Vnitřní lékařství, 1994 (vol. 40), issue 10
[Individualized supplemented low-protein diet in patients with chronic kidney failure].
V Teplan, O Schück, O Mengerová, J Růzicková
Vnitr Lek 1994, 40(10):623-627
The possibility of developing protein-energy malnutrition poses a serious risk associated with long-term administration of a restrictive low-protein diet. We conducted a randomized prospective study designed to evaluate 36 patients with chronic renal failure in initial malnutrition (BMI 22%, albumin 35 milligrams, WQ 2.02). In 20 of these patients (Group I), low-protein diet was supplemented with ketoanalogs of essential amino acids along with a low-phosphate drink from casein-free protein. The diet of another 16 patients (Group II) was supplemented with a mixture of essential and non-essential amino acids of egg white. Three-month follow-up revealed...
[A metabolic and gastroenterologic intensive care unit].
M Hertlová, J Lata, K Julínková, P Dítě
Vnitr Lek 1994, 40(10):628-631
The authors analyzed the work of the metabolic intensive care unit which due to the gastroenterological orientation of the clinic deals increasingly with treatment of patients with serious gastroenterological conditions. Since 1989 995 patients were hospitalized and the ratio of gastroenterological patients increased from 15% in 1990 to 35% in 1993. The most serious course and prognosis is in patients with hepatic failure who accounted for 42% of the total number of gastroenterological patients. Another large group was formed by a total of 46 patients with acute pancreatitis and 40 patients with severe forms of non-specific inflammations of the gut....
[Use of immunoreactive calcitonin and sonography in the diagnosis of medullary carcinoma of the thyroid gland].
P Vlcek, M Neradilová, J Němec
Vnitr Lek 1994, 40(10):632-635
In a group of 94 patients with a histologically verified medullary thyroid carcinoma were 59 patients with the sporadic form and 35 patients with the familial form. After radical surgery and subsequent actinotherapy in all patients the values of immunoreactive calcitonin were monitored along with the sonographic examination. In all with calcified thyroid residues confirmed on sonography, or when metastases were detected in the liver, elevated or high levels of immunoreactive calcitonin were found. The authors emphasize the importance of this examination for the early detection of relapses of medullary thyroid carcinoma.
[Significance of determination of antibodies to TSH receptors (using TRAK) in the diagnosis and monitoring of therapy in endocrine orbital disease].
S Vána, J Němec, P Rezek, I Sterzl, R Bílek, Z Novák
Vnitr Lek 1994, 40(10):636-638
The elevated antibody level against receptors for TSH assessed by the commercial set TRAK (Henning Berlin) supports the diagnosis of endocrine orbitopathy (EO) which is important in more complicated cases with unilateral EO or EO in euthyroid or hypothyroid patients. During treatment of EO by elimination of the thyroid with radioiodine 131I (with or without previous thyroidectomy) a decline of originally high TRAK values to normal suggests successful elimination. Persistence of high TRAK values is associated with a poorer therapeutic effect of elimination and reasons for this should be sought. In four of 26 such patients the authors found radioiodine...
[Rheumatoid arthritis--a diffuse connective tissue disease].
M Kucera, J Racek, B Kreuzberg, P Panzner
Vnitr Lek 1994, 40(10):639-644
The authors describe in a group of 100 patients, mostly with a severe form of rheumatoid arthritis, subjects with so-called "severe" extraarticular affections which can threaten the patients' lives or cause substantial deterioration of its quality, and those subjects where rheumatoid arthritis was the cause of death. These affections were associated--directly or indirectly--with the basic disease. From the absolute number of revealed affections the authors do not want to draw any conclusions as they are aware of various factors which could influence them. They assume, however, that the assembled data provide evidence that the American Rheumatological...
[The clinical picture of stenoses of the trunk of the left coronary artery].
P Cervinka, V Pidrman, J S»ásek, D Cernohorský, J Dominik, V Rozsíval
Vnitr Lek 1994, 40(10):645-648
In 1991-1993 the authors made at the Second Medical Clinic of the Faculty Hospital in Hradec Králové 651 coronarographic examinations: in 460 patients they detected ischaemic heart disease, of the latter 44 (9.6%) suffered from stenosis of the trunk of the left coronary. During the premorbid period the authors evaluated the grade of stenocardia according to the Canadian cardiovascular classification and also the incidence, number of coronary attacks and reason for indicating coronarography. In 29 patients (66%) the authors made an ergometric examination--in 82.8% the finding was positive and in 17.2 negative. The loading test was unequivocally positive...
[Treatment of acute myocardial infarct with magnesium].
