[The importance of cardiac bio-marker assay for the stratification and monitoring of AL amyloidosis patients -  single center experience]. / Význam stanovení kardiálních bio-markeru ve stratifikaci a sledování nemocných s AL amyloidózou -  zkusenosti jednoho centra.

INTRODUCTION: Cardiac involvement is a dominant prognostic factor in AL amyloidosis patients. A detailed assessment of the presence and degree of cardiac involvement utilizes an array of noninvasive investigation methods, particularly echocardiography and MRI; laboratory parameters include troponins and natriuretic peptides. Cardiac involvement detection aside, cardiac bio-markers are used as a relatively strong stratification and prognostic factor. OBJECTIVE: The presentation of cardiac bio-markers assay applications in AL amyloidosis patients at an individual treatment center. PATIENTS AND METHODS: The monitored patient set consisted of 22 patients with histologically confirmed AL amyloidosis, of whom 18 met the criteria for cardiac involvement. Levels of cardiac bio-markers troponin T (TnT) and Nterminal probrain natriuretic peptide (NT ProBNP) were determined in all patients. Risk stratification of the patients utilized the Mayo staging system which is based on both bio-markers assays; Log Rank Test was applied to survival evaluation. RESULTS: Median survival of patients with cardiac involvement stigmata was 10 months vs 60 months survival of patients without signs of cardiac involvement (p = 0.133). Of the 4 patients without cardiac involvement, 1 has shown positive levels of TnT and 2 positive levels of NT ProBNP. All cardiac involvement patients exhibited abnormal levels of NT ProBNP (median 4,752 ng/ l; 415.7- 35,000) as well as positive levels of TnT (median 0.0815 µg/ l; 0.02- 0.986). The application of the Mayo stratification system to the set had determined 2 patients at stage I, 5 patients at stage II and 15 patients at stage III. The median survival of the Mayo I + II group vs the Mayo III group was 60 vs 6 months (p = 0.015), revealing extremely limited survival of stage III patients. Assessment of TnT and NT ProBNP levels relative to treatment response shows that the degree of decrease in both markers depends on maximum treatment response -  respectively the attainment of a complete hematological remission. CONCLUSION: The results, although obtained from a limited set of patients, confirm a definitive benefit of the application of cardiac bio-markers assay in the diagnostic and therapeutic algorithm of AL amyloidosis patients. The Mayo stratification system utilizing the cardiac indicator values represents a robust tool for risk stratification of AL amyloidosis patients.

[Attainment of complete hematological remission is crucial for extended survival of AL amyloidosis patients with cardiac involvement]. / Dosazení kompletní hematologické remise je zásadní pro prodlouzení prezití nemocných s AL amyloidózou a srdecním postizením.

BACKGROUND: Symptomatic cardiac involvement is the most important prognostic factor in AL amyloidosis patients. Longterm survival is limited not only by cardiac involvement condition, but also by limited choice of treatment with unsatisfactory results. The aim of the present report is to assess the effect of achieved treatment response on survival of AL amyloidosis patients with symptomatic cardiac involvement under conventional treatment. MATERIAL AND METHODS: The monitored patient set consisted of 19 patients with systemic AL amyloidosis and symptomatic cardiac involvement, treated and monitored at the III. Clinic of Internal Medicine between 2004 and 2012. The male : female ratio was 17 : 2, and the age median was 64 (range 48 to 78 years). Thirteen patients died within the monitored period. Functional status was defined according to the NYHA classification, where five patients had class II involvement, 10 patients had class III involvement, and four patients had class IV involvement. Treatment response was assessed by the application of modified IMWG and ISA criteria; all patients were undergoing conventional treatment. Nine patients were treated by a combination of alkylating agents (alkeran, cyclophosphamide), six were treated by a combination treatment with thalidomide, and four were treated by a combination of bortezomib and dexamethasone. Data were analyzed with software SPSS v. 15 (SPSS, Inc., Chicago, USA). Log Rank Test was applied to survival evaluation. RESULTS: The statistical analysis included only 13 patients who underwent at least three months of treatment, where six patients attained complete remission (CR), four patients attained partial remission (PR), and three patients attained only stabilization of disease (SD). Significant difference in patient survival was found to be correlated with attained hematological response, where the patients who attained CR had median survival of 39 months vs 10 months in patients who attained PR or SD (p = 0.005). CONCLUSION: The results indicate that attainment of complete hematological remission is associated with significantly longer survival of AL amyloidosis patients with symptomatic cardiac involvement.

