Komunikace s handicapovanými

prof. ThLic. MUDr. Květoslav Šipr, CSc.

Interní Med. 2015; 17(3)  

Několik pohledů na žilní trombózu

MUDr. Roztočil Karel, CSc.

Interní Med. 2015; 17(3): 110  

Prolonged sitting: a new and underestimated risk factor of venous thromboembolism

doc.MUDr.Jana Hirmerová, Ph.D.

Interní Med. 2015; 17(3): 111-113  

Venous thromboembolic disease is a multicausal disease that results from an interaction of genetic factors and environmental effects. Recently, increasing importance has been placed on some of the risk factors in particular: older age, obesity, and immobility. There has been an increasing number of academic publications on thromboembolic events due to prolonged rigid sitting. To date, case reports or case series have been published describing often fatal cases resulting from long travel, sitting at work as well as participating in a computer game marathon. However, only a few studies have been conducted dealing with a more accurate definition...

Vena cava filters in patients with deep vein thrombosis

MUDr.Vladimír Čížek, MUDr.Dušan Kučera, Ph.D., MUDr.Martin Válka, MUDr.David Maděřič

Interní Med. 2015; 17(3): 114-116  

Vena cava filter is a small „basket“ introduced mostly into the inferior vena cava through catheterization Seldinger catheter technique. Its purpose is to capture loose thrombi (emboli) most efficiently and thus protect the patient from life-threatening pulmonary embolism.

Choosing patients for NOAC treatment: what to take into account?

prof.MUDr.Jan Bultas, CSc., doc.MUDr.Debora Karetová, CSc.

Interní Med. 2015; 17(3): 118-122  

Currently, several oral anticoagulant drugs are available to treat and prevent thrombotic and thromboembolic states – warfarin, dabigatran, rivaroxaban, and apixaban. In a number of indications, there are options to choose from; at other times, the preference of one approach is more favourable – both in terms of higher efficacy and better safety, or sometimes the choice is limited to one anticoagulant only. An example when any anticoagulant can be chosen is the prevention of stroke in an otherwise uncompromised patient; when there is a high risk of thromboembolic stroke, dabigatran at a higher dose will most likely be preferred....

Endovascular treatment for acute iliofemoral venous thrombosis

MUDr.Miroslav Chochola, CSc.

Interní Med. 2015; 17(3): 123-127  

Iliofemoral thrombosis is the most severe form of deep venous thrombosis. The patients are at an immediate risk of pulmonary embolism and venous limb ischaemia and, prospectively, of post-thrombotic syndrome. The management of acute and chronic complications with conservative anticoagulation therapy alone is mostly unsatisfactory. In selected patients presenting with phlegmasia, endovascular treatment with local thrombolysis/mechanical thrombectomy is currently recommended as an alternative to anticoagulation therapy. Iliac vein compression syndrome (May-Thurner syndrome) has to be addressed at the end of the procedure by means of percutaneous...

Treatment of idiopathic pulmonary fibrosis in the Czech republic in 2015

doc.MUDr.Martina Vašáková, Ph.D.

Interní Med. 2015; 17(3): 128-132  

Idiopathic pulmonary fibrosis (IPF) is a diffuse primarily fibrosing lung disease of unknown origin. Until 2011 IPF was considered untreatable, i.e. the currently used treatment modalities did not show any effectivity from the point of view of evidence-based medicine. The introduction of pirfenidone counted for the milestone in the treatment of IPF. In the Czech republic this drug was available from autumn 2011 by means of so called named-patient programme and since 2012 after a registration in EU pirfenidone was available in the Czech republic via extraordinary reimbursement of imported drug. Since 1st July 2014 is pirfenidone (ESBRIET, Roche)...

„Doc, my legs hurt!“ Differencial diagnosis of pain in lower extremities

doc.MUDr.Lenka Veverková, Ph.D., MUDr.Petr Vlček, Ph.D., prof.MUDr.Ivan Čapov, CSc.