V Spisák
Vnitr Lek 1994, 40(10):649-653
The author examined 78 patients with acute myocardial infarction (IM). Forty-four patients were treated with magnesium (Mg) in continual 48 hours infusions, whereby during the first 24 hours the patients were given 50 mmol Mg, during the subsequent 24 hours 12 mmol Mg. Thirty-four patients with acute IM served as placebo group. The two groups did not differ statistically as regards the presence of risk factors (hypertension, hyperlipoproteinaemia, smoking), the incidence of diabetes (DM), age, sex the presence of Q and non Q IM. The two groups did not differ as regards the frequence of streptokinase administration. During the 21-day follow-up period...
[Late and slow diagnosis of acute promyelocytic leukemias--the main cause of early death].
P Lemez, J Schwarz, J Jelínek, K Michalová, A Vítek, Z Vorlová, M Penka, J Neuwirt
Vnitr Lek 1994, 40(10):654-659
Acute hypergranular promyelocytic leukemia (AML M3) belongs to malignant diseases leading very rapidly to death. Immediate treatment based on early diagnosis may cure one third of patients. The typical finding in peripheral blood of patients is pancytopenia with or without atypical promyelocytes. In published studies only 15-25% patients exhibit leukocyte counts above 10 x 10(9)/l. Five of our ten patients studied had leukocyte count above 10 x 10(9)/l. The difference might be in connection with late and slow diagnosis of AML M3. AML is not taken into consideration during medical examination even if the disease occurs in medical family. Thus we describe...
[Elevated levels of plasma von Willebrand factor: a new risk factor for atherosclerosis?].
M Belicová, P Kubisz, V Kicko, J Dvorský, S Funiak, J Květenský, J Ivanková
Vnitr Lek 1994, 40(10):660-662
The authors assessed the plasma level of von Willebrand's factor in a total of 104 patients aged 32-60 years. Of these 10 patients are free from confirmed ischaemic heart disease with no history of acute myocardial infarction and 94 patients after acute myocardial infarction. Samplings for von Willebrand's factor in patients after acute myocardial infarction were made at least two months after the infarction. The patients were subjected to: A) ergometric examination, b) to ergometric and coronarographic examination. The patients after acute myocardial infarction with minimal atherosclerotic changes or without atherosclerotic changes on the coronaries...
[Transesophageal ventricular stimulation and ventricular tachycardia in the period before implantation of a cardioverter-defibrillator].
J Pella, J Bodnár, B Stancák, S Misíkoá, J Sedlák, P Cizmárik
Vnitr Lek 1994, 40(10):663-666
The administration of an implantable cardioverter-defibrillator (ICD) is the method of choice in life-threatening ventricular tachyarrhythmias. This effective non-pharmacological intervention was a great advance in the prevention of sudden cardiac death. As to ventricular tachycardias, relapsing ventricular tachycardias based on ischaemic alone need not influence ventricular tachycardia. The mechanism of ventricular tachycardia in ischaemic heart disease is reentry and therefore this arrhythmia can be terminated not only by a defibrillation discharge but also by antitachycardiac stimulation. Various types of antitachycardiac stimulation are part of...
[The pharmacology of biphosphonates and their use in hypercalcemia].
Z Adam, J Vorlícek, M Tomíska
Vnitr Lek 1994, 40(10):667-670
Bisphosphonates, derivatives of pyrophosphates are substances which block the function of osteoclasts and thus break down bone. They can be administered by the oral and i.v. route. Oral treatment is limited by poor absorption which e.g. in clodronate varies between 1 - 5%. The long half-life of bisphosphonates adsorbed on bone makes it possible to achieve the desired effect by administration once in 1 - 3 months. Bisphosphonates are considered the most effective drugs for treatment of hypercalcaemia. Their effect is, however, manifested on the second or third day and thus in case of a serious acute condition caused by hypercalcaemia it is necessary...
[Long-term administration of biphosphonates in oncology patients with bone involvement].
Z Adam, J Vorlícek, M Tomíska
Vnitr Lek 1994, 40(10):671-675
The usefulness of bisphosphonates in the treatment of acute hypercalcaemia has been known for some time. The problem of long-term administration of bisphosphonates to patients whose skeleton is afflicted with a malignant tumour is still being discussed. The benefit of ethidronate has not been confirmed. Clodronate and pamidronate administered in i.v. infusions or in adequate amounts by the oral route leads to a reduced incidence of hypercalcaemic crises and the number of pathological fractures. Both mentioned preparations diminish the intensity of pain, increase physical fitness and improve the quality of life of oncological patients. However, they...
[Prophylaxis of infectious endocarditis].
J Benes
Vnitr Lek 1994, 40(10):676-678
In spite of introducing antibacterial agents in prophylaxis of infective endocarditis (I.E.) more than 50 years ago, the optimal scheme for indication and application of the prophylaxis has not been solved. Evidences accumulate that prophylaxis (being developed to cover some medical procedures leading to bacteremia) can prevent only a small part (< 10%) of cases of I.E. The most effective protection from I.E. is the systematic care for gums and mucosae of the mouth cavity.