Biomedical papers - Latest articles

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Acute pancreatitis as a risk factor of chronic pancreatitis and pancreatic cancer. An overviewReviews

David Solil, Petr Dite, Michal Senkyrik, Martina Bojkova, Bohuslav Kianicka

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(4):284-287 | DOI: 10.5507/bp.2024.023  

Early diagnosis of pancreatic cancer and successful treatment is difficult. The optimization strategy is linked to identifying the specific subgroups of pancreatitis. To improve prognosis, it is crucial to identify patients at risk, in other words patients following acute pancreatitis and those with recurrent acute pancreatitis. The risk for pancreatic cancer development is very high in patients who are positive for other risk factors such as obesity, metabolic syndrome, alcohol abuse, smoking etc.

Exploring the benefits and challenges of AI-driven large language models in gastroenterology: Think out of the boxReviews

Jan Kral, Michal Hradis, Marek Buzga, Lumir Kunovsky

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(4):277-283 | DOI: 10.5507/bp.2024.027  

Artificial Intelligence (AI) has evolved significantly from its early concepts in the 1950s to today's advanced large language models (LLMs) like ChatGPT. This technology has the potential to revolutionize gastroenterology, including diagnosis, treatment, education, and decision-making support. The benefits to gastroenterology include accelerating diagnosis and treatment, providing personalized care, enhancing education, aiding decision-making, and improving patient communication. However, challenges like limited AI capability, biased data, errors, security and privacy concerns, and costs must be addressed. The future of LLMs in gastroenterology depends on processing large quantities of data, identifying patterns, and assisting in personalized treatment plans. Collaboration between AI developers, healthcare professionals, and regulatory bodies is essential for responsible use, ensuring LLMs support doctors and contribute to better patient care.

A severe case of pemphigoid gestationis persisting after labour - case report and review of the literatureCase report

Hynek Herman, Petr Krepelka, Adela T. Faridova, Klara Trojanova, Jiri Hanacek, Barbora Jaluvkova, Jaroslav Feyereisl, Spyridon Gkalpakiotis

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):271-275 | DOI: 10.5507/bp.2023.010  

The communication on pemphigoid gestationis is of paramount importance not only because of the need to report such a serious disease in a professional journal, but also as a recommendation for possible treatment of this rare condition in pregnancy which a large number physicians and especially obstetricians may not encounter in their entire careers. As with other diseases, early and accurate diagnosis and subsequent early therapy is of primary importance, to obviate major deterioration in the condition, the risk to the pregnant woman and the fetus, and to the newborn after delivery.

The Czech National MS Registry (ReMuS): Data trends in multiple sclerosis patients whose first disease-modifying therapies were initiated from 2013 to 2021Original papers

Dominika Stastna, Jiri Drahota, Michal Lauer, Aneta Mazouchova, Ingrid Menkyova, Jana Adamkova, Radek Ampapa, Michal Dufek, Marketa Grunermelova, Pavel Hradilek, Eva Kubala Havrdova, Jan Mares, Alena Martinkova, Zbysek Pavelek, Marek Peterka, Eva Recmanova, Petra Rockova, Ivana Stetkarova, Pavel Stourac, Marta Vachova, Dana Horakova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):262-270 | DOI: 10.5507/bp.2023.015  

Multiple sclerosis treatment strategies are changing in the Czech Republic. According to data from 2013-2021, the proportion of patients starting high-efficacy disease-modifying therapies is increasing. These findings come from the Czech National Multiple Sclerosis Registry ReMuS which provides a quality source of data for not only scientific publications, but national regulatory authorities as well. Its outputs offer feedback and a means for improving the management of multiple sclerosis in the future.

Point-of-care ultrasound (POCUS) in acute hospitalized older patients focused on hydrationOriginal papers

Vladimir Hrabovsky, Martina Skrobankova, Zdenek Lys, Adela Vrtkova, Veronika Spacilova, Jan Vaclavik

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):256-261 | DOI: 10.5507/bp.2023.038  

Ultrasound examination is non-invasive, simple to perform and it provides valuable information on a patient´s condition, including geriatric. Patients as older individuals frequently suffer from dehydration. This study showed that ultrasound assessment provides immediate key information for comprehensive understanding of clinical status in older patients and can be beneficial for optimizing the treatment strategy, including fluid management decisions.

