 2 diabetes moderately increases predisposition for manifestation of tumor disease. Both drugs stimulating insulin secretion (insulin secretagogues) and insulin injection therapy also moderately increases risk of tumor manifestation (OR approx 1.3). According to some reports pyoglitazon therapy could be of increased risk of bladder cancer. On the other hand, hunderds of study on isolated cells, experimental animal models and retrospective studies in patients have shown preventive effect of metformin therapy on manifestation tumors of pancreas, breast, colorectum, liver, endometrium and ovary. More over, the prognosis of diabetic cancer patients...

Colitis precipitated by Clostridium difficile - a serious current problem

P. Husa

Vnitr Lek 2013, 59(8):743-746  

Clostridium difficile is currently considered a significant cause of nosocomial infection. The probability of a colonisation of hospitalised patients rises with the length of their stay in hospital and depends on the local epidemiologic situation. Interdisciplinary collaboration is the foundation of the effort to limit the development of this very serious, often fatal disease. The basic element is a rational antibiotic therapy which builds on the knowledge that the administration of antibiotics, even though based on a correct indication, may be fatal in an environment which is massively contaminated by spores of Clostridium difficile....

Recent possibilities of treatment of End Stage Renal Desease

O. Viklický, S. Rajnochová-Bloudíčková

Vnitr Lek 2013, 59(8):747-751  

The End Stage Renal Deasease (ESRD) represents a significant medical and economic problem. The success of long-term outcome of ESRD is dependent on the adequate nephrological care. The treatment of choice represents a kidney transplantation from a living donor or in those who haven't got such possibility, a deceased donor kidney transplantation. Recently, number of living donor kidney transplants has been increasing during last years in Europe and USA, mainly because of large awareness campaign and by using incompatible pairs. There were 361 (34.3 pmp) deceased donor and 71 (6.7 pmp) living donor kidney transplants performed while 4,050 patients benefit...

Významné životní jubileum prof. MUDr. Evy Topinkové, CSc. (Osobní zprávy)

prim. MUDr. Tomáš Richter

Vnitr Lek 2013, 59(8)

Moderní farmakoterapie v pneumologii (Z odborné literatury)

prof. MUDr. Jana Skřičková, CSc.

Vnitr Lek 2013, 59(8)

Minimum z plicní chirurgie ... krok za krokem (Z odborné literatury)

Jiří Vokurka

Vnitr Lek 2013, 59(8)