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 | Všeobecné lékařství - Magisterský studijní program: výukové materiály pro mediky:
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| Diapozitivy k přednáškám (PPT; česká a anglická verze):
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 | Periferní cirkulace I - fyziologie cévní stěny (česky; english)
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| Doktorské studium (PhD v rámci společného programu pražských lékařských fakult UK a ústavů AV ČR "Postgraduální doktorské studium biomedicíny" [PDSB])
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| Doktorandi, které vedu (nebo to už mají za sebou):
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| Téma: Mechanismus vlivu hypoxie na fetoplacentární cévní řečiště
Přijat: 1. 10. 2004
Forma: Prezenční, poslední rok kombinovaná
Obhájil: 10. 9. 2009
Pracoviště: Fakultní Thomayerova nemocnice v Praze
Publikace
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| Téma: Podíl vazokonstrikce na mechanismu chronické plicní hypertenze
Přijata: 2001
Forma: Kombinovaná
Pracoviště: Anestesiologie UK 2.LF a FNM
Publikace
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| Téma: NOx pri šoku
Forma: Kombinovaná
Pracoviště: Traumatologie FNM a UK 2.LF
Publikace
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| MUDr. Alena Baňasová, PhD
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| Téma: Úloha iNOS a žírných buněk v mechanismu rozvoje hypoxické plicní hypertenze
Přijata: 2007
Forma: Kombinovaná
Obhájila: 12. 6. 2008
Pracoviště: Ústav patofyziologie UK 2.LF
Publikace
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| Téma: Aktivita tkáňového faktoru u nemocnych s akutním koronárním syndromem
Forma: Kombinovaná
Obhájil: 27. 9. 2007
Pracoviště: Kardiologie UK 2.LF a FNM
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 | J Veselka, D Cerna, P Zimolova, P Blasko, J Fiedler, P Hajek, M Maly, D Zemanek, and R Duchonova: Thirty-day outcomes of direct carotid artery stenting with cerebral protection in high-risk patients. Circ J, September 1, 2007; 71(9): 1468-72.
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| BACKGROUND: Implantation of a carotid artery stent after predilation is a standard approach in the endovascular treatment of carotid artery stenoses. Stenting without predilation may be an alternative approach in a certain subset of patients. The present prospective, single-center registry was designed to evaluate the feasibility and safety of direct carotid artery stenting (DCAS) in high-risk patients. METHODS AND RESULTS: Symptomatic patients with stenosis >50% and asymptomatic patients with stenosis >70% were eligible for enrolment. Criteria for high-risk patients included: need or history of open heart surgery, history of myocardial infarction, multivessel coronary artery disease, left ventricular dysfunction (ejection fraction < or =40%), severe pulmonary or renal disease, significant contralateral carotid disease, previous endarterectomy, and age > or =80 years. All procedures were performed using a filter protection device. Patients underwent complete clinical examination before and after DCAS and at 30-day follow-up. A total of 83 consecutive patients (45 males, 68+/-9 years, 33% symptomatic) underwent 100 procedures and 103 stents were deployed successfully. The technical success rate of stenting was 100%. Predilation of carotid stenosis was necessary in 1 (1%) procedure. Carotid-artery stenoses before and after DCAS were 80+/-9% and 7+/-9%, respectively. The median fluoroscopic time for DCAS was 7 min. The overall rate of in-hospital major adverse cerebrovascular events (death, stroke, myocardial infarction) was 5% (2 minor strokes, 3 transient attacks). There was 1 (1%) minor stroke within the 30-day follow-up. CONCLUSION: DCAS is feasible and can be performed with an acceptable risk in high-risk patients.
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| J Veselka, R Duchonova, J Palenickova, D Zemanek, P Svab, P Hajek, M Maly, P Blasko, D Tesar, and P Cervinka: Age-related hemodynamic and morphologic differences in patients undergoing alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Circ J, July 1, 2006; 70(7): 880-4.