Changes in vascular density in the macula after pars plana vitrectomy for idiopathic macular hole with macular peeling and one type of flapOriginal papers

Anna Tarkova, Nada Jiraskova, Jaroslava Dusova, Jan Marak, Jan Studnicka

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):248-255 | DOI: 10.5507/bp.2023.017  

In this study, the authors focused on changes in the vascular density of the superficial and deep vascular plexus in temporal and foveal-sparing flap after pars plana vitrectomy (PPV) with macular peel. The vascular density of the deep plexus increased in both groups and the vascular density of the superficial plexus was almost the same in the temporal flap and in the foveal-sparing flap was reduced during the one-year follow-up period. The results were also confirmed by the anatomical improvement. The authors demonstrated a statistical relationship between the duration of symptoms and changes in the microvasculature in the macula in both groups. No significant differences were found between the various forms of the flap method used in PPV.

A stylet use may be beneficial for elective and rescue intubation of prematurely born infants < 30 weeksOriginal papers

Klara Dunajova, Tereza Lamberska, Truong An Nguyen, Adam Kubica, Petr Kudrna, Richard Plavka

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):243-247 | DOI: 10.5507/bp.2024.015  

This study challenges the prevailing view that stylet use during intubation offers no benefit, specifically in the context of premature infants in the delivery room. Through the detailed analysis of 104 intubation attempts across 70 infants, the authors found that employing a stylet significantly enhances the success rate of initial intubation attempts, shortens the procedure's duration, and lowers the risk of severe desaturation events. The evidence suggests that the use of a stylet could be significant for stabilization of extremely premature infants during the golden hour of their life, marking a significant shift in current practices for this vulnerable population.

Severe congenital T-lymphocytopenia may affect the outcome of neonatal intensive careOriginal papers

Ivana Hulinkova, Veronika Medova, Andrea Soltysova, Veronika Dobsinska, Andrej Ficek, Peter Ciznar

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):235-242 | DOI: 10.5507/bp.2023.028  

This study evaluated the amount of TREC in a group of risk newborns and found a significant association between low TREC values and the occurrence of sepsis. The authors identified an association between mortality in preterm neonates with sepsis in patients with TREC < 5th percentile and they hypothesize that low TREC values may be a surrogate marker for mortality in preterm neonates.

A comparison of heart failure patients with reduced ejection fraction in the Moravian Midlands Registry with the LCZ696 patients in the Paradigm-HF trialOriginal papers

Ludek Pavlu, Marek Vicha, Jakub Flasik, Jana Petrkova, Milos Taborsky, Tereza Kacirkova, Ondrej Holy

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):229-234 | DOI: 10.5507/bp.2023.006  

This study aspired to provide comprehensive real-world data on a population with heart failure in the Moravian region of the Czech Republic. The authors compared local clinically relevant data with those from the ground-breaking Paradigm-HF trial and they found that local patients had a more advanced state of heart failure. The high prevalence of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy (CRT) confirms access to advanced and financially demanding treatment options in this region.

Influence of graft anastomosis and graft morphology on long-term patency of the saphenous vein after aortocoronary bypassOriginal papers

Okaikor Okantey, Tomas Jonszta, Jiri Sieja, Miriam Kende, Radim Brat, Lubomir Pavliska

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):223-228 | DOI: 10.5507/bp.2024.013  

Coronary artery bypass grafting (CABG) is a surgical modality that resolves ischemic myocardial disease. The success of the procedure depends on a number of factors. Construction of the anastomosis and graft characteristics play a functional role in graft patency. This follow-up analysis of a study on the effects of endoscopic vein harvest after bypass surgery compared the outcome of sequential anastomoses and single grafts, vein graft length and diameter, calcium score, and target artery quality on long-term vein graft patency. The differences between sequential and individual grafts were not statistically significant. Graft and target artery diameters had a statistically significant influence on patency. Longer graft lengths and higher calcium scores were associated with statistically significant graft occlusion.

