Až do padesátých let 20. století umírali lidé předčasně. Za posledních sto roků se střední délka života téměř zdvojnásobila, což představuje jeden z největších úspěchů lidstva a vědy vůbec. Délka lidského života se nyní začíná přibližovat jeho biologické hranici. Pravděpodobnost dožití se vysokého věku přestává být výjimečným jevem, ale stává se naopak normální a masovou záležitostí. Jedním z hlavních rysů světové populace 20. století je absolutní i relativní růst počtu seniorů, a to v rozvinutých i rozvojových zemích. Běžným pojmem se stává pro populaci v postproduktivním věku označení 3. věk. Vedle toho se formuluje velmi zjevně v geriatrické medicíně i označení 4. věk pro období závislosti na dopomoci v každodenním životě (nad 80 nebo dokonce 85 roků), kdy do popředí začíná vystupovat právě disabilita spojená těsně se stařeckou multimorbiditou, a s tím spojená stařecká křehkost „frailty“. Křehkost je chápána jako riziko vzniku náhlého zhoršení stavu u velmi rizikových osob (nad 80 let, žijící osaměle nebo s handicapovaným partnerem, se závažným somatickým nebo duševním onemocněním). Koncept frailty se tedy alespoň mírně blíží dříve užívanému pojmu rizikového geronta. Důraz je přitom kladen na aktivní záchyt těchto jedinců, kteří převážně svoji křehkost nejsou schopni signalizovat.

doc. MUDr. Pavel Weber CSc

Interní Med. 2008; 10(2): 47  

The role of thiazolidindiones in the treatment of type 2 diabetes

prof. MUDr. Jaroslav Rybka DrSc

Interní Med. 2008; 10(2): 50-53  

Thiazolidindiones, glitazones have a significant effect on the metabolism of carbohydrates as well as cardiovascular risk factors. In addition, they exert a beneficial effect on the development of atherosclerotic changes in patients with diabetes and may have a protective effect on the function of pancreatic cells. Glitazone indication are being further specified, and particular attention is being paid to any adverse effects and compromised liver function, weight increase, risk of bone fractures and fluid retention. The author pays special attention to possibly higher risk of myocardial infarction with the use of rosiglitazone and points out the possibility...

Biological drugs in colorectal cancer treatment

Jindřich Fínek

Interní Med. 2008; 10(2): 54-57  

Colorectal cancer ranks the second most common cause of cancer death in Europe. It accounted for 13% (413 000 incident cases) of all newly diagnosed cancers and for about 20% (335 000 deaths) cancer deaths in 2006. Treatment strategies involving combination of chemotherapy and biological treatment are prolonging the survival of cancer patients with advanced colorectal cancer.

What is the situation in the treatment of patients with hypertension and metabolic syndrome?

doc. MUDr. Miroslav Souček CSc

Interní Med. 2008; 10(2): 58-61  

Combination of clinical and metabolic factors that constitute metabolic syndrome has been explored thoroughly because of its high and constantly increasing prevalence in general population and clear relation of the syndrome to increased prevalence of cardiovascular diseases. The most important intervention is a life style change (dietary and physical activity modification), however in a number of patients further intervention including pharmacotherapy is indicated to influence blood pressure, obesity, lipids and blood sugar. The basic treatment of hypertension includes the blockade of renin-angiotensin system (ACE-inhibitors, sartans), that are frequently...

A patient with a proteinuria, the treatment

MUDr. Jiří Žabka CSc

Interní Med. 2008; 10(2): 62-63  

Survey article about particular clinical significance of proteinuria. Laboratory methods, clinical practice and treatment are involved.

Nutrition disturbances in elderly

prof. MUDr. Hana Kubešová CSc, doc. MUDr. Pavel Weber CSc

Interní Med. 2008; 10(2): 64-68  

The introduction of the article comprises factors influencing negatively quality and quantity of nutrition during the ageing. The importance of proteins and the role of the teeth and intact swolowing are stressed. The atrophic gastritis is discussed as well as damage of stomach mucosa by nonsteroidal antiinflamative drugs. Authors remember new factors appearing with higher age – the influence of advanced atherosclerosis and its followings – ischaemic colitis, diverticulosis and motility disturbances. Attention is paid to the relationship of energy intake, nourishment composition and metabolic syndrome development. Different components of...

