Jak se vede českému lázeňství?

MUDr. Eduard Bláha

Interní Med. 2014; 16(5): 176  

The treatment of hypercholesterolemia by PCSK9 inhibitors

prof.MUDr.Vladimír Bláha, CSc.

Interní Med. 2014; 16(5): 179-183  

Proprotein convertase subtilisin/kexin type (PCSK9) is a crucial protein in LDL cholesterol (LDL-C) metabolism because of its pivotal role in the degradation of the LDL receptor. In recent years, both in vitro and in vivo studies have greatly supplemented our understanding of the role of PCSK9 in human biology. As PCSK9 has emerged as a novel target for LDL-C lowering therapy, being discovered in 2003, recent developments in inhibition of PCSK9 are reviewed. Initial data from investigations of PCSK9 inhibition in humans are promising and indicate that PCSK9 inhibition may be a viable new therapeutic option for the treatment of dyslipidemia...

Pulmonary embolism - still underestimated diagnosis in outpatient practice

MUDr.Tomáš Indra

Interní Med. 2014; 16(5): 184-188  

Pulmonary embolism is one of the most common cardiovascular diseases. Although this disease is well known even among general public, diagnosis can be really difficult for its nonspecific and heterogeneous symptoms. Acute pulmonary embolism is characterized by high mortality especially in untreated patients. This article focuses on diagnosis possibilities in stable patients with suspected pulmonary embolism in outpatient practice and on treatment and secondary prevention of venous thromboembolism according to contemporary guidelines. New possibilities of treatment using new oral anticoagulants are mentioned as well.

News in treatment of idiopathic pulmonary fibrosis

doc.MUDr.Martina Vašáková, Ph.D.

Interní Med. 2014; 16(5): 189-191  

Idiopathic pulmonary fibrosis (IPF) is diffuse primarily fibrosing lung process of unknown etiology. The main clinical signs of IPF are middle and advanced age of patient, otherwise unexplainable breathelesness, clubbed fingers and crepitus on auscultation. The main investigation for diagnosis is CT of lungs with high resolution algorythm with finding of usual interstitial pneumonia (UIP). Bronchoalveolar lavage has rather auxiliary differential diagnostic meaning. In case of uncertainity the diagnosis should be supported by surgical lung biopsy with histopathologic finding of UIP. The new drug for treatment of IPF with causal action is pirfenidone.

Renal failure requiring haemodialysis occurs in 10-20 % of all multiple myeloma (MM) cases and it is associated with a greatly increased

MUDr.Jiří Orság, MUDr.Mgr.Jiří Minařík, Ph.D., MUDr.Zdenka Kosatíková, MUDr.Miroslav Hrubý, RNDr.Pavel Lochman, Ph.D., prof.MUDr.Vlastimil Ščudla, CSc., prof.MUDr.Josef Zadražil, CSc.

Interní Med. 2014; 16(5): 192-195  

morbidity and mortality. The main cause of renal injury is cast nephropathy, as a direct consequence of high concentrations of monoclonal free light chains (FLCs) in patients´ sera. Rapid reduction of FLCs levels plays a key role in renal recovery. Evidence of benefit of plasmapheresis in removing serum FLC is controversial. According to recent experience, haemodialysis using high cut-off dialysers reduces effectively the level of FLCs concentrations and improves renal functions in long term when combined with an effective chemotherapy. Nevertheless, further experiences and controlled trials are needed to determine the clinical benefit of this...

Pneumonic form of the lung cancer

MUDr.Jana Kulísková, prof.MUDr.Vítězslav Kolek, DrSc.

Interní Med. 2014; 16(5): 196-198  

Adenocarcinoma with prominent lepidic spread presents, in addition to it´s specific morphology, with certain clinical characteristics as higher incidence in women, non-smokers and younger patiens and lower susceptibility to conventional cytostatik therapy in comparison to other subtypes of non-small cell lung carcinoma (NSCLC). About 10 % of NSCLC express receptor for epidermal growth faktor (EGFR), which is predictor of effectiveness to biologic therapy. We present a case of a 33 years old man, who was treated at the begining for left lung pneumonia. Just with the passage of 3 months, after antibiotic therapy and repeated radiology controls,...

Granulomatosis with polyangiitis

MUDr.Kateřina Martinková, MUDr.Ivo Valkovský, Ph.D., MUDr.Petr Handlos

Interní Med. 2014; 16(5): 199-201  

Granulomatosis with polyangiitis (formerly known as Wegener‘s granulomatosis) is a necrotizing vasculitis that affects the small vessels, especially those of the respiratory system, and kidneys via the formation of granulomas, manifesting as necrotizing glomerulonephritis. Our case report presents the case of 56 years old man, who was sent to the Department of Internal Medicine at the University Hospital of Ostrava from a regional hospital because of a persisting intermittent fever. The patient´s clinical characteristics included bilateral perimaleolar oedema, mild weight loss, subjective complaints of an upper respiratory tract infection...

Komentář ke studii AUTONOMY: První randomizovaná studie porovnávající dva přístupy pacientů s diabetem 2. typu k zahájení a titraci dávek prandiálního inzulinu lispro

doc.MUDr.Martin Prázný, CSc., Ph.D.

Interní Med. 2014; 16(5): 202-204  

Heart rate variability: applications in medical practice with focus on metabolic syndrome

MUDr.Jiří Pumprla, MPH, MBA, prof.MUDr.Eliška Sovová, Ph.D, MBA, prof.Dr.med.Kinga Howorka, MPH, MBA, MSc

Interní Med. 2014; 16(5): 205-209  

The capability of quick adaptations is an important condition for preserving a long-term homeostasis of the body. Autonomic nervous system represents a dynamic control system that sensitively manages bodily response to a range of external and internal stimuli and in this way secures integrity of the organism. Cardiovascular reflexes, which represent basic principle of this system, can get impaired due to various factors over the time. Nowadays, due to swift technological developments, it is possible to detect even its early dysfunction by a relatively quick, simple and non-invasive method using analysis of heart rate variability. This method...

How to prepare a patient for colonoscopy

MUDr.Jiří Cyrany, Ph.D.

Interní Med. 2014; 16(5): 210-212  

The colonoscopy is an effective diagnostic method for colorectal diseases. Its importance both in diagnostics and therapy of premalignant and early malignant changes is growing recently. Efficacy and safety of colonoscopy depend on adequate preparation of the patient – the bowel cleansing being the most important. There is a spectrum of bowel cleansing agents available in the Czech Republic today with comparable efficiency and variable safety. A dietary restriction and an adequate liquid intake are essential parts of the bowel preparation. The planning for a colonoscopy comprises also an evaluation of patient overall status and procedure...

The illegal break of the obligatory secrecy - the present problem of Czech health service

Mgr.Markéta Zajíčková

Interní Med. 2014; 16(5): 213-214  

The following article briefly brings to mind the history of medical secret and the obligatory secrecy of health specialist in the Czech Republic. The text describes real situation of frequent break of the law applying to obligatory secrecy, the opinions of lawyers, and the suggestion of a possible soltion.