Vnitřní lékařství, 1993 (vol. 39), issue 5
[Intracoronary "stents" in the treatment of ischemic heart disease. Brief review].
J Kovác
Vnitr Lek 1993, 39(5):420-423
The author present a brief review of the contemporary development of stents. Stents are used in the therapy of ischaemic heart disease, they are "tubes" inserted by methods of intervention cardioangiology into the coronary lumen to ensure their patency. At present they are indicated in particular in the treatment of acute arterial obliteration after PTCA. Stents used at present do not meet the demands required by long-term follow up. Stents used at present in clinical work are made from different metals. The authors describe also experimental experience with stents made from bioabsorbable materials which potentially appear to have much more suitable...
[Variability of ECG changes in ambulatory Holter monitoring during treatment of hypothyroidism].
J Gonsorcík, V Gonsorcíková, M Tajtáková, A Tokárciková
Vnitr Lek 1993, 39(5):424-429
The authors examined by 24-hour Holter monitoring the ECG in 20 patients treated on account of primary hypothyroidism with thyroid hormones. The patients were divided, with regard to the presence or absence of manifest ischaemic heart disease, into two groups which differed significantly as to the mean age of patients and the minimal R-R interval. In both groups diffuse ectopia was found without persisting activity except for one patient after myocardial infarction with relapsing ventricular tachycardia, organic sinoatrial blocks were found in two patients, an organic atrioventricular grade II block in one female patient and a functional (vagotonic)...
[Blood component replacement in bone marrow aplasia in patients after aggressive chemotherapy for malignant hematologic diseases].
H Kubesová, E Krahulcová, I Kiss, J Vorlícek
Vnitr Lek 1993, 39(5):430-436
Aggressive chemotherapy of malignant haematological diseases causes long-term aplasia of bone marrow and it is necessary to supplement blood elements repeatedly. When procuring blood derivates frequently dramatic situations develop. In an attempt to prevent alloimmunization of the patient by careful selection of the donor the time interval between indication and administration of the transfusion is prolonged. The objective of the present work was to attempt an estimate, as regards time and amount, for transfusion of blood derivates. The authors analyzed 100 cycles of aggressive chemotherapy with regard to changes of the haemogram. The group was divided...
[Early empiric antibiotic therapy of infectious complications in patients with neutropenia].
H Kubesová, J Zemanová, J Vorlícek
Vnitr Lek 1993, 39(5):437-444
Aggressive chemotherapy used at present for the treatment of malignant haematological diseases leads to prolonged aplasia of the bone marrow with the possible development of fulminant infectious complications. Treatment of these complications must be started immediately when they are detected, i.e. as a rule without knowing the bacteriological finding at the time. The objective of the present work was to assess by analysis of 376 positive bacteriological findings from hospitalized patients with neutropenia and 141 findings of immunocompromised patients in their homes a combination of antibiotics for empirical treatment of infectious complications which...
[Erythropoietin or transfusion?].
V Bártová, K Němecek, J Lachmanová
Vnitr Lek 1993, 39(5):445-450
The cause of anaemia in dialyzed patients is multifactorial. In the submitted paper the authors give an account of their experience with the treatment of 40 patients with erythropoietin (Eprex Cilag Co.). The initial Hb values were 78 +/- 13 g/l and haematocrit 0.24 +/- 0.03. After three months of treatment the haematocrit values were 0.30 +/- 0.02 and the Hb values 103 +/- 7 g/l. After one year's treatment haematocrit values were 0.31 +/- 0.03, Hb 105 +/- 10 g/l. Treatment was started by administration of 150 u/kg/week. Despite considerable individual differences the mean maintenance dose after one-year treatment is only 65 u/kg/week. In two patients...
[The locomotor system in irreversible renal failure treated with regular dialysis].
J Vachtenheim, J Tocík, P Knetl, Z Novák
Vnitr Lek 1993, 39(5):451-458
Changes of the locomotor apparatus in prolonged uraemia with regular dialyzation treatment determine the quality of life with all its consequences for the patient. The greatest impact on osteodystrophic disease (the most typical finding on the skeleton) is exerted by the length of dialyzation treatment. Of 216 patients having regular dialyzation treatment in 1979 to 1992 the authors observed osteodystrophic disease in 25, i.e. 11.6%. As to other most frequently observed changes they recorded osteoporosis in 12.9%, only very rarely osteomalacia and even osteopetrosis (1.8%). Carpal tunnel syndrome was recorded in 17.4% as a symptom of so-called dialyzation...
