[Ultrasonography of the kidneys for the detection of incipient diabetic nephropathy].

V Růzek, M Kvapil, T Vaněcek

Vnitr Lek 1993, 39(8):732-737

At the First Medical Clinic of the Faculty Hospital in Prague 5 Motol a group of 15 men and 14 women treated on account of type I diabetes for a mean period of 12.8 +/- 5.8 years was examined. Their mean age was 26.3 +/- 5.8 years and their BMI 23.91 +/- 2.82. The control group was formed by 18 healthy subjects (10 men and 8 women) mean age 23.8 +/- 8.9 years, BMI 22.44 +/- 2.48. All subjects were subjected to a detailed ultrasonographic examination and, assessment of microalbuminuria. From the assembled sonomorphometric data the volume of the right kidney was related to the BMI and thus the renal volume index (RVI) was obtained. In the group of diabetic...

[Modelling the kinetics of C-peptide and hepatic extraction of insulin (in type 2 diabetics and non-diabetics with hypertriacylglycerolemia)].

M Kvapil, P Stolba, D Wichterle

Vnitr Lek 1993, 39(8):738-744

Increased glucose release from the liver which is responsible to a considerable extent for fasting hyperglycaemia in type 2 diabetics is associated with hepatic insulin resistance. Assessment of insulin extraction in the liver can therefore be useful in investigations of all pathophysiological conditions with deviations of glucose tolerance, or in the course of insulin secretion. The control group was formed by 8 healthy men, mean age 43.6 +/- 5.9 years, mean BMI 24.7 +/- 2.8. The authors examined also a group of 7 men with diabetes mellitus type II, mean age 46.7 +/- 5.9 years, BMI 31.4 +/- 8.9 and 6 men with hypertriacylglycerolaemia, mean age 44.2...

[Reaven's metabolic syndrome X in the families of individuals with premature cerebrovascular attacks].

H Vaverková, L Ficker, I Vlachová, J Chudácková, D Novotný, M Budíková

Vnitr Lek 1993, 39(8):745-754

In families of subjects with premature ischaemic cerebrovascular attacks (a total of 45 families with 190 members) the authors detected a high incidence of dyslipidaemia, arterial hypertension, impaired glucose tolerance and non-insulin dependent diabetes mellitus, frequently with striking cumulation. The authors investigated therefore the relationship of the insulin level as an indirect reflection of insulin resistance with these risk factors. The fasting insulin levels correlated significantly positively with triglyceride levels, apolipoprotein B, atherogenic indices and negatively with HDL-cholesterol. The probands and siblings with arterial hypertension...

[Are central hemodynamics the decisive factor in the manifestation of chronic heart failure?].

J Toman, J Vítovec, M Soucek, L Groch, B Zatloukal, J Novotný, M Stejfa

Vnitr Lek 1993, 39(8):755-760

In the past some authors revealed that data assembled during examinations of the central haemodynamics, echocardiography, subjective complaints, physical findings and load tolerance in patients with chronic heart failure are not mutually consistent. The authors examined therefore comprehensively 40 patients with different grades of cardiac failure. They revealed very loose relations between the grade of functional classification, echocardiographic and invasive haemodynamic parameters at rest on the one hand and spiroergometric indicators on the other hand. Closer relations with spiroergometric findings were obtained with values of invasive haemodynamic...

[Treatment of resistant forms of multiple myeloma using a combination of mitoxantrone, vincristine and prednisone (the NOP regimen)].

V Scudla, J Bacovský, L Faltýnek, T Papajík, K Indrák

Vnitr Lek 1993, 39(8):761-768

In the submitted study the authors summarize experience with the treatment of resistant forms of multiple myeloma by a combination of Mitoxantrone, Vincristine and Prednisone (NOP regime). The above treatment produced an objective therapeutic response in 33% of the patients, in 50% a partial response, in 17% it failed. The median of survival in the whole group was 10.5 months. Substantially poorer therapeutic results were recorded in patients with primary resistance to the initial chemotherapy (objective response only in one of 6 patients) than in the group with secondary resistance which developed during a relapse of the disease (objective response...

[Lipostat in the treatment of hyperlipoproteinemia].

V Růzek, J Procházka

Vnitr Lek 1993, 39(8):769-772

Within the framework of clinical tests of LIPOSTAT (pravastatin tablets 20 mg Bristol Meyers-Squibb Co.) this hypolipidaemic preparation was administered to 28 patients with different types of hyperlipoproteinaemias, mainly of type IIa. Administration for a period of four weeks--20 mg in the evening--had a significant effect on several basic indicators of the lipid metabolism. The total plasma cholesterol level declined by 20%, the apolipoprotein B level by 11%, the HDL cholesterol level rose by 38% and the triacylglycerol level declined by 18%. During administration the serum levels of aminotransferases, creatine kinase and alkaline phosphatase did...

[Takayasu's arteritis with primary involvement of the pulmonary artery].

K Hlavácek, V Janík, S Tůma

Vnitr Lek 1993, 39(8):773-777

The authors demonstrate a 23-year-old women in the fourth month of pregnancy with complaints and findings typical for Takayasu's arteritis. The onset of the disease can be safely located to the area of the pulmonary artery where the aorta and its branches were still unaltered. In the course of nine years not only a severe occlusive stage developed in the area of the thoracic aorta and its branches but there was also progression as regards the affection of the pulmonary artery. In the area of the subclavicular artery on the left balloon dilatation was performed. The collateral arterial blood supply of the left lung from the left coronary artery is also...

[Cystic lymphangioma of the retroperitoneum].