Ultrasonographic signs as predictors of metastatic involvement in the axillary lymph nodes in breast cancer patients: from minimal changes to the appearance of the pathological lymph node. A retrospective analysisOriginal papers

Lucia Veverkova, Marketa Koleckova, Katherine Vomackova, Nora Zlamalova, Lubica Lowova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):216-222 | DOI: 10.5507/bp.2023.009  

This is a retrospective analysis of ultrasound findings in axillary lymph nodes in the patients with newly diagnosed breast cancer. The study focuses on the minimal morphological changes as early signs of metastatic involvement. This could be the basis for the design of a scoring system to evaluate axillary lymph nodes apropos sonographic features and with regard to the type of primary breast cancer and its aggressiveness. This retrospective evaluation and research may contribute to better ultrasound evaluation of lymph nodes in breast cancer patients

Challenges with hippocampal MR spectroscopy as a surrogate for pre-radiotherapy assessment of neurocognitive impairment in patients with brain metastasisOriginal papers

Iveta Selingerova, Klara Holikova, Tomas Chodur, Ludmila Hynkova, Petr Pospisil, Martin Bulik, Renata Belanova, Kamila Siffelova, Ivana Kolouskova, Marek Slavik, Petr Burkon, Roman Hrstka, Radim Jancalek, Jiri Sana, Pavel Slampa, Tomas Kazda

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):206-215 | DOI: 10.5507/bp.2024.012  

Patients with multiple brain metastases (BM) benefit from hippocampal-avoiding whole brain radiotherapy (HA-WBRT), a less available form of WBRT. This study explores pre-radiotherapy (pre-RT) hippocampal magnetic resonance spectroscopy (MRS) as a tool for assessing neurocognitive functions (NCF) in order to identify which patients may benefit from HA-WBRT. 43 BM patients underwent pre-RT hippocampal MRS, correlating N-acetylaspartate (neuronal density surrogate) with NCF tests (HVLT and BVMT). Borderline statistically significant correlations were found with speculative interpretation underlying the challenges of hippocampal MRS as a surrogate for neurocognitive impairment. Further studies are needed to validate hippocampal MRS as a predictor for memory sparing radiotherapy benefit.

Interventions for increasing medication adherence in heart failure patients: A narrative reviewReviews

Libor Jelinek, Jan Vaclavik, Marie Lazarova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):200-205 | DOI: 10.5507/bp.2024.022  

Heart failure is one of the critical and most costly medical challenges of the 21st century. It is a chronic debilitating condition and adherence to medication, a precondition for successful treatment is often poor. There are various interventions for improving adherence. Depending on the goal of the intervention, these are roughly patient centric, healthcare provider centric and system centric. The authors provide an overview of these interventions with a focus on effectiveness and appropriateness in different clinical situations. Their use can lead to improved patient outcomes and reduced economic burden of the disease.

Chronic non-bacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO) with a focus on pamidronate therapyReviews

Katerina Bouchalova, Zuzana Pytelova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(3):191-199 | DOI: 10.5507/bp.2024.007  

CNO/CRMO is a rare autoinflammatory bone disease of unknown etiology. The authors review the etiology, epidemiology, clinical course, diagnostic criteria, development of classification criteria, diagnostic methods, association with other diseases, methods for disease activity evaluation, treatment and tasks for the future. Tables comparing different diagnostic criteria, recently developed RINBO index (radiologic index for nonbacterial osteomyelitis) and summary of studies on CNO/CRMO therapy using pamidronate are included.