[Aluminum osteopathy--experience with therapy].
S Sulková
Vnitr Lek 1993, 39(5):459-463
The author discusses the problem of aluminium osteopathy as one of the clinical manifestations of aluminium intoxication in dialyzed patients. She describes the case-histories of three patients treated on account of aluminium intoxication with desferrioxamine. The disease was manifested by pain in the bones and joints and muscular weakness, in two patients also with symptoms of encephalopathy. The diagnosis was assessed only after a special examination of bone trepanobiopsy (staining with aurintricarboxyl acetic acid) and confirmed by assessment of the aluminium serum concentration. While treatment of the first patient in 1986 was not successful, in...
[Arthropathy and para-arthropathy in uremic patients on regular hemodialysis].
D Sobotová, J Böhmová, V Vitulová
Vnitr Lek 1993, 39(5):464-469
Arthropathies and para-arthropathies occur in two thirds of regularly haemodialyzed uraemic subjects. The incidence does not depend on age but the period of haemodialyzation treatment. After five years of treatment the articular apparatus is affected in 100%. In women, as compared with men, the joints of the upper extremities, in particular the small joints of the hands are significantly more frequently affected.
[Hyperparathyroidism and parathyroidectomy in dialyzed patients].
I Sotorník, M Slavíková, V Kocandrle, M Lukác, R Petrásek, J Dutka, M Zichová
Vnitr Lek 1993, 39(5):470-475
The authors present older and more recent views regarding the pathogenesis of hypocalcaemia and secondary hyperparathyroidism in patients with chronic renal failure with emphasis on the impact of inorganic phosphate retention and lack of 1,25-dihydroxyvitamin D3 in body fluids. As regards therapeutic procedures the initial problem is to control hyperphosphataemia and to suppress the increased parathormone secretion in particular in dialyzed patients. When treating hyperphosphataemia it is necessary with regard to the severity of the finding to use concurrently several procedures and avoid aluminium phosphate binders. Aimed reduction of high parathormone...
[The carpal tunnel syndrome, its diagnosis and therapy].
V Bártová
Vnitr Lek 1993, 39(5):476-480
Secondary amyloidosis is a complication typical for patients on long-term haemodialysis (HD). The first clinical signs are usually shoulder joint pain and CTS. We have questioned 74 patients who were on regular HD treatment and divided them into 3 groups according to the length of HD. Group I--on HD for 1-4 years: there were 35 patients in this group, 15 of them (i.e. 43%) had shoulder joint pain and/or CTS. None of these patients had such symptoms, which would require surgical treatment. Group II--on HD for 5-9 years: there were 22 patients in this group, 15 of them (i.e. 68%) had shoulder joint pain and/or CTS. 3 patients from this group had severe...
[Methods of measuring hyperinsulinism and insulin resistance].
J Hrnciar
Vnitr Lek 1993, 39(5):481-486
The author gives an account of methods used for evaluation of hyperinsulinism and insulin resistance such as: hyperinsulinaemic, euglycaemic and hyper- and hypoglycaemic "clamp", minimal model of glucose and insulin kinetics. They evaluate specially indexes used in clinical practice such as: I/G, (insulin/glucose--the so-called insulinogenic index), the G/I index, (the so-called index of insulin resistance) and the index of C-peptide/IRI, basal and during the oral glucose tolerance test. In epidemiological studies of the prevalence of the X syndrome (5H) he recommends to use the G/I index basal and minimal two hours after a glucose load, along with...
[Hematopoietic growth factors in antineoplastic therapy from the therapeutic and economic aspect].
Z Adam, J Vorlícek, M Tomíska
Vnitr Lek 1993, 39(5):487-500
Haematopoietic growth factors help patients with intense chemotherapy and patients after transplantation of bone marrow to overcome the critical stage of leucopenia. In the submitted paper the authors present more detailed data on the results of investigations evaluating G-CSF, GM-CSF and erythropoietin in patients with anti-tumourous treatment. Both leucocytic growth factors, G-CSF and GM-CSF shorten the period of leucopenia by approximately one week which means a substantial reduction of the number of infectious complications and also a reduction of the hospitalization period. The price of the mentioned growth factors which is still high as compared...