Internal Medicine for Practice, 2007, issue 7

Editorial

Malé navýšení hodnoty bodu situaci interny neřeší

MUDr. Jana Lacinová

Interní Med. 2007; 9(7): 307

Review articles

Sarkoidóza - dosud nepoznaná (2)

prof. MUDr. Vítězslav Kolek DrSc

Interní Med. 2007; 9(7): 310-313

Prevention of heart failure in primary outpatient care

prof. MUDr. Jindřich Špinar CSc., FESC, prof. MUDr. Jiří Vítovec CSc

Interní Med. 2007; 9(7): 314-317

Chronic heart failure is called an epidemic of 21st century. Its increased prevalence is caused above all by aging of the population and improved care in acute situations, especially myocardial infarction. Under the term prevention of heart failure we understand an effective treatment of all situations leading to heart failure. It is mainly the treatment of hypertension with an adequate control of blood pressure and widespread use of blockers of renin-angiotensin system, control of metabolic parameters and modern therapy of ischemic heart disease both interventional and pharmacological. Healthy life style improves prognosis in patients with increased...

The treatment of hypertension in dialyzed patients

MUDr. Marta Nedbálková, doc. MUDr. Miroslav Souček CSc

Interní Med. 2007; 9(7): 319-323

Hypertension in chronically dialyzed patients is a frequent complication effecting their cardiovascular morbidity and mortality. The therapy is based on salt and fluid restriction, dietary phosphate restriction and treatment with phosphate binders, correct dialysis strategy and antihypertensive medications. High salt intake and high sodium concentration in dialysis fluid are connected with thirst and increased intake of fluid and it leads with decreased residual diuresis to fluid retention. During dialysis it is necessary to reach optimal dry weight, i. e. body weight without fluid surplus. Sufficient length of dialysis provides ultafiltration of fluid...

Glucocorticoid-induced osteoporosis

MUDr. Vít Zikán Ph.D

Interní Med. 2007; 9(7): 324-327

Glucocorticoid-induced osteoporosis (GIOP) is the most common cause of secondary osteoporosis. Glucocorticoid (GC) have adverse skeletal effects, mainly through inhibitions in bone formation and osteocyte apoptosis. Epidemiological studies have found that the increases in the risk of vertebral fractures in oral GC users are dose dependent and occur within 3-6 months of starting GC therapy. Clinically, it is important to note that fracture risk is increased even at low doses of GC. Primary prevention of bone loss and fractures should be considered in all high-risk patients taking oral GC at daily doses of > 2,5 mg prednisone equivalent for 3 months...

Tick-borne encephalitis

MUDr. Chmelík Václav

Interní Med. 2007; 9(7): 328-330

Tick-borne encephalitis is an inflammatory disease of the central nervous system. It is endemic in many regions of Europe and Asia. Hot spot areas are present in all parts of the Czech Republic. The number of focci is increasing probably due to climate changes. The infection of man is a result of his activity in nature. Outdoor activities of people are changing, and especially elderly people are exposed to natural focci more extensively compared to the past decades. The rapid increase of TBE is a result of these changes. Most of the patients have biphasic course of disease. In the second phase, the central nervous system is affected: meningitis, more...

Nonmyeloablative allogeneic stem cell transplantation in the treatment of hematological malignancies

Luděk Raida

Interní Med. 2007; 9(7): 331-333

More than ten years allogeneic stem cell transplantations after non-myeloablative conditioning regimens have already been used in hematooncological practice. This concept of allografting is based on the estimation of severe recipient immunosuppression that allows to engraft the donor hematopoiesis including the key immunocompetent cells. A toxicity, risk of early serious non-hematological complications as well as transplant related mortality are significantly reduced with this approach. The shift from intensive conditionings to non-myeloablative ones means to relay on the posttransplant immunological mechanisms allowing an effective control and elimination...

PANCREATIC MALDIGESTION

prof. MUDr. Přemysl Frič DrSc

Interní Med. 2007; 9(7): 334-337

The causes of pancreatic maldigestion include decreased exocrine pancreatic secretion, altered synchronization of digestion in the upper digestive tube, and decreased digestive potency of pancreatic enzymes in the small intestine. Maldigestion affects basic foodstuffs, liposoluble vitamins, calcium, and cobalamin. Functional diagnostics are limited at present to indirect tests (pancreatic enzymes in stools and 13C-breath test with mixed triglyceride). Therapy includes mainly dietary regimen and pancreatin replacement therapy. All available preparations (minimicrospheresTM, minitablets, and usual size tablets) are enterosolvent. The digestive potency...

Case report

Analýza preskripce léků u polypragmatických pacientů

PharmDr. Jan Šaloun, doc. RNDr. Jozef Kolář CSc, Mgr. Marek Csöllei, PharmDr. Lenka Smejkalová

Interní Med. 2007; 9(7): 349-351

Pharmacological profile

Možnosti inzulinové léčby diabetu typu 2 bazálním analogem detemir

MUDr. Svatopluk Solař

Interní Med. 2007; 9(7): 352-354

Interdisciplinary overviews

Panic disorder in outpatient internal clinic

MUDr. Josef Chval, MUDr. Viola Chvalová

Interní Med. 2007; 9(7): 338-342

Panic disorder is a frequent mental disease, manifested by repeated unexpected attacks of great anxiety, combined with marked somatic symptoms. For many reasons, these patients visits internists, specially in the early stage of their disease, and are frequently met by doctors in outpatient clinics. Although it is a common disease, doctors in other specialities are not familiar with panic disorder and frequently it is not diagnosed at all. Thus untreated disease often became chronic and considerably lowers quality of life of patients. Nevertheless, if correctly diagnosed, panic disorder could be cured pharmacologically and even psychologically.

Conundrums in immunotherapy of sepsis

MUDr. Roman Zazula Ph.D, MUDr. Miroslav Průcha Ph.D

Interní Med. 2007; 9(7): 343-344

Sepsis is a clinical syndrome that results from a systemic host response to an infection. The outcome of sepsis is poor, and mortality rates are high. Sepsis is associated with the activation of multiple inflammatory pathways, including the cytokine network and the coagulation system. Sepsis can also result in an immunodepressed state that could leave patiens more susceptable to secondary nosocomial infections. Modulations of the host response to infection has been studied as an adjunctive therapeutic approach in many preclinical investigations and clinical trials. As a result of these studies our knowledge of the pathogenesis of sepsis has increased...

Screening for Diabetic Retinopathy

MUDr. Natália Beszédešová

Interní Med. 2007; 9(7): 345-348

Diabetic retinopathy (DR) is the leading cause of blindness among working – age people in developed countries. The complex treatment strategies are 90 % effective in preventing the ocurrence of vision loss. These strategies include management of patient’s systemic disorder, active screening for DR and specialized ophthalmic treatment. Reference to a timely and regular eye examination of the diabetic patient is an essential requirement for the effective screening for DR allowing an early detection and treatment of DR. The diabetologists, internists and general practitioners play an important role in the screening programme as they refer...