zde - 1. lékařská fakulta - Univerzita Karlova

36
SEKCE POSTGRADUÁLNÍ – KLINICKÁ ČÁST I
Metodika: Do studie bylo zařazeno 25 obézních žen a 14 štíhlých zdravých žen, u kterých byly provedeny krevní odběry
a odběr subkutánní a viscerální tukové tkáně v průběhu plánovaného chirurgického výkonu (bandáž žaludku resp. cholecystektomie).
Sérové koncentrace inzulinu a cytoadhezivních molekul byly stanoveny multiplexovou imunoanalýzou pomocí Luminex
kitů, exprese mRNA CAM ve vzorcích tukové tkáně metodou real-time PCR a proteinová exprese CAM pomocí Luminex
kitů a normalizována k obsahu proteinů.
Výsledky: U obézních žen jsme zaznamenali signifikantně vyšší BMI a solubilních CAM E-selectinu a ICAM-1. Sérové koncentrace
VCAM-1 se mezi skupinami významně nelišily. Nebyl zaznamenán rozdíl v expresích mRNA a proteinů CAM v subkutánním
tuku mezi skupinou obézních a štíhlých žen. Naopak, ve viscerálním tuku byla exprese mRNA i proteinová exprese pro
ICAM-1 a VCAM-1 významně zvýšená ve skupině obézních žen (ICAM-1 kontroly vs. obézní (BMI 30-40): 6,4 x 10 -5 ± 2 x 10 -5 vs.
1,99 x 10 -4 ± 3,7 x 10 -5 , p < 0,01; VCAM-1 kontroly vs. obézní (BMI 30-40): 6,2 x 10 -5 ± 2 x 10 -5 vs. 2 x 10 -4 ± 6,3 x 10 -5 , p < 0,5).
Závěr: Výsledky svědčí pro zvýšenou produkci proaterogenně působících cytoadhezivních molekul ve viscerální tukové
tkáni obézních žen, ne však v subkutánní tukové tkáni. Výsledky studie tak mohou částečně objasnit vztah mezi rizikem kardiovaskulárních
onemocnění a akumulací viscerálního tuku u obézních jedinců popsaný zejména ve velkých epidemiologických
studiích.
Podporováno IGA 8302-5 a MZO 000064165.
UNRUPTURED INTRACRANIAL ANEURYSMS – CLIP, COIL OR NATURAL COURSE OF DISEASE?
A LONG TERM, PROSPECTIVE, SINGLE INSTITUTIONAL STUDY
1 2 1,3 1 Authors: Bradáč Ondřej, M.D., Beneš Vladimír III., M.D., Beneš Vladimír II., M.D., PhD., Department of
Neurosurgery, Central military hospital in Prague, Charles University in Prague, First Faculty of Medicine,
2Department of Neurosurgery, Regional Hospital Liberec
Supervisor: prof. Vladimír Beneš, DrSc., 1Department of Neurosurgery of the First Faculty of Medicine and Central
Military Hospital in Prague
Objective: Management of unruptured intracranial aneurysms is still a frequently discussed topic. We aim to predict optimal
age for changing the treatment from active to passive therapy and to determine differences between surgical and endovascular
procedures. These predictions are based on the data from our prospectively collected database during the period 1990 -
2006.
Methods: 321 unruptured aneurysms of anterior circulation were included in our study, divided into two groups – surgical
and endovascular (156 and 165 UIAs). Life expectancies of the patients posing UIA of certain diameter in various ages were
determined from annual rupture rates. These life expectancies were compared with the life expectancy after an active treatment
procedure with certain procedural risk derived from our database.
Results: The overall procedural mortality and morbidity was 5.8% in the surgical and 4.2% in the endovascular group. Zero
benefit ages were determined for small (age of 50 for surgery, age of 36 for endovascular techniques), medium (age of 68 and
59), large (age of 63 for surgery) and giant (age of 70 for surgery) aneurysms. The years saved by active therapy in comparison
with the watch and wait strategy for the patient at the age of 20 were determined as 1, 7, 27 and 42 years for small, medium,
large and giant UIAs, similar by both modalities.
Conclusions: The benefit of active treatment was proven for medium, large and giant unruptured intracranial aneurysms till
great age. In case of small aneurysms one should decide entirely on individual basis.
CARBOHYDRATE-DEFICIENT TRANSFERRIN HAS HIGHER SENSITIVITY AND SPECIFICITY FOR THE
DETECTION OF ALCOHOL ABUSE THAN GMT, AST/ALT RATIO AND MCV IN THE CIRRHOTIC POPU-
LATION
Authors: Dousa Miroslav, Zima Tomas, Mejstrikova Ester, Bruha Radan
Supervisor: doc. MUDr. Radan Brůha, CSc., IV. interní klinika 1. LF a VFN
In the cirrhotic patients correct knowledge about alcohol abuse is of great importance. In this study we analyzed the contribution
of the percentage of carboxy deficient transferrin (%CDT) to diagnose alcohol abuse in the cirrhotics. Sensitivity and specificity
of %CDT was compared with conventional markers (GMT, AST/ALT ratio, mean erythrocytes corpuscular volume MCV).
Methods: Patients (n=45) with liver cirrhosis (ethylic aetiology) were examined for laboratory markers of alcohol abuse and
average daily alcohol intake in the 28 days previous to the laboratory examination (calculated according to standardised self
reported protocol). %CDT was assessed using Axis-Shield assay.
Results: In the cirrhotics the higher level of %CDT was the most significant marker of alcohol abuse (Mann-Whitney,
p=0.0002). Higher MCV (Mann-Whitney, p=0.0015) was also significant. On the other hand, GMT and AST/ALT ratio were not
found to be significant. Sensitivity of %CDT (cut off 2.8) in estimation of alcohol abuse was 79%, sensitivity of MCV was (cut off
96 fL) 76%. Specificity of %CDT (cut off 2.8) in the estimation of alcohol abuse was 92% and specificity of MCV (cut off 96 fL) was
67%.