Co je nového v alergologii?

doc. MUDr. Petr Panzner, CSc.

Interní Med. 2012; 14(5): 191  

Current views on management of hypertension in patients with diabetes mellitus

MUDr.Josef Macháček

Interní Med. 2012; 14(5): 195-198  

Diabetes mellitus and arterial hypertension are risk factors that significantly affect cardiovascular prognosis and prevalence of chronic renal failure. Their co-occurrence potentiates this risk. The management of hypertension significantly affects these complications. Blood pressure between 130 and 139 mm Hg has been recommended as target level. RAAS-acting drugs are the mainstay of pharmacological treatment. It is important to actively search for risk factors, perform screening tests (evaluation of microalbuminuria, the fundus of the eye, Holter BP) and monitor the therapeutic effect.

Bone care in older age

MUDr.Jiří Jenšovský

Interní Med. 2012; 14(5): 199-202  

Bone care in the later decades of life requires a comprehensive approach involving evaluation of the patient’s clinical status along with assessment of the potential risk of fractures. In this setting, the term “frailty syndrome” has been increasingly used. In preventing osteoporotic fractures, it is always necessary to combine non-pharmacological intervention, nutritional intervention involving, in addition to dietary measures, supplementation with calcium and particularly vitamin D or its analogues, and pharmacological treatment. In the later decades of life, only a small number of medications have shown to have an effect...

Lyme borreliosis

MUDr.Hana Roháčová, Ph.D.

Interní Med. 2012; 14(5): 203-205  

Lyme borreliosis is a disease whose aetiology has only been uncovered relatively recently. The causative agent the spirochetal bacteria genus Borrelia – was discovered in the 1980’s. Lyme borreliosis is relatively common in the Czech Republic. Its clinical picture is very diverse; therefore, physicians from a variety of specialisations may encounter patients with this illness. Usually, classic symptoms are not difficult to diagnose; however, findings in many patients are not so clear cut, thus deciding if the patient does or does not have the disease is much more difficult. Particularly the later stages of Lyme borreliosis, from...

Treatment of lupus nephritis

doc.MUDr.Ivo Matl, CSc.

Interní Med. 2012; 14(5): 206-208  

Lupus nephritis occurs in approximately 60 % of patients with systemic lupus etythematosus. Main manifestation patterns are proteinuria, often associated with nephrotic syndrome, microscopic hematuria, and renal dysfunction. The treatment is directed by histopathological finding in renal biopsy. In patients with class I and II, ACE inhibitors and angiotensin receptor blockers are indicated. In proliferative forms of class III and IV, induction immunosuppression with corticosteroids and cyclophosphamide or mycophenolate mofetil is necessary. Maintenance therapy with corticosteroids and mycophenolate mofetil or azathioprin follows after achievement...

The clinical importance of antiplatelet resistance and its potential solution

doc.MUDr.Otto Mayer, CSc.

Interní Med. 2012; 14(5): 209-212  

Resistance to antiplatelets represents important limitation of secondary prevention of cardiovascular diseases. Residual platelet reactivity despite standard dual antiplatelet treatment is rather frequent condition and is associated by the excessive increase of coronary event, also with potentially fatal outcome. The use of new antiplatelet drugs, such as prasugrel and ticagrelor seems to be better solution, than increase of dosage of standard antiplatelets.

The patient with thyroid disease

doc.MUDr.Zdeněk Fryšák, CSc., MUDr.David Karásek, Ph.D., MUDr.Milan Halenka, Ph.D.

Interní Med. 2012; 14(5): 213-216  

The incidence of thyroid disease in the population can be compared to that of diabetes. There is clearly no shortage of patients with thyroid disease. Classic propaedeutic approach combined with modern ultrasonography resting on a sufficiently broad spectrum of laboratory methods allows a physician who has an understanding of the issue to determine, with a relatively high degree of precision and reliability, the diagnosis of thyroid disease even in an outpatient setting. The availability and the relative ease with which one can often come to a conclusion may lead to erroneous belief that the diagnostic process is straightforward and free of...

Aging men and steroid hormones - 1. Andropause

prof.MUDr.RNDr.Luboslav Stárka, DrSc.

