Internal Medicine for Practice, 2008, issue 6

Editorial

PROČ BY BŮH NEMOHL ZÍSKAT ANI MÍSTO ASISTENTA NA UNIVERZITĚ?

MUDr. Radkin Honzák CSc

Interní Med. 2008; 10(6): 263

Review articles

New insights in treatment of hyperuricemia and gout

prof. MUDr. Karel Pavelka DrSc

Interní Med. 2008; 10(6): 268-272

In introductory part discusses author problems of early and accurate diagnosis of gouty arthritis. The definitive diagnosis is confirmed by findings of natrium – urate crystals in polarized microscopy in synovial effusion. If material for crystal analysis is not available, diagnosis could be done by combination of clinical criteria. Recently published EULAR recommendations for diagnosis of gouty arthritis can be applicated with advantage. The main aim of the therapy of acute gouty arthritis is the termination of the acute attack, elimination of natrium urate crystals deposits, prevention of future attacks, prevention or reversal of complications...

ACE-inhibitors or sartans in coronary heart disease?

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

Interní Med. 2008; 10(6): 273-276

We review the current knowledge in ACE-inhibitors and angiotensin II receptor 1 blockers in patients with coronary heart disease. The data from clinical trials in hypertension revealed some advantages of ACE-inhibitors, however results of direct comparison of large multicentric trial ONTARGET confirms the assumption that both pharmaceutical groups are effective, safe and comparable, but the combination of ACE-inhibitors and AII antagonists is probably not advisable. The blockade of system renin-angiotensin-aldosteron is a base of treatment of patients in secondary prevention of coronary heart disease. Only further studies will show on what level it...

Acid-related diseases - main indication for proton pump inhibitors

doc. MUDr. Václav Jirásek CSc

Interní Med. 2008; 10(6): 277-280

Proton pump inhibitors (PPI) are effective for treatment of all acid-related disorders, i. e. gastroesophageal reflux disease, peptic ulcer disease and eradication of Helicobacter pylori, nonsteroidal anti-inflammatory drugs associated peptic ulcers, ulcers of endocrine origin, stress ulcers as well as peptic ulcer bleeding. Proton pump inhibitors are relative safe drugs with minimum interactions. All in Czech republic available agents – omeprazol, pantoprazol, lansoprazol – are simillary effective.

Management of the patients with chronic heart failure and decreased renal function

MUDr. Filip Málek, MUDr. Martin Havrda

Interní Med. 2008; 10(6): 281-284

The prevalence of chronic heart failure and renal insufficency is increasing. The association of heart failure and kidney disease is in the literature described as a “cardiorenal syndrome“. The cardiorenal syndrome has common risk factors of cardiovascular and renal impairment. One of the main principals of the non-pharmacological treatment of the cardiorenal syndrome patients is control of the fluid and salt intake. For the medical therapy of the patients with heart failure and decreased renal function it is necessary to use drug with the evidence of the cardioprotective properties and knowledge of its pharmacokinetics. Management of the...

Nutrition support with sipping

doc. MUDr. Miroslav Tomíška CSc

Interní Med. 2008; 10(6): 285-290

Oral nutrition supplements are complete mixtures of macronutrients and micronutrients, currently available in liquid ready-to-use forms. Most authors confirm significant increase of energy and nutrient intake during illness by these supplements compared with dietary advice alone, with little suppression of voluntary food intake. Meta-analyses of many randomized studies in various groups of patients give strong evidence in reduction of complications, shortening of hospital stay and in many cases even lowering of mortality. Evidence is the strongest for acute illness, elderly patients, malnutrition and in perioperative care. Oral nutrition supplements...

Complex treatment of abdominal catastrophe

prof. MUDr. Luboš Sobotka CSc, MUDr. Jan Maňák Ph.D, MUDr. Pavel Vyroubal, MUDr. Jiří Bajnárek, MUDr. Roman Mottl Ph.D, MUDr. Milan Fric, prof. MUDr. Vladimír Bláha CSc

Interní Med. 2008; 10(6): 291-294

By abdominal catastrophe we mean especially serious situation involving gastrointestinal tract, pancreas and partially also billiary system. The presented involvement endanger patients by bleeding, significant loss of fluid and septic complications. The approach to abdominal catastrophe must be complex. It is necessary to localize and treat infection, substitute fluid loss from gastrointestinal tract, provide nutritional support and local treatment. With regard to a complex character multidisciplinary cooperation is necessary. With regard to prolonged and expensive treatment it is suitable to concentrate these patients to special centers that have...

Vitamin D - readout

doc. MUDr. Pavel Hlúbik CSc, MUDr. Jana Fajfrová

Interní Med. 2008; 10(6): 295-297

Vitamin D is required to maintain normal blood levels of calcium and phosphate, that are in turn needed for the normal mineralisation of bone, muscle contraction, nerve conduction and general cellular function in all cells of the body. Vitamin D, a seco-steroid, can either be made in the skin from a cholesterol-like precursor by exposure to sunlight or can be provided pre-formed in diet. The foods rich in vitamin D are fatty fish, eggs, butter, liver and some meat. The early signs of vitamin D deficiency are decreased serum concentration of calcium resulting from depressed absorption of calcium from the intestine leading to depletion of calcium from...

Case report

Koarktace aorty jako vzácná příčina sekundární hypertenze

MUDr. Zdeněk Štekl

Interní Med. 2008; 10(6): 308-309

Interdisciplinary overviews

ADVANCES IN PHARMACOTHERAPY OF PAIN

prof. MUDr. Miloslav Kršiak DrSc

Interní Med. 2008; 10(6): 298-304

The paper draws attention to possibilities for improvements in pharmacotherapy of pain by making the best of guidelines and recommendations for treatment of pain elaborated in the Czech Republic and abroad in the last few years. There are given comments and links to several guidelines available in full length in the Internet: guidelines for pharmacotherapy of acute pain, chronic non-cancer pain, cancer pain, headache, post-operation pain, recommendations of EULAR for management of osteoarthritis and EFNS guidelines on pharmacological treatment of neuropathic pain. New analgesics introduced in the Czech Republic recently are briefly mentioned. The second...

Dermatomycosis

doc. MUDr. Eliška Dastychová CSc

Interní Med. 2008; 10(6): 305-307

Dermatomycosis belong to the most frequent skin disorders together with eczematous diseases and crural ulcers both in outpatient and inpatient care. The diseases involve a wide range of population and it is necessary to pay attention also to prevention. They are important from epidemiologic perspective because they are more or less infective. Some persistent disease may warn us about a serious systemic disease (diabetes mellitus, disorders of immune system).