Macrotroponins cause discrepancy in high-sensitivity examinationCase reports

Pavel Broz, Jaroslav Racek, Pavel Prokop, Jaroslav Novak, Daniel Rajdl, Ladislav Trefil

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):187-190 | DOI: 10.5507/bp.2023.001  

This work presents two cases of a discrepancy between clinical presentation and falsely elevated cardiac troponins concentrations. Cases like this are well known to laboratory professionals, however, according to the experience of the authors, clinical professionals are often not. Presentation of such cases to the wider medical community can help avoid unnecessary investigation and possible harm to patients.

Bacillus Calmette-Guérin pneumonitis after intravesical instillation: Report of two cases and a review of the literatureCase reports

Martina Spisarova, Stanislav Losse, Petr Jakubec, Igor Hartmann, Milan Kral, Jiri Ehrmann, Marek Szkorupa, Hana Studentova, Bohuslav Melichar

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):181-186 | DOI: 10.5507/bp.2022.051  

Two cases of BCG pneumonitis described in this study highlight the necessity to consider systemic BCG infection in patients after intravesical BCG therapy. Uncommon complications of bacillus Calmette-Guérin administration could be very serious and threaten the life of patients treated with this modality. Treatment with specific antituberculotic medication underlines the importance of correct diagnosis.

Robotic assisted living donor nephrectomy - the first in the Czech RepublicCase reports

Pavel Zemla, Igor Hartmann, Frantisek Hruska, Milan Kral, Jana Janeckova, Petr Utikal, Ales Vidlar, Karel Krejcí, Petr Bachleda

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):177-180 | DOI: 10.5507/bp.2023.034  

This work describes the first robotic assisted living donor nephrectomy in the Czech Republic which was performed in June 2022. Worldwide, this operation was first carried out in 2001 and has now become common practice at many workplaces. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. The authors believe this breakthrough in the Czech Republic will trigger an increase in robotic assisted kidney harvesting. This paper also incorporates our ten-year experience in living donor nephrectomies, conducted using various techniques.

B cell subsets reconstitution and immunoglobulin levels in children and adolescents with B non-Hodgkin lymphoma after treatment with single anti CD20 agent dose included in chemotherapeutic protocols: single center experience and review of the literatureOriginal papers

Eva Hlavackova, Zdenka Krenova, Arpad Kerekes, Peter Slanina, Marcela Vlkova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):167-176 | DOI: 10.5507/bp.2023.021  

This is a retrospective one tertiary centre study which investigated the humoral and cellular immunity reconstitution and clinical impact of chemotherapeutic protocols that included a single rituximab dose in children and adolescents treated for non-Hodgkin Lymphoma. The proportion of IgG, IgM, and IgA hypogammaglobulinemia decreased over the follow-up period. The median for B cell reconstitution was 3 months after the end of lymphoma treatment. Transitional B lymphocyte subsets dominated at the time of B cell subset reconstitution. No secondary antibody deficiency needing immunoglobulin replacement therapy was found.

High incidence of acute and subacute ischaemic foci on brain MRI in patients with a diagnosis of acute pulmonary embolism and confirmed patent foramen ovaleOriginal papers

Radomir Nykl, Martin Hutyra, Eva Cechakova, Jan Precek, David Vindis, David Richter, Milos Taborsky

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):162-166 | DOI: 10.5507/bp.2023.005  

The authors present an evaluation of 129 patients with a diagnosis of acute pulmonary embolism who were thoroughly examined (TTE, TEE, laboratory, brain MRI), They found a surprisingly high incidence of acute and subacute pathological findings on brain MRI in direct relation to the presence of PFO confirmed by TEE.

Utility of fine-needle aspiration biopsy (FNAB) in parotid pleomorphic adenoma diagnosis and managementOriginal papers

Alzbeta Fikova, Stepan Novak, David Kalfert, Martin Kuchar, Michal Zabrodsky, Lucie Dostalova, Jan Balko, Jan Plzak

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):156-161 | DOI: 10.5507/bp.2023.027  

The results confirmed, that ultrasound-guided fine-needle aspiration biopsy (FNAB) is valuable in the diagnostic algorithm for patients with pleomorphic adenoma. Ultrasound-guided FNAB is simple, accurate and valuable in the diagnosis of plemorphic adenoma and provides results that can lead to the choice of less invasive operative treatment. For smaller tumours in favourable locations, extracapsular dissection is a safe and adequate surgical technique with minimal risk to the facial nerve or other local complications and without increased risk of recurrence.