Contemporary antiplatelet treatment in clinical practice

doc. MUDr. Jiří Špác CSc

Interní Med. 2008; 10(2): 69-73  

Antiplatelet treatment remains one of the basic preventive therapeutic measures in treatment of atherosclerosis complications and must be accompanied by all other therapeutic measures. The goal of further research is to make the treatment even more effective with fewer side effects. Acetylsalicylic acid remains a basic antiplatelet medication that decreases the incidence of serious vascular events in patients with symptomatic atherosclerosis by 25 %. ADP receptor antagonists – clopidogrel and ticlopidin-are more effective in decrease of risk of vascular events by another 10 % with an increase of cost of treatment. A combination of...

Home parenteral nutrition

MUDr. Eva Kotrlíková, MUDr. Jaromír Křemen

Interní Med. 2008; 10(2): 76-79  

Patients dependent on long-term parenteral nutrition are very often admitted on metabolic units, from different, mainly surgical departments. It happens in situations when we are not able to secure adequate input of nutrition by enteral way – short bowel syndromes and chronic disorders of bowel function. Admission of parenteral nutrition is then only one reason for stay in hospital and this dependency on hospital bed practically leads to their invalidity. Ideal solution for these patients is arrangement of parenteral nutrition at home conditions which results in comeback to normal life. These patients are monitored in specialized nutrition ambulances...

Pharmacotherapy of immunopathological reactions - suppression of adverse reactions

PharmDr. Petr Jílek CSc

Interní Med. 2008; 10(2): 80-83  

Inadequate immune reactions against agents from environment could be found as allergies, while unregulated reactivity against self-structures is known as autoimmune disease. Many drugs are available for treatment of such disorders. Most frequently drugs suppressing the immune reactions on the level of intercellular signaling pathways as well as in the effector phase of pathological processes are used. Methods re-inducing the immunological tolerance of target structures of autoaggressivity are promising. Immunosuppressants bring the risk of impairment of antimicrobial and anticancer resistance.

Rituximab in the treatment of rheumatic diseases

prof. MUDr. Jiří Vencovský DrSc

Interní Med. 2008; 10(2): 97-99  

Rheumatoid arthritis and other systemic connective tissue diseases are characterized by immune system hyper-reactivity and production of autoantibodies. Rituximab is a monoclonal antibody against CD20 molecule, which is present on the surface of the large population of B cells. Administration of rituximab leads to B lymphocyte depletion from peripheral circulation. This is associated with treatment effects and significant suppression of inflammation. The most advanced is the use of rituximab in rheumatoid arthritis, which has become recently a routine indication for this type of treatment. Rituximab is indicated together with methotrexate in...

Breast cancer - an actual problem

MUDr. Josef Chovanec Ph.D, MUDr. Zuzana Dostálová Ph.D, MUDr. Jana Navrátilová

Interní Med. 2008; 10(2): 84-89  

Breast cancer is the most frequent tumor in women with constantly increasing prevalence, significant heterogenity and multifactorial etiology. About 10 % of cancer has a family occurrence and genetic predisposition. The occurrence of the tumor may be influenced by nutritional and life style. Currently the most effective detection of breast cancer is mammography. The treatment strategy is determined by a clinical stage of the disease and by prognostic factors. Local and regional treatment, i. e. surgical procedure, radiotherapy and systemic treatment, i. e. chemotherapy and hormonal therapy are used in the treatment of breast cancer. Further follow-up...

Urinary incontinence from the point of the view of gynaecologist

MUDr. Petr Dzvinčuk Ph.D, MUDr. Otakar Müller, MUDr. Eva Látalová

Interní Med. 2008; 10(2): 90-95  

The urinary incontinence belongs to the most frequent health problems in female population. Approximately 50 % of women suffer from any type of incontinence during their lifetime. This condition is not associated with high morbidity or mortality, however it influences the quality of life of affected patient. The aim of this article is to provide brief review of current diagnostical and therapeutical approach and methods in management of urinary incontinence.

Kdy doporučit suplementaci jódem?

prof. MUDr. Václav Zamrazil DrSc

Interní Med. 2008; 10(2): 100