Některé užitečné prvky komunikace

MUDr. Radkin Honzák, CSc.

Interní Med. 2014; 16(3): 91  

Pharmacotherapy of chronic venous disorder

MUDr.Lukáš Hnátek, Ph.D.

Interní Med. 2014; 16(3): 93-97  

Chronic venous disorder (CVD) is a common illness with high incidence existing especially in Europe and North America. The main goal of Venoactive Drugs (VAD) is to eliminate the symptoms of CVD (venous pain, fatigue, etc.). But there are some VAD that could be used also for treatment of venous oedema and venous ulcer. There are many papers that prove their effectiveness in the experiment and in the microcirculation. The most effective substance is micronized purified flavonoid fraction (MPFF) of diosmin hesperidin. It is proved that this substance could be used as an effective supplementary treatment of symptoms after venous intervention....

Cryptogenic stroke and patent foramen ovale - our indication criteria for interventional PFO closure

MUDr.Jiří Ostřanský, doc.MUDr.Dan Marek, Ph.D.

Interní Med. 2014; 16(3): 98-100  

Patent foramen ovale (PFO) is a common finding in healthy persons. The prevalence of PFO is increased in patients with a cryptogenic stroke. The role of PFO is supposed in ethiology of paradoxical embolisation in some patients. Transesophageal echocardiography remains a gold standard for detection of PFO and right-to-left shunt. It is unknown whether closure of PFO is effective in the prevention of recurrent stroke after a cryptogenic ischemic stroke. Observational studies have suggested that closure is associated with a benefit. In generally three randomized trials failed to show the superiority of closure over medical therapy alone. This...

The use of strong opioids in chronic pain treatment

MUDr.Eva Hegmonová

Interní Med. 2014; 16(3): 102-105  

The effective management of chronic pain is fundamental goal for all clinicians, who treat the pain. Nociceptive and neuropathic pain are two basic kinds of pain, which appears separetly or in combination. The three-step analgesic ladder developed by the World Health Organisation (WHO) outlines these opioids in the management of cancer pain, and these widely accepted and extensively validated guidelines have also been influential in the application of opioid therapy for treatment of chronic, non-malignant pain. Potent opioids – such as morfin and the newer-generation agents (fentanyl, buprenorfin, oxycodon, hydromorfon and tapentadol)...

Recent findings in therapy of oral antidiabetic drugs

MUDr.Alena Adamíková, Ph.D., prof.MUDr.Jaroslav Rybka, DrSc.

Interní Med. 2014; 16(3): 106-109  

The therapy of type 2 diabetic patients includes education directed at a change of life style, assessment of microvascular and macrovascular complications, normalization of glycaemia and minimization of cardiovascular and other risk factors. A majority of diabetic patients requires continual treatment increasing insulin secretion and sensitivity and reducing saccharide absorption. Initial monotherapy fails annually in 5–10 % patients. According to an analysis of UKPDS 50 % of patients require a second oral antidiabetic drug after three years of therapy. Entirely new therapeutic possibilities are provided by DPP-4 inhibitors and GLP-1...

The influence of vitamin D on immune mechanisms

prof.MUDr.Ivan Šterzl, CSc.

Interní Med. 2014; 16(3): 110-112  

Vitamin D plays a role in development and prevention of many pathological states. Immune system is involved in the whole organism, maintains homeostasis, position of the individual in the environment and is one of the most important regulatory systems of the organisms with incredible adaptation capability. In this review I am concerned with the influence of active vitamin D3 on the immune system, especially in the scope of innate and adaptive immunity. Through the immune system vitamin D is important in defense against infections, tumor diseases and in development of immunopathological reactions, especially in autoimmunity.

Constipation

MUDr.Zuzana Adamová, MUDr.Radim Slováček, MUDr.Petr Šindler

Interní Med. 2014; 16(3): 113-115  

Constipation is traditionally defined as less than 3 stools in a week and difficult stool passage. Risk factors for constipation include female sex, older age, low-fiber and fluid diet, inactivity, low income, low educational level. Chronic constipa tion is classified as functional (primary) or secondary. Secondary constipatin is related to organic disease, systemic disease or medications. The evaluation of constipa tion includes a history and physical examination to rule out alarm signs. Patients with such signs require futher evaluation by specialist, the other may be treated symptomaticaly.

Infection of hepatae cysts in patient with autosomal dominant polycystic kidney disease

MUDr.Michal Holánek, MUDr.Tomáš Pokrivčák, doc.MUDr.Kamil Ševela, CSc., MUDr.Darja Krusová, Ph.D., MUDr.Jan Svojanovský, Ph.D., prof.MUDr.Miroslav Souček, CSc.

Interní Med. 2014; 16(3): 116-118  

Infection of hepatal cysts in patients with autosomal dominant polycystic kidney disease is quite rare but severe complication. This case report describes a case of patient with ADPKD, history of kidney transplantation with chronic renal insufficiency of the graft, who developed sepsis. Subsequently, infected liver cyst was found. The cyst was treated with combination of antibiotic therapy and drainage followed by decrease of inflamatory markers and clinical recovery of the patient.

Diagnosis and differential diagnosis of hypocorticism

prof.MUDr.Michal Kršek, CSc.

Interní Med. 2014; 16(3): 119-122  

Hypocorticism is a state of insufficient secretion of adrenal cortex hormones mainly that of glucocorticoids and its clinical signs reflect a disproportion between their secretion and demands. It is a serious state with nonspecific signs in mild forms; however, it can progress to severe addisonian crisis with circulatory failure and a risk of death. Early establishment of correct diagnosis and immediate introduction of replacement therapy are therefore essential. Assessment of morning serum cortisol levels is a basic examination to detect hypocorticism regardless of aetiology. In partial deficiency and in case of uncertainty dynamic testing...

When and how to treat ventricular extrasystoles in an internist's practice

MUDr.Ondřej Moravec, MUDr.Tomáš Skála Ph.D., doc.MUDr.Petr Heinc, Ph.D.

Interní Med. 2014; 16(3): 123-126  

Ventricular extrasystoles are premature ventricular contractions resulting from electrical depolarization from an ectopic centre in the myocardium below the level of the bundle of His. They are the most frequent ventricular arrhythmias in the population. They occur both in patients with no organic heart disease and in those with various heart diseases. The vast majority are of a benign nature, thus requiring no treatment. In a proportion of patients, extrasystoles are perceived subjectively as very unpleasant and, in a small proportion, frequent ventricular extrasystole can even lead to left ventricular dysfunction – tachycardia-induced...