Retinal microvascular abnormalities in major depressionOriginal papers

Evgenii Sadykov, Ladislav Hosak, Alexandr Stepanov, Jana Zapletalova, Jan Studnicka

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):147-155 | DOI: 10.5507/bp.2023.026  

The authors detected significantly larger retinal arteriolar and venular calibres in a non-geriatric population with major depression compared with a population without depression. The finding may be useful for prevention as well as personalized treatment of this serious mental disorder.

High pre-transplant Mucosal Associated Invariant T Cell (MAIT) count predicts favorable course of myeloid aplasiaOriginal papers

Ivana Karlova Zubata, Jitka Smetanova Brozova, Tomas Karel, Barbora Bacova, Jan Novak

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):139-146 | DOI: 10.5507/bp.2023.011  

MAIT cell abundance detected before myeloablative conditioning and autologous stem cell transplantation predicts the course of myeloid aplasia. The number of MAIT cells negatively correlated with peak C-reactive protein level and the amount of red blood cell transfusion units resulting in earlier discharge of patients with the most abundant MAIT cells.

Levels of retinol and retinoic acid in pancreatic cancer, type-2 diabetes and chronic pancreatitisOriginal papers

Pavel Hrabak, Miroslava Zelenkova, Tomas Krechler, Jan Soupal, Michal Vocka, Tomas Hanus, Lubos Petruzelka, Stepan Svacina, Ales Zak, Tomas Zima, Marta Kalousova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):132-138 | DOI: 10.5507/bp.2023.049  

There are still uncertainties about role of retinoids in pancreatic pathologies. The authors used high-performance liquid chromatography with UV detection to measure the serum the retinol and ATRA levels in 246 patients with PDAC, CHP, T2DM and healthy controls. The authors confirmed a significant decrease in retinol levels in PDAC compared to CHP and healthy controls, significant decrease of ATRA levels in PDAC compared to T2DM and healthy controls and they found a correlation between retinol, prealbumin and transferrin, and of ATRA and insulin-like growth factor binding protein-2.

Serum concentrations of 25-OH vitamin D and the pro-inflammatory interleukins IL-17, IL-23, and IL-18 in patients with plaque psoriasisOriginal papers

Maria Ganeva, Zhivka Tsokeva, Tanya Gancheva, Evgeniya Hristakieva, Vanya Tsoneva, Irena Manolova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):124-131 | DOI: 10.5507/bp.2023.043  

The IL-23/IL-17 pathogenic axis plays a key role in the pathogenesis of psoriasis. Vitamin D is thought to be involved in the development of many diseases by modulating the inflammatory process. The study established a moderate negative correlation between 25(OH)D levels and the PASI score suggesting participation of vitamin D in the pathogenesis of psoriasis. Significantly higher concentrations of pro-inflammatory IL-17A and IL-18 in individuals with cardio-metabolic diseases (CMDs) in the study cohort and elevated levels of these cytokines in psoriasis patients with CMDs were detected.

Novel approach to adherence assessment based on parent drug and metabolite pharmacokinetics: pilot study with spironolactoneOriginal papers

Alena Pilkova, Martin Sima, Jan Miroslav Hartinger, Thi Minh Phuong Nikrynova Nguyen, Vera Maresova, Ivana Kurcova, Ondrej Slanar, Jiri Widimsky

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):117-123 | DOI: 10.5507/bp.2022.048  

Detection of drug or its metabolite in a blood sample without evaluation of serum concentration does not fully enable uncovering instances of improper drug use or white-coat adherence. Considering pharmacokinetic properties of the drug helps us to recognize if measured concentration refers to steady state, i. e. regular use, or is markedly reduced and therefore originates from irregular or single dose ingestion before sampling. Application of pharmacokinetic principles in the interpretation of serum concentrations of antihypertensive drugs leads to a more precise evaluation of a patient's behaviour.

