Internal Medicine for Practice, 2008, issue 3

Editorial

Nejenom nemoci léčit…

prof. MUDr. Stanislav Komenda DrSc

Interní Med. 2008; 10(3): 107

Review articles

Specificity of acute myocardial infarction in the elderly

MUDr. Blanka Fischerová Ph.D

Interní Med. 2008; 10(3): 110-112

This article describes the impact of age on clinical presentation and outcome in acute myocardial infarction (AMI). Hypertension, diabetes, prior angina, prior AMI, cerebrovascular events and heart failure are more prevalent with increasing age. Elderly patients with AMI are less likely to present with ST elevation and Q wave myocardial infarction. The proportion of patients undergoing coronary angiogram, primary percutaneous coronary intervention (PCI) or thrombolysis decreases with age. Old age is a powerful predictor of mortality of patients with AMI.

News in the gluten-free diet

doc. MUDr. Pavel Kohout CSc

Interní Med. 2008; 10(3): 113-116

Celiac disease is an autoimmune disease, its manifestation starts in genetically predisponed individuals after gluten ingestion. During transmission of toxic gliadin peptides through small bowel mucosa and its deamidations (by action of tissue transglutaminase from enterocytes) are formel in gut associated lymphatic tissue antibodies against enterocytes. Its activity leads to small bowel mucosa damage of various relevance and formation of clinical symptoms. The manifestations of celiac disease may be influenced only with elimination of toxic gliadin peptides for the diet, at this time are the other ways than searching of new gluten-free foodstufs.

What is new in new guidelines FOR diagnosis and treatment of lipid disorders in adulthood

prof. MUDr. Helena Vaverková CSc, doc. MUDr. Vladimír Soška CSc

Interní Med. 2008; 10(3): 117-120

New guidelines of diagnosis and treatment of lipid disorders in adulthood, prepared by the committee of the Czech society of atherosclerosis are based on results of new epidemiological and interventional studies with hypolipidemics and on new knowledge on pathophysiology of lipid disorders. They introduce new recommended target levels of LDL-cholesterol, inform about the use of apolipoprotein and non-HDL cholesterol as secondary targets in selected groups of individuals (with diabetes mellitus, metabolic syndrome, hypertriglyceridemy, cardiovascular disease with relatively low level of LDL-cholesterol). They improve the estimation of individual risk...

Current view on NSAID therapy

MUDr. Šárka Forejtová

Interní Med. 2008; 10(3): 121-125

Nonsteroidal anti-inflammatory drugs (NSAID) belong to the most frequently used medications. Their use is however accompanied by relatively frequent occurrence of adverse gastrointestinal events. Coxibs were developed with the goal to decrease the risk of adverse events in gastrointestinal tract; it was discovered later, that they might increase the occurrence of cardiovascular events. Recently it was discovered that the cardiotoxic effect is in a various extent a property of all NSAIDs, including e.g. diclofenac, ibuprofen etc. Concomitant use of acetylsalicylic acid (ATA) reduces the risk of cardiovascular events, if used together with rofecoxib,...

Use of beta-blockers in patients with diabetes mellitus

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

Interní Med. 2008; 10(3): 126-128

The article presents a review of beta-blocker use (BB) in patients with heart disease who suffer also from diabetes mellitus (DM). With regard to possible metabolic consequences of treatment with beta blockers and concealing of some of warning signals of hypoglycaemia we always should consider indication of beta blockers, that may have in many patients with cardiovascular disease significant influence on mortality decrease. Physicians must always in these cases evaluate benefit of the treatment in comparison to its risk.

Edema - pathogenesis and treatment

prof. MUDr. Otto Schück DrSc

Interní Med. 2008; 10(3): 130-133

The article informs about current views of the pathogenesis and treatment of generalised edema. Edema is ordinarly defined as an abnormal accumulation of extravascular intersticial fluid of sufficient magnitude to be clinically detectable. The initiating event appers to be a decrease in the effective intravascular volume. One of several of the homeostatic efector mechanisms involved in the regulation of the sodium excretion are then activated, leading to the retention of sodium and water. What distingishes the edematous patient from the normal is that the usual renal homeostatic response to extracelular expansion does not occure. The ideal approach...

Strategy of antithrombotic treatment in patients with atrial fibrillation

prof. MUDr. Jan Bultas CSc, MUDr. Debora Karetová CSc

Interní Med. 2008; 10(3): 134-137

Atrial fibrillation and flutter are characterized by disorganization of impulse conduction in cardiac atria. It results in decreased contractility; blood stagnation activates hemostasis and increases risk of thromboembolic stroke. This risk is increased in patients after a stroke, diabetic patients, patients with hypertension, heart failure and older patients, in patients with postreumatic valve disease, coronary heart disease and females. According the risk antithrombotic treatment is indicated, especially anticoagulation treatment with warfarin. In consistence with guidelines strategy of treatment and frequent situations from daily practice are discussed.

Comments

Hrozí zneužití - diskreditace lékařské genetiky

Interní Med. 2008; 10(3): 150

Case report

Alkohol u žen vyššího věku

MUDr. Emanuel Doněk, MUDr. Jana Doňková, Olga Doňková

Interní Med. 2008; 10(3): 146-147

Interdisciplinary overviews

The lice in pediatric practice

RNDr. Václav Rupeš CSc, MUDr. Jana Vlčková

Interní Med. 2008; 10(3): 138-141

The lice infection (Pediculus capitis) in children is a parasitic disease described as pediculosis. Its prevalence significantly increases in all developed countries in the world including the Czech Republic. Resistance to treatment is considered to be the primary cause. In the Czech Republic resistance to permethrine was discovered in 1992 and in 2004 resistance to malathion the most widely used agent in the world was found. Resistance was also the cause of loss of anti-infective efficacy to former Czech agents containing these agents (Orthosan BF 45, Diffusil H a Diffusil H 92 M), that lead to an increase of pediculosis prevalence. Currently delousing...

Diferrential diagnosis and treatment of low back pain

MUDr. Ivan Vrba

Interní Med. 2008; 10(3): 142-145

Low back pain (LBP) is defined as pain, muscle tension or stiffness localized below the costal margin and above the gluteal folds, with or without leg pain. There is a lot of LBP classification. The basic classification is a division to the acute and chronic LBP, the other is division to specific cause (only 10 % cases) and non-specific one (without clear cause – up to 90 % cases). It is a very important to distinguish between low back pain and referred pain from non-low back pain sources. But now, it seems, the most important is a division in to a diagnostic triage (very serious illness, radicular pain, simply LBP). LBP is currently...