Poslání

JUDr. MUDr. Igor Ulč, Ph.D

Interní Med. 2009; 11(7): 311  

Heart rate and cardiovascular disease

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

Interní Med. 2009; 11(7): 315-318  

Heart rate is a risk factor for cardiovascular morbidity and mortality in the general population as well as in patients already treated for cardiovascular disease. In the placebo arm of the SYST-EUR study in hypertensives, heart rate was a significant risk factor; similarly, in patients after myocardial infarction in the GISSI 3 study, mortality increased with increasing heart rate. Increased heart rate is a risk factor in patients with heart failure. The heart rate of 50–70 beats/min appears to be optimal. Four principal drug groups are used to lower heart rate: digitalis, beta blockers, calcium channel blockers of the phenylalkylamine class,...

Chronic obstructive pulmonary disease

doc. MUDr. Jaromír Musil CSc

Interní Med. 2009; 11(7): 319-323  

COPD is a treatable disease that can be prevented. COPD has significant extrapulmonary effects that can contribute to the overall severity of the disease in individual patients. Its pulmonary component is characterized by a limited air flow in the bronchi (hereafter referred to as bronchial obstruction) which is not fully reversible. Bronchial obstruction usually progresses and is associated with an abnormal inflammatory response of the lungs to harmful particles and gases. Bronchial obstruction typical for COPD results from a common involvement of the small airways (obstructive bronchiolitis) and the destruction of lung parenchyma (emphysema)....

Prevention of contrast-induced nephropathy in patients with chronic renal insufficiency

MUDr. Jana Reiterová Ph.D

Interní Med. 2009; 11(7): 324-326  

Renal toxicity of iodinated radiocontrast media is a major cause of acute renal failure in hospitalised patients. The incidence of contrast- induced nephropathy in patients with chronic renal insufficiency is about 30 %. The most optimal preventive strategy is adequate hydration, rational indication of invasive procedures and the use of iso-osmolar, non-ionic contrast-media. N-acetylcystein is often discussed as a preventive drug in recent years. It was found recently, that gadolinium-enhanced magnetic resonance can lead to acute renal failure in patients with chronic renal insufficiency. Moreover, gadolinium is associated with a severe, life-threatening...

ACE inhibitors, sartans and atrial fibrillation

MUDr. Růžena Lábrová, Ph.D, prof. MUDr. Jindřich Špinar CSc

Interní Med. 2009; 11(7): 327-331  

Atrial fibrillation is the most common susteined arrhythmia. It is associated with increased morbidity and mortality and decreased quality of life. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers redukce morbidity and mortality in patients with heart failure, vascular disease, and hypertension. The renin-angiotensin-aldosterone system (RAAS) is involved in the pathophysiology of atrial fibrillation, and that RAAS blockade improves outcomes in atrial fibrillation merits plausibility. There are now mounting data to suggest that modulation of the renin-angiotensin-aldosterone system might have an important role in the prevention...

Postinfectious irritable bowel syndrom

prof. MUDr. Milan Lukáš CSc

Interní Med. 2009; 11(7): 332-335  

The functional bowel disorders including the irritable bowel syndrome are the final diagnosis in significant proportion of gastroenterological patients. The irritable bowel syndrome is characterised by changes of bowel habits with abdominal dyscomfort or abdominal pain. The pathophysiology of irritable bowel syndrome is still not completely understood. Recently, it has been proved that in 20–30 % of patients with irritable bowel syndrome the infectious gastroenteritis preceded the clinical manifestation of the bowel functional disoorder. The bacterial infections (campylobacteriosis, shigelosis and salmonelosis) are considered as the most...

Secondary hypertension

MUDr. Tomáš Zelinka

Interní Med. 2009; 11(7): 336-339  

Hypertension as a sign of other disease is called secondary hypertension. In some cases, early diagnose and treatment may lead to a complete cure or at least to a dramatic improvement of hypertension. The most typical form of secondary hypertension is endocrine hypertension, in particular primary aldosteronism and less frequently pheochromocytoma, Cushing syndrome or very rarely acromegalia and primary hyperparathyreosis. The other causes are renovascular hypertension, renoparenchymatous hypertension, sleep apnoe syndrome, aortic coarctation or hypertension due to an intracranial tumor. Suspicion on secondary hypertension should arise when hypertension...

Highlights in diagnostics and management of rheumatoid arthritis

doc. MUDr. Radim Bečvář CSc, prof. MUDr. Karel Pavelka DrSc

Interní Med. 2009; 11(7): 340-344  

Rheumatoid arthritis (RA) is an autoimmune disease of unknown aetiology characterized by presence of chronic synovitis which leads to joint erosion formation. RA can start at any age and involves predominantly females (2 to 3-times). In aetiopathogenesis of RA hereditary and external factors are involved, major role is played by so called shared epitope. Immune system is activated, tolerance is lost, and the inflammation is localized into the joint tissues. Arthritis usually develops within weeks or months. At the same time morning stiffness occurs with constitutional symptoms. RA may involve all joints except of distal interphalangeal joints....

The case of bronchitis with prolonged course

MUDr. Šárka Pokorná

Interní Med. 2009; 11(7): 349-350  

The patiens often suffer from cough and breathlesness, when they visit practitioners or specialists. The differential diagnose is very broad and include the diseases of respiratory system, cardiovascular and nervous or haematopoetic system etc. The physician can deduce the most propably causes of illness from the first contact with the patient, which he specifies by targeted questions and insures by physical examination and other methods. These seemly properly formulated questions can take away the right diagnose and so miss the potential life threatening event, as it was in this reported case.

The management of back pain

doc. MUDr. Ivana Štětkářová CSc

Interní Med. 2009; 11(7): 345-348  

Back pain is one of the most common cause of short and long-term invalidity. Majority of disability is functional and it is promptly improved when provoking factors like overloading or infection disappeared. Back pain could be divided into acute cervical and thoracic blockage and low back pain. Risk factors of nervous system impairment have to be identified, as severe back pain, recurrent spinal blockage, pain radiation into upper and lower limbs, progressive muscle weakness and numbness, sphincter and gait disability. Radiological investigations of spine includes routine x-ray, CT a MRI. Pharmacological treatment of back pain comprises paracetamol,...

Urinary incontinence in woman - correction possibilities

MUDr. Ivan Belkov, MUDr. Martin Huser

Interní Med. 2009; 11(7): 351-354  

Problematic and therapy of urine incontinence is in general very known. Different grade of urine incontinence is present by womens during their live in more than 50 %. Incidence in Czech Republic is about 350 000 in a year and is growing up with age, especialy in the postmenopausal age. In this article is presenting classification, most known reasons of urine incontinence and possibilities of urine incontinence therapy.

Indication for examination of risk factors for venous thrombosis

MUDr. Miloslava Matýšková CSc, MUDr. Marie Šlechtová, prof. MUDr. Miroslav Penka CSc

Interní Med. 2009; 11(7): 355-357  

Pathogenesis of thrombosis is based on multiple factors. In past years many interacting factors were described, both inherited and environmental. Surveying these should be indicated only in cases where knowledge of the defect can influence patient’s treatment or prophylaxis. We should examine only factors in which there is a proven relation to clinical picture. We should always take family and personal history into account while interpreting the results.

Autodidaktický test 7/2009

Interní Med. 2009; 11(7): 358