Interní Med. 2015; 17(3): 133-136  

Two distinct clinical forms of pain with different pathophysiological mechanisms need to be considered. We can perceive pain both in positive and negative ways. The positive role of pain lies in its protective function as a defense of the human organism against damage. This protective function concerns especially the acute pain. The chronic pains are the outcome of serious illnesses, the cause of which needs to be diagnosed. Differential diagnostics will help us to make exact diagnosis. Only then, the adequate treatment can follow – either within the frame of recommended procedures or standards.

Hyponatremia

doc.MUDr.Věra Čertíková Chábová, Ph.D.

Interní Med. 2015; 17(3): 137-140  

Hyponatremia is a frequent potentialy dangerous condition. It is caused by a number of different conditions and diseases, such as cardiac, liver, or renal failure, endocrinological impairments, brain injury, etc. Not rarely it is the consequence of medication. It causes signs and symptoms from acute brain edema to higher incidence of fractures. The diagnosis should be established rapidly and treatment initiated immediately. Both are now subject to new European guidelines. It is neccesary to carefully monitor the rate of correction to prevent the osmotic demyelinisation.

Optimizing of heart failure pharmacotherapy - role of ivabradin

doc.MUDr.Filip Málek, Ph.D., MBA

Interní Med. 2015; 17(3): 147-149  

The aim of the chronic heart failure therapy is to reduce risk of death and risk of heart failure hospitalization without affecting quality of life. Beta-blockers are considered to be cornerstones of medical therapy. In many patients, increased heart rate persists despite the maximal tolerated beta-blocker dose. A case study shows, that optimizing of heart failure pharmacotherapy with ivabradin added to beta-blocker might decrease heart rate and increase tolerability to load, together with antiremodelling effect as assessed by the drop of NT-proBNP level.

Microscopic colitis as a cause of chronic watery diarrhea in a female patient with vertebrogenic algic syndrome

MUDr.Daniel Debnár

Interní Med. 2015; 17(3): 150-152  

Microscopic colitis is a common cause of a chronic watery non-bloody diarrhea where endoscopic, radiologic and thorough laboratory findings are mostly normal and the diagnosis is confirmed histologically from random biopsies over the colon. From the microscopic view we can distinguish between lymfocytic colitis and collagenous colitis. In this report we bring a case of a female patient with a vertebrogenic algic syndrome treated with standard chronical analgetic therapy who developed a sudden onset watery diarrhea, where the final diagnosis and the correct treatment was made histologically from a macroscopic intact colon after a very detailed...

Anticoagulation in cancer patients in palliative care

MUDr.Kateřina Menčíková, MUDr.Irena Závadová, MUDr.Ondřej Sláma, Ph.D.

Interní Med. 2015; 17(3): 154-155  

Venous thromboembolism (VTE) is a frequent complication and an important source of morbidity and mortality in advanced cancer patients in palliative care. These patients are often also at increased risk of bleeding. Primary prophylaxis of VTE is recommended for hospitalized cancer patiens with a good performance status and those undergoing active oncologic therapy. There is no evidence of benefit of prophylaxis for patients with life expectancy shorter than 3 months. Treatment of symptomatic VTE is recommended even in patients with limited survival with the exception of those who are imminently dying. The first choise drug is low-molecular...

Polymyositis

prof.MUDr.Jiří Vencovský, DrSc.

Interní Med. 2015; 17(3): 141-146  

Polymyositis is a rare disease manifesting with muscle weakness located particularly to proximal parts of extremities. A number of patients have also extramuscular manifestations, such as dysphagia, interstitial lung disease or arthritis. Muscle biopsy shows endomysial inflammatory infiltrate and MHC class I hyperexpression on muscle cells, EMG displays myogenic findings, and usually CK and/or other muscle enzyme levels are elevated. Detection of serum autoantibodies is diagnostically and prognostically helpful since some of them are specific for myositis and typical for particular clinical situations, such as antisynthetase syndrome. Many patients...

Quality of health care - what is it about?

MUDr.Jan Šťastný, MBA

Interní Med. 2015; 17(3): 156-158  

The Article looks on the Quality of the Health Care from the wide Viewpoint. It points out the three Component´s of the Healthsystem- -Quallity and of the two basic Accesses in the Quality-evaluate: public and private.