J Procházka, J Zelenková, J Hanika, J Trnka, V Růzek, V Zeman, E Cumlivská

Vnitr Lek 1993, 39(8):778-783

The authors present the case-history of a patient with a cystic retroperitoneal lymphangioma. Its diagnosis was established only by histological examination of the resected tissue. The authors draw attention to the symptomatology, diagnosis, therapy and discuss contemporary views regarding the cause of this disease.

[An unusual cause of recurrent septic states].

J Sochman, M Rocek, J Kakác, J Piťha

Vnitr Lek 1993, 39(8):784-787

The authors describe the septic sequelae of an unobserved embolization of a central venous catheter into right-sided cardiac compartments. The finding of an embolized fragment of a catheter which was in the patient's circulation for 89 days was quite incidental. The previous period was associated with diagnostic doubts in various departments. The most frequent diagnosis of repeated septicaemia was bacterial endocarditis, although repeated echocardiographic examinations did not confirm it. Similarly, repeated X-rays did not contribute to the diagnosis--this can be explained by dilatation of the heart of the patient. Extraction of the embolized fragment...

[Treatment of the leukostasis syndrome in chronic lymphadenosis using leukapheresis].

M Bláha, L Jebavý, J Malý, S Filip, M Kmonícek, O Siroký

Vnitr Lek 1993, 39(8):788-792

The authors draw attention to the leukostasis syndrome which develops in haematological patients in case of enormous leucocyte proliferation. It occurs most frequently in chronic myelosis but may occur also in other types of leukaemia. The diagnosis is not easy. Most frequently disorders of the microcirculation develop in the lungs and brain. These are frequently very urgent clinical situations which can be resolved by leukapheresis. The authors described a patient where during chronic lymphadenosis proliferation of lymphocytes occurred to values of 1432 x 10(9)/l. After leukapheresis and cytostatic treatment rapid improvement of the condition occurred...

[Lyme disease in internal medicine].

L Vladár, I Markuljak, J Květenský, J Kerný, E Martinka, M Stevík, D Vladárová, M Krkoska, P Makovický

Vnitr Lek 1993, 39(8):793-796

The authors present a review on the aetiology, clinical aspects, diagnosis and treatment of Lyme disease. They describe three patients who were treated in their department for Lyme disease. Although this disease has been followed up in Bohemia and Slovakia only for nine years, it is probable that it is more frequent than diagnosed. Lyme disease is a disease which affects different organs. Therefore it is important that specialists in internal medicine should more frequently consider the possible presence of this disease when making differential diagnoses.

[Pharmacotherapy of diastolic dysfunction in heart failure].

L Kameník, T Vaněcek

Vnitr Lek 1993, 39(8):797-801

Impaired left ventricular diastolic function is an indicator of early stages of heart disease. In cardiac failure it is not necessarily associated with impaired systolic function and correlates more closely with clinical symptoms or load tolerance. Pharmacotherapy leading to improved diastolic parameters improves also the clinical condition of cardiac failure. Based on data in the literature, the authors analyze drugs which exert a favourable effect on left ventricular diastolic function: ACE inhibitors, calcium channel blockers, beta adrenergic agonists, phosphodiesterase inhibitors, diuretic and direct vasodilating agents, from the aspect of clinical...

[The intestinal pseudo-obstruction syndrome].

K Lukás, M Lukás

Vnitr Lek 1993, 39(8):802-805

Intestinal pseudoobstruction is a syndrome characterized by manifestations and signs of intestinal obstruction without evidence of a lesion obstructing the intestinal lumen. It is divided into primary and secondary forms and into acute and chronic forms. Various diseases, incl. malignant tumours, can be manifested by this syndrome. In its therapy prokinetically acting preparations are used with a favourable effect of colonoscopic decompression.

[Diagnosis of primary aldosteronism].

J Widimský

Vnitr Lek 1993, 39(8):806-809

Clinical observations in recent years indicate that primary aldosteronism (PA) comprises more subtypes than was originally assumed. The author presents a brief account of the contemporary classification of different forms of the disease. He discusses some recent aspects of the laboratory and morphological diagnosis of PA with regard to the possible differentiation of the most frequent two forms: aldosterone producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). In the conclusion the author mentions the differential diagnosis of PA.

[Treatment of hypertension in kidney diseases].

K Horký, R Dzúrik, V Fedelesová

Vnitr Lek 1993, 39(8):810-816

The authors review recent therapeutic procedures in arterial hypertension associated with renal disease. Treatment of hypertension is comprehensive, it comprises non-medicamentous procedures, pharmacotherapy and in some affections also interventional and surgical therapy. Effective reduction of the blood pressure to values < or = 140/90 mmHg unequivocally retards progression of renal disease, the development of nephrosclerosis and delays the development of renal insufficiency. In medicamentous treatment of nephrogenic hypertension a wide range of conventional antihypertensive drugs is used. Their selection and dosage must be adapted to the type...

[Damage caused by monoclonal immunoglobulins and possibilities of therapy. 1].

Z Adam

Vnitr Lek 1993, 39(8):817-827

Pathological clones of plasma cells produce monoclonal immunoglobulins (M-Ig), either the entire molecule or only light chains. These proteins lead in the organism to various pathological process. The increased blood viscosity causes eyesight damage. Impaired coagulation or haemolysis caused by cold agglutinins are frequent. Depending on the orientation of the antigenic determinant of M-Ig, nervous and muscular structures suffer damage, as well as the kidney; metabolic disorders, hypoglycaemia or endocrinopathies may develop. Some of the mentioned disorders are readily diagnosed, some can be detected only by an aimed examination. The presented review...

[The Saint Vicent Declaration--a call to increased care of diabetics. V. Ischemic heart disease--ICHS in diabetics].

J Rybka

Vnitr Lek 1993, 39(8):828-830