Slovo úvodem

PhDr. Václav Mertin

Interní Med. 2013; 15(11-12): 331  

Anticoagulation with new antithrombotic agents - recommendations for daily practice

prof.MUDr.Jan Kvasnička, DrSc., Mgr.Ivana Malíková, doc.MUDr.Tomáš Kvasnička, CSc.

Interní Med. 2013; 15(11-12): 334-339  

The internists can indicate the new oral anticoagulants (rivaroxaban, apixaban and dabigatran) in the treatment of their patients now. We present an overview of their effects and several advice for possible monitoring in practice.

Hypolipidemic therapy in patients with chronic kidney disease

prof.MUDr.Helena Vaverková, CSc.

Interní Med. 2013; 15(11-12): 340-344  

The risk of death from cardiovascular disease is increased already in early stages of chronic kidney disease (CKD), and increases significantly in more advanced stages. This risk is comparable to that in diabetes and pre-existing ischemic heart disease. The increased cardiovascular risk in CKD is due to both traditional and untraditional risk factors, including dyslipidemia. Dyslipidemia is modifiable and should be treated. Statins slow the progression of CKD and have a beneficial effect on proteinuria. Statins reduce all-cause and cardiovascular mortality as well as the occurrence of cardiovascular events in early stages of CKD (stages 1 to...

Options of flexible insulin administration

MUDr.Marcela Szabó

Interní Med. 2013; 15(11-12): 346-348  

Insulin analogs are biosynthetically made insulins that differ from human insulins in the modification of amino acids in the chains at certain positions. The reason for this modification is altered insulin pharmacokinetics that, as a result, imitates the physiological secretion of endogenous insulin to a higher extent. A resulting advantage of insulin analogs in comparison to human insulins in their clinical use is reduced blood glucose fluctuation and, in the case of long-acting insulin analogs, particularly a lower risk of hypoglycemias, especially nocturnal ones, lower weight gain in patients, and flexible insulin administration.

Renal Denervation

prof.MUDr.Václav Monhart, CSc.

Interní Med. 2013; 15(11-12): 349-351  

Renal denervation is an invasive method of treatment resistant hypertension. Percutaneous transluminal catheter-based ablation of the sympathetic nerve endings in the wall of the renal arteries leads to a reduction in blood pressure, which persists for up to 3 years. The largest and longest experience is evidenced by the renal denervation system Symplicity (Medtronic). The study of Symplicity HTN-1 and Symplicity HTN-2 confirmed the safety and effectiveness of the procedures. The development of new renal denervation catheter-based systems is promising in terms of greater efficiency, shorter duration and safety of the treatment.

Advances in the treatment of viral hepatitis B and C

prof.MUDr.Petr Husa, CSc.

Interní Med. 2013; 15(11-12): 352-354  

Acute hepatitis B is in most cases benign disease without necessity of antiviral therapy. Chronic hepatitis B viral infection can be treated with pegylated interferon (PEG-IFN), tenofovir or entecavir. Standard of therapy in chronic hepatitis C naïve patients, infected with genotype 1, is still combination of PEG-IFN and ribavirin (RBV), Triple combination therapy – boceprevir or telaprevir + PEG-IFN + RBV is so far in the Czech Republic approved only for patients without sustained effect of initial dual PEG-IFN and RBV therapy.

Anticoagulation and antiplatelet therapy in endoscopic procedures

MUDr.Petr Vítek, Ph.D., MUDr.Ivana Mikoviny Kajzrlíková

Interní Med. 2013; 15(11-12): 355-358  

Correct management of anticoagulation and antiplatelet therapy for endoscopic procedures needs adequate evaluation of bleeding and thrombotic risks in every patient. Latest guidelines from medical societies enable correct risk stratification. Interdisciplinary cooperation between cardiologist and gastroenterologist is important in special cases. Diagnostic endoscopic procedures can ussually be performed without a change of therapy, however in therapeutic procedures therapy needs to be adjusted or withheld. For some patients postponement of endoscopic therapy can be beneficial.

Hyperkalemia as complication of gastroenteritis - case reports

MUDr.Pavel Polák, MUDr.Radana Pařízková, MUDr.Michaela Freibergerová, MUDr.Eva Pernicová, Prof.MUDr.Petr Husa, CSc.

Interní Med. 2013; 15(11-12): 363-364  

The authors present two educative case-reports of hyperkalemia with signs of cardiotoxicity in polymorbid patients with acute gastroenteritis. Concomitantly used long-term medication contributed to the hyperkalemia significantly. The aim of this article is to warn physicians about risks of diuretic and hypoglycemic therapy in chronically ill patients and especially in acute gastrointestinal disorders.

Treatment of diabetic neuropathy

prof.MUDr.Zdeněk Ambler, DrSc.

Interní Med. 2013; 15(11-12): 358-362  

The number of people with type 2 diabetes is rising rapidly worldwide. Neuropathy is the common complication of diabetes and it is associated with a wide range of clinical manifestations. Distal symmetrical sensory or sensorimotor polyneuropathy is a most frequent type and small fiber damage is thought to result in painful symptoms. Painful diabetic neuropathy is common and is associated with significant reduction in quality of life. No current disease-modifying treatments have been shown definitively to reduce or reverse diabetic sensory polyneuropathy. Modulators of α2-δ subunit of calcium channels (gabapentin and especially pregabalin),...

Cushing´s syndrome

prof.MUDr.Michal Kršek, CSc.

Interní Med. 2013; 15(11-12): 368-371  

Cushing’s syndrome is a disorder characterized by increased autonomous production of cortisol and increased effects of cortisol on peripheral tissues. It is a rare disorder; however it seriously affects patients and is connected with increased morbidity and mortality. Moreover, its aetiology is variable and its differential diagnosis belongs to the most difficult ones in clinical endocrinology. Early determination of correct diagnosis is essential for prognosis of patients. The article summarizes current approach to the diagnosis and differential diagnosis of Cushing’s syndrome.

Pain and how to manage it in medical care

doc.PaedDr.et Mgr.Eva Zacharová, Ph.D., PhDr.Jana Haluzíková, Ph.D.

Interní Med. 2013; 15(11-12): 372-374  

Pain is a phenomenon belonging to human being. It is a very sensitive effect reflecting both physiologic matters and psychical and social ones. This unpleasant sense and emotional experience is connected with current or possible damaging of organism. Patient perceives the pain individually; it depends on the current or chronic pain. In a modern treatment and nursing it is multispecialty approach to getting pain under control where a paramedical worker plays a very important role.

How to prepare the patient for coronary angiography?

MUDr.Roman Štípal jr., MUDr.Roman Miklík, Ph.D., MUDr.Roman Štípal, CSc.

Interní Med. 2013; 15(11-12): 365-367  

Selective coronary angiography is routinely performed procedure used to diagnose coronary artery disease. It is an invasive examination and preparation for this procedure has several important aspects. Given that it is an examination using the contrast medium, very important are precautions for prevention of contrast-induced nephropathy (CIN), special caution should be taken in patients with a history of allergic reaction to contrast medium, polyvalent allergy or in patients with thyroid disease. Specific preparation concerns also antiplatelet and anticoagulant therapy. Some important arrangements are also needed in patients with diabetes.