Interní Med. 2012; 14(5): 217-220  

Age related decrease of testosterone levels has been established many times. Late-onset hypogonadism is accompanied by rather unspecific symptoms including vasomotor and nervous signs, disturbances of mood and cognitive function and decease and weakening of sexual functions. Guidelines from expert committees are at disposal for the examination of the hypogonadal patients, diagnosis, treatment and monitoring of the hormonal substitution. Recent guidelines underline that the adepts for testosterone treatment are only those men, in which clinical signs are accompanied by repeated subnormal levels of testosterone. The treatment should be strictly...

Celiac disease - from screening to diagnosis

MUDr.Jiří Latta

Interní Med. 2012; 14(5): 221-223  

Celiac disease is poorly diagnosed in Czech population, mostly after a long duration of the disease. Undiagnosed celiac disease often leads to the development of osteoporosis, autoimmune disorders and malignant diseases. People with celiac disease, where the disease hasn´t been diagnosed, have almost four times increased mortality compared to serum negative persons. The introduction of targeted screening is an essential step to limiting the negative consequences of unrecognized disease. The persons indicated for celiac disease screening a quantitative test for antibodies against tissue transglutaminase and total IgA is performed. A pathological...

When decision to insist on the palliative care needs experiences and courage

doc.MUDr.Miroslav Kala, CSc.

Interní Med. 2012; 14(5): 227-228  

80yers old diabetic female was admitted to hospice with diagnosis of the acute myeloid leukaemia and carcinoma of the stomach. Due to increased predisposition to bleed subcutaneous haematomas on the head and in the face have arised after minor injury. After consultation of the haematologist the patient was transfered to the hospital for the blood transfusion. Despite of the terminal stage of the oncological disease a lot of diagnostic methods was used there. The author discusses dubious indications of diagnostic and therapeutic methods in the cases of terminal cancer patients.

Patience yields recovery

MUDr.Zdeněk Monhart, Ph.D., MUDr.Jitka Križanová

Interní Med. 2012; 14(5): 229-230  

A patient operated on for a malignant neoplasm of the digestive tract is at a significant risk of malnutrition. Thorough nutritional metabolic care in the postoperative period is important for a good outcome of the surgical procedure as well as for the overall fate of the patient. In some cases, artificial nutrition in postoperative care is required on a long-term basis, over several months, and patience and persistence of the attending team are essential. The case report of our patient, who underwent gastric resection for non-Hodgkin lymphoma, represents one of these cases. Postoperative artificial nutrition was administered for five months...

Clinical aspects of treatment of essential hypertension with calcium channel blockers: what is the place of lercanidipine?

MUDr.Antonín Mandovec

Interní Med. 2012; 14(5): 235-238  

Lercanidipine is a drug from a class of dihydropyridin calcium channel blockers, approved in the Czech Republic in treatment of arterial hypertension. Calcium channel blockers together with ACE-inhibitors, AT1-blockers, diuretics and beta-blockers are drugs of a first choice in the treatment of arterial hypertension. Regardless the initial problems are calcium channel blockers very well estabilished in the treatment of arterial hypertension, and at the present era of „drug-specific“ and combined therapy of arterial hypertension plays an important role. The aim of this article is show the practical aspects of lercanidipine use in...

The role of phytochemical substances in the prevention and treatment of tumors

doc.Ing.Zdeněk Zloch, CSc., MUDr.Pavel Sedláček

Interní Med. 2012; 14(5): 224-226  

Since time immemorial, the folk medicine tries to cure diseases including tumors using various parts of plants. Numerous epidemiological studies have shown that there is a statistically significant association between the frequency of consumption of foods of plant origin and incidence of cancer. In an effort to determine the cause of their favourable effect, many natural substances have been isolated from plants and their potential effects on different stages of carcinogenesis has been tested. Indeed, many from these substances hinder or stop, in vitro, tumor development. The molecular mechanisms of these interactions have been elucidated....

Is there possible to influence anaemia by nutrition?

MUDr.Dagmar Brančíková

Interní Med. 2012; 14(5): 231-234  

Anemia is not a single disease but a condition, with many possible causes and many forms. Cause of anemia include nutritional deficiencies, inherited genetic defects, medication-related side effects (examply NSA), and chronic disease (often times gastrointestinal malignancy). It can also occur be cause of blood loss from injury or internal bleeding, the destruction of red blood cells, or insufficient red blood cell production. The condition may be temporary or long-term, and can manifest in mild or severe forms. We are able to influence anemia with sufficient doses of the iron and vitamines in the foods, and with abolition of some specific...