[Prevention of venous thromboembolism in surgery, laparoscopic surgery and urology]. / Prevence zilního tromboembolizmu v chirurgii, laparoskopické chirurgii, urologii.

Deep venous thrombosis and pulmonary embolism are major health problems with potential serious outcomes. Acutely, pulmonary embolism may be fatal. In the long term, pulmonary hypertension can develop from recurrent pulmonary embolism. Often overlooked is post-thrombotic chronic venous insufficiency occurring as a result of deep venous thrombosis causing deep venous reflux or obstruction with skin changes and ulceration with adverse impact on quality of life and escalation of health care costs. Almost all hospitalized patients have at least one risk factor for venous thrombosis and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired deep venous thrombosis is approximately 10 to 40% among medical or general surgical patients and 40 to 60% following major orthopedic surgery. Abundant data from metaanalysis and blinded, randomized clinical trials have demonstrated strong evidence that primary thromboprophylaxis reduces deep venous thrombosis and pulmonary embolism and little or no increase in the rates of clinically important bleeding with prophylactic doses of low-dose unfractionated heparin, low-molecular-weight heparin or fondaparinuxem.

[Bleeding complications of anticoagulant therapy]. / Krvácivé komplikace antikoagulacní lécby.

Anticoagulant therapy is one of the most common forms of medical intervention. It is the mainstay of prevention and treatment of thrombotic events. Omission of adequate anticoagulant prophylaxis at least for moderate-risk and high-risk patients is a widely recognized medical error. Bleeding is one of the most feared complications of anticoagulant therapy, and is a risk of all anticoagulants. Whereas unfractionated heparin and warfarin, the oldest and most widely used anticoagulants, have specific antidotes for their anticoagulant effect, many of the newer agents (direct and indirect inhibitors of coagulation factors Xa and/or IIa) do not have specific antidotes to reverse their actions. The use of novel anticoagulants is further complicated by a lack of easily available laboratory tests to measure their levels and thereby optimize their benefit and safety in clinical practice. In this review, we evaluate the risk of bleeding associated with current anticoagulants, review the data available on current and experimental agents used for the reversal of anticoagulation, and provide recommendations for the management of major bleeding associated with anticoagulant therapy and for the management of asymptomatic overdosing of the anticoagulants.

Divergent kinetics of hsp70 induction in Oniscus asellus (Isopoda) in response to four environmentally relevant organic chemicals (B[a]P, PCB52, gamma-HCH, PCP): suitability and limits of a biomarker.

Mature specimens of the isopod Oniscus asellus were maintained on soil and leaf litter to which was added different concentrations of either benzo[a]pyren (B[a]P), 2,2',5,5'-tetrachlorobiphenyl (PCB52), gamma-hexachlorocyclohexane (gamma-HCH), or pentachlorophenol (PCP) for a maximum of 14 days. Time-dependent investigation of the body level of the 70 kD stress protein group (hsp70) in the isopods revealed a significant but transient induction of the hsp70 response after about 24 h of exposure to PCB52 or B[a]P. Despite continuous exposure, the hsp70 level decreased subsequently and ended up close to or below the control level independent of the concentration of PCB52 or B[a]P in the substrate. All applied PCP or gamma-HCH concentrations also resulted in an initial peak of hsp70 response after 24 h of exposure and a second peak after several days of exposure, as well as an elevated hsp70 level throughout the period of exposure. Although acute stress conditions posed by all four organic chemicals were monitored by stress protein induction, hsp70 can act as a biomarker of chronic exposure and effect for PCP and gamma-HCH only.

Colour change: A novel biomarker indicating sublethal stress in the millipede Julus scandinavius (Diplopoda).

Abstract During investigations on the induction of the 70 kD stress protein family (hsp70, stress-70) in Julus scandinavius following exposure to different biohazards, the colour of the supernatant of the homogenate was closely correlated to the hsp70 level. Hsp70 has recently been shown to be a suitable biomarker for sublethal toxicity in soil animals. Control millipedes typically exhibited red or red-orange supernatants whilst the supernatant of starved or toxin-exposed diplopods was orange, orange-yellow, or even bright yellow. Based on these observations, a quantitative colour test was established which was found to be able to indicate the degree of stress situations caused by exposure to heavy metals (cadmium, zinc), organic pollutants (lindane, PCB 52), or by food deprivation in laboratory tests. It is suggested that this is caused by a breakdown of the red-orange bilirubins into orange-yellow urobilins.