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| BACKGROUND: Alcohol septal ablation (ASA) decreases the left ventricular (LV) outflow gradient and relieves symptoms in patients with highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study was to evaluate the early course of hemodynamic, morphologic and clinical changes in younger and elderly patients. METHODS AND RESULTS: Forty-four consecutive patients (age, 24-81 years) underwent the ASA procedure for HOCM. Clinical and echocardiographic data were obtained at baseline and periodically up to 12 months after ASA. There was a significant correlation between septum thickness and age at baseline and in the early post procedural period (p = 0.004 at baseline, p = 0.0033 days postoperative, p = 0.0193 weeks pos operative). The dependence of septal thickness on the duration of follow-up (p < 0.001) was significantly influenced by age (p = 0.026), which retained statistical significance after multivariate adjustment (p = 0.031). A decrease in the gradient of the LV outflow was identified in all age-related groups of patients (p < 0.001). After multivariate adjustment, there was a significant influence of age (p = 0.003) and creatine kinase-MB peak (p = 0.016) on the course of outflow gradient reduction. CONCLUSIONS: ASA is an effective treatment option for patients with HOCM, irrespective of their age. Younger patients are characterized by a thicker basal septum at baseline and a slower hemodynamic improvement within the early post procedural period.
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| Acetylsalicylic acid inhibits aggregation of blood platelets through affecting arachidon acid metabolism--a precursor of thromboxan which is a strong platelet aggregation inhibitor. A standard method for measurement of aggregation activity blockade (in percents) of platelet rich plasma is turbidimetric aggregomethry based on spectrophotometric principle. According to results of recent studies administration of acetylsalicylic acid is one of the basic pillars of prevention of thrombotic complications in atherosclerotic arterial disease. Acetylsalicylic acid doses differ from study to study. An aim of our work was to measure speed of two different doses of acetylsalicylic acid. RESULTS: Level of aggregation activity blockade in samples of platelet rich plasma was measured by aggregometry in 26 healthy volunteers after administration of four inductors of thrombocyte aggregation (arachidon acid, adenosindiphosphate, collagen, and ristocetin). The samples were taken before administration and 120, 240, and 360 minutes after single peroral administration of 100 or 400 mg of acetylsalicylic acid. Samples of plasma were analysed immediately after sampling. Before drug administration there was no aggregation activity in 27.7% of the sample after arachidon acid administration, 28.3% after ADP administration, 21.5% after collagen administration and 25.3% after ristocetin administration. After administration of 400 mg of acetylsalicylic acid and administration of arachidon acid as an inductor 89.9% of the aggregation activity of the sample was blocked after 120 minutes, 89.6% after 240 minutes, and 90.6% after 360 minutes. After administration of adenosindiphosphate as an inductor 71.7% of the aggregation activity of the sample was blocked after 120 minutes, 68.3% after 240 minutes, and 69.9% after 360 minutes. And, after administration of ristocetin as an inductor 64% of the aggregation activity of the sample was blocked after 120 minutes, 66.4% after 240 minutes, and 54% after 360 minutes. Blockade of aggregation activity after collagen administration was not statistically significant. After administration of 100 mg of acetylsalicylic acid and administration of arachidon acid 83.8% of the aggregation activity of the sample was blocked after 120 minutes, 89.2% after 240 minutes, and 89.6% after 360 minutes. After adenosindiphosphate administration statistically significant blockade of aggregation activity was achieved after 360 minutes in the 56.7% of the sample. Also after collagen administration 42.5% of aggregation activity of the sample was blocked significantly after 360 minutes while ristocetin has not proved to influence aggregation in a statistically significant manner. CONCLUSION: Both doses of acetylsalicylic acid influenced aggregation activity of platelets in a statistically significant manner as soon as after 120 minutes following their peroral administration. However, they had different ability to influence platelets response to alternative ways of activation--by adenosindiphosphate, collagen, and ristocetin. 400 mg dose blocked these ways while 100 mg dose was efficient in blocking these ways after 360 minutes and in case of ristocetin--an inductor used to monitor platelet adhesion ability--100 mg dose has not led to statistically significant blockade at all.