[General psychotherapy]. / Obecná psychoterapie.

Nowadays a theoretical psychotherapeutical thinking develops from the eclectic practice and uses particularly the research of the effective factors of the therapy. Best they can be characterized as differentiate, synthetic, integrative and exceeding other approaches. The development in question goes on with attempts of creating a general model of the psychotherapy that could be a basis for models of special psychotherapies. The aim of such a model is to describe all that is present as important factor for inducing a desirable change of a human in all psychotherapeutical approaches. Among general models we can mention the generic model of D. E. Orlinski and K. I. Howard, Grawe's cube (the author is K. Grawe) and the equation of the psychotherapy.

[The strategy and contemporary subjects of research in psychotherapy]. / Strategie a soutasná témata výzkumu v psychoteraph.

By the means of the research of the psychotherapy we can obtain objective and reliable informations that help us to decrease the risk of the subjective distortion, to control the influence of the chance events and to find the connections otherwise not observed. We use several types of research strategies: a qualitative or quantitative strategy, intensive, extensive, multi-variational strategy etc. The contemporary research deals with the effectiveness of the therapy, the indication and the psychotherapeutical process. It was found out that the therapy by the psychological means is demonstrably more effective than the placebo therapy or no therapy, and using various methods we induce qualitatively different changes. That is why the differential approach is necessary; this approach leads in the theory towards progressive integration and towards forming the general model of the psychotherapy.

[The personality of psychotherapists] . / Osobnost psychoterapeuta.

The profession of the psychotherapist is very demanding and his or her personality, constituting one of the effective factors of the treatment, affects the entire psychotherapeutic process. The psychotherapist's desired personality traits include inner stability and high degree of self-knowledge leading to an understanding and accepting of his or her own self. The other useful personality traits--the therapist's openness for the patient as well as his or her unconditional acceptance, empathy and authenticity--create an optimal and safe therapeutical setting enabling the patient to communicate freely and sincerely. All these traits must be expressed simultaneously, otherwise they could be destructive. They are underscored by the therapist's ethical conduct towards the patient. Ignoring these moral principals anulls any positive influence of the above traits. The conclusion makes mention of Kant's categorical imperative.

[Personality changes in patients after voluntary alcoholism therapy from the aspect of the Rogers method]. / Zmeny v osobnosti nemocných po dobrovolné protialkoholní lécbe z pohledu Rogersovského prístupu.

The research deals with patients dependent on alcohol (F 10.2) who were treated on a voluntary basis by psychotherapeutic and sociotherapeutic methods in seven hospitals. For ethical, legal as well as professional reasons it was impossible to form a control group. Sixty six patients (28 women, 38 men) were put to the Regensburg inventory analysis of incongruities, its statistical evaluation was done by SPSS. The aim of the research was to detect personally changes in patients induced most probably by their hospital stay. As statistically significant (t-test, u-test, alpha adjustment, effect size), we detected positive changes in the following personality variables: the patient's self-confidence (p < 0.001, ES = 1.11), favourable self concept including the ability to tolerate and manage their inner incongruities (p < 0.001, ES = 0.48), an increase of self-congruent experiences (p < 0.001, ES = 0.45) and a decrease of insufficiency feelings (p < 0.001, ES = 0.40). We consider our findings as preliminary and it is necessary to prove them by further research.

[Empathy--understanding through identification]. / Empatie--porozumení vcítením.

Empathy is defined as an understanding of another individual through the projection of ones own personality. It is manifested by the willingness and effort to perceive, capture and understand the individuals both current and potential world as exactly as possible with all its subjective meanings and feelings. It is based on intuition attended by an emotional involvement and positive interest in the other person. The process of empathy runs in three stages which overlap: first we enter the other persons subjectivity, than share in his/her thoughts, emotions and feelings and finally comes the understanding of the other person. Empathy can be traced to phylogenesis, it is biologically anchored and in the course of human life (ontogenetic approach) it develops in the social milieu as do our other abilities. It is one of general effective factors of psychotherapy and, in the psychotherapeutic relationship, has both a direct and indirect effect upon the patient (within the hermeneutic process). Today, this matter is most extensively worked out by the Rogerian and psychoanalytic psychotherapy.