Current trends in the management of out of hospital cardiac arrest (OHCA)Reviews

Michal Plodr, Eva Chalusova

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):105-116 | DOI: 10.5507/bp.2024.006  

The last decade has seen the development of new procedures and technologies that have the potential to reverse the unfavourable prognosis of patients after OHCA. The early availability of AEDs in remote or sparsely populated destinations can be solved by deploying drones as AED carriers. Dispatchers will be able during an incoming emergency call to rely on the support of machine learning models or videocalls from the scene. The use of ECMO in patients after cardiac arrest is already an introduced method in the early in-hospital phase, and there are promising partial results from the pre-hospital area. The definition of input criteria for each method is a key factor in the misuse of forces and means and is a prerequisite to increasing the percentage of survival of OHCA with good neurological status.

Treatment adherence and the contemporary approach to treating type 2 diabetes mellitusReviews

Bela Kolars, Ivana Minakovic, Beata Grabovac, Dejan Zivanovic, Vesna Mijatovic Jovin

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(2):97-104 | DOI: 10.5507/bp.2024.009  

This paper explores the modern approach to treating type 2 diabetes mellitus (T2D), emphasizing the importance of adherence for successful management. It reviews various components of T2D treatment, lifestyle modifications, including medical nutritional therapy and physical activity. Medications in contemporary treatment are discussed, each with specific benefits and potential risks. Factors influencing the adherence to the components of treatment are analysed. Even though adherence leads to a better disease outcome, it is often poor. The review concludes that addressing factors affecting adherence can significantly improve T2D outcomes and reduce costs.

Endoscopic treatment of pancreatic fluid collection in gastric heterotopic pancreas. A case reportCase reports

Ivana Mikoviny Kajzrlikova, Jan Kuchar, Petr Vitek, Barbora Horavova, Hana Vankova, Martin Chrostek

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(1):92-96 | DOI: 10.5507/bp.2022.043  

This case report details the diagnostic work-up in a young woman with clinical presentation of heterotopic pancreas. Here, imaging and endoscopic findings of a newly diagnosed submucosal mass in the gastric antrum are well described. Technical issues of endosonographically-navigated drainage of symptomatic fluid collection in heterotopic pancreas with a plastic double pigtail stent under fluoroscopic control are also presented. Fluid collections after acute pancreatitis in heterotopic pancreas can be successfully managed by endoscopy.

Pediatric Cushing's disease: Case reports and retrospective reviewCase reports

Renata Pomahacova, Petra Paterova, Eva Nykodymova, Josef Sykora, Michal Krsek

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(1):85-91 | DOI: 10.5507/bp.2022.049  

This article describes growth retardation and change in facial appearance with development of moon face as the first symptoms of CS. Growth retardation is prior to development of moon face. CRH test and BIPSS contribute to confirming the diagnosis of CD and excluding ectopic ACTH syndrome in children with invisible adenoma on MRI.

Disposition of levobupivacaine during intraoperative continuous caudal epidural analgesia in a preterm neonateCase reports

Jan Sipek, Pavla Pokorna, Martin Sima, Jitka Styblova, Vladimir Mixa

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(1):81-84 | DOI: 10.5507/bp.2023.047  

The use of epidural analgesia in neonates raises concerns due to possible drug cumulation and toxicity. In general, studying PK and modelling using plasma concentrations of the used local anaesthetic (LA) in neonates is applicable in daily clinical practice because the intravenous blood volume is small, and the number of samples does not have to be large. To the best of their knowledge, this is the first case report of the pharmacokinetic profile of levobupivacaine (LA) achieving pharmacotherapy goals during epidural use in preterm neonates. A special adjustment of the laboratory method reduced the blood samples to 0.2-0.5 mL each. Although elimination of levobupivacaine was prolonged, no accumulation occurred and concentrations of total and free levobupivacaine were well below the toxicity threshold. Epidural analgesia at this age should be monitored and used with caution.