Internal Medicine for Practice, 2008, issue 5

Editorial

Má snad lékař souhlasit s eutanazií?

prof. MUDr. Marta Munzarová CSc

Interní Med. 2008; 10(5): 207

Review articles

Heart failure in elderly

prof. MUDr. Lenka Špinarová Ph.D., FESC, prof. MUDr. Jindřich Špinar CSc., FESC, prof. MUDr. Jiří Vítovec CSc

Interní Med. 2008; 10(5): 212-215

The goal of chronic heart failure (CHF) treatment is to increase a quality of life, i. e. decrease or completely remove symptoms, increase the exercise tolerance, decrease mortality and prolong patient’s life. Elderly patients have various priorities and in most of questionnaires in patient 70 year old and older the quality of life is placed on the first place. The basic treatment of patients with CHF regardless the age are medications with evidence about the increase of quality of life and decrease of mortality. These medications are ACE-inhibitors and/or AII antagonists and betablockers. Subgroup analyses show that the effect of RAS blockade...

Is statine treatment in patients with heart failure effective?

prof. MUDr. Jaromír Hradec CSc., FESC

Interní Med. 2008; 10(5): 216-218

Because of uncertainty about statine efficacy in patients with chronic heart failure and because of worries that statine treatment could be harmful in these patients a clinical trials CORONA was suggested and performed. Total of 5011 individuals with chronic heart failure of ischemic etiology older than 60 years in functional class NYHA II-IV were randomized to rosuvastatin in 10 mg dose daily or placebo. The primary aim of clinical efficacy was a combined endpoint of cardiovascular mortality and non fatal myocardial infarctions and strokes. Rosuvastatin in comparison to placebo decreased over the follow up time of 33 months plasmatic concentration...

TRAVELER´S VENOUS THROMBOSIS AND VARICOSE VEINS

doc. MUDr. Petr Gavorník PhD

Interní Med. 2008; 10(5): 219-223

Venous thrombosis (phlebothrombosis; venous thromboembolism) can be caused by prolonged sitting in cramped position during air travel. The symptoms of venous thromboembolism (VTE) can develop up to one months after a long distance travel (long-haul flight). It is known that some inherited and acquired factors increase the risk for travel-related thrombosis (f. e. chronic venous disease). Active prevention includes physical measures and antithrombotic drugs.

Dual action of parathormone and bone

prof. MUDr. Petr Broulík DrSc

Interní Med. 2008; 10(5): 224-226

PTH is a hormone that increases the plasmatic level of calcium, maintains the level by mobilisation of calcium from bones with the help of osteoclastic resorption. Receptors for PTH and rP are situated on a cell membrane of osteoblasts, preosteoclasts. The bone involvement-bone changes caused by PTH over secretion are described as hyperparathyroid osteodystrophy. Unusual variability and nonconsistance of bone changes are unfortunately the main cause why such a high number of PHPT is recognized very late. PTH in a surplus is very aggressive towards bones, it dilutes bone mineral, stimulates osteoklasts and fibrous rebuilding of bones, leads to cyst...

Obesity and pharmacologic therapy

MUDr. RNDr. Tomáš Brychta Ph.D, MUDr. Svetlana Brychtová Ph.D

Interní Med. 2008; 10(5): 227-230

Obesity is a chronic metabolic disease caused by pathophysiologic and genetic changes. The disease has serious medical and economical outcomes, recetly, it has even become the second most frequent cause of death after smoking. On the basis socioeconomics studies it is obvious that the treatment of obesity including pharmacotherapy will have to assume the same position in the health care system as hypertension or dyslipidemia. A therapy of obesity should be complex including in addition to a diet and changes of physical and behavioral states also pharmacotherapy. Currently three drugs have been recommended to long-therm therapy – sibutramin, rimonabant,...

Air conditioning - health risks and prevention

MUDr. Jarmila Kohoutová

Interní Med. 2008; 10(5): 231-232

Due to rising temperatures caused by the climatic changes, air conditioning of interior areas is becoming in the last three decades common and often necessary part of technical infrastructure of buildings. Spending time in areas without natural ventilation is no longer limited to professions with high demand to environment purity. We move through air-conditioned areas in shops, hotels, in culture and sport facilities. Air conditioning units are common in residential houses and are part of standard or advance equipment of vehicles. Many articles from the last years indicate increase of diseases that are related to exposure to air-conditioned areas....

Celiac disease - what shoUld an ambulant internist know

MUDr. Lucie Prokopová

Interní Med. 2008; 10(5): 233-239

Celiac disease (celiac sprue gluten sensitive entheropathy, nontropic sprue) is the life long hereditary autoimmune disease. It manifests in a geneticaly succeptible individual (association with HLA-DQ2, HLS-DQ8) after a variable time of the consumation of gluten containing cereals. Imunopathogenesis of celaic sprue has not been fully discovered. It is supposed that gliadin peptides (split products of gluten) after presentation to HLA- DQ2 and HLA-DQ8 possitive cells of predisposed individuals trigger in the mucosa of the small bowel an exaggerated reaction (T cell mediated immune response). In the same time highly specific autoimmune antibodies are...

Case report

Účinek fixní kombinace perindoprilu a indapamidu na makrovaskulární a mikrovaskulární komplikace u nemocných s diabetem 2. typu (studie ADVANCE)

MUDr. Marek Honka

Interní Med. 2008; 10(5): 245-246

Vzácná koincidence papulární mucinózy s primární systémovou al-amyloidózou

MUDr. Kamil Žamboch, prof. MUDr. Vlastimil Ščudla CSc, MUDr. Tomáš Pika, MUDr. Vlastislava Tichá CSc, MUDr. Martin Tichý Ph.D

Interní Med. 2008; 10(5): 248-250

Interdisciplinary overviews

age-related macular degeneration

MUDr. Jan Studnička Ph.D

Interní Med. 2008; 10(5): 240-244

Age-related macular degeneration is the most frequent cause of severe visual lost in people older than 55 years in industrial countries. The disease has two variants, dry and wet forms. The wet form develops only in 10–20 %, but without treatment causes in 80–90 % practical blindness. Symptoms of the disease are visual impairment, metamorphopsias and central visual field defect. Actual therapy stabilize the disease in 70–90 % of patients and in 30 % of patients even improves their visual functions. The important part of treatment is prevention of risk factors (smoking, insolation, higher intake of specific types of fat…).