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| BACKGROUND: Myocardial fractional flow reserve (FFR) is a useful method in assessment of functional significance of coronary stenosis. Deferral of intervention of angiographically intermediate lesion based on FFR measurement is safe in selected patient population as previously described. The aim of the study was to assess mid-term results after deferring coronary intervention of intermediate lesion in a non-selected patient population with no respect to the extent of coronary artery disease and to the results of stress tests if performed. METHODS: A coronary intervention of angiographically intermediate lesion (40 - 70% according to QCA) was deferred in a group of 50 consecutive patients (33 men, mean age 60.8 +/- 10.2 y.) on the basis of FFR > or = 0.75 (mean FFR 0.89 +/- 0.06). FFR was measured in 62 lesions (mean stenosis diameter 55 +/- 7%, left anterior descending 34 lesions, circumflex artery 13 lesions, right coronary artery 15 lesions). One-vessel disease was presented in 14 pts (28%), 36 pts (72%) presented with multivessel disease (two-vessel disease in 27 pts - 54% and three-vessel disease in 9 pts - 18%). Stress test was positive in 15 pts, in 1 pts. negative, and in 3 pts. non-diagnostic. All-cause mortality, cardiac mortality, non-fatal myocardial infarction (MI) and ischemia driven target vessel revascularization (TLR) were recorded during follow-up. Severity of angina pectoris (CCS classification) and a need for antianginal treatment (beta-blockers, nitrates, calcium channel blockers) at the baseline and at the end of clinical follow-up was recorded. RESULTS: Follow-up was completed in 49 patients (98%). Mean time of follow-up is 15.4 +/- 2 months (range 12 - 22 months, median 15 months), two patients died (4 %)--one from colon cancer, the other patient died from lung cancer, there was not any cardiac death recorded, two patients (4%) had target vessel revascularization. Estimated 22 months event-free (all-cause death, MI, TLR) survival was (mean +/- SEM) 86 +/- 7%. There was a significant difference in symptom severity--mean grade of angina pectoris at baseline was 1.8 +/- 1.3, at follow-up 1.1 +/- 1.0 (p < 0.05). There was not difference in use of antianginal drugs was same at baseline and at follow-up (1.7 +/- 0.8 vs. 1.7 +/- 0.7). Thirty-five patients (71%) were treated by statins. CONCLUSIONS: Deferring of coronary interventions of intermediate stenosis based on FFR measurement is safe in a mid-term follow-up. Despite of the same intensity of antianginal treatment there was a significant decrease in symptom severity.
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| The tissue factor plays a crucial role in initiating blood coagulation after plaque rupture in patients with acute coronary syndrome. It is abundant in atherosclerotic plaques. Moreover, P-selectin, some cytokines, endotoxin and immune complexes can stimulate monocytes and induce the tissue factor expression on their surface. The aim of the study was to compare plasma levels of the tissue factor, tissue factor pathway inhibitor, P-selectin, E-selectin and ICAM-1 in patients with acute myocardial infarction, unstable angina pectoris, stable coronary artery disease and normal control subjects. In addition, plasma levels of the tissue factor, tissue factor pathway inhibitor, P-selectin, E-selectin and ICAM-1 were measured in the blood withdrawn from the coronary sinus in a subgroup of patients with unstable angina pectoris and stable coronary artery disease in which the difference between concentrations in the coronary sinus and systemic blood was calculated. A significant increase in tissue factor pathway inhibitor plasma levels was detected in patients with acute myocardial infarction (373.3+/-135.1 ng/ml, p<0.01) and unstable angina pectoris (119.6+/-86.9 ng/ml, p<0.05) in contrast to the patients with stable coronary artery disease (46.3+/-37.5 ng/ml) and normal subjects (45.1+/-14.3 ng/ml). The plasma levels of tissue factor pathway inhibitor were significantly increased both in the coronary sinus and systemic blood in the patients with unstable angina pectoris. There was only a non-significant trend to higher plasma levels of the tissue factor in patients with acute myocardial infarction and unstable angina pectoris as compared to the patients with stable coronary artery disease and normal subjects, the values being 129.1+/-30.2 pg/ml, 130.5+/-57.8 pg/ml, 120.2+/-45.1 pg/ml and 124.9+/-31.8 pg/ml, respectively. Plasma levels of soluble P-selectin was only slightly, but non-significantly higher in patients with unstable angina pectoris and stable coronary artery disease (184.2+/-85.4 ng/ml and 201.6+/-67.9 ng/ml, respectively) than in patients with the acute myocardial infarction (157.4+/-88.4 ng/ml) or normal subjects (151.4+/-47.1 ng/ml). The difference in plasma levels of soluble ICAM-1 between the blood withdrawn from the coronary sinus and systemic circulation correlated significantly with the corresponding difference in plasma levels of soluble P-selectin and E-selectin. In conclusion, the tissue factor and the tissue factor pathway inhibitor play a crucial role in the initiation of arterial thrombosis. The tissue factor pathway inhibitor levels are increased both in the systemic blood and in the coronary sinus of patients with the acute coronary syndrome.