[Training in psychotherapy at the First Medical Faculty of Charles University]. / Vzdelávání v psychoterapii na 1. lékarské fakulte Univerzity Karlovy.

Psychotherapy has become an independent interdisciplinary subject including prophylaxis, therapy and rehabilitation of health disorders by psychological methods, i.e. methods of communicative and relational nature. The effectiveness of psychotherapy has been scientifically proved. Since 1994, psychotherapy has been mandatory for undergraduate students at the 1st Faculty of Medicine of Charles University. Students even sit for a final state exam in psychotherapy. Postgraduate studies in psychotherapy have started in 1995 and take four years. The enrollment is 66 now. The curriculum is based on a differentially integrative concept and general model of psychotherapy.

[Research in psychotherapy]. / Výzkum v psychoterapii.

Psychotherapy is an empirical discipline and is therefore open to exact investigations which is one of the prerequisites of its further development. The beginnings of exact research are associated with the names of H. J. Eysenck and C. R. Rogers. The contemporary research based frequently on the generic model of psychotherapy whose authors are D. E. Orlinsky and K. J. Howard is concerned in particular with the effectiveness of psychotherapy; it compares the action of different procedures, deals with differentiated indications and "mechanisms" inducing changes. The most frequent research strategies are an experimental approach, comparative (correlating) research and intensive research strategy. The most important source of information on research are meta-analyses which make it possible to summarize and compare an unlimited amount of mutually independent investigations. The hitherto most extensive meta-analytic processing of research projects was implemented in the Institute of Psychology of Bern University headed by K. Graw. It was revealed among others that psychotherapy exerts a very differentiated action and that in neurotic patients and patients with personality disorders cognitive behavioural psychotherapy, Rogers psychotherapy and psychoanalytic psychotherapy, cca 100 sessions, proves definitely effective. Close to the criterium of objectively effective psychotherapy is also shape psychotherapy and systematically oriented family therapy. In the Czech Republic research is conducted on a small scale but the work is demanding as regards methods and is of a high standard. Exact research of the psychotherapeutic process and therapeutic results contributes to the gradual shaping of a psychotherapeutic model which is internally differentiated and which integrates verified findings of various psychotherapeutic schools and trends.

[The concept of aggression in psychology and psychotherapy]. / Pojem agresivity v psychologii a psychoterapii.

Aggressiveness is one of the basic characteristics of human beings. It can be defined as a relatively constant individual disposition or group characteristic manifested by the frequency, intensity and mode of aggressive behaviour. Aggressiveness has an inborn basis but its frequency, intensity and form are acquired during life and can therefore be influenced by the environment, i.e. also by training and psychotherapy. With regard to the genesis and purpose we differentiate between reflex, instrumental aggression, aggression with an end in itself and aggression resulting from affection. Psychological theories on the genesis of aggression can be divided into endogenous, exogenous and the interaction approach. The author discusses in his paper also the relationship between aggression and the type of psychotherapeutic treatment, and expands in more detail on aggressiveness and its control within the framework of Rogers' approach (person-centered approach).

[Moderating pain by psychological means]. / Mírnení bolesti psychologickými prostredky.

Pain is one of the most original and oldest experiences of humans and is an example of the psychosomatic interconnection and unity of processes in the human organism. For man it is above all a subjective experience and condition. Pain can be divided into acute and chronic pain. In both it is possible to influence by psychological means in particular the intensity of pain, which is done by means which reduce anxiety, fear and tension. In case of acute pain this is achieved by the psychological approach of the doctor who should be empathic and be an authority for the patient. Muscular relaxation of the patient has also a favourable effect, similarly as the possibility to manifest pain freely and distracting attention from pain. Only in exceptional cases hypnosis and suggestion can be used. Chronic pain can be mitigated by psychotherapeutic programmes by means of which we alter the patient's incorrect idea on the origin of pain and help him to gain control over his pain and promote his activity and self-consciousness. It is advisable to engage in therapy also the family and support the formation of self-help groups. In the USA and FRG favourable and stable results are reported with influencing of pain and its therapy by psychological procedures.

[The role of medical psychology in modern medicine]. / Uloha lékarské psychologie v dnesní medicíne.

Medical psychology is concerned in the first place with the psychological aspect of the mutual relationship and interaction of doctor and patient and relevant people from the patient's closest environment. The main task of medical psychology is to protect the patient and doctor from undesirable consequences of technization of medicine, narrow specialization and bureaucratization of the operation of the health services and to use psychological findings and procedures in the prevention of disorders and diseases and in the treatment and rehabilitation of patients. A prerequisite and part of these activities is the psychological approach and attitude of the doctor to his patient. The main features are authority and truthfulness--esteem and respect--understanding of the patient and his position. Medical psychology gives patient care a human dimension, i.e. above all subjectivity of the patient, doctor and their mutual relationship. With regard to the proved importance of personality and relations for human health and disease medicine supported by psychology becomes true contemporary medicine and the doctors activities are lege artis.

[Altruism--unselfish help given by one person to another]. / Altruismus--nezistná pomoc cloveka cloveku.

Altruistic behaviour belongs to so-called prosocial activities. It is focused on the benefit of another human being who is in want or is threatened. Its substantial features include voluntariness, unselfishness and specific motivation, based on human mutuality and unity. Altruism was at the very beginnings of organized health care. As a result of the development of medicine the human attitude of the doctor to the patient, and thus also psychological care and treatment were pushed into the background. At present "patient-orientated medicine" is enforced which comprises a psychological approach with altruistic elements.

[Psychotherapeutic crisis intervention in ambulatory general practice]. / Krizová psychoterapeutická intervence v ambulanci praktického lékare.

Psychotherapeutic crisis intervention is the term used for intervention implemented by the doctor dealing with a subject experiencing a mental crisis. Every doctor should be able to make this intervention. The authors recommend to apply the procedure they summarize in the following seven paragraphs: 1. The first step assisting a subject in mental crisis is to ensure conditions for an undisturbed talk; the patient should be received as somebody in whom we have personal interest. 2. We try to direct the interview quickly to the situation which has arisen and we concentrate on the patient's experience, we try to understand his problem and its causes. 3. If necessary, we engage the assistance of persons close to the patient, we mediate medical, social or legal assistance. 4. We consider the possibility of suicidal behaviour and select adequate preventive measures. 5. In indicated cases we offer short-term assistance by means of psychopharmaceutical preparations. 6. If the patient is motivated for another interview and the case calls for this cooperation, we offer it. We reach agreement on the time, frequency and approximate number of interviews. In the latter it is useful to proceed according to principles of non-directive psychotherapeutic talks. 7. If stabilization of the mental condition is achieved, we terminate after agreement with the patient the intervention. If the problems are rather "inside" the patient, we refer him for psychotherapeutic treatment.

[The psychotherapeutic relationship and use of psychological methods]. / Psychoterapeutický vztah a pomoc psychologickými prostredky.

On a quotation from the early dialogue of Plato, Charmides, the author demonstrates that since the beginnings principle to treat man as a whole, as his psychic and bodily processes are closely interlinked. At the same time the irreplaceable role of psychotherapy in the prevention and treatment of impaired health is explained. Psychotherapy is implemented mostly by the relationship between the therapist and patient; its course depends on the behaviour of the therapist and his personality characteristics. Based on an almost hundred-year tradition of systematic psychotherapy and due to empirical research of processes and therapeutic results during the past forty years, it may be taken for granted that for a desirable psychotherapeutic relationship the following characteristics on the part of the psychotherapist are typical: unconditional acceptance of the patient and he therapists emotional affection, empathic understanding of the patient and authenticity--genuineness of the therapist's personality. Due to advances of knowledge various psychotherapeutic trends converge in the sphere of psychotherapeutic theory and practice. Finally the author quotes views of professor K. Weis, director of the Psychiatric University in Leipzig who considers psychotherapy the axis of treatment, surrounded by somatotherapy, sociotherapy and rehabilitation measures.