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| INTRODUCTION: When evaluating angiographically marginal coronary stenoses (i.e. 40-70% reduction of the diameter of the arterial lumen) it is under certain conditions difficult to decide on their actual functional impact. Assessment of the fractional flow reserve (FFR) is a simple method based on assessment of intracoronary pressures during pharmacologically induced hyperaemia. For the severity of stenosis according to previous studies the liminal values is FFR lower than 0.75; furthermore it was proved that intervention of angiographically marginal stenoses with FFR values of 0.75 or more can be safely postponed. OBJECTIVE: Test the safety of FFR examination and take in a group of patients with marginally severe stenosis further steps according to results of FFR assessment. MATERIAL AND METHODS: During the period from January to Juky 2000 FFR assessments were made in a total of 34 patients (11 women, 23 men, mean age 62 +/- 12 years) who suffered from marginal stenosis of some coronary vessel. The FFR examination took place under pharmacologically induced hyperaemia after intracoronary adenosine administration. RESULTS: Measurements were made in a total of 41 stenoses. Only in two a value lower than 0.75 was found. In these patients coronary intervention was implemented; intervention was also made in two patients on account of technical problems and inconsistent results of FFR measurements. A FFR value of 0.75 or less was found in 37 stenoses (90%) and intervention was therefore postponed. Examination and the immediate subsequent course were without complications. CONCLUSION: According to initial experience FFR examination is a safe, simple and easily reproducible method. Based on the results of assessment and knowledge of the accomplished studies in the group of marginally significant stenoses in a great proportion of patients coronary intervention was postponed.<
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| Téma: Experimentální plicní hypertenze
Forma: Kombinovaná (školitel: prof. Herget, já spoluškolitel)
Obhájila: 11/2003
Pracoviště: Dětská lékařka v soukromé ordinaci
Publikace
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| Informace pro zájemce o doktorské studium u nás
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| Těžištěm je vlastní výzkumná práce pod vedením školitele v rámci rozsáhlejšího výzkumného projektu laboratoře
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| Minimum přednášek a seminářů
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| Odborná příprava zahrnuje formulaci hypotéz a plánování pokusů, vyhledávání relevantních informací (Medline, www) a jejich kritické vyhodnocování, statistické a grafické zpracování vlastních výsledků, přípravu publikací, prezentační dovednosti,...
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| Možnost odborného růstu na mezinárodně uznávaném pracovišti
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| Pro absolventy lékařských fakult možnost příležitostné klinické práce ve Fakultní nemocnici Motol (na základě individuální dohody se školitelem a vedoucím příslušné kliniky)
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| Ukončené studium lékařské nebo veterinární fakulty nebo ukončené magisterské studium biologického oboru v době zahájení postgraduálního studia (přihlásit se lze před definitivním dokončením studia)
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| Alespoň elementární znalost angličtiny
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| Podmínkou přihlášky je předchozí osobní domluva se školitelem (na základě e-mailového kontaktu)
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| Zpět na domácí stránku V.H.
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